Baseline OCT Biomarkers Associated with Visual Acuity in Diabetic Macular Edema
Bibliographic record
Abstract
TOPIC: To determine effect estimates and certainty of evidence for the associations between baseline OCT biomarkers and (1) patient visual acuity (VA) and (2) changes in VA from baseline to 6, 12, and 24 months after initiation of anti-vascular endothelial growth factor, steroid, or laser treatment for diabetic macular edema. CLINICAL RELEVANCE: Understanding the prognostic value conferred by biomarkers can help predict disease activity and inform treatment decisions. METHODS: This review was registered in the International Prospective Register of Systematic Reviews (identifier, CRD42023487798). Ovid MEDLINE, EMBASE, and CENTRAL databases were searched. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines informed certainty of evidence. RESULTS: Twenty-eight reports from 27 studies evaluating 75 biomarkers were included. No biomarker with at least a moderate certainty was associated with improved VA or change in VA. Results are reported in Early Treatment Diabetic Retinopathy Study letters. Five biomarkers were associated with reduced VA at 2 or more time points with moderate certainty: (1) hyperreflective retinal foci (HRF; 6 months, -6.5 [95% confidence interval (CI), -10.4 to -2.6]; 12 months, -7.3 [95% CI, -11.6 to -3.0], (2) hyperreflective choroidal foci (HCF; 6 months, -7.3 [95% CI, -13.3 to -1.3]; 12 months, -7.5 [95% CI, -11.9 to -3.0], (3) disorganization of retinal inner layers (DRIL; 6 months, -6.0 [95% CI, -11.7 to -0.3]; 12 months, -7.3 [95% CI, -12.8 to -1.7], (4) disrupted ellipsoid zone (EZ) or external limiting membrane (ELM; 6 months, -9.7 [95% CI, -15.4 to -3.9]; 12 months, -7.5 [95% CI, -11.9 to -3.0]; 12 months isolated EZ disruption, -5.4; [95% CI, -9.2 to -1.6] ; 24 months, -9.0 [95% CI, -14.3 to -3.6], and (5) disrupted cone outer segment termination (COST) line (12 months, -8.5 [95% CI, -13.5 to -3.5]; 24 months, -8.8 [95% CI, -14.0 to -3.6]. DISCUSSION: Baseline HRF, HCF, DRIL, disrupted EZ or ELM, and disrupted COST lines were associated with worse VA at 2 or more time points with moderate certainty of evidence. Greater standardization in biomarker classification and better control of confounding variables are needed. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.035 | 0.161 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.009 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".