Ophthalmic Posterior Segment OCTA Metrics as Potential Biomarkers for Systemic Involvement in Systemic Sclerosis, Systemic Lupus Erythematosus, and Behçet Disease: A Systematic Review

Michael Drakopoulos, Hayden Flynn Sikora, Joseph D Fahey, Rukhsana G Mirza Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USACorrespondence: Rukhsana G Mirza, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N Michigan Avenue, Suite 440, Chicago, IL, 60611, USA, Email [email protected]: To investigate the potential of quantitative ophthalmic posterior segment optical coherence tomography angiography (OCTA) imaging metrics to serve as biomarkers for systemic involvement in three rheumatologic diseases, systemic sclerosis (SSc), systemic lupus erythematosus (SLE), and Behçet disease (BD), by reviewing the reported correlations between such OCTA metrics and clinically relevant features of systemic involvement in these diseases.Methods: This review is a correlational study conducted through a systematic review of the PubMed database for articles reporting OCTA metrics in any of SSc, SLE, and BD. Articles correlating ophthalmic posterior segment OCTA metrics to clinically relevant features of systemic involvement, specifically serum, cerebrospinal fluid (CSF), or other established biomarkers; systemic symptom and severity scores; stage; non-ocular organ involvement; non-ocular imaging findings; and medication use were included.Results: OCTA parameters have been significantly correlated to autoantibody presence, digit and pulmonary involvement, disease stage, and medication use in SSc with significance values ranging from p = 0.008 to p = 0.048. OCTA parameters have been significantly correlated to serum markers, renal and cardiac involvement, damage indices, and medication use in SLE with significance values ranging from p < 0.0001 to p = 0.028. OCTA parameters have been correlated to systemic vascular involvement in BD with significance value p = 0.006.Conclusion: Ophthalmic posterior segment OCTA metrics may provide value in prognosis, stratification, and treatment monitoring of the examined rheumatologic conditions. These results warrant further study.Keywords: optical coherence tomography angiography, oculomics, capillary plexus, systemic sclerosis, systemic lupus erythematosus, Behçet disease