September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Monitoring Blood Pressure, Glucose Control, and Retinal Findings in Patients with Long Duration Type One Diabetes
Author Affiliations & Notes
  • Lesley Wu
    Rutgers New Jersey Medical School, Marlboro, New Jersey, United States
  • Nicole Mendez
    Rutgers New Jersey Medical School, Marlboro, New Jersey, United States
  • Pooja Anand Padgaonkar
    Rutgers New Jersey Medical School, Marlboro, New Jersey, United States
  • Sumana Sri Kommana
    Rutgers New Jersey Medical School, Marlboro, New Jersey, United States
  • Ellen Wu
    Northwestern University, Evanston, Illinois, United States
  • Ben Szirth
    Rutgers New Jersey Medical School, Marlboro, New Jersey, United States
  • Albert S Khouri
    Rutgers New Jersey Medical School, Marlboro, New Jersey, United States
  • Footnotes
    Commercial Relationships   Lesley Wu, None; Nicole Mendez, None; Pooja Padgaonkar, None; Sumana Kommana, None; Ellen Wu, None; Ben Szirth, None; Albert Khouri, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6327. doi:
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      Lesley Wu, Nicole Mendez, Pooja Anand Padgaonkar, Sumana Sri Kommana, Ellen Wu, Ben Szirth, Albert S Khouri; Monitoring Blood Pressure, Glucose Control, and Retinal Findings in Patients with Long Duration Type One Diabetes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6327.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Demonstrate the need for tight control of blood pressure (BP) with blood glucose in patients with Type 1 Diabetes (T1D) as ocular changes are monitored using non-mydriatic retinal imaging, Optical Coherence Tomography (OCT), and OCT Angiography (OCTA).

Methods : Various types of digital imaging were performed on 189 patients with T1D. Inclusion criteria included diagnosis of Type 1 diabetes for over 2 years. An 18 Mp non-mydriatic retinal camera and 5 micron Spectral Domain OCT were used to assess the posterior pole including macula/fovea. An OCTA capturing centered on macula was also used. TeamViewerTM provided remote tele-ophthalmology of patients with retinal findings.

Results : Forty-two patients out of 189 with T1D ≥ 15 years duration were identified during a 2015 screening: 13 had hypertension (BP >130/80) and 9 had A1C ≥ 8%, as seen in Table 1. Only one patient had very elevated hypertension in addition to A1C >13% and presented with 259 retinal hemorrhages in the left eye. The patient’s BG and BP were managed until 2013, when the left retina showed mild retinopathy (2 dot hemorrhages); A1C was 13%. When BP in 2015 increased to 142/62 mmHg with A1C = 13.5%, the left retinal imaging showed worsening retinopathy (38 flame and 221 dot hemorrhages). OCT showed no macular edema while OCTA revealed new retinal telangiectasia and micro aneurysms. In the weeks following diagnosis of severe non-proliferative retinopathy diagnosis, tighter control of BP and BG was achieved and hemorrhage count decreased, as seen in Table 2.

Conclusions : Strict management of BP and BG for 8 weeks resulted in a 69% decrease in retinal hemorrhages. Digital retinal imaging, OCT, and OCTA allowed for continuous monitoring of microvascular and macrovascular changes including the macular zone. BP, glucose levels as well as retinal digital imaging should be monitored at each ophthalmic visit for patients with 5-years duration to control NPDR complications.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Table 1: Data is from patients with at least 15 years duration T1D. Highlighted is a select case to demonstrate retinal hemorrhages that result from uncontrolled hypertension and HbA1c.

Table 1: Data is from patients with at least 15 years duration T1D. Highlighted is a select case to demonstrate retinal hemorrhages that result from uncontrolled hypertension and HbA1c.

 

Table 2: Ocular changes collected from the past 5 years in select case. *Between this period, 50 mg of CoQ10 was taken twice a day as self-prescribed by subject.

Table 2: Ocular changes collected from the past 5 years in select case. *Between this period, 50 mg of CoQ10 was taken twice a day as self-prescribed by subject.

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