Abstract
Purpose:
To identify the differences at presentation between Type 1 and Type 2 diabetic retinopathy patients by assessment of slit lamp bio-microscopy, SD OCT and FA findings.
Methods:
A retrospective consecutive case analysis was performed at Aspirus Grand View Eye Center. Aspirus Wausau Hospital’s Institutional Review Research Board (AWH-IRB) approved this study (14.12.409E). Diabetic patients referred for evaluation and treatment of diabetic retinopathy to the retina clinic at Aspirus Grand View Eye center were included in the study. Seventeen eyes of 9 patients with type 1 diabetes (diagnosed before the age of 30) were compared to 22 eyes of 12 patients with Type 2 diabetes. The first clinical evaluation at the retina clinic was used for analysis; slit lamp biomicroscopy, SD-OCT/FA (Spectralis, Heidelberg Inc) findings were compared between the 2 groups.
Results:
At initial presentation, 76% of Type 1 diabetic patients had vision better than 20/40 and only 24% between 20/40-20/200. Whereas for Type 2 diabetic patients, only 46% had VA better than 20/40, 50% had VA between 20/40-20/200 and 5% poorer than 20/200. The poorer vision in Type 2 diabetic group correlated with CSME present on slit lamp bio-microscopy and center involved diabetic macular edema on OCT in 73% of the eyes, compared to only 29% in Type 1 group. Furthermore, 41% did not reveal any DME on OCT in Type 1 group compared to only 23% in Type 2 group. Central subfield thickness (CST) was more than 320 microns in 24% in Type 1 group compared to 50% in Type 2 group. FA correlated with clinical exam findings, where Proliferative Diabetic retinopathy (NVD/NVE) existed at presentation in 47% in Type 1 group compared to only 23% in Type 2. Macular ischemia was comparable in both groups at 18% in Type 1 vs 27% in Type 2. NVE was present over the fovea only in Type 1 group in 3 eyes (18%).
Conclusions:
Clinical, SD-OCT and FA findings are different at initial presentation in patients with Type 1 and Type 2 diabetic retinopathy. Type 1 Diabetic patients tend to present with better vision, less maculopathy but more proliferative disease; compared to Type 2 diabetics who present with poorer vision, corresponding to higher prevalence of maculopathy and more commonly non-proliferative retinopathy.