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H. W. van Dijk, P. H. B. Kok, M. E. J. van Velthoven, C. Biallosterski, R. O. Schlingemann, F. D. Verbraak; White Spots in the Macula of Patients With Diabetes Mellitus Type 1, Without or With Minimal Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3215.
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To evaluate white spots seen in the macula of patients with diabetes mellitus (DM) type 1, without or with minimal diabetic retinopathy (DR) with spectral domain OCT.
Forty-five patients with DM type 1, without or with minimal DR on biomicroscopy, underwent a full ophthalmologic examination, including best corrected VA, slitlamp examination, funduscopy, (redfree) fundus photography and OCT scanning of the macula. At the same day, HbA1c, bloodpressure and total cholesterol were measured. Small white spots (diameter 10 micron) seen on (redfree) fundus photography scattered around the fovea were examined on corresponding B-scan images using spectral domain OCT (3D OCT-1000,Topcon).
Ninety eyes of 45 patients were included in the study. Fundus photography showed white spots in the central fundus in 39 eyes (28 patients), the median number of spots per eye was 5, range 1 to 50. High definition B-scan images corresponding with the localisation of a white spot showed a hyperreflective lesion at the level of the retinal nerve fiber layer (RNFL). There was no correlation found between the presence of white spots and the presence of DR, nor with high bloodpressure, HbA1c or total cholesterol.
White spots seem to be a common occurrence in the retina of patients with DM type 1, without or with minimal DR. Previous studies located these white spots at the level of the retinal pigment epithelium, based on stereoscopic slitlamp examination. In contrast, we localized the white spots at the level of the RNFL using the spectral domain OCT. This implicates that these white spots are not small depigmented lesions of the RPE. Their true nature is still unclear.
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