Retinal Vessel Signs and Early Retinopathy in Type 1 Diabetes

Abstract

 

Purpose:

 

To evaluate and grade arteriolosclerotic retinal vessel signs in the ocular fundus and to study their association with early DR in T1D.

 

Methods:

 

This preliminary cross-sectional IDEAL substudy of the collaborative multicenter FinnDiane study comprised of 76 consecutive patients (58% men) aged 26 (SD 6), with T1D duration of 9 (2) yrs and age at onset 17 (SD 6) (Table). One macula and one optic disc centered 50-60º red-free fundus image was digitized. In patients with DR (45%) the more affected eye and in patients without DR a randomly selected eye was graded by J.P.K. and P.A.S. unaware of the patient characteristics.The grading focused on:1) arteriolar signs2) venular signs3) arteriovenous nickings (AVN: remoteness, arching, banking, compression and deviation) according to a classification based on early literature of vascular signs4) DR (a modified ETDRS classification)5) AVN signs summed as the AVN risk sum (ANR)6) all arteriolar, venular and nicking signs expressed as the arteriolosclerotic risk burden (ARB)

 

Results:

 

Thirty-one patients (41%) had minimal to mild and 3 (4%) moderate DR. Arteriolar signs (sinusoidal elongation 74% (n=56), generalized 45% (n=34), and focal narrowing 3% (n=2), pronounced light streak 40% (n=30), straightening 1% (n=1) as well as venular signs (tortuousity 65% (n=49), minimal tortuousity 51% (n=39), tortuousity in macula 57% (n=43) and local narrowing 1% (n=1) were common in all 76 eyes. At least one AVN occurred in 96% of patients. ANR and ARB did not differ between patients with and without DR, although there was a trend of higher ARB in patients with DR (p=0.064).In a univariate regression analysis, ANR was associated with duration (r=0.263, p=0.022). ARB was associated with duration (r=0.262, p=0.022) and HDL cholesterol (r= 0.241, p=0.036).

 

Conclusions:

 

These preliminary data show that early arteriolar and venular signs are common in T1D with short duration.  

 

Keywords: diabetic retinopathy • imaging/image analysis: clinical • clinical (human) or epidemiologic studies: prevalence/incidence