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.