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Manan Shah, Bernard Szirth, Albert S Khouri; Use of optical coherence tomography angiography in evaluating foveal vascularization in Type 1 Diabetes Mellitus. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2911. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Recent technology allows for visualizing the avascular zone of the fovea without fluorescein angiography. We performed an observational study to assess the screening potential of foveal vascularization in a population of Type 1 Diabetes Mellitus (T1DM) subjects using optical coherence tomography angiography (OCTA).
Optical coherence tomography, OCTA and retinal imaging were collected from T1DM subjects. Foveae were determined by an expert as vascularized if it contained at least one blood vessel crossing through the avascular zone. Two-sample independent t-tests were used to explore the differences (e.g. age, duration of T1DM, foveal thickness, Foveal Avascular Zone (FAZ) area, blood pressure, and HbA1C) among the control subjects who have an avascular fovea (AF) (n = 183), subjects who have a unilateral non-avascular fovea (NAF) (n = 50) and subjects who have bilateral NAF (n = 21).
NAF subjects had an average 13.4 year history of T1DM, while AF subjects had an average 9.4 year history of T1DM (p = 0.007). NAF subjects were older (average age 26.2 years) than AF subjects (average age 22.1 years), p = 0.075.NAF subjects had a thicker fovea (268.2 μm) than subjects with AF (246.0 μm), p < 0.001. Bilateral NAF subjects had a greater foveal thickness (275.6 μm) than unilateral NAF subjects (265.1 μm), p = 0.018. Foveal thickness does not correlate with duration of T1DM (R2 = 0.013).NAF subjects had a smaller FAZ (0.213 mm2) than AF subjects (0.276 mm2), p < 0.001.NAF subjects had a greater systolic (119 mm Hg) and diastolic (73 mm Hg) blood pressure than AF subjects (systolic: 111 mm Hg) (diastolic: 70 mm Hg), p-values 0.002 and 0.027, respectively. Bilateral NAF subjects had a greater diastolic (76 mm Hg) blood pressure than unilateral AF subjects (72 mm Hg), p = 0.065.The last HbA1c was the same in NAF (7.56%) and AF (7.51%) subjects (p = 0.763).
NAF subjects were older by four years and have had T1DM for four more years than AF subjects. Bilateral NAF subjects had thicker foveae and increased diastolic blood pressure than unilateral NAF subjects, and overall NAF subjects had thicker foveae and increased blood pressure than AF subjects. NAF subjects had a smaller FAZ than subjects with an avascular fovea. Recognizing the vascular trends of the FAZ, further studies need to be performed on the sequelae of long standing T1DM.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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