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Daniel Camras, Albert S Khouri, Bernard Szirth; Use of Optical Coherence Tomography Angiography in Tele-Screenings to Determine Early Foveal Avascular Changes in Type 1 Diabetes Mellitus Compared to Retinal Imaging Sensitivity. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2803.
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© ARVO (1962-2015); The Authors (2016-present)
Current standards of practice from the American Academy of Ophthalmology indicate retinal exam for Diabetic Retinopathy (DR) 5 years post diagnosis. Optical Coherence Tomography Angiography (OCTA) allows for visualization of retinal vasculature including the Foveal Avascular Zone (FAZ) without use of fluorescein angiography. An observational study was performed during a comprehensive tele-ophthalmology screening to determine the prevalence of OCTA-visualized FAZ vascular disruption in T1DM subjects compared to those exhibiting DR on Fundus Photography.
Fundus Color Photographs and OCTA images were collected from T1DM subjects (n = 104). Presence of hemorrhages and disruption of the FAZ were recorded for each subject. Each subject was categorized by Avascular Fovea (AF) (N = 54), NAF (N = 50), and DR (N = 11). Groups were compared for number of subjects, average self-reported HbA1c, duration since diagnosis, age of subject, Blood glucose levels, use of an Insulin Pump, and Systolic Blood Pressure (SBP). Subjects were further subcategorized into pre and post 5 years since diagnosis.
Larger number of subjects exhibited AF (N = 54) than NAF (N = 50), and NAF than DR (N = 11). Further, the average HbA1c values, duration since diagnosis, and age of subject all increased between each group (HbA1c AF = 7.46, NAF = 7.89, DR = 8.32; Duration AF = 11.96 yr, NAF = 13.3 yr, DR = 15.95 yr; Age AF = 23.9 yr, NAF = 25.2 yr, DR = 29.6 yr). No consistent trends were correlated between same day Blood Glucose and Systolic Blood Pressure (Glu mg/dl AF = 165.2, NAF = 162.1, DR = 189.5; SBP mmHg AF = 120.7, NAF = 118.4, DR = 123.3). Subjects with a duration of ≤ 5 years (N = 28) exhibited NAF (N = 14) 50% and DR (N = 4) 14% of the time.
Initial trends indicate that DR subjects with a higher average HbA1c, duration of disease, and age than OCTA detected NAF and AF. There was a greater number of subjects that exhibited changes to the FAZ in OCTA imaging than those with DR on Fundus Photography. Subjects with a duration of ≤ 5 years exhibited both OCTA NAF and DR earlier than standard of practice recommendations. Further studies are needed to validate of the role of FAZ imaging in early detection of T1DM retinal changes compared to the current standards of practice.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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