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Javier Zarranz-Ventura, Anibal Alé-Chilet, Marina Barraso, Teresa Hernandez, Cristian Oliva, Marc Figueras-Roca, Anna Sala-Puigdollers, Irene Vinagre, Emilio Ortega, Enric Esmatjes, Alfredo Adán; Glycated Haemoglobin (HbA1c) levels correlate with superficial perifoveal network vessel and perfusion density assessed by optical coherence tomography angiography (OCTA) in type I Diabetes Mellitus: A large scale prospective OCTA study. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2802. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the relationship between optical coherence tomography angiography (OCTA)-derived parameters and systemic levels of glycated haemoglobin (HbA1c) in a large cohort of type 1 Diabetes Mellitus (DM) patients.
Prospective, interventional OCTA study. 612 eyes of 308 type 1 DM patients with recent blood tests underwent a comprehensive ocular exam which included a specifically designed OCTA battery of images. OCTA scanning protocols included 3x3 and 6x6 mm (Cirrus Zeiss AngioPlex). Quantitative analysis was performed using the manufacturer built-in commercially available software. Vascular density (VD) and perfusion density (PD) measurements of the superficial vascular plexus were analyzed. Glycated Haemoglobin (HbA1c) levels were systematically obtained from last 5 years (2013-2017) yearly reviews in the Diabetes Unit, including a recent determination within 1 month of OCTA capture. Mean HbA1c levels were determined as an average of these 5 measurements as an adequate value of DM status control over last 5 years. To reduce the risk of bias eyes were randomized 1:1 and only 1 eye per patient was included in the analysis.
Three groups were created and all study eyes were classified as per their mean HbA1c levels over the last 5-year period, HbA1c <6.5% (n=22), HbA1c 6.5-7.5% (n=113) and HbA1c >7.5% (n=173). Greater mean HbA1c levels were significantly associated with lower vessel density and perfusion density in both the 3x3 mm (p=0.004, p=0.034) and the 6x6 mm cubes (p=0.015, p=0.033). A significant correlation was observed between mean HbA1c levels and VD (R=-0.18, p=0.002) and PD (R=-0.14, p=0.017) in the 3x3mm and also in the 6x6mm OCTA cubes (VD: R=-0.14, p=0.012 and PD: R=-0.12, p=0.038). These correlations remained significant after controlling by diabetic retinopathy status, duration of DM disease and age for almost all parameters.
Mean HbA1c levels of previous 5 years correlate with OCTA-derived parameters in the macula of type 1 DM patients. These parameters may be a robust marker of adequate vs inadequate past diabetic control in patients with no documented previous medical records.
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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