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Loka Thangmathesvaran, Bernard Szirth, Albert S Khouri; Synergistic Use of Novel Imaging Technology in Type 1 Diabetes Screenings. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1918.
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© ARVO (1962-2015); The Authors (2016-present)
Management of diabetic retinopathy has relied on fundus photography. However, ocular coherence tomography (OCT) and ocular coherence tomography-angiography (OCT-A) can help detect early ocular changes in patients with type 1 diabetes mellitus (T1DM). A retrospective, observational study was done to highlight each non-mydriatic imaging modality in the context of T1DM.
Subjects (n=4) average age 23 years old were included for analysis. Inclusion criteria was having T1DM for greater than 10 years. Color and auto-fluorescence retinal imaging, OCT, and OCT-A images were reviewed. HbA1C, visual acuity, and intraocular pressure were collected over a five year period.
Subject A maintained HbA1C levels of 6.0 over a period of 10 years is our control subject. No signs of diabetic retinopathy were noted. (Fig 1A-C). Subject B has optic nerve head drusens that coalesced, impeding vasculature flow predisposing to glaucoma and flame hemorrhages. (Fig 1D-F). Subject C had a spike in glucose lasting 12 months with HbA1C levels at >13.5 and elevation in blood pressure (140/90) inadequately controlled on ACE inhibitors. He developed 271 hemes in his left eye. However, since his foveal avascular zone (FAZ) was not compromised, anti-VEGF were not used (Fig 2A-B). Subject D had chronically elevated glycemic parameters at HbA1C of 9.0 (with peaks of over 10.5). Macular edema and neovascularization of the FAZ were noted (Fig 2C-E). Anti-VEGF agents were recommended.
These current advances for diabetic retinopathy imaging can be synergistically used in non-mydriatic mode. Consolidation of information from these imaging sources will help dictate appropriate clinical management.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Figure 1: Subject A: A. (top-left) ONH centered fundus- 2016. B. (top-middle) OCT-2016. C. (top-right) OCT-A- 2016 Subject B: D. (bottom-left) ONH centered fundus- 2013 E. (bottom-middle) ONH Centered Fundus Auto Fluorescence- 2013 F. (bottom-right) ONH Centered Fundus Emboss- 2013.
Figure 2: Subject C: A. (top-left) macula centered fundus- 2015. Dot hemorrhages, flame hemorrhages, and IRMAs noted B. (top-right) OCT-A image- 2015. Macular edema and neovascularization is not present. Subject D: C. (bottom-left) macula centered fundus-2016. D. (bottom-middle) SD-OCT- 2016. Macular edema is noted. E. (bottom-right) OCT-A- 2016. Neovascularization of the FAZ zone can be noted.
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