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Subhashini Chandrasekaran, Hadeel Sadek, Peter Khouri, Bernard Szirth; Synergetic Digital Ocular Imaging for Baselines upon Diagnosis of Type 1 Diabetes Mellitus. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2792.
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© ARVO (1962-2015); The Authors (2016-present)
Current recommendations by the American Academy of Ophthalmology for initial retinal evaluation in Type 1 Diabetes Mellitus (T1DM) is five years after the onset of the disease. Retrospective analysis suggests that ocular synergetic imaging should be performed as a baseline at the time of diagnosis of T1DM by using more sensitive instruments, such as a high-resolution color digital retinal camera, fundus autofluorescence (FAF), OCT and OCTA.
Two hundred and five subjects (M: 32% F: 68%) with an average age of 21 with T1DM (average duration: 9.7 years) with glucose of 167 and BP of 120/70 were imaged using a 45° non-mydriatic retinal camera, OCT and an OCT-A with 3x3 mm fields.
Color retinal image findings were seen in 22% (M 29%; F 71%) of the subjects, including dot hemorrhages (8.3%), flame hemorrhages (3.5%), Intraretinal Microvascular Abnormality (IRMA) (1%) and hemorrhages in FAF (17.6%). Of the subjects with retinal findings, 36% had T1DM for less than five years. OCT-A showed crossovers and vascularized foveal avascular zones in 51% (M 33%, F 67%) of the subjects. Of those, 19% of the subjects had T1DM for less than five years. In addition, in 58 subjects (56% of the subjects with OCT-A findings), OCT-A findings were seen when retinal color images showed to be normal.The earliest sign of a dot hemorrhage on FAF was seen in a subject with T1DM for six months. The earliest dot hemorrhage on color retinal images and earliest crossover seen on OCTA was in a subject with T1DM for one year. For subjects with T1DM less than five years (N=61), 40% had a retinal finding that would have been missed had they waited for the recommended screening period.
Our findings suggest that upon diagnosis of T1DM, incorporate a baseline of digital ocular images for all individuals regardless of age and create a registry. This would allow for better follow-up and earlier detection with more sensitive digital ocular imaging modalities. Compared to the color retinal images alone, OCT-A imaging highlighted vascular changes in the avascular zone that would have otherwise been missed by other modalities. Retinopathy was detected by synergetic digital ocular imaging in more than a third of subjects less than 5 years after diagnosis. Further studies will be performed to increase N value as well as incorporating the use of insulin pumps.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
3mm field OCTA with small FAZ (Duration of T1DM: 4 years)
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