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Omar Singer, Ibraheem S Shaikh, Nithisha Prasad, Catherine Ye, Bernard Szirth, Albert S Khouri; Case Series of Ganglion Cell Complex as a Predictor for Ocular Damage in Type 1 Diabetes Mellitus over a 4 Year Period. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3325.
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© ARVO (1962-2015); The Authors (2016-present)
Type 1 Diabetes Mellitus (T1DM) currently affects 1.25 million people in the USA, with its yearly incidence increasing by 2% - 5% worldwide. The American Academy of Ophthalmology suggests that children with T1DM have their first annual diabetic retinopathy screening at age 15 or 5 years after diagnosis, whichever occurs later. We hypothesize that as in glaucoma, thinning of the Retinal Ganglion Cell Complex (RGCC) with focal loss volume could be an early predictor for future structural damage and vision impairment related to T1DM.
Our study measured the RGCC thickness in 7 subjects with T1DM over a 4-year period (2016-2019). Measurements were taken using data analyzed from an OCT (Avanti, Optovue, Fremont, California) with a resolution of 5 microns. We collected our data at an annual conference for children with T1DM (Orlando, FL). We categorized our participants based on self-reported age, duration of T1DM, HbA1C, duration of insulin pump use, Continuous Glucose Monitor use and body mass index.
Analyses of variance (ANOVA) using SPSS 25 were done and slopes calculated in the inferior, superior and overall portion of the RGCC measured 6 mm away from the fovea in both eyes looking for significant changes in RGCC thickness. We found that there was an overall negative slope in RGCC thickness across all four years (OD slope = -.675 m/year, OS -.483 m/year). Currently, there is no reference comparative data indicating that negative slopes were steeper than expected physiologic thinning for the respective age groups. However, we found there were significant changes in GCC thickness over the four-year time period from 2016-2019 in three subject groups: those with an insulin pump for 5-10 years (OD -1.038; OS -0.888), those less than 14 years of age (OD -0.842), and those older than 20 years of age (OS -0.875). These three subject groups were derived from our initial categorical groupings based on our findings.
RGCC changes may precede visual changes and can be used as an early predictive biomarker of retinal damage. Follow up studies will be conducted in order to further track trends relating to RGCC thickness and T1DM. Subjects with T1DM should be imaged yearly particularly with OCT, done upon diagnosis as a baseline with yearly follow-up imaging in order to precisely track changes in RGCC thickness.
This is a 2020 ARVO Annual Meeting abstract.
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