Abstract
Purpose :
Arteriole tortuosity (AT) is an important but often overlooked sign of retinal disease. Our group has been evaluating the importance of AT in patients with diabetes as a supplement to retinopathy, but it is not clear how AT changes over time. Here we expand our original study of AT to evaluate follow up data for a group of diabetes patients in a telehealth screening program.
Methods :
126 subjects of the original 246 subjects evaluated for tortuosity had follow up retinal photographs 3-5 years later (49 ± 9 months). The inclusion criteria for the teleretinal screening program had to be met for subjects to remain eligible for follow up. Additional reasons for attrition include follow up outside of the study timeframe, poor image quality, moving, and death (n=32). The photographs from both eyes were graded by 3 or 4 graders (3 graders for the initial study, 4 for follow up) for AT (straight, wavy, tortuous) and retinopathy using ETDRS grading. The consensus AT and retinopathy grades were used. When a consensus grade was not reached (n=11) or the image quality was too poor to grade, the subject was removed from analysis. 218 eyes from 109 subjects were included in final analysis. Other health markers such as duration of DM, HbA1c, neuropathy status, and if the patient was taking insulin was also recorded.
Results :
Overall, only 24 eyes had retinopathy initially and 26 eyes had retinopathy at follow up, which was almost all mild (93%). The average AT at follow up was between straight and wavy. AT grades were largely unchanged over the follow up period (76.0%). Nine eyes had less AT (4.3%). The final 19.7% had worsening AT over the follow up period. The patients with worsening AT at follow up had diabetes for a shorter length of time at the onset of the study (5.8 years vs 7.4 years, p<0.04). There was no relationship between retinopathy development and AT increasing. There was also no relationship between HbA1c and change in AT.
Conclusions :
It appears that AT may worsen most over early years of diabetes development and then stabilize. This indicates that it may be more critical to monitor AT in early years of diagnosis before retinopathy is present. More research is needed following changes in AT in patients with diabetes over time.
This is a 2020 ARVO Annual Meeting abstract.