Integration of Optical Coherence Tomography in Remote Screenings for Macular Edema in Type 1 Diabetes Mellitus

Abstract

Purpose : Diabetic Retinopathy (DR) is one of the leading causes of Vision Threatening Disease. Currently, worldwide estimates show 290 million individuals with Type 1 Diabetes Mellitus (T1D), with 1/3 of those having DR and 1/3 of those having signs of Diabetic Macular Edema (DME). We incorporated Ocular Coherent Tomography B-scan (OCT) into our mobile remote screening to help identify and refer DME early for clinical management.

Methods : A Topcon (Tokyo, Japan) Retinal camera/OCT Maestro1^TM non-mydriatic imaging system was selected for its portability and ease of use with auto-align and auto capture functions. An on-site certified reader reviewed 184 patients with T1D during a five-day remote screening during Friends for Life^TM annual T1D gathering at Disney World, Orlando, Florida. Measurements of Cube Average Thickness (CAT), Cube Volume (CV), and Central Subfield Thickness (CST) of the macular area were automatically generated in addition to 45-degree field of view color retinal imaging using the 3D Macula OCT scans pre-setting. Data was stratified across years with T1D (0-10 yrs, 11-20 yrs, 21-30 yrs, >31 yrs) and years since a last eye exam (never, <1 yr. ago, 1-2 yrs, 2-5 yrs, >5 yrs).

Results : Right and left eye scans were obtained for 184 T1D patients for 367 eyes, with one patient having only right eye scanned. The mean age was 24.15 ± 18.74 years, with a distribution of 59% females, 39% males, and 2% identifying as “other.” The average CAT was 284.41 ± 16.62. The average CV was 8.04 ± 0.47. The average CST was 240.68 ± 28.44. Patients who had T1D between 11-20 years (CAT= 288.20, CV = 8.15, and CST = 247.22) had a larger CAT, CV, and CST than those in the 0-10 year group (CAT = 283.75, CV = 8.02, and CST = 234.40). Differences between CAT, CV, and CST were mostly insignificant between years with T1D or since eye exam visit.

Conclusions : The screening results show insignificant changes between groups over time, but this may be due to a well-controlled T1DM population using insulin pumps and a small sample of patients. The results demonstrate the potential of remote OCT scans to provide useful metrics when evaluating DME over years of disease since onset. Further studies should be done evaluating progression of DME using OCT-B scans over several years.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Table 1: Measures of CAT, CV, and CST across years of T1D

 

Table 2: Measures of CAT, CV, and CST across years since last eye exam