Associations between Macular OCT Angiography and Nonproliferative Diabetic Retinopathy in Young Patients with Type 1 Diabetes Mellitus.

Nina C. B. B. Veiby,Goran Petrovski,Morten C. Moe,Hanna D. Margeirsdottir,Naila Saddique,Martin Heier,Cathrine Brunborg,Aida Simeunovic,Knut Dahl-Jørgensen,Mladen Krnić

doi:10.1155/2020/8849116

Nina C. B. B. Veiby, Goran Petrovski + Show 8 more

Open Access

https://doi.org/10.1155/2020/8849116

Copy DOI

Abstract

Methods OCTA of both eyes was performed in a cross-sectional study of 14 to 30-year-old individuals with at least 10-year duration of T1D and controls recruited from the Norwegian Atherosclerosis and Childhood Diabetes (ACD) study. Vessel density (VD) and foveal avascular zone (FAZ) area in the superficial and deep capillary plexus (SCP and DCP), total retinal volume (TRV), and central macular thickness (CMT) were calculated using automated software. Univariate and multivariate ordered logistic regression (OLR) models were used accordingly. Results We included 168 control eyes and 315 T1D eyes. Lower VD in DCP (OR 0.65, 95% CI 0.51–0.83), longer diabetes duration (OR 1.51, 95% CI 1.22–1.87), and higher waist circumference (OR 1.08, 95% CI 1.02–1.14) were significantly associated with progression of NPDR. VD in SCP and DCP were significantly lower in T1D patients without diabetic retinopathy than in controls. Conclusions Sparser VD in DCP is significantly associated with severity of NPDR, supporting that OCTA might detect the earliest signs of NPDR before it is visible by ophthalmoscopy.

Highlights

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the leading cause of blindness in the working population of developed countries across the world
Reasons for exclusion were poor optical coherence tomography angiography (OCTA) image quality (n = 28 eyes) and poor fixation (n = 8 eyes), clinically significant diabetic macular edema (CDME) (n = 5 eyes), proliferative diabetic retinopathy (PDR) (n = 4 eyes), and spherical equivalent ðSEÞ > 6 diopters (n = 2 eyes); 40 eyes could not have their OCT taken because the OCT NIDEK machine was out of order on the examination day (24 eyes with type 1 diabetes (T1D) without DR, 2 with moderate nonproliferative diabetic retinopathy (NPDR), and 14 control eyes)
In a population of young patients with T1D imaged with macular OCTA, the vessel density (VD) in the deep capillary plexus (DCP) was found to be the only OCTA parameter associated with the increasing level of NPDR, and it could predict the development of NPDR

Summary

Introduction

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the leading cause of blindness in the working population of developed countries across the world. Diabetic macular ischemia (DMI) in the absence of DME and PDR is a less commonly recognized cause of visual loss. DMI is characterized by retinal capillary loss and enlargement of the foveal avascular zone (FAZ). The understanding of the natural pathology, risk factors, and functional outcomes of DMI is limited. This has partly been because of the need for fluorescein angiography (FA) to diagnose it. Microvascular changes in DR such as microaneurisms, capillary dropouts such as decreased vessel density (VD), and foveal avascular zone (FAZ) enlargement are not visible by ophthalmoscopy at the early stages but can be detected by optical coherence tomography angiography (OCTA) [5]. Considering that >90% of vision loss cases can be prevented with early accurate staging and classification of DR [6, 7], OCTA plays an ever-increasing role in the diagnosis of DR and the assessment of treating options [4, 8]

Objectives

Methods

Results

Conclusion