Abstract
BackgroundDiabetic retinopathy (DR) is the leading cause of blindness in type 1 Diabetes Mellitus (DM) patients, as a consequence of impaired blood flow in the retina. Optical coherence tomography angiography (OCTA) is a newly developed, non-invasive, retinal imaging technique that permits adequate delineation of the perifoveal vascular network. It allows the detection of paramacular areas of capillary non perfusion and/or enlargement of the foveal avascular zone (FAZ), representing an excellent tool for assessment of DR. The relationship of these microvascular changes with systemic factors such as metabolic control or duration of the disease still needs to be elucidated.MethodsProspective, consecutive, large-scale OCTA study. A complete ocular examination including a comprehensive series of OCTA images of different scan sizes captured with 2 OCT devices (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA, and Triton Deep Range Imaging OCT, Topcon Corp, Topcon, Japan) will be obtained as part of the yearly routine follow up visits in type 1 DM patients seen in the Diabetes Unit of the Endocrinology department which give written informed consent to participate in the project. The aim of this study is to investigate the relationship between OCTA-derived parameters and systemic factors, as metabolic control (Hb1Ac, lipid profile, cholesterol, etc), and other relevant clinical factors as demographics or duration of the disease.DiscussionThis study is directed to investigate the relationship between the status of the perifoveal vascular network and systemic markers of the disease, and in particular to study whether these changes reflect those occurring elsewhere in the body affected by diabetic microvascular disease, as the kidneys or the brain. If these relationships were demonstrated, early detection of these microvascular changes by OCTA could lead to modifications in the pharmacological management of type 1 diabetic patients, as a way to reduce the risk of future complications in both the eye and other organs.Trial registrationClinicalTrials.gov, trial number NCT03422965.
Highlights
Diabetic retinopathy (DR) is the leading cause of blindness in type 1 Diabetes Mellitus (DM) patients, as a consequence of impaired blood flow in the retina
In the field of diabetic retinopathy, Optical coherence tomography angiography (OCTA) represents an interesting opportunity to evaluate the status of the perifoveal vascular network at different times of the disease, to identify early changes such as capillary dilation, enlargement of foveal avascular zone (FAZ), paramacular areas of capillary nonperfusion and presence of microaneurisms in a non-invasive way [13,14,15,16,17,18]
These preclinical alterations could be correlated with systemic factors such as time of diabetes evolution and metabolic control, and may reflect those occurring elsewhere in the body affected by diabetic microvascular disease
Summary
Diabetic retinopathy (DR) is the leading cause of blindness in type 1 Diabetes Mellitus (DM) patients, as a consequence of impaired blood flow in the retina. Optical coherence tomography angiography (OCTA) is a newly developed, non-invasive, retinal imaging technique that permits adequate delineation of the perifoveal vascular network. It allows the detection of paramacular areas of capillary non perfusion and/or enlargement of the foveal avascular zone (FAZ), representing an excellent tool for assessment of DR. In the field of diabetic retinopathy, OCTA represents an interesting opportunity to evaluate the status of the perifoveal vascular network at different times of the disease, to identify early changes such as capillary dilation, enlargement of foveal avascular zone (FAZ), paramacular areas of capillary nonperfusion and presence of microaneurisms in a non-invasive way [13,14,15,16,17,18]
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