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  • Retinal Changes That Precede DR in Type 1 Diabetes

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, November 2019

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    Few studies have focused on the initial retinal changes in children who have type 1 diabetes without diabetic retinopathy (DR). Inanc et al. sought to determine whether the abnormal glucose metabolism that occurs in type 1 disease affects the microcirculation of children with the disease. They compared their findings with those for healthy children and noted that diabetic eyes without clinically detect­able DR had alterations in the acircu­larity index (AI), perimeter, and foveal density of parafoveal capillaries in the deep capillary plexus, which preceded enlargement of the foveal avascular zone (FAZ). These parameters might serve as imaging biomarkers to define early DR, the researchers said.

    This cross-sectional prospective study included 60 patients with well-controlled diabetes and clinically undetectable DR as well as 57 age-matched controls. Optical coherence tomography angiography (OCTA) was performed, and various parameters were measured, including FAZ area, nonflow area, superficial and deep vessel density, FAZ perimeter, FAZ AI, and foveal density in the 300 μm (FD-300) surrounding the FAZ. The authors looked at the findings for these parameters in relation to the duration of diabetes and the level of glycated hemoglobin (HbA1c).

    Differences in mean values between the patients and control children were significant for FAZ perimeter (p < .001), AI (p = .001), and FD-300 (p = .009). Significant differences between these groups also were noted for vessel density in the deep superior hemiparafovea, deep temporal parafovea, and deep superior parafoveal zones (p = .008, p = .015, and p = .005, respectively). There were no meaningful correlations between OCTA findings and disease duration or HbA1c levels.

    These findings imply that defects in retinal microcirculation and irregulari­ties at the FAZ margin can occur before DR becomes clinically apparent. The observed changes in FD-300, AI, FAZ perimeter, and vessel density of the parafoveal capillaries in the deep capil­lary plexus precede enlargement of the FAZ. The authors recommend further investigation of the role of OCTA in disease detection and treatment guid­ance for children with type 1 diabetes.

    The original article can be found here.