Analysis of Retinal Perfusion in Children, Adolescents, and Young Adults with Type 1 Diabetes Using Optical Coherence Tomography Angiography

Abstract

We performed a cross-sectional study to analyze the retinal vasculature in children, adolescent, and young adults with type 1 diabetes using optical coherence tomography angiography (OCTA). Patients underwent funduscopic examination for diabetic retinopathy (DR) screening during an annual visit for the screening of diabetes-related complications which included the evaluation of glycated hemoglobin (HbA1c), microalbuminuria, lipid profile, arterial pressure, and neurological assessment. In addition, OCTA of the retinal vasculature was performed. Quantitative analysis of the OCTA images evaluated the vessel density at the superficial (SCP) and deep (DCP) capillary plexus of the retina. Structural vascular alterations were evaluated qualitatively. Results were compared to those obtained in a group of healthy age-, sex-, and pubertal stage-matched controls. The effect of age, disease duration, age at the disease onset, mean HbA1c since the onset, and lipid profile on vascular density was tested. Fifty-three patients (median age 15.5, IQR 12.4-19.4 years; 57% females) with type 1 diabetes and 48 controls were enrolled. The median (IQR) HbA1c was 7.6% (60 mmol/mol) (6.9-8.1%, 52-65 mmol/mol), and the median (IQR) duration of disease was 6.0 (3.3-10.3) years. Mean vessel density measured with OCTA was lower in patients compared to controls with the temporal sector showing the highest difference both in the SCP (0.55 vs. 0.57, p<0.001) and the DCP (0.63 vs. 0.65, p<0.001). None of the predictors was associated with the superficial and deep vascular densities. Only 2 patients had clinically detectable DR. Microvascular structural changes were found on OCTA in both of these patients and in one without funduscopic alterations. In conclusion, patients with type 1 diabetes without clinically detectable DR had decreased capillary density compared to controls on OCTA images. These findings may provide useful information for the screening and the management of patients with type 1 diabetes. Further studies are needed to confirm our results and their clinical relevance.

Influence of Metabolic Parameters and Treatment Method on OCT Angiography Results in Children with Type 1 Diabetes

“…In our study, this parameter negatively correlated with FAZ. This is contrary to the research by Onoe et al, where the larger FAZ area was associated with the older onset age [ 20 ] or to the study of Mameli et al, in which the correlation was not statistically significant [ 21 ]. Nevertheless, the number of participants in the aforementioned studies was remarkably smaller in comparison with our analysis.…”

Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus. Report 1: Diabetic Retinopathy

“…25 The largest series in type 1 DM have been described in children, and they interestingly have shown controversial results. [26][27][28][29][30] Golebiewska et al reported that no differences were seen in the VD or FAZ area in any of the studied plexuses between patients with type 1 DM and controls (n = 188 vs. 60); however, Niestrata-Ortiz et al described that FAZ area was different between diabetic and healthy children (n = 112 vs. 30). 27,28 In this last paper, a greater FAZ area was also associated with a longer duration of the disease.…”

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

“…DR is uncommon before puberty, and there are only a few OCTA studies on children with T1D. Some of them have found no differences in macular OCTA parameters between T1D without DR and controls [23,24], while others have found children with T1D without DR to have significantly lower VD in the DCP and larger FAZ than controls [25][26][27]. Puberty significantly increases the risk of DM complications; hence, adolescence is the time when efforts should be directed to screening for early signs of DR and modifiable risk factors [2]; therefore, patients aged 15-30 years with T1D with at least 10 years of diabetes duration are a very important age group.…”