Retinal Microvascular Abnormalities in Children with Type 1 Diabetes Mellitus Without Visual Impairment or Diabetic Retinopathy

Li, Tao; Jia, Yan; Wang, Shanshan; Wang, Anken; Yang, Chenhao; Zou, Haidong

doi:10.1167/iovs.18-25499

Cited by 43 publications

(33 citation statements)

References 42 publications

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“…Both groups were similar with respect to the demographic and baseline characteristics, including age, gender, arterial blood pressure, heart rate, body mass index, ocular axial length, intraocular pressure and best-corrected visual acuity (Table 1). Of note, and as previously reported elsewhere, 36,37 a baseline rarefaction of the superficial and deep parafoveal plexuses was noted in the group of patients with diabetes, even before clinically evident retinopathy (Table 1).…”

Section: Demographics and Baseline Datasupporting

confidence: 86%

Retinal Vascular Reactivity in Type 1 Diabetes Patients Without Retinopathy Using Optical Coherence Tomography Angiography

Sousa

Leal

Moreira

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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We hypothesize that patients with type 1 diabetes (T1D) may have abnormal retinal vascular responses before diabetic retinopathy (DR) is clinically evident. Optical coherence tomography angiography (OCTA) was used to dynamically assess the retinal microvasculature of diabetic patients with no clinically visible retinopathy. METHODS. Controlled nonrandomized interventional study. The studied population included 48 eyes of 24 T1D patients and 24 demographically similar healthy volunteers. A commercial OCTA device (AngioVue) was used, and two tests were applied: (1) the hypoxia challenge test (HCT) and (2) the handgrip test to induce a vasodilatory or vasoconstrictive response, respectively. The HCT is a standardized test that creates a mild hypoxic environment equivalent to a flight cabin. The handgrip test (i.e., isometric exercise) induces a sympathetic autonomic response. Changes in the parafoveal superficial and deep capillary plexuses in both tests were compared in each group. Systemic cardiovascular responses were also comparatively evaluated. RESULTS. In the control cohort, the vessel density of the median parafoveal superficial and deep plexuses increased during hypoxia (F 1,23 = 15.69, P < 0.001 and F 1,23 = 16.26, P < 0.001, respectively). In the T1D group, this physiological response was not observed in either the superficial or the deep retinal plexuses. Isometric exercise elicited a significant decrease in vessel density in both superficial and deep plexuses in the control group (F 1,23 = 27.37, P < 0.0001 and F 1,23 = 27.90, P < 0.0001, respectively). In the T1D group, this response was noted only in the deep plexus (F 1,23 = 11.04, P < 0.01). CONCLUSIONS. Our work suggests there is an early impairment of the physiological retinal vascular response in patients with T1D without clinical diabetic retinopathy.

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Section: Demographics and Baseline Datasupporting

confidence: 86%

Retinal Vascular Reactivity in Type 1 Diabetes Patients Without Retinopathy Using Optical Coherence Tomography Angiography

Sousa

Leal

Moreira

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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“… 25 The largest series in type 1 DM have been described in children, and they interestingly have shown controversial results. 26 – 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.…”

Section: Discussionmentioning

confidence: 92%

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

Barraso

Alé-Chilet

Hernandez

et al. 2020

Trans. Vis. Sci. Tech.

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The purpose of this study was to evaluate specifically in type 1 diabetes mellitus (DM) individuals the relationship between perifoveal superficial capillary plexus (SCP) parameters assessed by optical coherence tomography angiography (OCTA) and diabetic retinopathy (DR) grade. Methods: Cross-sectional analysis of a large scale prospective OCTA trial cohort (Clini-calTrials.gov NCT03422965). A total of 1186 eyes (593 individuals), 956 type 1 DM eyes (478 patients), and 230 control eyes (115 healthy volunteers) were included in this study. DR stage was graded according to the International Classification. OCTA imaging was performed with a commercially available device (Cirrus HD-OCT). Vessel density (VD), perfusion density (PD), and foveal avascular zone (FAZ) area, perimeter and circularity measurements were quantified in the SCP and receiver operating characteristic (ROC) curves were constructed for each OCTA parameter. Results: VD and PD (in both 3 × 3 and 6 × 6 mm captures) were inversely associated with DR stage (P < 0.001 in all cases) in a multiple regression analysis after controlling by age, gender, signal strength index, axial length, and DM duration. Greater FAZ area and perimeter and conversely lower circularity measurements were observed as DR severity increased in both scanning protocols (P < 0.05 in all cases). Conclusions: In type 1 DM individuals, OCTA provides an objective, continuous, and reliable method for accurate quantification of VD, PD, and FAZ parameters in the SCP, which ultimately correlate with DR stages. Translational Relevance: Objective OCTA measurements of the retinal microvasculature could substitute the clinical DR classification in patients with type 1 DM, identify patients at risk of DR progression, and inform treatment decisions to modify the evolution of the disease.

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“…For example, females have a larger FAZ area in normal eyes [17]. In addition, DM, even without DR, can affect macular microvascular parameters, e.g., an enlarged FAZ area [18] and decreased VD [19]. Hypertension has also been suggested to be associated with a larger FAZ area and lower VD [20].…”

Section: Discussionmentioning

confidence: 99%

Posterior vitreous detachment and macular microvasculature in the elderly

et al. 2020

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To investigate the association between different stages of posterior vitreous detachment (PVD) and macular microvasculature in the elderly. Methods Swept-source optical coherence tomography (OCT), OCT angiography, and color fundus images of 490 eyes without retinal pathologies of 322 participants aged �65 years were evaluated. PVD was classified using enhanced vitreous visualization mode as no apparent PVD (stage 0/1), vitreous adhesions at the fovea and optic disc (stage 2), adhesion at the optic disc (stage 3), or complete PVD (stage 4). Microvascular parameters, including foveal avascular zone (FAZ) and vessel density (VD), were analyzed for their associations with complete PVD. Additionally, the association between PVD and central retinal thickness (CRT) was also addressed. Results Overall, 80, 31, 31, and 349 eyes were categorized into stages 0/1, 2, 3, and 4, respectively. Using multivariate mixed-effects model, the mean superficial FAZ area was smaller in stage 4 compared with stages 0-3 (0.29 vs. 0.32 mm 2 ; P = 0.014), and the mean superficial VD was lower in stage 4 compared with stages 0-3 (34.96% vs. 35.24%; P = 0.0089). However, PVD was not significantly associated with deep macular microvascular parameters or CRT. Conclusions Complete PVD was associated with smaller FAZ area and lower VD in superficial macular microvasculature, while it was not associated with central retinal thickness.

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Retinal Microvascular Abnormalities in Children with Type 1 Diabetes Mellitus Without Visual Impairment or Diabetic Retinopathy

Cited by 43 publications

References 42 publications

Retinal Vascular Reactivity in Type 1 Diabetes Patients Without Retinopathy Using Optical Coherence Tomography Angiography

Retinal Vascular Reactivity in Type 1 Diabetes Patients Without Retinopathy Using Optical Coherence Tomography Angiography

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

Posterior vitreous detachment and macular microvasculature in the elderly

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