Structural Changes by Spectral Domain Optical Coherence Tomography in Patients with Type 1 Diabetes Mellitus

Background: With a possible increase in the prevalence of type 1 diabetes mellitus (DM1), the pediatric patient population is expected to be at risk for other health care complications. Current imaging modalities, such as the spectral domain optical coherence tomography (SD-OCT), that allow micron resolution imaging of the retina have become a standard of care for showing morphological changes seen in the retina in adults with diabetes. Such pathologies can be associated with known risk factors such as poor glycemic control (HbA1C) and body mass index (BMI). Methods: A comprehensive screening was performed in subjects with DM1 including nonmydriatic fundus imaging (Canon, CR2 Plus-AF with EOS-60D, Tokyo, Japan) and SD-OCT imaging (Optovue, iVue, Fremont, CA). SD-OCT scans were acquired showing macular thickness (MT) and thickness of the parafoveal regions and the perifoveal regions. Associations of macular, paramacular, and perimacular thickness were analyzed as a function of HbA1C and BMI by simple linear regressions. Results: SD-OCT changes were analyzed in eyes of subjects with DM1 and normal fundus appearance by color imaging. Linear regression analysis of thickness of macula right eye (RT), paramacula RT, paramacula left eye (LT), perimacula LT with BMI were statistically significant (P <.05). HbA1C >7.5% was also found statistically significant in the macula RT, paramacula RT, paramacula LT, perimacula RT, and perimacula LT. A general trend of thickening of the macula, paramacula, and perimacula was observed with increasing HbA1C (>7.5%) and increasing BMI; however, no statistical significance was found. Conclusions: SD-OCT with retinal imaging was feasible in young individuals with DM1 and revealed ultrastructural macular and perimacular changes prior to manifest clinical disease.