Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Acta Diabetologica

Open Access 03-05-2024 | Diabetic Retinopathy | Original Article

Evaluation of optical coherence tomography angiography metrics in children and adolescents with type 1 diabetes: 4-year longitudinal study

Authors: Xinran Qin, Ying Xiao, Lipu Cui, Shuli Chen, Qingyu An, Tianyi Yuan, Yiwei Wu, Qiurong Lin, Chenhao Yang, Haidong Zou

Published in: Acta Diabetologica

Login to get access

Abstract

Purpose

To evaluate longitudinal changes in optical coherence tomography angiography (OCTA) metrics in children and adolescents with type 1 diabetes (T1D).

Methods

This prospective observational cohort study included thirty-two eyes from thirty T1D children with no history of diabetic retinopathy (DR) who were followed up for 4 years. Participants underwent OCTA examinations at baseline and during follow-up. Quantitative OCTA metrics were measured using a customized MATLAB algorithm. Generalized mixed-effect models were used to determine their relationship with DR development. Systemic parameters and OCTA metrics were screened using least absolute shrinkage and selection operator to identify predictors for visual function.

Results

Over the 4-year period, seven of the included eyes developed DR, and most OCTA metrics decreased with diabetes duration. Higher peripapillary and parafoveal nasal quadrant vessel area density (VAD) in the superficial capillary plexus (SCP) and vessel skeleton density (VSD) in both the SCP and the deep capillary plexus (DCP) were associated with a lower risk of DR in T1D. Parafoveal DCP VSD and VAD in the temporal and inferior quadrants were anticorrelated with changes in best corrected visual acuity.

Conclusions

OCTA metrics dynamically change over the duration of diabetes and can be used as biomarkers to improve the risk evaluation of DR development and visual function in T1D children and adolescents.
Appendix
Available only for authorised users
Literature
1.
Gregory GA, Robinson TIG, Linklater SE et al (2022) Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol 10(10):741–760CrossRefPubMed
2.
Bebu I, Braffett BH, de Boer IH et al (2023) Relationships between the cumulative incidences of long-term complications in type 1 diabetes: the DCCT/EDIC study. Diabetes Care 46(2):361–368CrossRefPubMed
3.
Donaghue KC, Marcovecchio ML, Wadwa RP et al (2018) ISPAD clinical practice consensus guidelines: microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 19(27):262–274CrossRefPubMedPubMedCentral
4.
Sohn EH, van Dijk HW, Jiao C et al (2016) Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus. Proc Natl Acad Sci U S A 113(19):E2655–E2664CrossRefPubMedPubMedCentral
5.
Lachin JM, Genuth S, Nathan DM et al (2008) Effect of glycemic exposure on the risk of microvascular complications in the diabetes control and complications trialdrevisited. Diabetes 57:995e1001CrossRef
6.
Tan B, Chua J, Lin E, et al (2020) Quantitative microvascular analysis with wide-field optical coherence tomography angiography in eyes with diabetic retinopathy [published correction appears in JAMA Netw Open. 2020 Jun 1;3(6):e2010994]. JAMA Netw Open 3(1):e1919469.
7.
Takase N, Nozaki M, Kato A et al (2015) Enlargement of foveal avascular zone in diabetic eyes evaluated by en face optical coherence tomography angiography. Retina 35:2377–2383CrossRefPubMed
8.
Sun Z, Tang F, Wong R et al (2019) OCT angiography metrics predict progression of diabetic retinopathy and development of diabetic macular edema: a prospective study [published correction appears in Ophthalmology. 2020 Dec;127(12):1777]. Ophthalmology 126(12):1675–1684.
9.
Li T, Jia Y, Wang S et al (2019) Retinal microvascular abnormalities in children with type 1 diabetes mellitus without visual impairment or diabetic retinopathy. Invest Ophthalmol Vis Sci 60(4):990–998CrossRefPubMed
10.
WHO (1977) Health needs of adolescents. World Health Organization, Geneva
11.
American Diabetes Association (2015) Diagnosis and classification of diabetes mellitus. Diabetes Care 38:S8–S16CrossRef
12.
Lim J, Chia A, Saffari SE, Handa S (2019) Factors affecting pupil reactivity after cycloplegia in Asian children. Asia Pac J Ophthalmol (Phila) 8(4):304–307CrossRefPubMed
13.
Biswas S, Jhanji V, Leung CK (2016) Prevalence of glaucoma in myopic corneal refractive surgery candidates in Hong Kong China. J Refract Surg 32(5):298–304CrossRefPubMed
14.
Chu Z, Lin J, Gao C et al (2016) Quantitative assessment of the retinal microvasculature using optical coherence tomography angiography. J Biomed Opt 21(6):66008CrossRefPubMed
15.
Zhao Q, Yang WL, Wang XN et al (2018) Repeatability and reproducibility of quantitative assessment of the retinal microvasculature using optical coherence tomography angiography based on optical microangiography. Biomed Environ Sci 31(6):407–412PubMed
16.
Dai Y, Xin C, Zhang Q et al (2021) Impact of ocular magnification on retinal and choriocapillaris blood flow quantification in myopia with swept-source optical coherence tomography angiography. Quant Imaging Med Surg 11(3):948–956CrossRefPubMedPubMedCentral
17.
Yang B, Ye C, Yu M, Liu S, Lam DS, Leung CK (2012) Optic disc imaging with spectral-domain optical coherence tomography: variability and agreement study with Heidelberg retinal tomograph. Ophthalmology 119(9):1852–1857CrossRefPubMed
18.
Linderman R, Salmon AE, Strampe M, Russillo M, Khan J, Carroll J (2017) Assessing the accuracy of foveal avascular zone measurements using optical coherence tomography angiography: segmentation and scaling [published correction appears in Transl Vis Sci Technol. 2017 Aug 15;6(4):17]. Transl Vis Sci Technol 6(3):16
19.
Cheung CMG, Fawzi A, Teo KY et al (2022) Diabetic macular ischaemia- a new therapeutic target? Prog Retin Eye Res 89:101033CrossRefPubMed
20.
Hayreh SS et al. The central artery OF the retina. Its role IN the blood supply OF the optic nerve. Br J Ophthalmol 47(1963):651–663
21.
Yu Q, Xiao Y, Lin Q et al (2022) Two-year longitudinal study on changes in thickness of the retinal nerve fiber layer and ganglion cell layer in children with type 1 diabetes mellitus without visual impairment or diabetic retinopathy. Curr Eye Res 47(8):1218–1225CrossRefPubMed
22.
Cao D, Yang D, Yu H et al (2019) Optic nerve head perfusion changes preceding peripapillary retinal nerve fibre layer thinning in preclinical diabetic retinopathy. Clin Exp Ophthalmol 47(2):219–225CrossRefPubMed
23.
Um T, Seo EJ, Kim YJ, Yoon YH (2020) Optical coherence tomography angiography findings of type 1 diabetic patients with diabetic retinopathy, in comparison with type 2 patients. Graefes Arch Clin Exp Ophthalmol 258(2):281–288CrossRefPubMed
24.
Zhang B, Chou Y, Zhao X, Yang J, Chen Y (2021) Early detection of microvascular impairments with optical coherence tomography angiography in diabetic patients without clinical retinopathy: a meta-analysis. Am J Ophthalmol 222:226–237CrossRefPubMed
25.
Nesper PL, Roberts PK, Onishi AC et al (2017) Quantifying microvascular abnormalities with increasing severity of diabetic retinopathy using optical coherence tomography angiography. Investig Ophthalmol Vis Sci 58:307–315CrossRef
26.
Tang FY, Chan EO, Sun Z et al (2020) Clinically relevant factors associated with quantitative optical coherence tomography angiography metrics in deep capillary plexus in patients with diabetes. Eye Vis (Lond) 7:7CrossRefPubMed
27.
Richter GM, Sylvester B, Chu Z et al (2018) Peripapillary microvasculature in the retinal nerve fiber layer in glaucoma by optical coherence tomography angiography: focal structural and functional correlations and diagnostic performance. Clin Ophthalmol 12:2285–2296CrossRefPubMedPubMedCentral
28.
Richter GM, Chang R, Situ B et al (2018) Diagnostic performance of macular versus peripapillary vessel parameters by optical coherence tomography angiography for glaucoma. Transl Vis Sci Technol 7(6):21CrossRefPubMedPubMedCentral
29.
Yuan M, Wang W, Kang S et al (2022) Peripapillary microvasculature predicts the incidence and development of diabetic retinopathy: an SS-OCTA study. Am J Ophthalmol 243:19–27CrossRefPubMed
30.
Ikram MK, Ong YT, Cheung CY, Wong TY (2013) Retinal vascular caliber measurements: clinical significance, current knowledge and future perspectives. Ophthalmologica 229(3):125–136CrossRefPubMed
31.
Ong JX, Konopek N, Fukuyama H, Fawzi AA (2023) Deep capillary nonperfusion on OCT angiography predicts complications in eyes with referable nonproliferative diabetic retinopathy. Ophthalmol Retin 7(1):14–23CrossRef
32.
Yang D, Tang Z, Ran A et al (2023) Assessment of parafoveal diabetic macular ischemia on optical coherence tomography angiography images to predict diabetic retinal disease progression and visual acuity deterioration. JAMA Ophthalmol 141(7):641–649CrossRefPubMed
33.
Wong PW, Lau JK, Choy BN et al (2020) Sociodemographic, behavioral, and medical risk factors associated with visual impairment among older adults: a community-based pilot survey in Southern District of Hong Kong. BMC Ophthalmol 20(1):372CrossRefPubMedPubMedCentral
34.
Wang X, Kong X, Jiang C, Li M, Yu J, Sun X (2016) Is the peripapillary retinal perfusion related to myopia in healthy eyes? A prospective comparative study. BMJ Open 6(3):e010791CrossRefPubMedPubMedCentral
35.
Iafe NA, Phasukkijwatana N, Chen X, Sarraf D (2016) Retinal capillary density and foveal avascular zone area are age-dependent: quantitative analysis using optical coherence tomography angiography. Invest Ophthalmol Vis Sci 57(13):5780–5787CrossRefPubMed
36.
Garrity ST, Iafe NA, Phasukkijwatana N, Chen X, Sarraf D (2017) Quantitative analysis of three distinct retinal capillary plexuses in healthy eyes using optical coherence tomography angiography. Invest Ophthalmol Vis Sci 58(12):5548–5555CrossRefPubMed
37.
Li S, Yang X, Li M et al (2020) Developmental changes in retinal microvasculature in children: a quantitative analysis using optical coherence tomography angiography. Am J Ophthalmol 219:231–239CrossRefPubMed
38.
Yang N, Li MX, Peng XY (2022) Effects of intensive insulin therapy on the retinal microvasculature in patients with type 2 diabetes mellitus: a prospective observational study. BMC Ophthalmol 22(1):187CrossRefPubMedPubMedCentral
39.
Spaide RF (2015) Volume-rendered optical coherence tomography of diabetic retinopathy pilot study. Am J Ophthalmol 160(6):1200–1210CrossRefPubMed
40.
Guo Y, Hormel TT, Xiong H et al (2019) Development and validation of a deep learning algorithm for distinguishing the nonperfusion area from signal reduction artifacts on OCT angiography. Biomed Opt Express 10(7):3257–3268CrossRefPubMedPubMedCentral
41.
Spaide RF, Fujimoto JG, Waheed NK et al (2018) Optical coherence tomography angiography. Prog Retin Eye Res 64:1–55CrossRefPubMed
42.
Sacconi R, Borrelli E, Querques G (2018) Reproducibility of vessel density, fractal dimension, and foveal avascular zone using 7 different optical coherence tomography angiography devices. Am J Ophthalmol 192:252–253CrossRefPubMed
43.
Wang XN, Cai X, Li SW, Li T, Long D, Wu Q (2022) Wide-field swept-source OCTA in the assessment of retinal microvasculature in early-stage diabetic retinopathy. BMC Ophthalmol 22(1):473CrossRefPubMedPubMedCentral
44.
Niederleithner M, de Sisternes L, Stino H et al (2023) Ultra-widefield OCT angiography. IEEE Trans Med Imaging 42(4):1009–1020CrossRefPubMed
Metadata
Title
Evaluation of optical coherence tomography angiography metrics in children and adolescents with type 1 diabetes: 4-year longitudinal study
Authors
Xinran Qin
Ying Xiao
Lipu Cui
Shuli Chen
Qingyu An
Tianyi Yuan
Yiwei Wu
Qiurong Lin
Chenhao Yang
Haidong Zou
Publication date
03-05-2024
Publisher
Springer Milan
Published in
Acta Diabetologica
Print ISSN: 0940-5429
Electronic ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-024-02291-4
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits