For children with type 1 diabetes, the looming threat of diabetic retinopathy is a major concern for vision and quality of life. Early detection is key, and new research suggests that monitoring patients using optical coherence tomography angiography may help detect early retinal microvascular changes. In a study published recently in Retina, researchers measured microvascular and neurodegenerative changes in children with type 1 diabetes without diabetic retinopathy and also assessed the effects of two types of insulin therapy on the microvasculature. They found that one of these therapies may be more protective.

Because of its noninvasive nature and repeatability, OCT-A may be a useful modality for monitoring early microvascular retinal changes in children with type 1 diabetes mellitus before diabetic retinopathy manifestation. Photo: Carolyn Majcher, OD. Click image to enlarge.

The study included 41 children receiving multiple daily insulin injections (MDI), 22 receiving continuous subcutaneous insulin infusion (CSII) and 62 age-matched healthy controls. The researchers scanned a 6x6mm² area of posterior retina using the Spectralis OCT.

They observed significantly lower vessel density of the superficial vascular plexus, intermediate capillary plexus and deep capillary plexus in the MDI group vs. the CSII and control groups. The MDI group also demonstrated an association between lower vessel density of the superficial vascular plexus and higher hemoglobin A1c. The foveal avascular zone morphology index in this group and the CSII group were smaller than that of the control group. The researchers found no statistically significant difference in retinal thickness among the three groups.

The researchers say their results and those of previous studies suggest that “reduction of blood flow and impairment of the blood-retinal barrier [occur] due to chronic hyperglycemia before apparent signal of diabetic retinopathy in type 1 diabetes mellitus children.”

They concluded that OCT-A may be beneficial for detecting retinal abnormalities in children with early type 1 disease, and that CSII may be a better choice for preventing retinal complications compared with MDI, as “CSII therapy may be protective against retinal microvascular damage in early diabetic retinopathy stages.”