Role of Optical Coherence Tomography Angiography in Early Detection of Retinal Microvascular Changes in Adolescents with Type 1 Diabetes

Purpose: Early detection of diabetic retinopathy can prevent progressive visual loss. Evaluate the role of Optical Coherence Tomography Angiography (OCTA) in early detection of diabetic retinopathy (DR) in type 1 diabetes (T1D) adolescents with normal fundus photography. Methods: Cross-sectional study included 150 eyes of 75 T1D adolescents from the Diabetes Endocrine and Metabolism Pediatric Unit, Children hospital, Cairo University. Their ages ranged from 10-18 years and diabetes duration 2 years or more. Fundus photography, OCT and OCTA were done in the diagnostic and laser unit, Ophthalmology department. Results: Twenty-eight patients (37.3%) had abnormalities in the OCTA despite normal fundus examination, photography and OCT. Diabetes duration, DKA at presentation and frequency, elevated blood pressure, limited joint mobility, elevated HbA1c and dyslipidemia had a negative correlation with OCTA measurements (foveal, parafoveal and perifoveal densities). Patients with abnormal OCTA had significantly higher mean age, higher DKA frequency, and lower height SDS (p=0.034, 0.011 and 0.001 respectively). Univariate and multivariate analysis revealed age and DKA at diabetes presentation are significant predictors for abnormal OCTA. Conclusion: OCTA can be used in early detection of diabetic retinopathy in T1D adolescents especially with risk factors (Elevated HbA1c, frequent DKA, decreased height SDS and limited joint mobility)