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Diabetic macular ischemia in type 1 diabetes

Session Details

Session Title: Vascular Diseases III

Session Date/Time: Sunday 29/09/2013 | 08:00-10:00

Paper Time: 08:08

Venue: Hall 3 (Level 0)

First Author: D.Sim UK

Co Author(s):    Z. Durani   G. Liew   P. Keane   M. Fruttiger     

Abstract Details

Purpose:

To investigate the relationship between diabetic macular ischemia (DMI), age, and visual acuity (VA) in type 1 diabetes.

Setting:

Tertiary referral diabetic retinopathy clinic

Methods:

Data were retrospectively collected over a period of 24 months. FAs were analysed using the Early Treatment Diabetic Retinopathy Study (EDTRS) protocol for DMI. The Foveal Avascular Zone (FAZ), and ischemia elsewhere- capillary non-perfusion areas, temporal to the fovea, and the overlying the papillomacular (PM) nerve fibre bundle, were quantified using custom software.

Results:

86 patients with type 1 diabetes (DM) who had undergone a FA were included in the analysis. 26 eyes (30.2%) had “no DMI”, 13 (15.1%) “questionable”, 28 (32.6%) “mild”, 10 (11.6%) “moderate”, and 9 (10.5%) “severe” ischemia. Temporal ischemia was present in 45/86 eyes (52.3%), with a median area of 0.60mm2 (IQR, 0.17 to 1.69), and PM ischemia in 22/86 (25.6%), with a median area of 0.033 mm2 (IQR, 0.016 to 0.069). Of the patients with DMI, 54/60 (90.0%) were aged greater than 30 years, compared to 6/14 (42.9%) in those younger than 30 years. (χ²=4.32, p=0.04). Furthermore, an age of greater than 30 years, was significantly associated the presence of any grade of DMI (b=1.39, SE=0.60, p=0.02), This association was strengthened, when modelled with diabetic retinopathy, and visual acuity (b=2.87, SE=0.95, p=0.003). A significant difference between the median logMAR visual acuity (VA), was observed in eyes with “no DMI”, 0 (IQR: -0.1 to 0.2), compared to eyes with “DMI” 0.2 (IQR: 0 to 0.5) (p=0.007). Eyes with a VA of greater than 0.3 logMar (6/12 Snellen), were associated with DMI (b=2.06, SE=0.71, p=0.004) and diabetic maculopathy (b=0.83, SE=0.34, p=0.01).

Conclusions:

In type 1 diabetes, DMI was more commonly observed in patients aged greater than 30 years, and was associated with reduced visual acuity.

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