Association between the onset of diabetic retinopathy and thickness changes in the retina and choroid of children with type 1 diabetes: A three-year longitudinal study

Purpose: To explore the longitudinal changes in retinal and choroidal thickness and their relation with the onset of type 1 diabetes mellitus (T1DM) in children.

Methods: Thirty-eight children with T1DM and 71 healthy controls were included in this 3-year longitudinal study. Ophthalmic and systemic examinations were conducted on each participant. Retinal and choroidal thickness were measured by optical coherence tomography. Baseline values and changes in retinal and choroidal thickness were compared with DR onset, diabetics without DR and healthy controls. Logistic regression was used to explore the association with DR development.

Results: Six children developed DR during the follow-up period (15.79%) and five of them developed microaneurysms in the parapapillary temporal quadrant. During follow-up, greater retinal thickening occurred in subjects with DR compared with diabetic participants without DR (p = 0.03) and healthy controls (p = 0.02) in the parapapillary outer temporal section. Compared with the control group, greater retinal thickening was observed in DR subjects in the averaged parapapillary outer ring (p = 0.01), the macular inner temporal section (p = 0.03) and several macular sections (all p < 0.05). Additionally, greater retinal thickening was observed in several parapapillary regions in non-DR T1DM participants compared with healthy controls (all p < 0.05). The thickness change in the outer temporal parapapillary section was independently associated with DR onset (OR = 1.33, 95% CI 1.01-1.73, p = 0.04).

Conclusion: Children with T1DM showed a significant or a trend of increasing retinal and choroidal thickness compared with normal controls over a 3-year period. The change of retinal thickness in the parapapillary outer temporal section was associated with the development of DR in children with T1DM, suggesting that it could serve as a biomarker for predicting and screening DR in these individuals.