OCT-A Finds Subclinical Choroidal Changes in Pediatric Patients with Type 1 Diabetes

Similar to OCT-A’s value as a noninvasive tool for detecting early retinal microvascular changes in adult patients with diabetes, recent findings underscore its potential as a rapid and noninvasive tool to detect subclinical changes in pediatric patients with diabetes, a more vulnerable and at-risk cohort. These images from the study show choroidal vascular maps of a 17-year-old without diabetes (A-D), a 16-year-old with Type 1 diabetes (E-H) and 16-year-old with Type 2 diabetes (I-L). Colors higher in saturation represent higher values. Photo: Aman S, et al. Ophthalmol Sci. August 17, 2025. Click image to enlarge. Measurements from swept-source OCT-angiography (OCT-A) can uniquely illustrate contemporaneous pathology in both retinal and choroidal vasculature as well as surrounding non-vascular structure (e.g., choroidal stroma), thereby allowing a comprehensive understanding of the temporal relationship between pathology in these regions. Quantitative assessment of the retinal and choroidal microcirculation has improved our understanding of preclinical vascular changes in various retinal diseases, including diabetic retinopathy (DR).While there is limited data on preclinical OCT-A changes in youth with type 1 diabetes, there are no studies describing such changes in youth with type 2. There are also no studies that contemporaneously assess retinal and choroidal changes in these populations. A recent study sought out to characterize contemporaneous changes in retinal and choroidal vascular metrics using OCT-A in children with type 1 and type 2 diabetes without clinically detectable DR and compare the results to those obtained from kids and adolescents without diabetes.Children with type 1 diabetes without DR exhibited larger choroidal and choriocapillaris vascularity than controls, and no contemporaneous differences in retinal vascularity measures were found. “This suggests that subclinical choroidal changes are present in pediatric diabetic patients before clinical or subclinical signs of DR,” the study authors wrote in their paper, which was published in Ophthalmology Science.This was a cross-sectional study performed from 2022 to 2024 in children with diabetes being prospectively followed at the Johns Hopkins Pediatric Diabetes Center (Baltimore, MD) and children without diabetes from the Wilmer Eye Institute (Baltimore, MD).A total of 32 subjects (44% female, 57 eyes) were included: 10 with type 1 diabetes, seven with type 2 diabetes and 15 without diabetes. The mean ages of the type 1diabetes, type 2 diabetes and control groups were 16, 16 and 12, respectively. The mean duration of diabetes in youth with type 1 diabetes was longer compared to those with type 2 (8.0 vs. 2.4). In youth with type 1 and 2 diabetes, the mean HbA1c was 7.7% and 8.7%, respectively. Right eyes comprised 51% of the eyes imaged. Participants had no significant comorbidities or known complications of diabetes mellitus.Choroidal vascular volume and choroidal vascularity index (CVI)— a newer metric that quantifies the vascular area of the choroid as a percentage of the entire structure—were significantly higher in type 1 diabetes compared to controls (choroidal vascular volume: 18.9mm3 vs.16.2mm3; CVI: 0.69 vs. 0.63) but not in type 2 diabetes. Choriocapillaris thickness was also significantly higher in type 1 diabetes (9.5μm) compared to controls (8.4μm), with no significant difference in type 2 diabetes. Retinal thickness, choroidal thickness, vessel skeleton density, vessel diameter index and flux were not different among the groups.“Our findings support histopathologic findings of choroidal remodeling and inflammation in type 1 diabetes and suggest the timing of such changes precedes the more widely recognized retinal changes,” the researchers wrote. “We also show that choroidal thickening may be unique to type 1 diabetes and/or the duration of disease since similar changes are not observed in our cohort of those with type 2 diabetes who have a shorter duration of disease.”The relatively short disease duration in type 2 diabetes participants limited the team’s ability to observe potential long-term vascular changes, but this problem is inherent in studying children.“These findings support the possibility that subclinical choroidal changes in type 1 diabetes may precede, or at least be more easily detectable than, retinal vascular changes,” the study authors wrote. “Future studies should be longitudinal and include a more ethnically diverse cohort and a broader range of disease durations to validate these findings in a larger pediatric population.”Click here for the journal source. Aman S, Asebot M, Patel D, et al. Optical coherence tomography angiography of chorioretinal microvasculature in children with type 1 and 2 diabetes without retinopathy. Ophthalmol Sci. August 17, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.