Neuroretinal Layer Thinning on OCT Imaging and Hemoglobin A1c in Youth With Type 1 Diabetes

Supriya Ramanujam; Roomasa Channa; T. Y. Alvin Liu; Elizabeth A. Brown; Neha Parimi; Yoohee Claire Kim; Lee Bromberger; Harold P. Lehmann; Michael D. Abramoff; Risa M. Wolf

doi:10.1001/jamaophthalmol.2026.1341

Back

Neuroretinal Layer Thinning on OCT Imaging and Hemoglobin A1c in Youth With Type 1 Diabetes

Journal article

Open access

Peer reviewed

Neuroretinal Layer Thinning on OCT Imaging and Hemoglobin A1c in Youth With Type 1 Diabetes

Supriya Ramanujam, Roomasa Channa, T. Y. Alvin Liu, Elizabeth A. Brown, Neha Parimi, Yoohee Claire Kim, Lee Bromberger, Harold P. Lehmann, Michael D. Abramoff and Risa M. Wolf

JAMA ophthalmology

06/25/2026

DOI: 10.1001/jamaophthalmol.2026.1341

PMID: 42348200

Files and links (1)

url

https://doi.org/10.1001/jamaophthalmol.2026.1341View

Published (Version of record) Open Access

Abstract

This prospective cohort study determines if retinal layer thickness changes on optical coherence tomography (OCT) imaging were associated with glycemic outcomes and diabetic retinal disease in youth with type 1 diabetes. Importance Diabetic retinal neurodegeneration precedes vascular changes associated with diabetic retinal disease (DRD). Studies in adults with type 1 diabetes (T1D) show there is retinal layer thinning with DRD, yet there are limited data in youth with T1D. Objectives To determine if retinal layer thickness changes on optical coherence tomography (OCT) imaging were associated with glycemic outcomes and DRD in youth. Design, Setting, and Participants This prospective cohort study was conducted at an academic pediatric diabetes center among youth with T1D aged 9 to 21 years participating in the ACCESS2 (AI for Pediatric Diabetic Eye Exams Study 2) study. Participants were enrolled and data were collected July 11, 2022, and April 30, 2025. Data analysis was performed from June 2025 through October 2025. Exposure OCT imaging. Main Outcomes and Measures The primary outcome was macular OCT volumes, which were segmented by the Topcon Maestro camera software and reviewed by the Wisconsin Reading Center for 3 neuroretinal layers: (1) retinal nerve fiber layer (RNFL) thickness, (2) ganglion cell and inner plexiform layer (GCL+IPL) thickness, and (3) GCL+IPL+RNFL thickness, as well as total retinal thickness. Layer thicknesses were analyzed for associations with glycemic outcomes and DRD and for potential covariates. Results A total of 294 youth with T1D (n = 578 eyes), among whom mean (SD) age was 15.8 (2.8) years, 153 participants (52.0%) were female, and 108 participants (36.7%) had public insurance, were included. Participants had a median (IQR) duration of diabetes of 7.0 (4.6-10.1) years and a median (IQR) hemoglobin A1c (HbA1c) of 8.5% (7.5%-9.9%); 210 participants (71.4%) used an insulin pump. Of the total 578 eyes, 65 eyes (11.2%) had mild DRD and 10 eyes (1.73%) had moderate DRD. In adjusted analyses, moderate DRD vs no DRD was associated with RNFL thickness of −1.2 µm (95% CI, −2.9 to 0.5; P = .20), GCL+IPL thickness of −1.2 µm (95% CI, −2.8 to 0.4; P = .19), and outer retinal layer thickness of −0.8 µm (95% CI, −3.9 to 2.2; P = .80). In multivariable models, GCL+IPL and outer retinal layer thickness were associated with HbA1c (β = −0.39; 95% CI, −0.78 to −0.01; P = .04; and β = −0.81; 95% CI, −1.49 to −0.12; P = .02, respectively). Conclusions and Relevance In this prospective cohort study, neuroretinal layer thinning was observed in youth with T1D without clinically apparent DRD and was associated with higher HbA1c. These findings support elucidating the development of diabetic retinal neurodegeneration and its potential role as a biomarker of retinal vascular disease in youth.

Comments

Online First

Original Investigation

Details

Title: Subtitle: Neuroretinal Layer Thinning on OCT Imaging and Hemoglobin A1c in Youth With Type 1 Diabetes
Creators: Supriya Ramanujam - Johns Hopkins University
Roomasa Channa - University of Wisconsin–Madison
T. Y. Alvin Liu - Johns Hopkins University
Elizabeth A. Brown - Johns Hopkins University
Neha Parimi - Johns Hopkins University
Yoohee Claire Kim - Johns Hopkins University
Lee Bromberger - Johns Hopkins University
Harold P. Lehmann - Johns Hopkins University
Michael D. Abramoff - University of Iowa
Risa M. Wolf - Johns Hopkins University
Resource Type: Journal article
Publication Details: JAMA ophthalmology
DOI: 10.1001/jamaophthalmol.2026.1341
PMID: 42348200
NLM abbreviation: JAMA Ophthalmol
ISSN: 2168-6165
eISSN: 2168-6173
Publisher: American Medical Association
Grant note: National Eye Institute of the US National Institutes of Health (NIH): R21EY036948, 2-SRA-2023-1306-M-B Research to Prevent Blindness National Eye Institute of the NIH: 5K23EY030911-03, R01EY035994 Research to Prevent Blindness Career Development Award
This study was supported by the National Eye Institute of the US National Institutes of Health (NIH) under award number R21EY036948 and by Breakthrough T1D (formerly Juvenile Diabetes Research Foundation) under award number 2-SRA-2023-1306-M-B to Dr Wolf. Dr Channa receives research support in part by an unrestricted grant from Research to Prevent Blindness to the University of Wisconsin-Madison Department of Ophthalmology and Visual Sciences and by the National Eye Institute of the NIH under award numbers 5K23EY030911-03 and R01EY035994. Dr Liu receives funding support from the Research to Prevent Blindness Career Development Award.
Alternative title: Neuroretinal Layer Thinning on OCT Imaging and Hemoglobin A1c in Youth With Type 1 Diabetes
Language: English
Electronic publication date: 06/25/2026
Academic Unit: Electrical and Computer Engineering; Fraternal Order of Eagles Diabetes Research Center; Ophthalmology and Visual Sciences
Record Identifier: 9985177838102771

Metrics

3 Record Views

1 Times Cited - Web of Science