Optical coherence tomography angiography findings in diabetic retinopathy

ABSTRACT

Introduction: Diabetic retinopathy (DR) is a common complication of diabetes and a leading cause of blindness in working age population. Fluorescein angiography is still the gold standard in the evaluation of retinal vascular perfusion and diagnosis of macular ischemia. However, it is a costly, time-consuming procedure and it requires intravenous injection of contrast agent, exposing patients to potential side effects. Optical coherence tomography angiography (OCTA) is a novel, non-invasive imaging technique that provides dyeless visualization of blood flow in different retinal layers.

Areas covered: An extensive review of the literature was performed to detail technical principles of OCTA and to discuss the current concepts on its application in diabetic patients.

Expert commentary: In patients with DR, OCTA shows early features in unprecedented detail: enlargement of the FAZ, areas of capillary non-perfusion, and some microvascular abnormalities can be seen with much better clarity than with fluorescein angiography. OCTA is also able to detect several features that are currently accepted as prognostic indicators in patients with DME. The most relevant are the presence of diabetic macular ischemia and pronounced microvascular abnormalities. It has been shown that these alterations may influence the response to anti-VEGF therapy.

KEYWORDS:

• OCT
• optical coherence tomography
• OCTA
• optical coherence tomography angiography
• DME
• diabetic macular edema
• superficial capillary plexus
• deep capillary plexus
• macular ischemia
• prognostic indicator

Declaration of interest

P Lanzetta has received honoraria from Alcon, Alimera, Allergan, Bausch & Lomb, Bayer, Boehringer Ingelheim, Centervue, Genentech, Lupin, Lutronic, Novartis Pharma AG, Roche, Teva, Topcon, and Iridex Co. A Loewenstein has received honoraria from Allergan, Bayer, Forsightlabs, Notal Vision and Novartis Pharma AG. S R Vas has received honoraria from Carl Zeiss Meditec, Centervue, Optos, Heidelberg Engineering, Genentech, Allergan, Iconic, Thrombogenics and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.