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Review
. 2019 Nov 18:6:37.
doi: 10.1186/s40662-019-0160-3. eCollection 2019.

Optical coherence tomography angiography in diabetic retinopathy: a review of current applications

Kai Yuan Tey  1 , Kelvin Teo  2 , Anna C S Tan  2 , Kavya Devarajan  3 , Bingyao Tan  3 , Jacqueline Tan  3 , Leopold Schmetterer  3 , Marcus Ang  4
Affiliations
Review

Optical coherence tomography angiography in diabetic retinopathy: a review of current applications

Kai Yuan Tey et al. Eye Vis (Lond). .

Abstract

Background: Diabetic retinopathy (DR) is a leading cause of vision loss in adults. Currently, the standard imaging technique to monitor and prognosticate DR and diabetic maculopathy is dye-based angiography. With the introduction of optical coherence tomography angiography (OCTA), it may serve as a potential rapid, non-invasive imaging modality as an adjunct.

Main text: Recent studies on the role of OCTA in DR include the use of vascular parameters e.g., vessel density, intercapillary spacing, vessel diameter index, length of vessels based on skeletonised OCTA, the total length of vessels, vascular architecture and area of the foveal avascular zone. These quantitative measures may be able to detect changes with the severity and progress of DR for clinical research. OCTA may also serve as a non-invasive imaging method to detect diabetic macula ischemia, which may help predict visual prognosis. However, there are many limitations of OCTA in DR, such as difficulty in segmentation between superficial and deep capillary plexus; and its use in diabetic macula edema where the presence of cystic spaces may affect image results. Future applications of OCTA in the anterior segment include detection of anterior segment ischemia and iris neovascularisation associated with proliferative DR and risk of neovascular glaucoma.

Conclusion: OCTA may potentially serve as a useful non-invasive imaging tool in the diagnosis and monitoring of diabetic retinopathy and maculopathy in the future. Future studies may demonstrate how quantitative OCTA measures may have a role in detecting early retinal changes in patients with diabetes.

Keywords: Diabetic retinopathy; Fluorescein angiography; Monitoring; Optical coherence tomography angiography; Screening.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of Fluorescein Angiography and OCTA. a & b Fluorescein angiography images of a patient with proliferative diabetic retinopathy. These FA images show patchy areas of capillary drop out and presence of neovascularizations elsewhere (NVE). c & d Corresponding OCTA images (generated via ZEISS AngioFlex) of (a) and (b) being superimposed on the FA images. The OCTA images also show areas of capillary drop out and new vessels without leakage
Fig. 2
Fig. 2
A series of montaged OCTA in patients with diabetic retinopathy (DR). This is a series of montaged OCTA images 15 mm × 15 mm taken at different segment in the right eye of a male (a-h) with DR. a Foveal avascular zone; b Choriocapillaris; c Choroid; d Deep capillary plexuses; e Outer-retina-choroid complex; f Retina; g Superficial capillary plexuses; h Vitreoretinal interface
Fig. 3
Fig. 3
Monitoring of treatment outcome in patients with proliferative diabetic retinopathy using OCTA. This is a series of OCTA images of a 26 years old female with proliferative diabetic retinopathy taken at baseline (a & b), 1st month (c & d) and 6th month (e & f) post IVT treatment (bevacizumab). OCTA is able to detect changes - NVE regression is noted
See this image and copyright information in PMC

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