Optical coherence tomography angiography in diabetic retinopathy: A major review

Diabetic retinopathy (DR) is characterized by retinal vasculopathy and is a leading cause of visual impairment. Optical coherence tomography angiography (OCTA) is an innovative imaging technology that can detect various pathologies and quantifiable changes in retinal microvasculature. We briefly des...

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Bibliographic Details
Published in:Survey of ophthalmology 2024-07, Vol.69 (4), p.558-574
Main Authors: Nouri, Hosein, Abtahi, Seyed-Hossein, Mazloumi, Mehdi, Samadikhadem, Sanam, Arevalo, J. Fernando, Ahmadieh, Hamid
Format: Article
Language:English
Subjects:
Diabetes Mellitus
Diabetic Retinopathy
Fluorescein Angiography
Macular Edema
Optical Coherence Tomography
Optical Coherence Tomography Angiography
Retinal Neovascularization
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Summary:Diabetic retinopathy (DR) is characterized by retinal vasculopathy and is a leading cause of visual impairment. Optical coherence tomography angiography (OCTA) is an innovative imaging technology that can detect various pathologies and quantifiable changes in retinal microvasculature. We briefly describe its functional principles and advantages over fluorescein angiography and perform a comprehensive review on its clinical applications in the screening or management of people with prediabetes, diabetes without clinical retinopathy (NDR), nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME). OCTA reveals early microvascular alterations in prediabetic and NDR eyes, which may coexist with sub-clinical neuroretinal dysfunction. Its applications in NPDR include measuring ischemia, detecting retinal neovascularization, and timing of early treatment through predicting the risk of retinopathy worsening or development of DME. In PDR, OCTA helps characterize the flow within neovascular complexes and evaluate their progression or regression in response to treatment. In eyes with DME, OCTA perfusion parameters may be of predictive value regarding the visual and anatomical gains associated with treatment. We further discussed the limitations of OCTA and the benefits of its incorporation into an updated DR severity scale.
ISSN:0039-6257
1879-3304
DOI:10.1016/j.survophthal.2024.03.004