Clinical detection of diabetic macular edema

Abstract

Diabetic macular edema (DME) continues to provide a significant challenge to physicians attempting to treat this important cause of vision loss in diabetics. Treatment options currently consist of laser treatment and, more recently, intravitreal injections of steroid and anti-VEGF medications. Multiple imaging techniques have been used to monitor treatment outcomes, with stereo fundus photography being the standard for many years and fluorescein angiography being used as an important adjunct to help guide laser therapy. Instruments such as the retinal thickness analyzer and scanning laser ophthalmoscope attempted to detect DME reliably but were limited by their axial and later resolution. Optical coherence tomography (OCT) has provided an important breakthough in the monitoring of patients with retinal edema because of the high resolution of the scans, which are easy to aquire for both the patient and technician. Spectral OCT is now also providing more reliable retinal thickness measurements over a larger area of the retina compared with traditional systems. Future developments of ‘functional OCT’ may provide not only morphologic information but also insights into retinal blood flow and oxygenation. Continued advances in modalities for imaging retinal diseases are certain to translate to improved outcomes for patients with DME.