Abstract
BackgroundDiabetic 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 textRecent 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.ConclusionOCTA 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.
Highlights
Recent studies on the role of optical coherence tomography angiography (OCTA) in Diabetic retinopathy (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
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
Summary
Literature search We conducted a literature search via PUBMED database for articles written in the English language until January 1, 2019, with the following medical subject headings: “OCTA,” “OCT angiography,” “Diabetic Retinopathy,” or “Diabetes”. Processing of high-resolution images can be time-consuming [37] and images generated via OCTA are highly susceptible to projection artefacts due to the presence of the superficial blood flows resulting in difficulty in interpreting the deep retinal vasculatures [38] While this can be corrected via projection removal algorithms, this method may potentially result in loss of flow information within the deeper layer, giving a disjointed image [39]. As capillary non-perfusion area enlarges with progression in severity of DR, the quantitative analysis of retinal non-perfusion on OCTA may be useful for early detection and monitoring of disease in patients with diabetes and DR [76]. Studies demonstrated a method of obtaining OCTA images of the cornea and limbal vasculature with great consistency [101] and allow us to compare normal and diseased iris vessels in the detection of NVI [102]. Since OCTA are optimized for the posterior segment which has mainly traversing blood flows in the vessels, anterior segment vessels with axial flow may not be detected [106]
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