Optical Coherence Tomography Angiography in Diabetic Retinopathy: an Updated Review

Overview

Journal Eye (Lond)

Specialty Ophthalmology

Date 2020 Oct 25

PMID 33099579

Citations 64

Authors

Zihan Sun

Dawei Yang

Ziqi Tang

Danny S Ng

Carol Y Cheung

Affiliations

Soon will be listed here.

Abstract

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. Optical coherence tomography angiography (OCTA) has been developed to visualize the retinal microvasculature and choriocapillaris based on the motion contrast of circulating blood cells. Depth-resolved ability and non-invasive nature of OCTA allow for repeated examinations and visualization of microvasculature at the retinal capillary plexuses and choriocapillaris. OCTA enables quantification of microvascular alterations in the retinal capillary network, in addition to the detection of classical features associated with DR, including microaneurysms, intraretinal microvascular abnormalities, and neovascularization. OCTA has a promising role as an objective tool for quantifying extent of microvascular damage and identify eyes with diabetic macular ischaemia contributed to visual loss. Furthermore, OCTA can identify preclinical microvascular abnormalities preceding the onset of clinically detectable DR. In this review, we focused on the applications of OCTA derived quantitative metrics that are relevant to early detection, staging and progression of DR. Advancement of OCTA technology in clinical research will ultimately lead to enhancement of individualised management of DR and prevention of visual impairment in patients with diabetes.

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References

Ogurtsova K, da Rocha Fernandes J, Huang Y, Linnenkamp U, Guariguata L, Cho N . IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017; 128:40-50. DOI: 10.1016/j.diabres.2017.03.024. View

Wong T, Cheung C, Larsen M, Sharma S, Simo R . Diabetic retinopathy. Nat Rev Dis Primers. 2016; 2:16012. DOI: 10.1038/nrdp.2016.12. View

Jampol L, Glassman A, Sun J . Evaluation and Care of Patients with Diabetic Retinopathy. N Engl J Med. 2020; 382(17):1629-1637. DOI: 10.1056/NEJMra1909637. View

Spaide R . Optical Coherence Tomography Angiography Signs of Vascular Abnormalization With Antiangiogenic Therapy for Choroidal Neovascularization. Am J Ophthalmol. 2015; 160(1):6-16. DOI: 10.1016/j.ajo.2015.04.012. View

Spaide R, Fujimoto J, Waheed N, Sadda S, Staurenghi G . Optical coherence tomography angiography. Prog Retin Eye Res. 2017; 64:1-55. PMC: 6404988. DOI: 10.1016/j.preteyeres.2017.11.003. View

NOVOTNY H, ALVIS D . A method of photographing fluorescence in circulating blood in the human retina. Circulation. 1961; 24:82-6. DOI: 10.1161/01.cir.24.1.82. View

Spaide R, Klancnik Jr J, Cooney M . Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol. 2014; 133(1):45-50. DOI: 10.1001/jamaophthalmol.2014.3616. View

Weinhaus R, Burke J, Delori F, Snodderly D . Comparison of fluorescein angiography with microvascular anatomy of macaque retinas. Exp Eye Res. 1995; 61(1):1-16. DOI: 10.1016/s0014-4835(95)80053-0. View

Klein R, Meuer S, Moss S, Klein B . Retinal microaneurysm counts and 10-year progression of diabetic retinopathy. Arch Ophthalmol. 1995; 113(11):1386-91. DOI: 10.1001/archopht.1995.01100110046024. View

10.

Klein R, Meuer S, Moss S, Klein B . The relationship of retinal microaneurysm counts to the 4-year progression of diabetic retinopathy. Arch Ophthalmol. 1989; 107(12):1780-5. DOI: 10.1001/archopht.1989.01070020862028. View

11.

Ribeiro M, Nunes S, Cunha-Vaz J . Microaneurysm turnover at the macula predicts risk of development of clinically significant macular edema in persons with mild nonproliferative diabetic retinopathy. Diabetes Care. 2012; 36(5):1254-9. PMC: 3631829. DOI: 10.2337/dc12-1491. View

12.

Thompson I, Durrani A, Patel S . Optical coherence tomography angiography characteristics in diabetic patients without clinical diabetic retinopathy. Eye (Lond). 2018; 33(4):648-652. PMC: 6461750. DOI: 10.1038/s41433-018-0286-x. View

13.

Ishibazawa A, Nagaoka T, Takahashi A, Omae T, Tani T, Sogawa K . Optical Coherence Tomography Angiography in Diabetic Retinopathy: A Prospective Pilot Study. Am J Ophthalmol. 2015; 160(1):35-44.e1. DOI: 10.1016/j.ajo.2015.04.021. View

14.

Schwartz D, Fingler J, Kim D, Zawadzki R, Morse L, Park S . Phase-variance optical coherence tomography: a technique for noninvasive angiography. Ophthalmology. 2013; 121(1):180-187. PMC: 4190463. DOI: 10.1016/j.ophtha.2013.09.002. View

15.

Miwa Y, Murakami T, Suzuma K, Uji A, Yoshitake S, Fujimoto M . Relationship between Functional and Structural Changes in Diabetic Vessels in Optical Coherence Tomography Angiography. Sci Rep. 2016; 6:29064. PMC: 4924142. DOI: 10.1038/srep29064. View

16.

Yu S, Lu J, Cao D, Liu R, Liu B, Li T . The role of optical coherence tomography angiography in fundus vascular abnormalities. BMC Ophthalmol. 2016; 16:107. PMC: 4944429. DOI: 10.1186/s12886-016-0277-2. View

17.

Hamada M, Ohkoshi K, Inagaki K, Ebihara N, Murakami A . Visualization of microaneurysms using optical coherence tomography angiography: comparison of OCTA en face, OCT B-scan, OCT en face, FA, and IA images. Jpn J Ophthalmol. 2018; 62(2):168-175. DOI: 10.1007/s10384-018-0570-0. View

18.

Couturier A, Mane V, Bonnin S, Erginay A, Massin P, Gaudric A . CAPILLARY PLEXUS ANOMALIES IN DIABETIC RETINOPATHY ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina. 2015; 35(11):2384-91. DOI: 10.1097/IAE.0000000000000859. View

19.

Stitt A, Gardiner T, Archer D . Histological and ultrastructural investigation of retinal microaneurysm development in diabetic patients. Br J Ophthalmol. 1995; 79(4):362-7. PMC: 505103. DOI: 10.1136/bjo.79.4.362. View

20.

Parravano M, De Geronimo D, Scarinci F, Querques L, Virgili G, Simonett J . Diabetic Microaneurysms Internal Reflectivity on Spectral-Domain Optical Coherence Tomography and Optical Coherence Tomography Angiography Detection. Am J Ophthalmol. 2017; 179:90-96. DOI: 10.1016/j.ajo.2017.04.021. View