Advertisement

Current Diabetes Reports

, 16:123 | Cite as

Optical Coherence Tomography Angiography in Diabetes

  • Jessica Lee
  • Richard RosenEmail author
Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Microvascular Complications—Retinopathy

Abstract

Diabetic retinopathy is a progressive microvascular disease that leads to increased vessel permeability, retinal ischemia, and retinal neovascularization. Optical coherence tomography angiography (OCTA) is a novel angiography technique that has the capability to advance our understanding of diabetic eye disease by providing high-resolution images of retinal and choroidal microvasculature blood flow and structure. Using OCTA, the vascular changes of diabetic retinopathy including microaneurysms, retinal non-perfusion, intraretinal microvascular abnormalities, and neovascularization can be clearly visualized. OCTA offers several advantages over fluorescein angiography (FA) in that it is faster, safer, and non-invasive, allows better visualization of retinal vessels in both the superficial and deep capillary layers, and can provide quantitative measurements of areas of non-perfusion of the macula and nerve. OCTA capillary perfusion density maps and average perfusion density values provide an easy way to grade progressive vascular change. Despite these advantages, imaging with OCTA can only provide a limited view of the peripheral retina and is unable to demonstrate leakage, staining, or pooling. OCTA requires patients to maintain good fixation to obtain high-resolution images which can be a challenge for those with severe macular disease. In patients who cannot safely undergo FA, OCTA may serve as an alternative form of angiography that can be safely and more frequently performed for the management of diabetic retinopathy.

Keywords

OCT angiography Diabetes Diabetic retinopathy Diabetic macular edema Diagnosis Staging 

Notes

Compliance with Ethical Standards

Conflict of Interest

Richard Rosen reports personal fees from Optovue, Nano Retina, Clarity, Regeneron, Allergan, and OCATA Therapeutics; grants from Genentech; and non-financial support from OD-OS. In addition, Dr. Rosen has a pending patent for Optovue AngioAnalytics.

Jessica Lee declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Klein R, Klein BE, Moss SE, et al. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984;102(4):527–32.CrossRefPubMedGoogle Scholar
  2. 2.
    WHO Global report on Diabetes. http://www.who.int/diabetes/global-report/en/.
  3. 3.
    Yau JWY, Rogers SL, Kawasaki R, et al. Global prevalance and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–64.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care. 1993;16:642–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye. 2015;2:17.Google Scholar
  6. 6.
    Saaddine J, Honeycutt AA, Venkat Narayan KM, et al. Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus. Arch Ophthalmol. 2008;126(12):1740–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Venkat Narayan KM, Gregg E, Fagot-Campagna A, et al. Diabetes — a common, growing, serious, costly, and potentially preventable public health problem. Diabetes Res Clin Pract. 2000;50:S77–84.CrossRefGoogle Scholar
  8. 8.
    Mohamed Q, Gillies M, Wong T. Management of diabetic retinopathy. JAMA. 2007;298(8):902.CrossRefPubMedGoogle Scholar
  9. 9.
    Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991;98:786–806.Google Scholar
  10. 10.
    Diabetic retinopathy study. Report Number 6. Design, methods, and baseline results. Report Number 7. A modification of the Airlie House classification of diabetic retinopathy. Prepared by the Diabetic Retinopathy. Invest Ophthalmol Vis Sci.1981;21:1–226.Google Scholar
  11. 11.
    Wilkinson CP, Ferris 3rd FL, Klein RE, Global Diabetic Retinopathy Project Group, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2013;110(9):1677–82.CrossRefGoogle Scholar
  12. 12.
    Salz DA, Witkin AJ. Imaging in diabetic retinopathy. Middle East Afr J Ophthalmol. 2015;22(2):145–50. doi: 10.4103/0974-9233.151887.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kwiterovitch KA, Maguire MG, Murphy RP, et al. Frequency of adverse systemic reactions occurring after fluorescein angiography – results of a prospective study. Ophthalmology. 1991;98:1139–42.CrossRefGoogle Scholar
  14. 14.
    Yannuzzi LA, Rohrer KT, Tindel LJ, et al. Fluorescein angiography complication survey. Ophthalmology. 1986;93:611–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Hitosugi M, Omura K, Yokoyama T, et al. An autopsy case of fatal anaphylactic shock following fluorescein angiography: a case report. Med Sci Law. 2004;44:264–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Halperin L, Olk R, Soubrane G, et al. Safety of fluorescein angiography during pregnancy: reply. Am J Ophthalmol. 1990;110(3):324–5.CrossRefGoogle Scholar
  17. 17.
    ••Jia Y, Ou T, Tokayer J, et al. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography. Opt Express. 2012;20(4):4710–25. This paper describes the development of split-spectrum amplitude-decorrelation angiography (SSADA) to improve the signal-to-noise ratio of flow detection in OCT angiography.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: a prospective pilot study. Am J Ophthalmol. 2015;160(1):35–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Matsunaga D, Yi J, De Koo L, et al. Optical coherence tomography angiography of diabetic retinopathy in human subjects. Ophthalmic Surg Lasers Imaging Retina. 2015;46(8):796–805.CrossRefPubMedGoogle Scholar
  20. 20.
    Jia Y, Bailey S, Hwang T, et al. Quantitative optical coherence tomography angiography of vascular abnormalities in the living human eye. Proc Natl Acad Sci. 2015;112(18):E2395–402.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Freiberg F, Pfau M, Wons J, et al. Optical coherence tomography angiography of the foveal avascular zone in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2015;254(6):1051–8.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Takase N, Nozaki M, Kato A, et al. Enlargement of foveal avascular zone in diabetic eyes evaluated by en face optical coherence tomography angiography. Retina. 2015;35(11):2377–83.CrossRefPubMedGoogle Scholar
  23. 23.
    Popovic Z, Knutsson P, Thaung J, et al. Noninvasive imaging of human foveal capillary network using dual-conjugate adaptive optics. Invest Ophthalmol Vis Sci. 2011;52(5):2649–55.CrossRefPubMedGoogle Scholar
  24. 24.
    Tam J, Dhamdhere KP, Tiruveedhula P, et al. Disruption of the retinal parafoveal capillary network in type 2 diabetes before the onset of diabetic retinopathy. Invest Ophthalmol Vis Sci. 2011;52(12):9257–66.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    •Mo S, Krawitz B, Efstathiadis E, et al. Imaging foveal microvasculature: optical coherence tomography angiography versus adaptive optics scanning light ophthalmoscope fluorescein angiography. Invest Ophthalmol Vis Sci. 2016;57(9):130–40. This paper compares the use of optical coherence tomography angiography (OCTA) and adaptive optics scanning light ophthalmoscope fluorescein angiography (AOSLO FA) for characterizing the foveal microvasculature in healthy and vasculopathic eyes.CrossRefGoogle Scholar
  26. 26.
    ••Spaide RF, Klancnik Jr JM, Cooney MJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol. 2015;133(1):45–50. This paper reports on the ability of OCT angiography to image the vascular layers within the retina compared with conventional fluorescein angiography.CrossRefPubMedGoogle Scholar
  27. 27.
    Krawitz BD, Mo S, Geyman L, et al. Acircularity index and axis ratio of the foveal avascular zone in diabetic eyes and healthy controls measured by optical coherence tomography angiography. Vision Res. In press.Google Scholar
  28. 28.
    Hwang T, Jia Y, Gao S, et al. Optical coherence tomography angiography features of diabetic retinopathy. Retina. 2015;35(11):2371–6.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    •Agemy S, Scripsema N, Shah C, et al. Retinal vascular perfusion density mapping using optical coherence tomography angiography in normals and diabetic retinopathy patients. Retina. 2015;35(11):2353–63. This paper describes a novel way of grading diabetic retinopathy using retinal vascular perfusion density mapping and optical coherence tomography angiography.CrossRefPubMedGoogle Scholar
  30. 30.
    Yu S, Pang CE, Gont Y, et al. The spectrum of superficial and deep capillary ischemia in retinal artery occlusion. Am J Ophthalmol. 2015;159(1):53–63.CrossRefPubMedGoogle Scholar
  31. 31.
    Yu DY, Cringle SJ, Alder V, et al. Intraretinal oxygen distribution in the rat with graded systemic hyperoxia and hypercapnia. Invest Ophthalmol Vis Sci. 1999;40(9):2028–87.Google Scholar
  32. 32.
    Lee J, Agemy S, Shah C, et al. Quantitative retinal blood flow density study of normals and diabetic retinopathy patients using novel OCT angiography AngioAnalytics™ software. ASRS poster presentation. San Francisco, CA; 2016.Google Scholar
  33. 33.
    Yanoga F, Garcia P, Rosen R. Optic nerve head perfusion changes in diabetic retinopathy assessed by OCT angiography perfusion density mapping. ASRS poster presentation. San Francisco, CA; 2016.Google Scholar
  34. 34.
    Jia Y, Morrison JC, Tokayer J, et al. Quantitative OCT angiography of optic nerve head blood flow. Biomed Opt Express. 2012;3(12):3127–37.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.The New York Eye & Ear Infirmary of Mount SinaiNew YorkUSA

Personalised recommendations