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      Optical coherence tomography angiography in diabetic retinopathy: a review of current applications

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          Abstract

          Background

          Diabetic 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 text

          Recent 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.

          Conclusion

          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.

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          Most cited references81

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          A review of optical coherence tomography angiography (OCTA)

          Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging technique that generates volumetric angiography images in a matter of seconds. This is a nascent technology with a potential wide applicability for retinal vascular disease. At present, level 1 evidence of the technology’s clinical applications doesn’t exist. In this paper, we introduce the technology, review the available English language publications regarding OCTA, and compare it with the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA). Finally we summarize its potential application to retinal vascular diseases. OCTA is quick and non-invasive, and provides volumetric data with the clinical capability of specifically localizing and delineating pathology along with the ability to show both structural and blood flow information in tandem. Its current limitations include a relatively small field of view, inability to show leakage, and proclivity for image artifact due to patient movement/blinking. Published studies hint at OCTA’s potential efficacy in the evaluation of common ophthalmologic diseases such age related macular degeneration (AMD), diabetic retinopathy, artery and vein occlusions, and glaucoma. OCTA can detect changes in choroidal blood vessel flow and can elucidate the presence of choroidal neovascularization (CNV) in a variety of conditions but especially in AMD. It provides a highly detailed view of the retinal vasculature, which allows for accurate delineation of the foveal avascular zone (FAZ) in diabetic eyes and detection of subtle microvascular abnormalities in diabetic and vascular occlusive eyes. Optic disc perfusion in glaucomatous eyes is notable as well on OCTA. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.
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            Quantification of Retinal Microvascular Density in Optical Coherence Tomographic Angiography Images in Diabetic Retinopathy.

            Quantitative measurements based on optical coherence tomographic angiography (OCTA) may have value in managing diabetic retinopathy (DR), but there is limited information on the ability of OCTA to distinguish eyes with DR.
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              The evolving diabetes burden in the United States.

              A diabetes epidemic emerged during the 20th century and continues unchecked into the 21st century. It has already taken an extraordinary toll on the U.S. population through its acute and chronic complications, disability, and premature death. Trend data suggest that the burden will continue to increase. Efforts to pre- vent or delay the complications of diabetes or, better yet, to prevent or delay the development of diabetes itself are urgently needed.
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                Author and article information

                Contributors
                kytey@utas.edu.au
                kelvin.teo.y.c@singhealth.com.sg
                anna.tan.c.s@singhealth.com.sg
                kavya.devarajan@seri.com.sg
                tan.bingyao@seri.com.sg
                jacqueline.chua.y.m@seri.com.sg
                leopold.schmetterer@seri.com.sg
                Marcus.Ang@Singhealth.com.sg
                Journal
                Eye Vis (Lond)
                Eye Vis (Lond)
                Eye and Vision
                BioMed Central (London )
                2326-0254
                18 November 2019
                18 November 2019
                2019
                : 6
                : 37
                Affiliations
                [1 ]Hobart Clinical School, Level 3, 43 Collins Street, Hobart, TAS 7000 Australia
                [2 ]ISNI 0000 0000 9960 1711, GRID grid.419272.b, Singapore National Eye Centre, ; 11 Third Hospital Ave, Singapore, 168751 Singapore
                [3 ]ISNI 0000 0001 0706 4670, GRID grid.272555.2, Singapore Eye Research Institute, ; 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
                [4 ]ISNI 0000 0000 9960 1711, GRID grid.419272.b, Singapore National Eye Centre, ; 11 Third Hospital Ave, Singapore 168751; Duke-NUS Medical School, 8 College Rd, Singapore, 169857 Singapore
                Author information
                http://orcid.org/0000-0003-3022-0795
                Article
                160
                10.1186/s40662-019-0160-3
                6859616
                31832448
                5c27b307-a51e-41f8-88bd-7b3de335024c
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 April 2019
                : 14 October 2019
                Categories
                Review
                Custom metadata
                © The Author(s) 2019

                optical coherence tomography angiography,fluorescein angiography,diabetic retinopathy,screening,monitoring

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