Optical coherence tomography angiography findings in diabetic retinopathy

Introduction: Diabetic retinopathy (DR) is a common complication of diabetes and a leading cause of blindness in working age population. Fluorescein angiography is still the gold standard in the evaluation of retinal vascular perfusion and diagnosis of macular ischemia. However, it is a costly, time-consuming procedure and it requires intravenous injection of contrast agent, exposing patients to potential side effects. Optical coherence tomography angiography (OCTA) is a novel, non-invasive imaging technique that provides dyeless visualization of blood flow in different retinal layers. Areas covered: An extensive review of the literature was performed to detail technical principles of OCTA and to discuss the current concepts on its application in diabetic patients. Expert commentary: In patients with DR, OCTA shows early features in unprecedented detail: enlargement of the FAZ, areas of capillary non-perfusion, and some microvascular abnormalities can be seen with much better clarity than with fluorescein angiography. OCTA is also able to detect several features that are currently accepted as prognostic indicators in patients with DME. The most relevant are the presence of diabetic macular ischemia and pronounced microvascular abnormalities. It has been shown that these alterations may influence the response to anti-VEGF therapy.