Early Detection and Management of Diabetic Retinal Disease with OCT and OCT-A

OCT and OCTA in Diabetes
Written By Kylie Apalla

Dr. Kaitlyn Sapoznik delivered an insightful presentation on the role of Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCT-A) in the early detection and management of diabetic retinal disease. Here are a few key points of her presentation:

Epidemiology of Diabetes:

  • Approximately 15% of the U.S. population has diabetes.

  • 38% of U.S. adults have pre-diabetes.

  • Diabetes remains the leading cause of new cases of blindness among working-aged adults

OCT Biomarkers in Diabetic Macular Edema (DME):

Photo from RetinaRisk

  • Perfusion Status Assessment: OCT-A offers a non-invasive way to evaluate retinal perfusion.

  • DRIL (Disorganization of Retinal Inner Layers):

    • Represents an inability to distinguish inner retinal layers.

    • Associated with worse visual acuity and prognosis, typically seen in chronic macular edema.

  • Ellipsoid Zone (EZ) Disruption:

    • The extent of EZ disruption correlates with poorer visual acuity in DME.

OCT-A Overview:

OCT-A is a non-invasive imaging modality that uses motion contrast to visualize blood flow through retinal vessels. It allows for earlier detection of microvascular abnormalities before they are evident on clinical examination.

Clinical Applications of OCT-A in Diabetes:

  • Early Detection of Subclinical Vascular Changes:

    • Capillary non-perfusion, microaneurysms, and remodeling of the foveal avascular zone (FAZ) can be visualized before clinical signs appear.

    • Enlargement of the FAZ diameter and area correlates with worsening disease.

    • Vessel density measurements have shown a negative correlation with increasing diabetic retinopathy severity.

    • Identification of macular ischemia is another key benefit.

  • Limitations and Evolving Research:

    • Currently, there is no standardized quantification system for OCT-A metrics or a consensus on how to incorporate findings into clinical decision-making.

    • However, research is rapidly evolving, and OCT-A holds significant promise for enhancing diabetic eye care..

Clinical Pearls and Case Discussions:

Dr. Sapoznik reviewed case examples demonstrating how OCT-A findings can guide patient counseling, follow-up intervals, and decisions regarding referral versus continued monitoring. Check out Dr. Sapoznik's presentation and handouts on Woou.org under past events!

Kylie Apalla
Next

Clinical Pearls from Dry Eye in the Desert!