Which imaging platform is your ‘go-to’ tool for diagnosis and management of macular edema?

Perspective

K. Bailey Freund

To just pick one tool for managing macular edema is tough because the choice depends on what is the underlying cause of the retinal thickening. For instance, in some cases of diabetic macular edema there may be an opportunity to treat focally if the thickening is related to just a few focal aneurysmal changes. In that situation, I will need fluorescein angiography in addition to OCT. So, I use OCT with or without fluorescein angiography, depending on whether I am considering laser, steroids, or weighing the risks and benefits of laser vs. anti-VEGF therapy for treating macular edema.

K. Bailey Freund, MD

Disclosure: Freund is a consultant for Genentech and Regeneron and receives research support from Genentech.

Perspective

Judy E. Kim

For a new patient with macular edema, I order both OCT and FA because they provide complementary information. OCT is better than FA in detecting macular edema associated with conditions such as retinitis pigmentosa and demonstrating any vitreoretinal interface problems that may be contributing to macular edema. While OCT is helpful in quantifying the retinal thickening as well as demonstrating the distribution of retinal edema, FA provides information regarding the perfusion status and vascular changes. In diabetic macular edema and macular edema due to vascular occlusions, knowing the amount of macular ischemia seen on FA is helpful in discussing prognosis and treatment effects with the patients. FA is helpful in showing the distribution of microaneurysms and also for distinguishing diabetic macular edema from pseudophakic macular edema. I have been using wide-field FA, which provides excellent macular images and is able to detect peripheral neovascularization and ischemia that may have been missed by conventional FA.

While I perform both OCT and FA at the initial diagnosis, OCT is my “go-to” imaging tool for subsequent visits. It is noninvasive and quick, and I find it to be sufficient in most cases to guide my treatment decisions.

Judy E. Kim, MD

Disclosure: Kim’s institution receives research grant  funding from Genentech and Regeneron.

Perspective

Jennifer I. Lim

I order both OCT and FA. It is important at the initial visit to determine whether the macular edema is mostly from ischemia or from actual leakage. After verifying that the edema is from leakage as seen on the FA, then I follow the edema response to therapy with OCT. A baseline OCT is needed for comparison on follow-up visits.

Jennifer I. Lim, MD

Disclosure: Lim receives honoraria from and is on the advisory boards of Genentech and Regeneron.

Perspective

Timothy W. Olsen

I prefer to have a fluorescein angiogram in the early stage of diabetic macular edema to assess for vascular perfusion, identify areas of ischemia, and evaluate the location and extent of microaneurysm formation. I seldom request a second angiogram and rely mostly on the SD-OCT unless there is a major change in macular status.

Timothy W. Olsen, MD

Disclosure: Olsen’s financial disclosures include RO-1AG025392, NIH/NEI: R44 EY016229, RPB unrestricted grant, Emtech Biotechnology grant, Georgia Research  Alliance, Dobbs Foundation and Johnson & Johnson.