OCT angiography may be effective for early detection of diabetic retinopathy
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Use of OCT angiography to detect macular changes in patients with diabetes may aid in the early diagnosis, treatment and follow-up care for diabetic retinopathy, according to a study published in BMC Ophthalmology.
“OCT-A is a new, noninvasive diagnostic technique for visualizing the retinal vasculature in the macular region,” Mehrdad Afarid, of the Poostchi Ophthalmology Research Center at Shiraz University of Medical Sciences in Iran, and colleagues wrote. “This project aimed to study the effectiveness of OCT-A in detecting early pathological changes in the retina in diabetic patients by using MATLAB-based software and measuring several radiomics indices such as macular vascular density and parameters related to [foveal avascular zone] shape.”
In a cross-sectional study, Afarid and colleagues included 21 patients with type 2 diabetes, aged at least 35 years, and no clinical signs of diabetic retinopathy (DR) along with 21 healthy individuals. Researchers quantitatively analyzed OCT-A images to assess macular thickness, macular vascular density and morphological changes in the foveal avascular zone (FAZ).
“This study focused on the question of whether a patient with diabetes (regardless of how diabetes is controlled or the duration of diabetes) who has no clinical evidence of retinopathy shows any microvascular changes in the macula compared to controls,” researchers wrote.
According to study results, the FAZ area in the superficial layer was significantly larger in diabetic patients (P < .001), but the FAZ area in the deep layer was not. Researchers also reported that foveal vascular density was significantly lower in the inferior temporal region of the superficial layer (P = .004), and that there was less vascular density in the parafoveal zone in all four regions of the superficial layer.
“Since macular involvement and macular edema are very important and common causes of vision loss in diabetic patients at any stage of diabetic retinopathy, we conclude that OCT-A may be an important and effective tool for early detection of macular involvement,” Afarid and colleagues wrote.
Perspective
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The authors suggest that certain radiomics parameters as obtained by OCT-A can be applied as a screener for DR and for continued disease monitoring and management. Specifically, FAZ enlargement, reduced macular vascular density and changes to FAZ shape (an increase in convex shape and irregularity) are all indicators of early DR before its presence can be detected on funduscopy.
While promising, this was a very small study, and a much larger sample size will be needed to evaluate the applicability of these parameters prior to widespread use. However, this indicates an important, practical use for doctors who are debating on investing in OCT-A technology for their practice. Because DR continues to be a leading cause of visual impairment and blindness in adults worldwide, good and easy-to-use tools are essential for the early detection and diagnosis of diabetic changes within the eye as well as in disease management. Because we serve as the primary caregivers to our patients’ eyes, this technology could help make a significant impact on their health, especially in underserved populations where disease is often caught at already more advanced stages.
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