More research needed to ‘realize the full potential of OCTA’ for diabetic retinopathy
Click Here to Manage Email Alerts
Key takeaways:
- OCTA can identify early evidence of microvascular change and help assess diseases such as diabetic retinopathy.
- Expert consensus and validation of metrics is needed for OCTA to “have true clinical utility.”
Despite the promise of OCTA as a valuable tool in the evaluation of diabetic retinopathy and its complications, challenges remain and more research is needed to standardize its use in clinical trials, according to a published review.
“Numerous studies have confirmed that OCTA can be used to identify the earliest evidence of microvascular change and provide quantitative assessment of the extent of diseases such as DR and its common complications, including [diabetic macular ischemia (DMI)],” Nadia K. Waheed, MD, MPH, retina specialist and associate professor at Tufts University School of Medicine, and colleagues wrote in Progress in Retinal and Eye Research.
“OCTA has been shown to be more sensitive than physician examination or fundus imaging and detects capillary loss earlier than when the clinical lesions of DR become apparent, indicating its sensitivity and promise as a tool for assessing DMI.”
Waheed and colleagues reviewed the potential use of OCTA for DR, aiming to provide guidance for future research, support for development of new treatments and improved understanding of DR and associated complications.
According to researchers, several OCTA metrics have potential for use in clinical trials of DR, diabetic macular edema and DMI, including foveal avascular zone, vessel density, extrafoveal avascular zones and neovascularization.
“In order for OCTA to have true clinical utility, it is critical to establish a consensus among experts and to validate OCTA metrics through research and clinical trials for its use in DR,” they wrote.
Researchers also identified several challenges associated with use of OCTA for these conditions, including variability at the patient level, as well as variability among devices, noting: “As a relatively new technology, there is still a lack of standardized tools and procedures to address common imaging problems like artifacts, segmentation errors and image focus.”
Waheed and colleagues highlighted the use of wide-field OCTA imaging to assess peripheral retinal vasculature and aid in predicting DR progression, as well as automated methods and algorithms for analysis of OCTA images, which will benefit efficiency and standardization of results.
“When we have solved these issues and established a common set of OCTA procedures for use in clinical trials, it will be possible to realize the full potential of OCTA as a robust and regulator-accepted clinical trial endpoint,” they wrote.
Perspective
Back to Top
OCTA is quickly moving from being a novelty to becoming part of the clinical mainstream.
It has been less than 10 years since the first OCTA-enabled instruments became commercially available, and the technology is evolving quickly. Recent developments include improved handling of image artifacts, more useful quantitative metrics and the availability of wide-field imaging.
The clinical impact of OCTA is perhaps nowhere greater than in the diagnosis and management of diabetic retinopathy. The microvascular damage that leads to retinal nonperfusion and neovascularization can be visualized noninvasively and in high resolution. This enables clinicians to detect diabetic retinopathy at the earliest stages and monitor progression of the disease using quantitative metrics.
Clinicians involved in the care of diabetic patients would benefit from becoming proficient at interpreting OCTA scans. Incorporating OCTA into your practice will enhance your ability to detect retinopathy, make more timely retinal referrals and enhance co-management of patients with retinopathy.
This paper is a comprehensive review of the application of OCTA technology in diabetic retinopathy and would be valuable reading for anyone interested in employing this technology in their practice.
Collapse
Read more about
Click Here to Manage Email Alerts