Spectral domain optical coherence tomography (SD-OCT) (Cirrus HD-OCT, Carl Zeiss Meditec; iVue, Optovue; Spectralis, Heidelberg Engineering; 3D OCT-1 Maestro, Topcon) has become essential in diagnosing and monitoring DME. In our experience, we have found that its use has led to a decrease in the amount of macular angiography imaging performed in recent years.
Given that DME can be asymptomatic and present at any stage of the disease, OCT becomes a critical element in the assessment of DME. SD-OCT is also important in guiding continuous treatment. SD-OCT may prove to be valuable in the assessment of concomitant maculopathies, such as epiretinal membranes and vitreomacular traction. Additionally, it may help determine causes attributing to poor visual prognosis, such as the loss of photoreceptor integrity line.8
Advancements in OCT have included the ability to evaluate the retinal vasculature without the use of dye. This novice tool is known as OCTA (AngioPlex OCT Angiography, Carl Zeiss Meditec; AngioVue, Optovue). The capillary plexus is an area of interest in the evaluation of patients with DR. OCTA’s use in evaluating patients with DR may aid in the proper identification of microaneurysms, which are often indiscernible using ophthalmoscopy alone, and yet they represent the earliest sign of the disease (mild NPDR). Additionally, subtle areas of IRMA or neovascularization are easily denoted using OCTA, which may not always be detected with ophthalmoscopy alone.
Ischemia, which is a critical pathophysiology element of the underlying disease, may further be assessed using OCTA. It provides both structural and blood flow changes simultaneously at different layers of the retina. Alterations in both the retinal vasculature and structure may be invisible fundoscopically, and thus, both SD-OCT and OCTA can aid in the diagnosis of the disease and help to properly classified the stage of the disease.
Creating a partnership between the optometrists and retinal practices will enhance the care of patients and serve as a continuing source of education and reference for the OD community. This constant communication will help diabetic patients who are suffering from this multifactorial disease that affects their bodies. DR must be addressed from the optometrist’s point of view, retinal specialist’s point of view, and the primary-care physician’s point of view.
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