Patients with diabetes may present a variety of interesting findings best unveiled by use of spectral domain optical coherence tomography (SD-OCT). OCT is one of the best way to assess patients for the presence of diabetic macular edema (DME). It is extremely useful for monitoring responses to treatments such as anti-VEGF injections, grid or focal laser, intravitreal steroids, or any combination thereof in patients with DME involving or threatening the fovea (center-involved DME).
However, detecting and monitoring increased retinal thickness associated with diabetes is not the only relevant anatomical feature best visualized and appreciated with OCT.
Let’s consider a few cases showing multiple OCT presentations that might be encountered in patients who have diabetes.
Previously from Dr. Chous: Fasting regimens may be key in treating type 2 diabetes
The case of the epiretinal membrane (ERM)
Jim is a 58-year-old man with type 2 diabetes diagnosed three years ago. He takes his diabetes medications, which include combination canigliflozin with metformin (Invokamet XR, Janssen), lisinopril (Prinivil, Merck), simvastatin (Zocor, Merck), and 81 mg of aspirin.
His last HbA1c was 6.2 percent, and his last dilated eye examination was two years earlier at another office. He has recently experienced visual distortion in the right eye and was referred to me for evaluation by his endocrinologist.
Jim’s vision is 20/40 in the right eye and 20/20 in the left. His anterior segment exam and intraocular pressures (IOP) are normal, and his dilated exam shows no evidence of retinopathy or macular edema. However, SD-OCT shows a significant epiretinal membrane (ERM) on the right side with loss of the foveal depression (see Figure 1).
Though ERM is a common condition, it may be up to twice as likely in people with diabetes and is a known complicating risk factor for macular edema.1,2 Jim was offered a consultation with a vitreo-retinal specialist who recommended his condition be monitored for progression or development of DME.