Imaging of Diabetic Retinopathy and Diabetic Macular Edema

Abstract

Imaging of the retinal complications of diabetes mellitus is rapidly changing from the emergence of new technology such as optical coherence tomography. In particular, the characterization of diabetic macular edema is much easier for the clinician and there are new, more sensitive clinical research end points. However, our understanding of structure-functional relationships remains suboptimal and the classification of macular edema by optical coherence tomography continues to evolve. The classification of diabetic retinopathy severity continues to rely upon fundus photography, although the transition from film to digital photography presents both challenges and advantages.

Assessment of Diabetic Retinopathy Using Nonmydriatic Ultra-Widefield Scanning Laser Ophthalmoscopy (Optomap) Compared With ETDRS 7-Field Stereo Photography

“…However, imaging techniques have evolved; digital photography has outlived analog color slide film, as it becomes less and less available, in clinical practice. In addition, several limitations exist, as mydriatic ETDRS 7-field stereo photography is time consuming and highly dependent on both the photographer’s experience and the patient’s compliance (6,22,23). Therefore, although remaining standard for clinical trials, it is not well suited for screening purposes.…”

Contemporary retinal imaging techniques in diabetic retinopathy: a review

“…6 Seven standard field colour fundus photographs have been used to identify features of DR such as microaneurysms, intraretinal haemorrhages, cotton-wool spots, venous beading and intraretinal microvascular abnormalities (IRMA). 7 In current clinical practice, colour fundus photography can be used to document the status of DR, and especially useful in recording the distribution of hard exudates, retinal alterations in severe non-proliferative DR and the appearance of laser photocoagulation burns. Figure 1 is an example of multimodal imaging of a patient with proliferative diabetic retinopathy with findings on color fundus photography, red-free imaging, and fluorescein angiography.…”

“…There are three types of fundus photography: colour fundus photography, red‐free imaging and stereo fundus photography . Seven standard field colour fundus photographs have been used to identify features of DR such as microaneurysms, intraretinal haemorrhages, cotton‐wool spots, venous beading and intraretinal microvascular abnormalities (IRMA) . In current clinical practice, colour fundus photography can be used to document the status of DR, and especially useful in recording the distribution of hard exudates, retinal alterations in severe non‐proliferative DR and the appearance of laser photocoagulation burns.…”

“…Digital imaging is currently widely used in the clinical and trial setting and has a high agreement with film photography . Digital fundus photography has been shown to be equivalent to stereoscopic film imaging in grading DME, although neither is as sensitive as an OCT . Widefield colour fundus photography used in conjunction with OCT is able to detect more DR than clinical examination alone and clinical examination combined with non‐widefield imaging .…”

Diabetic Macular Edema: Therapeutic Options

“…With the advent of pharmacotherapy (anti-VEGF agents or corticosteroids) DME is more appropriately defined as center-involved versus non-center involved, with most cases of center-involved macular edema appropriately eligible for treatment with pharmacotherapy [12]. Intravenous fluorescein angiography (FA) and optical coherence tomography (OCT) can assist in the evaluation of DME [13]. Angiographic findings reflect changes in vessel permeability and patency [14].…”