Detection of Clinically Unsuspected Retinal Neovascularization with Wide-Field Optical Coherence Tomography Angiography

Abstract

Purpose : To evaluate wide-field optical coherence tomography angiography for detection of clinically unsuspected retinal neovascularization in diabetic retinopathy.

Methods : This prospective observational single center study included adult patients with a clinical diagnosis of nonproliferative diabetic retinopathy. Participants underwent a clinical examination, standard 7-field color photography, optical coherence tomography angiography with commercial and prototype swept-source devices. The wide-field optical coherence tomography angiography was achieved by montaging five 6x10-mm scans from a prototype device into a 25 x10-mm image and three 6x6-mm scans from a commercial device into a 15x6-mm image. A masked grader determined the retinopathy severity from color photographs. Two trained readers examined conventional and the wide-field optical coherence tomography angiography images for the presence of neovascularization.

Results : Of 27 participants, photographic grading found 13 mild, 7 moderate, and 7 severe nonproliferative diabetic retinopathy. Conventional 6x6mm optical coherence tomography angiography detected retinal neovascularization in 2 eyes (7%) and none with 3x3-mm scans. (Figure 1) Both prototype and commercial wide-field optical coherence tomography angiography detected retinal neovascularization in 2 additional eyes. (Figure 2) The mean area of neovascularization was 0.38 mm² (range 0.17 - 0.54 mm²). All eyes with optical coherence tomography angiography detected retinal neovascularization were photographically graded as severe nonproliferative diabetic retinopathy.

Conclusions : Wide-field optical coherence tomography angiography can detect small retinal neovascularization not seen on clinical examination or color photographs and may improve the clinical evaluation of diabetic retinopathy.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.