OCT-A Enhances Early Detection and Management of Diabetic Retinopathy

Julie Rodman, OD, MS, FAAO, clinic chief at Nova Southeastern University College of Optometry, Fort Lauderdale, Florida, discusss how optical coherence tomography angiography (OCT-A) has been beneficial in diagnosing and managing diabetic retinopathy, ahead of her session on OCT to be held at the Southeastern Educational Congress of Optometry (SECO) 2025 meeting.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What is the role of OCT and wide-field imaging in diagnosing and managing diabetic retinopathy?

Great question. So OCT-A, OCT angiography is a functional test. What that means is, it's using structure to look at function, but we're looking at the health and integrity of the retina and choroid in a noninvasive manner. We're using regular OCT scans to get that information. And the beauty of it is that it's showing us functional changes that are happening at the level of the retina before we see these changes clinically. Patients come in, we look at them, we say, "Oh, you look fantastic, your retina looks great. Keep doing whatever you're doing." Which means, if you're eating a box of Junior Mints every night or you're eating a chocolate eclair, whatever you're doing, keep doing it right.

And then you go do OCT-A and it's a whole different picture, because what it's doing is it's showing us behind the scenes all this damage that has not yet manifested clinically. Being able to say to the patient, "If you continue these habits, you will develop retinopathy in X number of years or X number of months," is really helpful. Because it's all about what you tell the patient. If someone told me, "Whatever you're doing is perfect," I would keep doing it, when you don't know that there's all this stuff happening behind the scenes. So OCT-A, particularly in diabetes, has been huge.

This year we got a reimbursement code for OCT-A, so for those practitioners who didn't want to do it because they felt like they were not being reimbursed for their time, that's no longer an excuse. I would argue that it provides the highest level of care. You're looking at things that we cannot see unless we do that test.

We have found over the years that looking just at a standard 45, 50 degree image is not enough anymore in diabetes. That gives us a really nice assessment of what's happening in the posterior poll. But a lot of studies have been done looking at what happens if you have retinopathy outside that central area. They're actually finding that patients that have what we call predominantly peripheral lesions are actually at a greater risk of developing advanced stages of the disease; not being able to see beyond that 50 degrees is really a detriment. Anybody that doesn't have wide field imaging and isn't using it really should be using it, particularly in our diabetic patients, because again, it's not enough anymore just to use the standard 7 fields that we've been trained to do.

I just wanted to kind of throw that out there, that there's been a lot of studies done on that and looking at the relevance of those lesions in advancement of the disease.