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ULTRAHIGH SPEED SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF RETINAL AND CHORIOCAPILLARIS ALTERATIONS IN DIABETIC PATIENTS WITH AND WITHOUT RETINOPATHY

Choi, WooJhon PhD; Waheed, Nadia K. MD; Moult, Eric M. BS; Adhi, Mehreen MD; Lee, ByungKun MS; De Carlo, Talisa MD; Jayaraman, Vijaysekhar PhD; Baumal, Caroline R. MD; Duker, Jay S. MD; Fujimoto, James G. PhD

doi: 10.1097/IAE.0000000000001250
Original Study
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Purpose: To investigate the utility of ultrahigh speed, swept source optical coherence tomography angiography in visualizing retinal microvascular and choriocapillaris (CC) changes in diabetic patients.

Methods: The study was prospective and cross-sectional. A 1,050 nm wavelength, 400 kHz A-scan rate swept source optical coherence tomography prototype was used to perform volumetric optical coherence tomography angiography of the retinal and CC vasculatures in diabetic patients and normal subjects. Sixty-three eyes from 32 normal subjects, 9 eyes from 7 patients with proliferative diabetic retinopathy, 29 eyes from 16 patients with nonproliferative diabetic retinopathy, and 51 eyes from 28 diabetic patients without retinopathy were imaged.

Results: Retinal and CC microvascular abnormalities were observed in all stages of diabetic retinopathy. In nonproliferative diabetic retinopathy and proliferative diabetic retinopathy, optical coherence tomography angiography visualized a variety of vascular abnormalities, including clustered capillaries, dilated capillary segments, tortuous capillaries, regions of capillary dropout, reduced capillary density, abnormal capillary loops, and foveal avascular zone enlargement. In proliferative diabetic retinopathy, retinal neovascularization above the inner limiting membrane was visualized. Regions of CC flow impairment in patients with proliferative diabetic retinopathy and nonproliferative diabetic retinopathy were also observed. In 18 of the 51 of eyes from diabetic patients without retinopathy, retinal mircrovascular abnormalities were observed and CC flow impairment was found in 24 of the 51 diabetic eyes without retinopathy.

Conclusion: The ability of optical coherence tomography angiography to visualize retinal and CC microvascular abnormalities suggests it may be a useful tool for understanding pathogenesis, evaluating treatment response, and earlier detection of vascular abnormalities in patients with diabetes.

Swept source optical coherence tomography angiography visualizes retinal and choriocapillaris microvasculature alterations in diabetic patients with and without retinopathy.

*Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts;

Tufts University Medical Center, New England Eye Center, Boston, Massachusetts;

Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts; and

§Praevium Research Inc, Santa Barbara, California.

Reprint requests: James G. Fujimoto, PhD, Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 36-345, Cambridge, MA 02139; e-mail: jgfuji@mit.edu

Supported by the National Institute of Health (NIH R01-EY011289-30, R44-EY022864-03, R01-CA075289-19), Air Force Office of Scientific Research (AFOSR FA9550-15-1-0473 and FA9550-12-1-0499), and Thorlabs matching funds to Praevium Research Inc. Additional support from an unrestricted Research to Prevent Blindness grant and the Massachusetts Lions Clubs, a Samsung Scholarship, and a Natural Sciences and Engineering Research Council of Canada Scholarship.

Results presented in part at Association for Research in Vision and Ophthalmology meeting, Orlando, FL, May 4, 2014.

J. S. Duker, Research support from Carl Zeiss Meditec Inc and Optovue Inc, and Topcon Medical Systems Inc; and stock in Hemera Biosciences Inc, EyeNetra, and Ophthotech Corp. J. G. Fujimoto, Royalties from intellectual property owned by Massachusetts Institute of Technology and licensed to Carl Zeiss Meditec Inc and Optovue Inc, and stock options with Optovue Inc. V. Jayaraman, Stock and employment at Praevium Inc, Royalities from Thorlabs Inc. The remaining authors have no conflicting interests to disclose.

© 2017 by Ophthalmic Communications Society, Inc.