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La Mantia, Alberto, MD, FEBO; Kurt, Rengin A., MD, FEBO; Mejor, Samantha; Egan, Catherine A., MD, FRANZCO; Tufail, Adnan, MD, FRCOphth; Keane, Pearse A., MD, FRCOphth; Sim, Dawn A., FRCOphth

doi: 10.1097/IAE.0000000000002045
Original Study

Purpose: To compare fundus fluorescein angiography (FFA) and swept-source optical coherence tomography angiography (SS-OCTA) in the evaluation of macular perfusion in diabetic patients.

Methods: Forty-one eyes (21 diabetic patients) seen at Moorfields Eye Hospital (London) over a 1-month interval underwent color fundus photography, FFA, and SS-OCTA imaging of the capillary superficial plexus using 2 different protocols: 3 × 3 mm and 4.5 × 4.5 mm. Quantitative assessment (foveal avascular zone diameters and area), qualitative analysis (macroscopic and microscopic levels) and Early Treatment Diabetic Retinopathy Study diabetic macular ischemia grading were performed. Artifacts were recorded. Intraclass correlation coefficients and weighted kappa values were calculated.

Results: Mean (SD) foveal avascular zone area was 0.695 (0.52) mm2 on FFA, 0.627 (0.54) mm2 on SS-OCTA 3 × 3 and 0.701 (0.54) mm2 on SS-OCTA 4.5 × 4.5 protocol. Intraclass correlation coefficients showed good agreement between FFA and SS-OCTA for both vertical diameter and foveal avascular zone area measurements. The agreement between SS-OCTA 3 × 3 and 4.5 × 4.5 was good for all quantitative measurements. Weighted kappa for diabetic macular ischemia grading showed low to fair agreement between FFA and SS-OCTA, whereas the agreement was good between two different SS-OCTA protocols.

Conclusion: Swept-source OCTA is a reproducible technique in the assessment of macular perfusion in diabetic patients with special regards to foveal avascular zone analysis. The agreement with FFA is limited especially for diabetic macular ischemia grading. Fundus fluorescein angiography is more sensitive in identifying microaneurysms.

This article compares fundus fluorescein angiography and swept-source optical coherence tomography angiography in the assessment of macular perfusion of diabetic patients.

NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology Medical Retina Service, London, United Kingdom.

Reprint requests: Alberto La Mantia, MD, FEBO, Moorfields Eye Hospital NHS Trust, EC1V 2PD London, United Kingdom; e-mail:

The publication of this article was funded by the Moorfields Eye Charity. P. A. Keane and D. A. Sim have received travel grants from the Allergan European Retina Panel. D. A. Sim also receives funding from Fight For Sight UK, Grant number 1987. C. A. Egan has been on advisory boards for Novartis Pharmaceuticals. A. Tufail has been on advisory boards for Heidelberg Engineering, Novartis, Pfizer, GSK, Thrombogenics, Bayer, and Allergan. The remaining authors have no conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.