Original StudyDETECTION OF CLINICALLY UNSUSPECTED RETINAL NEOVASCULARIZATION WITH WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHYYou, Qi Sheng MD, PhD*; Guo, Yukun MS*; Wang, Jie MS*,†; Wei, Xiang MS*; Camino, Acner PhD*; Zang, Pengxiao MS*; Flaxel, Christina J. MD*; Bailey, Steven T. MD*; Huang, David MD, PhD*; Jia, Yali PhD*,†; Hwang, Thomas S. MD*Author Information *Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; and †Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon. Reprint requests: Thomas S. Hwang, Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, 3375 SW Terwilliger Boulevard, Portland, OR 97239; e-mail: email@example.com Supported by grants R01 EY027833, DP3 DK104397, R01 EY024544, and P30 EY010572 from the National Institutes of Health, an unrestricted departmental funding grant and William & Mary Greve Special Scholar Award from Research to Prevent Blindness, New York, New York. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Oregon Health & Science University (OHSU) and Y. Jia and D. Huang have a significant financial interest in Optovue, Inc, a company that may have a commercial interest in the results of this research and technology. These potential conflicts of interest have been reviewed and managed by OHSU. No other disclosures were reported. Retina: May 2020 - Volume 40 - Issue 5 - p 891-897 doi: 10.1097/IAE.0000000000002487 Buy Metrics AbstractIn Brief Purpose: To evaluate wide-field optical coherence tomography angiography (OCTA) for detection of clinically unsuspected neovascularization (NV) in diabetic retinopathy (DR). Methods: This prospective observational single-center study included adult patients with a clinical diagnosis of nonproliferative DR. Participants underwent a clinical examination, standard 7-field color photography, and OCTA with commercial and prototype swept-source devices. The wide-field OCTA was achieved by montaging five 6 × 10-mm scans from a prototype device into a 25 × 10-mm image and three 6 × 6-mm scans from a commercial device into a 15 × 6-mm image. A masked grader determined the retinopathy severity from color photographs. Two trained readers examined conventional and wide-field OCTA images for the presence of NV. Results: Of 27 participants, photographic grading found 13 mild, 7 moderate, and 7 severe nonproliferative DR. Conventional 6 × 6-mm OCTA detected NV in 2 eyes (7%) and none with 3 × 3-mm scans. Both prototype and commercial wide-field OCTA detected NV in two additional eyes. The mean area of NV was 0.38 mm2 (range 0.17–0.54 mm2). All eyes with OCTA-detected NV were photographically graded as severe nonproliferative DR. Conclusion: Wide-field OCTA can detect small NV not seen on clinical examination or color photographs and may improve the clinical evaluation of DR. Wide-field optical coherence tomography angiography can detect clinically unsuspected retinal neovascularization in diabetic retinopathy, providing a sensitive surveillance method that is amenable to routine clinical use.