OCT‐A: guided treatment of diabetic retinopathy

Summary Diabetic retinopathy (DR) is the leading cause of blindness in working‐age individuals in the developed world, affecting approximately 75% of patients with diabetes mellitus after 15 years. One of the early changes in diabetic eyes is loss of pericytes and proliferation of endothelial cells leading to the development of microaneurysms. Pericyte loss impairs the blood–retinal barrier, thereby leading to venous dilation and beading. The gold standard to screen for DR is dilated biomicroscopic fundus examination, where microaneurysms in the posterior pole are typically the first sign on ophthalmoscopy. Although fluorescein angiography is more sensitive than examination to detect early DR, it is invasive, costly, and time consuming, and therefore, is not appropriate as a screening test for DR. Optical coherence tomography angiography (OCT‐A) is a fast, noninvasive imaging technique that uses motion contrast to create OCT‐angiograms by comparing the decorrelation signal among sequential OCT B‐scans. Optical coherence tomography angiography may be a valuable screening tool for DR, useful as a clinical trial endpoint, and efficient in guiding early treatment decisions in the future.