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Original Investigation
Journal Club
April 2017

Optical Coherence Tomographic Angiography in Type 2 Diabetes and Diabetic Retinopathy

Journal Club PowerPoint Slide Download
Author Affiliations
  • 1Vitreo-retinal Department, Singapore National Eye Center, Singapore, Singapore
  • 2Singapore Eye Research Institute, Singapore, Singapore
  • 3Duke-National University Singapore Medical School, Singapore, Singapore
  • 4National healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
JAMA Ophthalmol. 2017;135(4):306-312. doi:10.1001/jamaophthalmol.2016.5877
Key Points

Question  What is the effect of the severity of diabetic retinopathy and systemic vascular risk factors on the structural changes at the retinal capillary level?

Findings  In this observational cohort study, structural changes in the retinal microvasculature were associated with severity of diabetic retinopathy and systemic metabolic and vascular risk factors in patients with type 2 diabetes.

Meaning  These data suggest that optical coherence tomographic angiography potentially can be used in larger epidemiologic and clinical studies, including interventional trials, to directly visualize the previously inaccessible microvasculature in a noninvasive manner.


Importance  Optical coherence tomographic angiography (OCT-A) is able to visualize retinal microvasculature without the need for injection of fluorescein contrast dye. Nevertheless, it is only able to capture a limited view of macula and does not show leakage.

Objectives  To evaluate the retinal microvasculature using OCT-A in patients with type 2 diabetes as well as the association of OCT-A characteristics with diabetic retinopathy (DR) and systemic risk factors.

Design, Setting, and Participants  A prospective, observational study was conducted from January 1 to June 30, 2016, at medical retina clinics at the Singapore National Eye Center among 50 patients with type 2 diabetes with and without DR (n = 100 eyes). We examined the retinal microvasculature with swept-source OCT-A and a semiautomated software to measure the capillary density index (CDI) and fractal dimension (FD) at the superficial vascular plexus (SVP) and deep retinal vascular plexus (DVP). We collected data on histories of patients’ glycated hemoglobin A1c, hypertension, hyperlipidemia, smoking, and renal impairment.

Main Outcomes and Measures  The CDI and FD at the SVP and DVP for each severity level of DR and the association of systemic risk factors vs the CDI and FD.

Results  The mean (SD) glycated hemoglobin A1c of the 50 patients (26 men and 24 women; 35 Chinese; mean [SD] age, 59.5 [8.9] years) was 7.9% (1.7%). The mean (SD) CDI at the SVP decreased from 0.358 (0.017) in patients with no DR to 0.338 (0.012) in patients with proliferative DR (P < .001) and at the DVP decreased in patients with no DR from 0.361 (0.019) to 0.345 (0.020) in patients with proliferative DR (P = .04). The mean (SD) FD at the SVP increased from 1.53 (0.05) in patients with no DR to 1.60 (0.05) in patients with proliferative DR (P < .01) and at the DVP increased from 1.55 (0.06) in patients with no DR to 1.61 (0.05) in patients with proliferative DR (P = .02). For systemic risk factors, hyperlipidemia (odds ratio [OR], 9.82; 95% CI, 6.92-11.23; P < .001), smoking (OR, 10.90; 95% CI, 8.23-12.34; P < .001), and renal impairment (OR, 3.72; 95% CI, 1.80-4.81; P = .05) were associated with reduced CDI, while increased glycated hemoglobin A1c (≥8%) (OR, 8.77; 95% CI, 5.23-10.81; P < .01) and renal impairment (OR, 10.30; 95% CI, 8.21-11.91; P < .001) were associated with increased FD.

Conclusions and Relevance  Optical coherence tomographic angiography is a novel imaging modality to quantify the retinal capillary microvasculature in patients with diabetes. It can be potentially used in interventional trials to study the effect of systemic risk factors on the microvasculature that was previously not accessible in a noninvasive manner. The relevance of these findings relative to visual acuity, however, remains largely unknown at this time.