Diabetic retinopathy is one of the major microvascular complications of diabetes mellitus. The most common causes of vision loss in diabetic retinopathy are diabetic macular edema and proliferative diabetic retinopathy. Recent developments in ocular imaging have played a significant role in early diagnosis and management of these complications. Color fundus photography is an imaging modality, which is helpful for screening patients with diabetic eye disease and monitoring its progression as well as response to treatment. Fundus fluorescein angiography (FFA) is a dye-based invasive test to detect subtle neovascularization, look for areas of capillary non-perfusion, diagnose macular ischemia, and differentiate between focal and diffuse capillary bed leak in cases of macular edema. Recent advances in retinal imaging like the introduction of spectral-domain and swept source-based optical coherence tomography (OCT), fundus autofluorescence (FAF), OCT angiography, and ultrawide field imaging and FFA have helped clinicians in the detection of certain biomarkers that can identify disease at an early stage and predict response to treatment in diabetic macular edema. This article will summarize the role of different imaging biomarkers in characterizing diabetic retinopathy and their potential contribution in its management.

https://journals.sagepub.com/doi/pdf/10.1177/2515841420950513

Novel imaging biomarkers in diabetic retinopathy and diabetic macular edema.

Importance Nitric oxide signaling alterations in outflow facility and retinal blood flow autoregulation are implicated in primary open-angle glaucoma (POAG). Nitric oxide donation has emerged as a POAG therapeutic target. An exogenous source of nitric oxide is dietary nitrates. Objective To evaluate the association between dietary nitrate intake, derived mainly from green leafy vegetables, and POAG. Design, Setting, and Participants We followed up participants biennially in the prospective cohorts of the Nurses’ Health Study (63 893 women; 1984-2012) and the Health Professionals Follow-up Study (41 094 men; 1986-2012) at each 2-year risk period. Eligible participants were 40 years or older, were free of POAG, and reported eye examinations. Exposures The primary exposure was dietary nitrate intake. Information on diet and potential confounders was updated with validated questionnaires. Main Outcomes and Measures The main outcome was the incidence of POAG and POAG subtypes; 1483 cases were confirmed with medical records and classified into subtypes defined by intraocular pressure (IOP) (≥22 or Results During 1 678 713 person-years of follow-up, 1483 incident cases of POAG were identified. The mean (SD) age for the 1483 cases was 66.8 (8.3). Compared with the lowest quintile of dietary nitrate intake (quintile 1: approximately 80 mg/d), the pooled MVRR for the highest quintile (quintile 5: approximately 240 mg/d) was 0.79 (95% CI, 0.66-0.93; P for trend = .02). The dose response was stronger ( P for heterogeneity = .01) for POAG with early paracentral VF loss (433 cases; quintile 5 vs quintile 1 MVRR = 0.56; 95% CI, 0.40-0.79; P for trend  P for trend = .50). The association did not differ ( P for heterogeneity = .75) by POAG subtypes defined by IOP (997 case patients with IOP ≥22 mm Hg: quintile 5 vs quintile 1 MVRR = 0.82; 95% CI, 0.67-1.01; P for trend = .11; 486 case patients with IOP P for trend = .12). Green leafy vegetables accounted for 56.7% of nitrate intake variation. Compared with consuming 0.31 servings per day, the MVRR for consuming 1.45 or more servings per day was 0.82 for all POAG (95% CI, 0.69-0.97; P for trend = .02) and 0.52 for POAG with paracentral VF loss (95% CI, 0.29-0.96; P for trend  Conclusions and Relevance Higher dietary nitrate and green leafy vegetable intake was associated with a lower POAG risk, particularly POAG with early paracentral VF loss at diagnosis.

/pdf/association-of-dietary-nitrate-intake-with-primary-open-bjgjuuvdrd.pdf

Association of Dietary Nitrate Intake With Primary Open-Angle Glaucoma: A Prospective Analysis From the Nurses’ Health Study and Health Professionals Follow-up Study

https://pureadmin.qub.ac.uk/ws/files/153174294/1_s2.0_S0039625717301133_main.pdf

Ischemic Retinal Vein Occlusion: characterizing the more severe spectrum of retinal vein occlusion

Over the last decade, there has been an expansion of imaging modalities available to clinicians to diagnose and monitor the treatment and progression of diabetic retinopathy. Recently, advances in image technologies related to OCT and OCT angiography have enabled improved visualization and understanding of this disease. In this review, we will describe the use of imaging techniques such as colour fundus photography, fundus autofluorescence, fluorescein angiography, infrared reflectance imaging, OCT, OCT-Angiography and techniques in adaptive optics and hyperspectral imaging in the diagnosis and management of diabetic retinopathy.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/ceo.12711

Contemporary retinal imaging techniques in diabetic retinopathy: a review.

Optical coherence tomography (OCT) was introduced about two decades ago and has revolutionized ophthalmic practice in recent years. It is a noninvasive noncontact imaging modality that provides a high-resolution cross-sectional image of the cornea, retina, choroid and optic nerve head, analogous to that of the histological section. Advances in OCT technology in signal detection technique from time-domain (TD) to spectral-domain (SD) detection have given us the potential to study various retinal layers more precisely and in less time. SD-OCT better delineates structural changes and fine lesions in the individual retinal layers. Thus, we have gained substantial information about the pathologic and structural changes in ocular conditions with primary or secondary retinal involvement. This review we discuss the clinical application of currently available SD-OCT in various retinal pathologies. Furthermore, highlights the benefits of SD-OCT over TD. With the introduction of enhanced depth imaging and swept - source OCT visualization of the choroid and choriocapillaris has become possible. Therefore, OCT has become an indispensable ancillary test in the diagnosis and management of diseases involving the retina and/or the choroid. As OCT technology continues to develop further it will provide new insights into the retinal and choroidal structure and the pathogenesis of posterior segment of the eye.

Clinical applications of spectral domain optical coherence tomography in retinal diseases.

Purpose To investigate the correlation of fundus autofluorescence (FAF) with the findings of spectral domain optical coherence tomography and visual acuity in patients with branch retinal vein occlusion and to determine the visual prognostic factors. Methods Retrospectively, an evaluation of FAF, spectral domain optical coherence tomography images, and visual acuity before and after intravitreal injection of bevacizumab (pre- and post-IVB) was obtained in 42 patients with branch retinal vein occlusion who underwent IVB as their first treatment. The FAF of fovea was graded on a scale of 1 to 4. Results The visual acuity post-IVB was associated with the visual acuity pre-IVB. Preservation of external limiting membrane and photoreceptor inner and outer segment junction pre- and post-IVB were associated with better visual acuity post-IVB. Eyes with less FAF pre-IVB were closely associated with better visual acuity post-IVB. Conclusion The shorter length of photoreceptor inner and outer segment junction and external limiting membrane defect and less FAF pre-IVB showed a significant association with better visual acuity post-IVB. These associations could help to predict potential restoration of photoreceptor integrity and visual recovery in patients with branch retinal vein occlusion, in whom photoreceptor integrity before treatment could not be adequately evaluated, even with spectral domain optical coherence tomography.

Correlation of fundus autofluorescence with foveal microstructures and vision in branch retinal vein occlusion.

between the two groups. Results: Patients from both ICS and IPS groups were of similar age, gender, family history of glaucoma, and follow-up periods. Frequency of disc hemorrhage was significantly higher among patients with ICS than in patients with IPS. Moreover, systemic risk factors such as hypotension, migraine, Raynaud’s phenomenon, and snoring were more prevalent in the ICS group than in the IPS group. There were no statistical differences in lifestyle risk factors such as smoking or body mass index. Pattern standard deviation was significantly greater in the ICS group than in the IPS group, but the mean deviation was similar between the two groups. Conclusions: NTG Patients with ICS and IPS have different profiles of risk factors and clinical characteristics. This suggests that the pattern of initial visual field loss may be useful to identify patients at higher risk of central field loss.

/pdf/comparison-of-risk-factors-for-initial-central-scotoma-5fdgkszn6g.pdf

Comparison of Risk Factors for Initial Central Scotoma versus Initial Peripheral Scotoma in Normal-tension Glaucoma

Correlation of fundus autofluorescence with spectral-domain optical coherence tomography and vision in diabetic macular edema.

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Correlation of fundus autofluorescence with foveal microstructures and vision in branch retinal vein occlusion.

Comparison of Risk Factors for Initial Central Scotoma versus Initial Peripheral Scotoma in Normal-tension Glaucoma

Correlation of fundus autofluorescence with spectral-domain optical coherence tomography and vision in diabetic macular edema.