Author: Victor H. Gonzalez, MD

In diabetic retinopathy (DR), macular involvement can present as either macular edema or ischemia. Fluorescein angiography remains the gold standard in the evaluation of retinal vascular perfusion and diagnosis of macular ischemia. However, Optical coherence tomography angiography (OCTA) is becoming widely accepted as a useful noninvasive technique that provides detailed imaging of the ocular vessels. It is also becoming an increasingly essential tool for both quantitative and qualitative assessment of DR. Angiographic features such as microaneurysms, intraretinal microvascular abnormalities, neovascularization, and nonperfusion have been comprehensively studied and described using OCTA. Different quantitative OCTA metrics have been introduced, such as vessel density, foveal avascular zone (FAZ) area, and area of nonperfusion. Current research has been focusing on the application of quantitative OCTA for the diagnosis of DR and treatment monitoring. This paper will review the use of OCTA, including its challenges, in the diagnosis and management of DR.