This material has been developed for use on desktop computers.

OCT knowledge checker:
Diagnosis of DMO

Images provided by Richard Gale, York and Scarborough
Teaching Hospitals, NHS Foundation Trust

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This material has been developed for use on a desktop computer.

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DMO, diabetic macular oedema; OCT, optical coherence tomography.
This promotional OCT knowledge checker is organised and funded by Bayer and is intended for UK healthcare professionals only.

The information provided in this presentation is according to the views of the author.

July 2024 | PP-EYL-GB-2281

Disclosures

Fees for:

AbbVie, Alimera Sciences, Allergan, Amgen, Bayer, Biogen, Boehringer Ingelheim, Gilead Sciences, Heidelberg Pharma, Lux Biosciences, Notal Vision, Novartis, Roche, Santen.

Disclaimers

 

The case studies presented are from real patients and are used with permission.

OCT, optical coherence tomography.

This patient is a 54-year-old male;
what is the most likely diagnosis?

Choose from the options shown.

The image presented is from a real patient.

Image courtesy of author.

This patient is a 54-year-old male;
what is the most likely diagnosis?

 

That is incorrect. Usually with RVO, there are multiple intraretinal haemorrhages in the affected quadrants and dilated tortuous venules.1,2

In central RVO, there may be a swollen disc.2

The image presented is from a real patient.

RVO, retinal vein occlusion. Image courtesy of author. 1. BMJ. Retinal vein occlusion. Available at: https://bestpractice.bmj.com/topics/en-gb/959#:~:text=Treatment%20is%20focused%20on%20vision-threatening%20complications%20such%20as,detect%20complications%20and%20treatment%20of%20underlying%20risk%20factors. Accessed July 2024. 2. Information courtesy of author.

This patient is a 54-year-old male;
what is the most likely diagnosis?

 

That is incorrect. Hypertensive retinopathy has four grades:1,2

Grade 1: Silver wiring of the arterioles
Grade 2: Arteriovenous nicking
Grade 3: Cotton wool spots, intraretinal haemorrhages and exudates/transudates
Grade 4: Swollen disc

The image presented is from a real patient.

Image courtesy of author. 1. Cuspidi C et al. J Hypertens 2015; 33 (11): 2204–2206. 2. Information courtesy of author.

This patient is a 54-year-old male;
what is the most likely diagnosis?

 

That is incorrect. Usually, telangiectasia cannot be seen, although there may be other features such as crystals temporal to the fovea, right-angle vessels, pigment temporal to the fovea, and haemorrhage if there is choroidal neovascularisation.1,2

The image presented is from a real patient.

Image courtesy of author. 1. Kedarisetti KC et al. Clin Ophthalmol 2022; 16: 3297–3309. 2. Information courtesy of author.

This patient is a 54-year-old male;
what is the most likely diagnosis?

 

That is correct. This patient was diagnosed with diabetic macular oedema. The presence of microaneurysms, intraretinal haemorrhages and exudate make this the most likely diagnosis.1,2

The image presented is from a real patient.

Image courtesy of author. 1. Bahrami B et al. Diabetologia 2016; 59: 1594–1608. 2. Information courtesy of author.

What would you do next?

 

The same patient complains of 4 months of worsening central vision and difficulty reading in their right eye. Which of the following imaging modalities is used most and could reveal more about the status of disease in this eye?

The image presented is from a real patient.

FFA, fundus fluorescein angiography; ICGA, indocyanine green angiography; OCT, optical coherence tomography; OCT-A, optical coherence tomography angiography. Image courtesy of author.

What would you do next?

 

 

 

 

 

 

 

Structural OCT is used most out of these four imaging modalities

The same patient complains of 4 months of worsening central vision and difficulty reading in their right eye. Which of the following imaging modalities is used most and could reveal more about the status of disease in this eye?

The images presented are from a real patient.

FFA, fundus fluorescein angiography; ICGA, indocyanine green angiography; OCT, optical coherence tomography; OCT-A, optical coherence tomography angiography. Image and information courtesy of author.

OCT biomarkers in DMO

 

 

OCT biomarkers in DMO can be considered to fall into three categories:

1 - Biomarkers that are useful to commence treatment or to help retreatment, including central retinal thickness, intraretinal fluid and subretinal fluid
2 - Biomarkers that are useful for predicting visual prognosis, including ellipsoid zone disruption, large intraretinal cysts with no Müller bridges and disorganisation of the retinal inner layers (DRIL)
3 - Biomarkers demonstrating the pathophysiology of DMO, including highly reflective foci

Can you identify biomarkers that fall into categories 1 and 2 in this image? Click anywhere to reveal them.

The images presented are from a real patient.

DMO, diabetic macular oedema; OCT, optical coherence tomography.
Image and information courtesy of author.

OCT biomarkers in DMO1,2

 

 

Intraretinal fluid causes an increase in central retinal thickness (CRT), which is one of the key treatment targets to help preserve vision.

The images presented are from a real patient.

DMO, diabetic macular oedema; OCT, optical coherence tomography.
Image courtesy of author. 1. Kaiser P et al. Retina 2021; 41: 1579–1586. 2. Information courtesy of author.

OCT biomarkers in DMO: Highly reflective foci

 

 

There are a number of different biomarkers seen on OCT in DMO. Can you click on this OCT to identify the location of highly reflective foci?

The images presented are from a real patient.

DMO, diabetic macular oedema; OCT, optical coherence tomography.
Image and information courtesy of author.

OCT biomarkers in DMO: Highly reflective foci

 

 

Large highly reflective foci may represent exudates (the foci marked in green on the image), while small highly reflective foci may represent Müller cells or another marker of intraocular inflammation (the foci marked in blue on the image)1–3

At present, highly reflective foci are not used as biomarkers for the treatment of DMO3,4

The images presented are from a real patient.

DMO, diabetic macular oedema; OCT, optical coherence tomography.
Image and information courtesy of author. 1. Fragiotta S et al. J Ophthalmol 2021; 6096017. 2. Corradetti G et al. IOVS 2019; ;60:4451–4461. 3. Information courtesy of author. 4. Huang H et al. Ophthalmol Retina 2022; 6 (9): 814–827.

Summary: Diagnosis of DMO

Intraretinal haemorrhages, microaneurysms and exudates seen in the macula often suggest
diabetic maculopathy, but other differential diagnoses need to be considered

Structural OCT is helpful in identifying intraretinal fluid

  • There are a number of other biomarkers that can be seen in patients with diabetic maculopathy,
    such as highly reflective foci, ellipsoid zone disruption, disorganisation of inner retinal layers, and large intraretinal cysts with no Müller bridges

DMO, diabetic macular oedema; OCT, optical coherence tomography.
Information courtesy of author.

Thank you for completing this OCT knowledge checker

OCT, optical coherence tomography.

July 2024 | PP-EYL-GB-2281