Background: Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR. Methods: A systematic literature search was performed in PubMed and Embase, including the keywords “OCTA” OR “OCT angiography” OR “optical coherence tomography angiography” AND “diabetes” OR “diabetes mellitus” OR “diabetic retinopathy” OR “diabetic maculopathy” OR “diabetic macular oedema” OR “diabetic macular ischaemia”. Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review. Results: We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease. Conclusion: OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.

Ischemia is the main cause of cell death in retinal diseases such as vascular occlusions, diabetic retinopathy, glaucoma, or retinopathy of prematurity. Although excitotoxicity is considered the primary mechanism of cell death during an ischemic event, antagonists of glutamatergic receptors have been unsuccessful in clinical trials with patients suffering ischemia or stroke. Our main purpose was to analyze if the transient receptor potential channel 7 (TRPM7) could contribute to retinal dysfunction in retinal pathologies associated with ischemia. By using an experimental model of acute retinal ischemia, we analyzed the changes in retinal function by electroretinography and the changes in retinal morphology by optical coherence tomography (OCT) and OCT-angiography (OCTA). Immunohistochemistry was performed to assess the pattern of TRPM7 and its expression level in the retina. Our results show that ischemia elicited a decrease in retinal responsiveness to light stimuli along with reactive gliosis and a significant increase in the expression of TRPM7 in Müller cells. TRPM7 could emerge as a new drug target to be explored in retinal pathologies associated with ischemia.

Choroidal dystrophies comprise a group of chorioretinal degenerations. However, the different findings observed among these patients make it difficult to establish a correct clinical diagnosis. The objective of this study was to characterize new clinical findings by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in these patients. Four family members with a PRPH2 gene mutation (p.Arg195Leu) were included. OCT was performed at the macula, and the thickness of the outer and inner retina, total retina, and choroid was measured. The features of the vascular network were analyzed by OCTA. Patients showed a decreased outer nuclear layer in the avascular area compared with the controls. Two patients presented greater foveal and parafoveal degeneration of the outer retina, whereas the most degenerated area in the rest was the perifovea. Disruption of the third outer band at the foveola is one of the first-altered outer bands. Slow blood flow areas or capillary dropout were main signs in the deep capillary plexus. Microaneurysms were frequently observed in less degenerated retinas. Vascular loops and intraretinal microvascular abnormalities (IRMAs) were present in the superficial plexus. Extensive degeneration of the choriocapillaris was detected. Phenotypic differences were found between patients: two showed central areolar choroidal dystrophy and the rest had extensive chorioretinal atrophy. These signs observed in OCT and OCTA can help to more appropriately define the clinical disease in patients with choroidal dystrophies.

Background: This study evaluates the feasibility and acceptability of a virtual reality platform (VRP) for home monitoring of visual function in patients with neuro-ophthalmic conditions. Methods: Fifteen patients with nonarteritic anterior ischemic optic neuropathy (NAAION), optic neuritis, or papilledema were enrolled and monitored remotely over 12 weeks. Visual acuity, color vision, and visual field testing were collected 3 times per week using the VRP. Compliance and satisfaction levels were analyzed. Results: A total of 21 eyes were included (38.1% NAAION, 42.9% optic neuritis, 19% papilledema). Most participants (71.4%) found weekly VRP use easy, and all felt confident using it at home. While 86% reported no technical issues, 21%–28% experienced transient symptoms such as blurred vision or dizziness. Compliance was highest in the NAAION group, with 75% completing the full 12-week period. In the optic neuritis group, 55.6% remained after Week 1 and 44.4% continued through Week 8. The papilledema group discontinued by Week 4. Main reasons for discontinuation included time constraints, scheduling conflicts, and stable vision after improvement. In general, visual acuity and visual field indices (mean deviation and pattern SD [PSD]) showed no significant changes over time, confirming good VRP’S reproducibility for home monitoring. This VRP also detected cases of visual function worsening, enabling earlier rescheduling of clinical appointments. Conclusion: The VRP is a feasible and well-accepted tool for home-based visual monitoring in neuro-ophthalmic patients as an alternative to in-person eye examinations. This approach enables early detection of changes and can improve long-term management.

Purpose: This study aimed to compare the AI-assisted Virtual Reality Platform (VRP) with technician-assisted exams for assessing visual acuity, color vision (CV), and visual field (VF) in a neuro-ophthalmology clinic. Methods: A comparative, cross-sectional study including 59 adult patients was performed in the neuro-ophthalmology clinic at Bascom Palmer Eye Institute. The Snellen chart for visual acuity, Ishihara testing, and the SITA or AVA Fast strategy for VF testing were used in both the VRP and technician-based examinations. Best corrected visual acuity (BCVA), CV results, mean deviation (MD), pattern standard deviation (PSD), and reliability indices were collected. Results: The study included 118 eyes with a mean age of 47.2 ± 18.8 (71.19% female). Significant positive correlations were found between the VRP and technician-based examination for BCVA ( r = .641, P <.001) and CV ( r = .824, P <.001). Bland-Altman analysis showed good agreement between VRP and the traditional exams for BCVA (mean bias 0.09 ± 0.25, limits of agreement (LOA): [0.58] to [-0.40]) and CV (mean bias 0.07 ± 0.11. LOA: [0.29] to [-0.16]). The MD and PSD of the VRP were significantly correlated with the standard Humphrey Visual Field (HVF) exam (MD: r = .91, P <.001; PSD: r = .88, P <.001). Bland-Altman analysis revealed a mean bias of -0.71 ± 2.81 for MD and − 0.90 ± 2.08 for PSD. The VRP reduced test duration (124.31 ± 0.35 s) compared to the standard exam (256.8 ± 7.1 s, P <.0001). Conclusions: The VisuALL VRP, a compact portable device, effectively provides results comparable to technician-based assessments in neuro-ophthalmological patients while reducing test duration and improving clinical workflow.