Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus, leading to visual impairment if left untreated. This review discusses the use of optical coherence tomography angiography (OCTA) as a diagnostic tool for the early detection and management of DR. OCTA is a fast, non-invasive, non-contact test that enables the detailed visualisation of the macular microvasculature in different plexuses. OCTA offers several advantages over fundus fluorescein angiography (FFA), notably offering quantitative data. OCTA is not without limitations, including the requirement for careful interpretation of artefacts and the limited region of interest that can be captured currently. We explore how OCTA has been instrumental in detecting early microvascular changes that precede clinical signs of DR. We also discuss the application of OCTA in the diagnosis and management of various stages of DR, including non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), diabetic macular ischaemia (DMI), and pre-diabetes. Finally, we discuss the future role of OCTA and how it may be used to enhance the clinical outcomes of DR.

Fig. 1 Pooled 2-year results from two Phase 3 trials (TENAYA and LUCERNE) of faricimab, a bispecific antibody targeting both Ang-2 and VEGF-A, in patients with nAMD. These results support dual Ang-2/VEGF-A inhibition with faricimab as a novel approach to durable efficacy, enabling treatment interval extensions without compromising nAMD patient outcomes.

In this study, we investigated the influences of retinal structural changes on photopic and scotopic visual functions. Participants aged 55 years or over with early or intermediate age-related macular degeneration (AMD) in at least one eye, and controls with healthy maculae and were included. Associations between visual functions and retinal structural changes were investigated using linear regression and survival analysis in all participants. Additional multivariable analyses were also performed in the control group and the AMD group. We found that the presence of refractile drusen and nascent geographic atrophy (nGA) and were associated with poorer BCVA, LLVA, and increased LLD (P < 0.05). In survival analysis, eyes with thicker subfoveal choroidal thickness (SFCT) had a higher hazard rate of rod intercept (hazard ratio, HR = 1.287), suggesting a decreased RIT. Eyes with nGA (HR = 0.260), drusen (HR = 0.208), refractile drusen (HR = 0.126), SDD (HR = 0.157) have a significantly lower hazard rate of rod intercept (i.e. increased RIT, P < 0.05). Among them, thinner SFCT (HR = 1.229), drusen (HR = 0.421), and SDD (HR = 0.167) were identified as independent factors associated with an increased RIT in the final multivariate model (P < 0.05). Given the associations between visual functions with outer retinal layers thickness and presence of established precursors of progression to advanced AMD, our findings serve as a strong foundation for future investigations into the relationships between retinal phenotypes and functional changes.

Background/objectives: Although decline in visual functions have been reported in eyes with non-advanced age-related macular degeneration (AMD), it is not known if visual functions in these eyes are influenced by structural changes on optical coherence tomography (OCT). We investigated the association between known OCT changes with photopic and scotopic visual functions. Subjects/methods: Participants aged 55 years or over with early or intermediate AMD in at least 1 eye, and controls with healthy maculae and were included. Associations between visual functions and retinal structural changes were investigated using linear regression and survival analysis. Results: We found that the presence of refractile drusen and nascent geographic atrophy (nGA) and were associated with poorer best-corrected visual acuity (BCVA), low luminance VA (LLVA), and increased low luminance deficit (LLD) (P < 0.05). In survival analysis, eyes with thicker subfoveal choroidal thickness (SFCT) had a higher hazard rate of rod intercept, suggesting a decreased rod-intercept time (RIT). Eyes with nGA, drusen, refractile drusen, subretinal drusenoid deposits (SDD) have a significantly lower hazard rate of rod intercept (i.e. increased RIT, P < 0.05). Among them, thinner SFCT, drusen, and SDD were identified as independent factors associated with an increased RIT in the final multivariable model (P < 0.05). Conclusions and relevance: Given the associations between visual functions with outer retinal layers thickness and presence of established precursors of progression to advanced AMD, our findings serve as a strong foundation for future investigations into the relationships between retinal phenotypes and functional changes.