Evaluating Diabetic Retinopathy Using Ultra-widefield Swept-Source Optical Coherence Tomography Angiography

Purpose: To highlight the clinical utility of ultra-widefield swept-source optical coherence tomography angiography (SS-OCTA) in evaluating diabetic retinopathy (DR), particularly focusing on its ability to detect peripheral ischemia and neovascularization. Methods: Eyes of 5 participants with varying severity of DR were imaged with expanded-field 12 × 12-mm SS-OCTA scans and ultra-widefield SS-OCTA montages. Montages were created by stitching five 21 × 26-mm scans, offering up to a 200° field of view. Cases were assessed for areas of nonperfusion, intraretinal microvascular abnormalities, and neovascularization extending beyond the posterior pole. Results: Ultra-widefield SS-OCTA imaging demonstrated progressive mid-peripheral and peripheral nonperfusion, intraretinal microvascular abnormalities, and neovascularization in association with increasing DR severity. Peripheral nonperfusion and neovascular changes were detected beyond the scope of standard 12 × 12-mm scan areas. Conclusions: Ultra-widefield SS-OCTA is effective in noninvasively detecting peripheral retinal lesions such as ischemia and neovascularization. This technology offers potential to refine DR staging, improve risk stratification, and guide earlier clinical interventions.