Prognostic relevance of optical coherence tomography angiography biomarkers in diabetic macular edema

Optical coherence tomography angiography (OCTA) enables visualization of the retinal capillary plexus structure at various depths, identifying flow density and microaneurysms from the deep capillary plexus (DCP) in diabetic retinopathy (DR) beyond the ability of fluorescein angiography (FA) [1,2]. Diabetic macular edema (DME) is one of the leading causes of vision loss in diabetic patients with a variable and temporary improvement in response to treatment [3]. In this scenario, recognizing particular OCTA features is crucial for identifying the prediction of DME that can be of paramount importance to establishing a better glycometabolic control and thus preventing DME development. Indeed, DME eyes with macular center involvement retaining a good visual acuity of 20/25 letters or better showed no significant differences in vision loss at 2 years in patients managed with aflibercept, laser photocoagulation, or observation [4]. In addition, another important role of OCTA consists in predicting the responsiveness to treatment [5].