CASE 2

History

54-year-old black female presents for a diabetic eye exam. Type 2 diabetes mellitus x 19 years. Blood sugar 104. BCVA 20/25 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Widening and irregularity of the FAZ (red arrow); microaneurysm formation (red circles) juxtafoveally; areas of nonperfusion (white circles); overall decrease in vascular density; motion artifacts (yellow arrows)
   
2. En face structural OCT (SCP): Exudate and hemorrhaging (red arrow); motion artifact (yellow arrow)
   
3. Vessel density map (DCP): Diffuse ischemia. Note the presence of cool colors (navy), indicating areas of nonperfusion.
   
4. B-scan structural OCT: Minimal diabetic retinopathy changes
   

   

CASE 3

History

45-year-old black female. Type 2 diabetes mellitus x 2 years. HbA1C 6.0. Visually asymptomatic.

Diagnostic Imaging

1. OCTA 3 x 3 OD (SCP and DCP): Mild enlargement of the FAZ (red arrows); juxtafoveal areas of nonperfusion (red circles); capillary congestion (**)
   
2. OCTA 3 x 3 OS (SCP and DCP): Mild enlargement of the FAZ (red arrows); juxtafoveal areas of nonperfusion (red circles)
   
3. B-scan structural OCT: Minimal diabetic retinopathy changes

CASE 4

History

60-year-old black female presents for a diabetic eye exam. Type 2 diabetes mellitus x 10 years. Blood sugar 180. Decreased vision in left eye x 6 months. BCVA 20/60 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Enlargement of the FAZ (red arrow); microaneurysms (red circle); juxtafoveal areas of nonperfusion (white circles); overall decrease in vascular density (**); widespread ischemia
   
2. Fundus photography: Diffuse exudation (green arrow); scattered hemorrhages; macular edema
   
3. En face structural OCT (DCP): Excellent visualization of exudation, hemorrhaging, and edema (yellow arrow)
   
4. B-scan structural OCT: Diabetic macular edema (DME; blue arrow); intraretinal hemorrhages, cysts, and exudates (*); neurosensory detachment (**)

CASE 5

History

71-year-old black female with decreased vision in right eye x 5 months. Type 2 diabetes mellitus x 16 years. Blood sugar 146. BCVA 20/30 OD.

Diagnostic Imaging

CASE 6

History

61-year-old black female presents for a diabetic eye examination and has no visual complaints. Type 2 diabetes mellitus x 14 years. Blood sugar 123 and HbA1C 6.5. BCVA 20/20 OS.

Diagnostic Imaging

1. OCTA 3 x 3 (SCP and DCP): Enlargement of the FAZ (red arrows); juxtafoveal areas of nonperfusion (white circles); overall diminution in capillary density; telangiectatic vessels (white arrow)
   
2. Vessel density map (SCP): Note the enlargement of the FAZ and patches of nonperfusion, as illustrated by blue coloration.
   
3. En face structural OCT (DCP): Hemorrhages and exudates (yellow arrow)
   
4. B-scan structural OCT: Focal hyper-reflectivity from hard exudate (green arrow)

CASE 7

History

46-year-old black female presents for a comprehensive eye examination and has no visual complaints. Type 2 diabetes mellitus x 30 years. Blood sugar 121 and HbA1C 6.7. BCVA 20/20 OD.

Diagnostic Imaging

1. OCTA 3 x 3 (SCP and DCP): Enlargement of the FAZ (red arrows); widespread juxtafoveal capillary nonperfusion (white circles); microaneurysm formation (red circles)
   
2. OCTA/FAZ analysis: (Left) FAZ of this patient; (right) FAZ of control. Note the marked enlargement of the FAZ in the diabetic patient.
   
3. B-scan structural OCT: Minimal evidence of diabetic retinopathy

CASE 8

History

65-year-old black female has no visual complaints. Type 2 diabetes mellitus x 20 years. Blood sugar 168 and HbA1C 7.0. BCVA 20/20 OD.

Diagnostic Imaging

CASE 9

History

73-year-old black female has no visual complaints. Type 2 diabetes mellitus x 13 years. Blood sugar 132.

Diagnostic Imaging

CASE 10

History

38-year-old Hispanic male. Type 1 diabetes mellitus x 15 years. Blood sugar 103. BCVA 20/20 OS.

Diagnostic Imaging

1. OCTA 6 x 6 OS (SCP and DCP): The dense capillary network is consistent with a young patient profile. Scattered pockets of nonperfusion (red circles). Artifact (yellow arrow).
   
2. En face structural OCT (SCP and DCP): Hemorrhage and exudate (red arrow); artifact (yellow arrow)
   
3. B-scan structural OCT: Minimal diabetic retinopathy changes

CASE 11

History

67-year-old black male presents for an annual eye examination. Type 2 diabetes mellitus x 6 years. Blood sugar 124. BCVA 20/25 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Normal FAZ shape and size; small pockets of juxtafoveal nonperfusion (red circles)
   
2. OCTA 3 x 3 (SCP and DCP): The magnified view of the FAZ illustrates a slight enlargement (red arrow). Juxtafoveal areas of nonperfusion (red circles). Capillary congestion (**). Microaneurysm (white circle).
   
3. B-scan structural OCT: Minimal diabetic retinopathy; vitreomacular adhesion (yellow arrow)

CASE 12

History

49-year-old black female. Newly diagnosed diabetic x 1 year. Blood sugar 82. BCVA 20/20 OS.

Diagnostic Imaging

CASE 13

History

62-year-old black male. Type 2 diabetes mellitus x 15 years. Blood sugar 150 and HbA1C 7.0. BCVA 20/25 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Pronounced irregularity of the FAZ (**). Extensive capillary nonperfusion (superior nasal to fovea) correlates with retinal edema (red arrow). Widespread capillary nonperfusion.
   
2. Color overlay angiogram: Visualization of nonperfusion throughout the DCP (purple) is greatest from superior nasal to fovea (yellow arrow).
   
3. Fundus photography: Circinate exudate (green arrow); hemorrhage; macular edema
   
4. B-scan structural OCT: Macular edema; exudate; hemorrhages (blue arrow)

CASE 14

History

68-year-old diabetic white male with hypertension x 14 years. BCVA 20/30 OS.

Diagnostic Imaging

1. OCTA 3 x 3 OD and OS (SCP and DCP): Irregularity and enlargement of the FAZ (*); generalized areas of nonperfusion (red circles); telangiectatic vasculature (white circle)
   
2. B-scan structural OCT: Minimal diabetic retinopathy
   
3. Vessel density map (SCP): Widespread nonperfusion reflected by cool (blue) coloration within the scan.

CASE 15

History

53-year-old black male. Type 2 diabetes mellitus x 5 years. Blood sugar 267 and HbA1C 13. BCVA 20/20 OD.

Diagnostic Imaging

CASE 16

History

51-year-old black female. Type 2 diabetes mellitus x 2 years. Unknown blood sugar or HbA1C. BCVA 20/20 OS.

Diagnostic Imaging

CASE 17

History

48-year-old black female presents for a diabetic eye exam. Newly diagnosed diabetic. Unknown blood sugar or HbA1C. BCVA 20/20 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Enlargement and irregularity of the FAZ (red arrows); microaneurysms (red circles); capillary nonperfusion (white circles)
   
2. Three-dimensional (3D) fundus photography: Juxtafoveal exudate and hemorrhage (yellow arrow)
   
3. En face structural OCT (DCP): Exudate and hemorrhage (green arrow)
   
4. B-scan structural OCT: Cluster of exudate visible in inner retina (blue arrow); vitreomacular adhesion (*)

CASE 18

History

38-year-old Hispanic male. Type 1 diabetes mellitus x 15 years. Blood sugar 103.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): The dense capillary network is consistent with a young patient profile. Slight irregularity of the FAZ (red arrows). Scattered pockets of nonperfusion (red circles).
   
2. En face structural OCT (SCP and DCP): Exudates and hemorrhages (yellow arrows)
   
3. B-scan structural OCT: Hyper-reflective patch of exudate within inner retina (green arrow)

CASE 21

History

64-year-old black female presents for a diabetic eye exam. Type 2 diabetes mellitus x 3 years. Blood sugar 98 and HbA1C 5.6. BCVA 20/25 OD.

Diagnostic Imaging

1. OCTA 3 x 3 (SCP and DCP): Enlargement of the FAZ is the most visible inferiorly (red arrow) and correlates with a cystic space on the B-scan. Areas of nonperfusion surround the FAZ (red circles). Vascular congestion and tortuosity (*) were noted in the DCP.
   
2. OCTA 6 x 6 (SCP and DCP): Wider field of view; less magnification; highlights the extent of capillary nonperfusion and the aforementioned changes
   
3. B-scan structural OCT: A cystic space was noted infratemporally to the macula (yellow arrow). Center-involving DME.

CASE 22

History

65-year-old black male. Asymptomatic. Type 2 diabetes x 15 years. Blood sugar 90. BCVA 20/20 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Generalized reduction in vascular density; remodeling of capillary beds; enlargement of the FAZ (*); microaneurysms (red circle); traction on vasculature from the ERM (white arrows); intraretinal microvascular abnormality (IRMA; white circles)
   
2. Vessel density map (SCP): Excellent visualization of ischemic maculopathy and generalized reduction in vascular density (red arrow). The cool colors reflect the lack of perfusion.
   
3. En face structural OCT (DCP): Parafoveal exudate and hemorrhage (red arrow); cystoid edema centrally located (*); artifact (yellow arrow)
   
4. B-scan structural OCT: Intraretinal hemorrhage and exudate (green arrow); center-involving DME (*); ERM (blue arrow)

CASE 23

History

55-year-old white male with blurry vision in right eye. Type 2 diabetes mellitus x 12 years. Blood sugar 275 and HbA1C 10.10.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Diffuse capillary nonperfusion (white circles) with overall reduction in capillary density; microaneurysms (red circles)
   
2. Fundus photography: Hemorrhages; CWS; exudate
   
3. En face structural OCT (DCP): Scattered hemorrhaging and exudate (yellow arrow)
   
4. B-scan structural OCT: Center-involving DME; cystoid pockets, exudate, and hemorrhage (green arrow)

CASE 24

History

52-year-old black male with decreased vision in right eye. Type 2 diabetes mellitus x 17 years. Blood sugar 105. BCVA 20/100 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Ischemic maculopathy; enlargement of the FAZ (red arrows); IRMAs (white circles); multiple pockets of capillary nonperfusion (red circles); overall reduction in capillary density
   
2. En face structural OCT (SCP and DCP): Cystoid macular edema (red arrows); exudate and hemorrhage (yellow arrow)
   
3. B-scan structural OCT: Cystoid macular edema; exudate and hemorrhage (*); center-involving DME (green arrow); neurosensory detachment (**)

CASE 25

History

68-year-old black female with blurry vision. Type 2 diabetes mellitus x 9 years. Blood sugar 105. BCVA 20/60 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Enlargement of the FAZ (red arrow) and overall reduction in vessel density. Microaneurysms (red circles). Intraretinal cystic spaces altered the DCP, showing diffuse vascular anomalies and congestion. Capillary dilatation and diffuse remodeling (white circles).
   
2. En face structural OCT (DCP): The dark pockets represent cystoid macular edema (yellow arrow) and are surrounded by hemorrhages and abnormal vasculature.
   
3. B-scan structural OCT: Center-involving DME; large cystoid pockets of fluid (green arrow)

CASE 26

History

65-year-old black male with reduced vision in left eye. Type 2 diabetes mellitus x 7 years. Blood sugar 128.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Enlargement and irregularity of the FAZ (red arrow); overall reduction in capillary density; microaneurysms (red circle); capillary dilatation and remodeling (*)
   
2. En face structural OCT (DCP): Heavy perifoveal exudate and hemorrhage (yellow arrow)
   
3. Fundus photography: Minimal exudates and hemorrhage in perifoveal area (green arrow)
   
4. B-scan structural OCT: Cystic spaces at fovea (blue arrow); hemorrhages and exudates (*)

CASE 27

History

74-year-old black female with blurry vision in right eye. Type 2 diabetes mellitus x 32 years. Blood sugar 112. BCVA 20/30 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Ischemic maculopathy; enlargement of the FAZ (red arrow); microaneurysm formation (red circles); pockets of nonperfusion (white circles); overall reduction in vessel density; capillary remodeling (yellow arrow)
   
2. En face structural OCT: Cystoid macular edema; hemorrhage and exudate foveally and parafoveally (green arrows)
   
3. B-scan structural OCT: Center-involving DME; cystic space (blue arrow); hemorrhage and exudate (*)

CASE 30

History

67-year-old black male complains of new floaters of 2 months duration. Type 2 diabetes mellitus x 17 years. Blood sugar 185 and HbA1C 9.0. BCVA 20/60 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP): Widespread capillary nonperfusion. Multiple pockets of nonperfusion (red arrows). Microaneurysms (red circles). Intraretinal microvascular abnormalities (yellow circles). The absence of the FAZ is consistent with retinal thickening due to the overlying ERM.
   
2. B-scan structural OCT: Epiretinal membrane with vitreomacular adhesion (yellow arrows); cystoid macular edema; thickening (*)

CASE 31

History

54-year-old black male. Type 2 diabetes mellitus x 4 years. Blood sugar 140. BCVA 20/40 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP): Capillary nonperfusion (*); enlargement of the FAZ (red arrow); IRMAs (yellow circles); microaneurysms (red circles)
   
2. Color overlay OCTA: White represents superficial capillary vasculature; purple represents deep capillary vasculature. Note the lack of homogeneity in the DCP, indicating severe areas of nonperfusion (red arrows).
   
3. B-scan structural OCT: Nonproliferative diabetic retinopathy

CASE 35

History

65-year-old black male presents for a diabetic eye exam. Type 2 diabetes mellitus x 20 years. Blood sugar 340 and unknown HbA1C. BCVA 20/30 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (vitreous and nerve head): The fine abnormal vessels that are visible in the vitreous slab indicate extension of the abnormal vasculature into the vitreoretinal interface (red arrow). Excellent visualization of neovascularization on optic nerve slab (red arrow).
   
2. B-scan structural OCT: Fibrovascular proliferation through ONH canal (green arrow)
   
3. B-scan structural OCT with flow overlay: The red pixelation evident within the abnormal fibrous proliferation is indicative of neovascular activity (blue arrow).
   
4. ONH photography: Fragile lacy vessels on the temporal surface of the ONH (yellow arrow)

CASE 36

History

71-year-old black male. Type 2 diabetes mellitus x 33 years with uncontrolled blood sugar. BCVA 20/50 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (vitreous): Extensive NVD; vascular extension into vitreous cavity (yellow circle)
   
2. B-scan structural OCT with flow overlay: Segmentation is set at vitreoretinal interface (red arrows). The red pixelation coursing through the fibrosis indicates neovascularization within (white arrow).
   
3. Fundus photography: Neovascularization of the disc extends superior and inferior. Tractional retinal detachment and preretinal hemorrhages; scattered hemorrhages, exudates, and CWS
   
4. OCTA montage: Visualization of ONH, macula, and retinal blood vessels in one view. Excellent overview of proliferative disease affecting entire posterior pole. Foveal neovascularization is evident at the border of the FAZ (yellow arrow).

CASE 38

History

68-year-old white male. Type 2 diabetes mellitus x 14 years and hypertension. Unknown blood sugar or HbA1C. BCVA 20/30 OD.

Diagnostic Imaging

1. OCTA 3 x 3 (SCP and DCP): Ischemic maculopathy; enlargement and irregularity of the FAZ (red arrows); vessel anastomoses and collateral circulation (*); marked capillary nonperfusion in area of occlusion (red circles)
   
2. En face structural OCT (SCP and DCP): Hemorrhaging and anomalous vasculature (*)
   
3. B-scan structural OCT: Unremarkable findings

CASE 39

History

60-year-old black male with decreased vision in right eye. History of retinal tear superior temporal—status post laser. Pseudophakic. BCVA 20/25 OD.

Diagnostic Imaging

1. OCTA 3 x 3 (SCP and DCP): Ischemia in area of occlusion (red arrows). Anastomoses and collateral circulation form at the borders of the ischemic areas (*). Capillary dilatation and truncation.
   
2. En face structural OCT (SCP and DCP): Vessel alteration in occluded region (yellow arrow); hemorrhage (*)
   
3. B-scan structural OCT: Retinal thickening and edema correspond to the area of occlusion (green arrow).

CASE 43

History

59-year-old black male. Floaters x 1 week. Hypertension x 22 years. History of hemi-retinal vein occlusion in left eye. BCVA 20/20 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Superior/superior temporal area of nonperfusion is consistent with vascular occlusion (red arrow). Anastomoses and collateralization throughout images (yellow arrows).
   
2. OCTA montage: Generalized ischemia throughout posterior pole; most pronounced temporal/superior temporal; excellent visualization of collaterals and anomalous posterior pole
   
3. Fundus photography: Vascular occlusion superior temporal arcade; pronounced collateralization adjacent to optic nerve and temporal to macula (green arrows)

CASE 45

History

54-year-old hypertensive white female presents with “splattered-like” film over vision in left eye x 1 day. BCVA 20/60 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Generalized reduction in capillary perfusion (DCP more than SCP). Large pockets of nonperfusion (red circles). Enlargement of the FAZ. Widening and distortion of the capillary networks (*) are present in areas of retinal edema.
   
2. En face structural OCT (DCP): Intraretinal edema (yellow arrow); flame and dot hemorrhages (*)
   
3. Fundus photography: Central retinal vein occlusion and widespread hemorrhages; neurosensory detachment (red arrow)
   
4. B-scan structural OCT with flow overlay: Diffuse retinal thickening (green arrow) and cystic changes; subretinal fluid (*)

CASE 46

History

59-year-old black male presents with decrease in central vision in left eye x 2 months. Type 2 diabetes mellitus and hypertension x 4 years. BCVA 20/200 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Irregularity and enlargement of the FAZ (red arrow); decreased vascular density in the DCP; abnormal (truncated) collateral networks (*); areas of nonperfusion (white circles); vascular dilatation and tortuosity (red circle)
   
2. Fundus photography: Diffuse hemorrhages are consistent with central retinal vein occlusion. Abnormal ONH vasculature with sectoral edema.
   
3. En face structural OCT (DCP): Cystoid macular edema (yellow arrow); widespread hemorrhages
   
4. B-scan structural OCT: Center-involving cystoid macular edema (green arrow); subretinal fluid (*)

CASE 51

History

43-year-old black male with bilateral decreased vision x 1 year. BCVA 20/60 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Superficial puckering is not affecting vascular perfusion to the inner capillary network.
   
2. En face structural OCT (SCP): Traction is visible nasal to partial thickness hole (red arrow).
   
3. Fundus photography: Partial thickness macular hole (yellow arrow); ERM
   
4. B-scan structural OCT: Lamellar hole (green arrow); ERM; vitreomacular adhesion (*)

CASE 55

History

68-year-old hypertensive black male presents with recent onset blurry vision in left eye. BCVA 20/60 OS.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Early telangiectatic changes of the DCP temporal to the fovea (red arrow); mild temporal ectatic capillaries at the SCP (yellow arrow)
   
2. B-scan structural OCT: Cystic hypo-reflective cavities involving the inner and outer retina (red circles); disruption of the ellipsoid zone (green arrow)

CASE 56

History

68-year-old Hispanic female presents with complaints of bilateral near blur and “veil” nasally in left eye. Type 2 diabetes mellitus x 3 years and hypertension. BCVA 20/30 OD.

Diagnostic Imaging

1. OCTA 6 x 6 (SCP and DCP): Right-angled draining venule at the 3-o’clock position (red arrow); adjacent localized vascular abnormalities (white circle); telangiectatic changes temporally (red circle)
   
2. B-scan structural OCT: Draping of ILM over cavitation (blue arrow); RPE migration; hyperplasia; atrophy of the RPE and choriocapillaris (red circle)
   
3. Fundus photography: Anomalous right-angled venules temporal to fovea; RPE plaques and retinal atrophy