title: The Evaluation of Diabetic Macular Ischemia Using Optical Coherence Tomography Angiography.
abstract: OBJECTIVE
  The purpose of this study was to compare optical coherence tomography (OCT) angiography to standard fluorescein angiography (FA) in the grading of diabetic macular ischemia.
  
  
  METHODS
  In our study, OCT angiography and traditional FA images were acquired from 24 diabetic patients. The level of diabetic macular ischemia in the superficial capillary plexus was graded with standard Early Treatment Diabetic Retinopathy Study (ETDRS) protocols and a comparison between conventional FA and OCT angiography was performed. The deep vascular plexus and choriocapillaris were also graded for macular ischemia. Additionally, flow indices were analyzed for all OCT angiography images.
  
  
  RESULTS
  We identified moderate agreement between diabetic macular ischemia grades for conventional FA and OCT angiography (weighted κ of 0.53 and 0.41). In addition, the intergrader agreement for the superficial, deep, and choriocapillaris scores was substantial (weighted κ of 0.65, 0.61, and 0.65, respectively). Finally, the parafoveal flow indices were shown to have a statistically significant relationship with diabetic macular ischemia grades for the superficial capillary plexus (P = 0.04) and choriocapillaris (P = 0.036), with a trend toward significance for the deep capillary plexus (P = 0.13).
  
  
  CONCLUSIONS
  We demonstrated moderate agreement between diabetic macular ischemia grading results for OCT angiography and conventional FA using standard ETDRS protocols. We also showed that OCT angiography images could be graded for diabetic macular ischemia with substantial intergrader agreement.
authors.affiliation: Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Bradley
authors.affiliation: Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom.
authors.forename: Dawn A
authors.initials: DA
authors.lastname: Sim
authors.affiliation: Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom.
authors.forename: Pearse A
authors.initials: PA
authors.lastname: Keane
authors.affiliation: Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom 2Hospital Garcia de Orta E.P.E., Almada, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Cardoso
authors.affiliation: Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Agrawal
authors.affiliation: Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom.
authors.forename: Adnan
authors.initials: A
authors.lastname: Tufail
authors.affiliation: Moorfields Eye Hospital NHS Foundation Trust London, United Kingdom.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Egan
mesh_terms: D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005654:Fundus Oculi; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology; D008266:Macula Lutea / Q000098:blood supply* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence / Q000379:methods*