Recent advances in imaging technologies for assessment of retinal diseases.

INTRODUCTION: Retinal imaging is a key investigation in ophthalmology. New devices continue to be created to keep up with the demand for better imaging modalities in this field. This review looks to highlight current trends and the future of retinal imaging. AREAS COVERED: This review looks at the advances in topographical imaging, photoacoustic microscopy, optical coherence tomography and molecular imaging. There is future scoping on further advances in retinal imaging. EXPERT OPINION: Retinal imaging continues to develop at a rapid pace to improve diagnosis and management of patients. We will see the development of big data to gain powerful insights and new technologies such as teleophthalmology mature in the future.

DETERMINING THE EFFECT OF DIABETES DURATION ON RETINAL AND CHOROIDAL THICKNESSES IN CHILDREN WITH TYPE 1 DIABETES MELLITUS.

PURPOSE: Determining the effect of diabetes mellitus duration on retinal and choroidal thicknesses in children with Type 1 diabetes mellitus (T1DM). METHODS: Children (aged 6-18 years) with Type 1 diabetes and no diabetic retinopathy and age-matched controls were examined using Topcon spectral domain optical coherence tomography. Choroidal thickness and retinal thickness in macula area were measured. The study group was divided into 3 subgroups depending on diabetes mellitus duration-Group 1: <5 years (n = 52), Group 2: 5 to 10 years (n = 39), and Group 3: >10 years (n = 30). RESULTS: One hundred and twenty-one diabetic children and 32 controls were included. The central choroidal thickness increased from 305.5 µm (SD: 61.7 µm) in the control group to 309.2 µm (SD: 70.1 µm) in Group 1, 315.2 µm (SD: 64.3 µm) in Group 2, and 367.4 µm (SD: 66.0 µm) in Group 3. Group 3 differed significantly from Group 1 (P = 0.0002), Group 2 (P = 0.0014), and the control group (P = 0.0003). The choroid-to-retina thickness ratio was lowest in controls, 1.01 (SD: 0.17), and highest in Group 3, 1.21 (SD: 0.2). Group 3 differed significantly from Group 1, Group 2, and the control group with P = 0.0002, P = 0.0014, and P = 0.0001, respectively. No retina thickening was found. CONCLUSION: Changes in the choroid may occur before the development of diabetic retinopathy and seem to progress with increasing diabetes mellitus duration despite the absence of diabetic retinopathy and without associated retina thickening. Choroidal thickness could be valuable for screening in diabetic children.

Enlargement of the foveal avascular zone detected by optical coherence tomography angiography in diabetic children without diabetic retinopathy.

PURPOSE: Evaluation of foveal avascular zone (FAZ) in children with diabetes (DM) using OCTA. METHODS: We examined 112 diabetic children without DR aged 6-18 years and 30 age-matched controls using Topcon OCT Angiography and measured FAZ in superficial (SCP) and deep capillary plexus (DCP). The study group was divided into three subgroups depending on DM duration group 1: < 5 years (n = 40), group 2: 5-10 years (n = 42), group 3: > 10 years (n = 30). RESULTS: The mean DCP FAZ increased with DM duration from 502.2 µm2 (SD 137.8) in group 1 to 523.9 µm2 (SD 159.2) in group 2 and 539.7 µm2 (SD 189.1) in group 3. Control group differed significantly from group 1 (p = 0.0120), group 2 (p = 0.0019) and group 3 (p = 0.0011). The mean DCP to SCP FAZ surface ratio was 1.88 (SD 0.68) in the study vs 1.58 (SD 0.48) in the control group (p = 0.0232). The DCP and SCP FAZ surface difference was 217.6 µm2 (SD 100.8 µm2) in diabetics vs. 124.2 µm2 (SD 72.8 µm2) in controls (p < 0.0001). In the control group, it was significantly smaller than in group 1 (p < 0.006), group 2 (p < 0.0001) and group 3 (p < 0.0001). CONCLUSIONS: Changes can be detected in FAZ of diabetic children before DR development which can be vital for screening.

Sex-Related Variations of Retinal and Choroidal Thickness and Foveal Avascular Zone in Healthy and Diabetic Children Assessed by Optical Coherence Tomography Imaging.

PURPOSE OF THE STUDY: The aim of this study was to investigate the presence of gender differences in the chorioretinal microvasculature of children with and without vascular pathology. METHODS: Healthy and type 1 diabetic children without diabetic retinopathy underwent optical coherence tomography angiography (OCTA) and structural OCT. We measured the foveal avascular zone (FAZ) area in the superficial capillary plexus (SCP) and deep CP (DCP), central retina, and choroid thickness. RESULTS: OCTA examination was conducted in 112 diabetic and 30 healthy children, and structural OCT in 121 diabetic children and 32 controls. DCP FAZ area in boys was significantly smaller than in girls both in diabetics (p = 0.0010) and healthy children (p = 0.0302). In diabetics, SCP FAZ area was significantly smaller in boys (p = 0.0006), analogically to controls (p = 0.0870). Central retinal thickness was significantly greater in boys compared with girls in diabetics (p = 0.0001) and controls (p = 0.1008). CONCLUSION: Significant differences exist in the FAZ area and retinal thickness between sexes, likely representing physiological differences. Different norms must be used for boys and girls regardless of diabetic status.

Recommendations for ultrasound examination in ophthalmology. Part II: Orbital ultrasound.

Pathological processes within the orbits are a heterogeneous group of diseases of various etiologies, clinical pictures and therapy models. Due to poor access to the orbits in a clinical examination, imaging plays a significant role in both diagnosis and treatment monitoring in patients with an orbital pathology. One of such imaging modalities is ultrasonography. It is relatively well-available, rapid and safe for the patient. This paper enumerates indications for an orbital ultrasound scan, including functional ocular disorders (vision disorders, mobility disorders), autoimmune diseases, inflammatory conditions, proliferative processes, and others. The authors present Ossoinig's standardized method which encompasses topographic, qualitative and kinetic echography, and may facilitate orbital ultrasound examinations. Moreover, the article shows management standards for ultrasound imaging of orbital pathologies with an emphasis on the relevance of equipment selection, scanning technique (transducer position, transocular technique, paraocular technique) and patient preparation for the examination, and indicates appropriate elements of an examination report. The authors discuss the ultrasound presentation of the orbital structures in physiological conditions and selected orbital pathologies, such as pseudotumor, thyroid orbitopathy, cancerous tumors of the optic nerve, and others. The ultrasonographic characteristics of the presented pathologies are shown taking into account A and B scans. Attention was paid to the evaluation of angle kappa in the A scan in echographic assessment of the orbits. Furthermore, the authors include referential values for extraocular muscle thickness and quantitative measurement of the severity of thyroid ophthalmopathy based on Ossoinig's muscle index.Pathological processes within the orbits are a heterogeneous group of diseases of various etiologies, clinical pictures and therapy models. Due to poor access to the orbits in a clinical examination, imaging plays a significant role in both diagnosis and treatment monitoring in patients with an orbital pathology. One of such imaging modalities is ultrasonography. It is relatively well-available, rapid and safe for the patient. This paper enumerates indications for an orbital ultrasound scan, including functional ocular disorders (vision disorders, mobility disorders), autoimmune diseases, inflammatory conditions, proliferative processes, and others. The authors present Ossoinig's standardized method which encompasses topographic, qualitative and kinetic echography, and may facilitate orbital ultrasound examinations. Moreover, the article shows management standards for ultrasound imaging of orbital pathologies with an emphasis on the relevance of equipment selection, scanning technique (transducer position, transocular technique, paraocular technique) and patient preparation for the examination, and indicates appropriate elements of an examination report. The authors discuss the ultrasound presentation of the orbital structures in physiological conditions and selected orbital pathologies, such as pseudotumor, thyroid orbitopathy, cancerous tumors of the optic nerve, and others. The ultrasonographic characteristics of the presented pathologies are shown taking into account A and B scans. Attention was paid to the evaluation of angle kappa in the A scan in echographic assessment of the orbits. Furthermore, the authors include referential values for extraocular muscle thickness and quantitative measurement of the severity of thyroid ophthalmopathy based on Ossoinig's muscle index.

Rubeosis iridis in patients with diabetes: not forgetting oculoischaemic syndrome as a differential.

This case illustrates an oculoischaemic syndrome presenting with iris neovascularisation in a patient with established diabetic retinopathy. It highlights the importance of considering the differential diagnosis of rubeosis in all patients, including those with an underlying vascular pathology. Moreover, it urges clinicians to consider the sequelae of a compromised vascular system, such as the iatrogenic central retinal artery occlusion as a result of intravitreal injections. Early diagnosis not only informs correct ophthalmic treatment, but is crucial in preventing ischaemic stroke and, therefore, reducing the risk of systemic morbidity and mortality.