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Comparison of diabetic retinopathy classification using fluorescein angiography and optical coherence tomography angiography
  1. Mário Soares1,2,
  2. Catarina Neves1,
  3. Inês Pereira Marques1,
  4. Isabel Pires1,2,
  5. Christian Schwartz1,
  6. Miguel Ângelo Costa1,
  7. Torcato Santos1,
  8. Mary Durbin3,
  9. José Cunha-Vaz1,4
  1. 1AIBILI—Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
  2. 2Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
  3. 3Advanced Development, Carl Zeiss Meditec, Inc, Dublin, California, USA
  4. 4University of Coimbra, Coimbra, Portugal
  1. Correspondence to Mário Soares, AIBILI, Azinhaga de Santa Comba, Celas. Coimbra 3000-548, Portugal; mariosoares0001{at}


Purpose To analyse and compare the classification of eyes with diabetic retinopathy using fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) performed either with AngioPlex or AngioVue.

Methods This was an observational cross-sectional study of 50 eyes from 26 diabetic subjects. Two independent graders classified the FA angiograms, to assess the presence and severity of several characteristics according to the ETDRS Report 11, and a similar evaluation was performed for each 3×3 mm OCTA image from the superficial retinal layer and for the full retina slab.

Results Percentages of non-gradable images for the outline of foveal avascular zone (FAZ) in the central subfield (CSF) were 29.0% for FA, 12.0% for AngioVue and 3.0% for AngioPlex. For capillary loss, percentages of non-gradable images in the CSF were 25.0% for FA, 11% for AngioVue and 0.0% for AngioPlex. For the inner ring (IR), percentages of non-gradable images were 12.5% for FA, 11.5% for AngioVue and 0.5% for AngioPlex. Agreement between graders was substantial for outline of FAZ. For capillary loss, the agreement was fair for the CSF, and moderate for the IR.

Conclusions The OCTA allows better discrimination of the CSF and parafoveal macular microvasculature than FA, especially for FAZ disruption and capillary dropout, without the need of an intravenous injection of fluorescein. In addition, FA had also a higher number of non-gradable images. The OCTA can replace with advantage the FA, as a non-invasive and more sensitive procedure for detailed morphological evaluation of central macular vascular changes.

Trial registration number NCT02391558, Pre-results.

  • Retina
  • Imaging

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  • Contributors MS, CN, MD, MAC and JC-V researched data and wrote and edited the manuscript. MS, CN, IPM, IP, CS, MAC, TS, MD and JCV researched data, contributed to the discussion and review the manuscript. MAC analysed the data, contributed to the discussion and reviewed/edited the manuscript. MS, CN, MAC, MD and JCV contributed to the study design, discussion, review the manuscript and are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests JC-V reports grants from Carl Zeiss Meditec, outside the submitted work; and José Cunha-Vaz is consultant for Alimera Sciences, Allergan, Bayer, Gene Signal, Novartis, Pfizer, Precision Ocular, Roche, Sanofi-Aventis, Vifor Pharma and Carl Zeiss Meditec. MD reports employment from Carl Zeiss Meditec.

  • Patient consent Obtained.

  • Ethics approval National Ethics Committee for Clinical Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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