The document discusses diabetic retinopathy (DR) and the advancements in imaging technologies like ultra-wide field (UWF) imaging that enhance the classification and diagnosis of DR and diabetic maculopathy. It highlights the limitations of traditional methods, noting how UWF can capture a greater percentage of lesions and improve prognostic outcomes. Additionally, it details OCT-based classifications and the importance of various morphological features in assessing DR and planning surgical interventions.

1. Navigating the
Complexities of
Diabetic Retinopathy
Mohamed ELShafie
Lecturer of ophthalmology
Harvard Medical School Almuni
Director of training unit

4. Diabetic Retinopathy
Classification

7. Reproducible, Well validated,
and are Robust in Prediction of important
outcomes
Limitations
• Rely only on 7 standard field photographs (30% of the retina)
• DR classification system prognosticates the risk of progression to PDR and does not effectively

12. Ultra-Wide Field Imaging
ü Images of up to 200º of the retina (80%).
ü Screening
• May not require mydriasis
• 133º-200º with 1 single image (vs. 30º-50º standard cameras).
ü UWF imaging vs 7 ETDRS fields
à15% greater DR stage
ü Predominantly peripheral lesions
• >50% of lesions outside 7 ETDRS fields
• X 3.2 progression of 2 steps DR
• X 4.7 progression into PROLIFERATIVE DR

14. Diabetic Maculopathy
Classification

15. OCT-based classification
• Depending on the morphology of the edema (E)
• E1: diffuse thickening (spongiform) without cysts
• E2: cystic thickening
• E3: detachment of the neuroepithelium
• Depending on the existence of vitreomacular traction (T)
• T0: absence of preretinal hyperreflectivities
• T1: presence of hyperreflective line adhered to the retina without traction
• T2: hyperreflective line with multiple traction points
• T3: hyperreflective line with anteroposterior traction in “gull wings”

18. DISORGANIZATIO
N OF INTERNAL
RETINAL LAYERS
D R I L

19. DISORGANIZATION
OF OUTER RETINAL
LAYERS
D R O L

21. OCT /OCTA
Imaging
Fluid:
• Intra or subretinal
• Hyperreflective material
• Confluent cystic spaces

25. • Suspended Scattering Particles In
Motion
(SSPiM)

26. OCT/OCTA
Imaging
Microaneurysm:
• Hyperreflective contour & Continuous .. No
leakage
• Loss of continuity … leakage

27. • OCT delineate the capsular structure,
hyperreflective spots, and location of
microaneurysms
• Microaneurysms with the ring sign
were positively correlated with
exudation

28. OCT /OCTA
Imaging
Hard Exudate
• Hyperreflective foci leading to exudation
• When central involvement, severe vision loss

30. Cotton Wool Spot
Paracentral Acute Middle Maculopathy (PAMM)

36. OCT /OCTA
Imaging
Proliferation
Surgical planning
• New vessels vs IRMA