There is a fascinating new eye test for patients with diabetes. It can detect diabetic retinopathy three years earlier than a conventional diabetic eye exam. It is a picture of tiny eye arteries, and it gives you the same information as a retinal angiogram. The pictures are even better, and the test is totally non-invasive. The short name for it is OCTA. That stands for optical coherence tomography angiography. It is a great test for microvascular disease.
Look at the normal picture in the images above. Let’s focus on the left image. There are no arteries at all in the central black spot which is very well defined. You can see arteries down to the very smallest ones. Now look at the left moderate DR (diabetic retinopathy picture). You can easily see that the black area in the middle is larger and more ragged. There are other black areas outside that spot meaning there are no arteries. Now look at the severe DR picture. There is much more area without any arteries at all. That reduces blood flow to the retina. If there is microvascular disease in the eye, it is very likely there is microvascular disease in other organs too and that blood flow is reduced to those organs as well.
The ability to detect diabetic eye disease three years earlier is a tremendous advantage. It usually takes a few years to develop diabetic eye disease. In type 1 diabetes, it takes an average of five years to develop. It may appear three years into the disease. It is important to discover diabetic eye disease as early as possible because it is a great opportunity to engage patients in more effective care. Optimal medical therapy for diabetes cuts the need for more aggressive treatments for diabetic eye damage in half. If you have type 2 diabetes and you are on OMT, you are one third as likely to lose the vision in one eye. If your retinopathy progresses, you won’t like it. The most common treatment to slow down diabetic eye damage in our country is to get an injection directly into the affected eye once a month. These injections cost up to $2000 each. Some people have disease in both eyes. That is $4000 a month.
OCTA is so important because it allows us to see the smallest arteries in the body noninvasively and without side effects. This is especially important because microvascular disease reflects a process that is going on throughout the body. It is not just in the eye. OCTA images show us that individuals with microvascular disease have tiny areas where there are fewer vessels and that means there is decreased blood supply. People with microvascular disease in the eye have microvascular disease in the heart, kidney, and lower extremities that contribute to heart attack, stroke, and lower limb amputation. This is especially true in women with repeated chest pain.
Women with repeated chest pain have more symptoms, more disability, and are much less likely to have large heart arteries that are blocked more than 50% compared to men when evaluated for chest discomfort. It takes a blockage of 70% to justify a stent or heart artery bypass. Microvascular disease is a common cause of chest pain in women. If a woman has repeated chest pain, no heart artery blockage over 50%, and an abnormal stress test, that is the likely problem. Microvascular heart disease is dangerous and disabling. Twenty-five percent of these women will die, have a heart attack, have a stroke, or develop congestive heart failure within ten years. Because they have no blockages in the large heart arteries, they are often told they don’t have heart trouble and they don’t receive the only treatment that matters—optimal medical therapy.
OCTA does not merely reflect the condition of the eye. It reflects the condition of the microvasculature of the entire body. Mechanically opening arteries is not a solution in this setting, but optimal medical therapy (OMT) dramatically reduces heart attack, stroke, kidney disease progression, heart failure hospitalizations, amputations, and eye damage. An OCTA test that shows microvascular disease provides a great opportunity for improved patient engagement. It is a great opportunity to help them understand they have artery disease, they are in danger, and it is important to begin optimal medical therapy for vascular disease.
Dr. Bestermann, I can't remember if I've already mentioned this to you. But at the beginning of the year your emails started showing up in my promotions folder and not my inbox. I've tried to move your mail to my primary box but it keeps moving back into promotions. I get hundreds of emails each day unfortunately- out of control! I usually simply delete the promotions barely looking at them. Just too many. But I wanted you to know something has changed and your mails are not coming to my primary box anymore despite my actions to label them "primary".
I agree that in the end it all goes back to our cardiovascular system- eyes and all. But interesting test!
Thank you for sharing this information