The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 1, January/February 2018 Review Article

Multimodality Imaging in Diabetic Macular Edema

Acón, Dhariana; Wu, Lihteh

Author Information

From the *Asociación para Evitar la Ceguera, Hospital Luis Sanchez Bulnes. Mexico City, Mexico; and †Asociados de Mácula, Vítreo y Retina de Costa Rica, San José, Costa Rica.

Reprints: Lihteh Wu, MD, Asociados de Mácula, Vítreo y Retina de Costa Rica, Primer Piso Torre Mercedes Paseo Colón, San José, Costa Rica. E‑mail:


Throughout ophthalmic history it has been shown that progress has gone hand in hand with technological breakthroughs. In the past, fluorescein angiography and fundus photographs were the most commonly used imaging modalities in the management of diabetic macular edema (DME). Today, despite the moderate correlation between macular thickness and functional outcomes, spectral domain optical coherence tomography (SD-OCT) has become the DME workhorse in clinical practice. Several SD-OCT biomarkers have been looked at including presence of epiretinal membrane, vitreomacular adhesion, disorganization of the inner retinal layers, central macular thickness, integrity of the ellipsoid layer, and subretinal fluid, among others. Emerging imaging modalities include fundus autofluorescence, macular pigment optical density, fluorescence lifetime imaging ophthalmoscopy, OCT angiography, and adaptive optics. Technological advances in imaging of the posterior segment of the eye have enabled ophthalmologists to develop hypotheses about pathological mechanisms of disease, monitor disease progression, and assess response to treatment. Spectral domain OCT is the most commonly performed imaging modality in the management of DME. However, reliable biomarkers have yet to be identified. Machine learning may provide treatment algorithms based on multimodal imaging.

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