OCT Angiography: The Next Step in Retinal Imaging Jonathan Zelenak D.O.
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1 OCT Angiography: The Next Step in Retinal Imaging Jonathan Zelenak D.O. Hillsdale Hospital Michigan State University
2 Overview Evolution of OCT How does OCT angiography work? Clinical examples Potential future applications
3 Zeiss Stratus Time domain Zeiss Cirrus 3000 Spectral domain Zeiss Cirrus 5000 HD Spectral domain Evolution of OCT
4 OCT Angiography: How it works?
5 OCT Angiography: How it works? Multiple B scans taken of same location, changes between identical images = motion factor Theoretically, only the motion of red blood cells changes between images; this is used to create vasculature images
6 OCT Angiography: Our machine Zeiss Cirrus 5000 with AngioPlex Combination of amplitude decorrelation and phase variance Other Algorithms Swept speed, Swept Source Amplitude decorrelation Speckle variance Phase variance
7 OCT Angiography Pros Greater detail of vascular anatomy Able to see anatomy from various levels independently No dye / injection needed Faster than traditional FA Cons Currently unable to show functional defects as seen in traditional FA, such as leakage and staining Smaller field of view than FA Cost of machine / software Currently no reimbursement changes expected
8 Clinical Examples: Diabetic Retinopathy
9 Traditional FA vs OCT Angiography
10
11 BRAO
12
13 Peripapillary CNV in Pregnancy
14
15 Macular Telangiectasia
16
17 Retinal Artery Macroaneurysm
18 Retinal Artery Macroaneurysm
19 Hypertensive Retinopathy
20 Dr. David Huang: Co Inventor of OCT. Oregon Health & Science University Casey Eye Institute in Portland, OR. Numerous studies published and currently underway developing and studying OCT angiography and anterior segment OCT technologies.
21 COOL Lab: Center for Ophthalmic Optics and Lasers Glaucoma Earlier diagnosis by detecting abnormalities in ONH perfusion and loss of microcirculation.
22 COOL Lab: Center for Ophthalmic Optics and Lasers Diabetic Retinopathy Identifying high risk biomarkers Total retinal blood flow Retinal arterial pulsatility Capillary dropout Earlier detection of subtle neovascularization.
23 COOL Lab: Center for Ophthalmic Optics and Lasers ARMD Imaging of CNV in detail never seen before. Improving our understanding of ARMD, its management and evaluation of individual responses to treatment.
24 COOL Lab: Center for Ophthalmic Optics and Lasers What else is in the future? Structural/ Functional OCT angiography OCT angiography of optic nerve and parafovea for identifying multiple sclerosis Keratoconus and post LASIK corneal ectasia OCT based IOL calculations OCT guided femtosecond laser surgery
25 References Pechauer AD, Jia Y, Liu L, Gao SS, Jiang C, Huang D. Optical coherence tomography angiography of peripapillary retinal blood flow in response to hyperoxia. Invest Ophthalmol Vis Sci May;56(5): Liu L, Jia Y, Takusagawa H, Pechauer AD, Edmunds B, Lombardi L, Davis E, Morrison JC. Huang D. Optical coherence tomography of the peripapillary retina in glaucoma. JAMA ophthalmology. 2015;133: Jia Y, Bailey ST, Wilson DJ, Tan O, Klein ML, Flaxel CJ, Potsaid B, Liu JJ, Lu CD, Kraus MF, Fujimoto JG, Huang D. Quantitative optical coherence tomography angiography of choroidal neovascularization in age related macular degeneration. Ophthalmology doi: /j.ophtha Zhang C, Bald M, Tang M, Li Y, Huang D. Interface quality of different corneal lamellar cut depths for femtosecond laser assisted lamellar anterior keratoplasty. J Cataract Refract Surg Wang X, Jia Y, Spain R, Potsaid B, Liu JJ, Baumann B, Hornegger J, Fujimoto JG, Wu Q, Huang D. Optical coherence tomography angiography of optic nerve head and parafovea in multiple sclerosis. Br J Ophthalmol 2014;98: Qin B, Chen S, Brass R, Li Y, Tang M, Zhang X, Wang X, Wang Q, Huang D. Keratoconus diagnosis with an optical coherence tomography based pachymetric scoring system. J Cataract Refract Surg 2013;39(12):
26 Thank You!
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