FA vs. OCTA? The status of OCTA, today. Fukuoka, JSOS 2016 Gerd Klose. Korobelnik J Fr Ophthalmol (2015)

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Cecilia Shaw
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1 FA vs. OCTA? The status of OCTA, today Korobelnik J Fr Ophthalmol (2015) Fukuoka, JSOS 2016 Gerd Klose 1

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3 FA / ICGA a well-founded Gold standard! Benefits Useful for many pathologies High contrast, detailed images Supports widefield imaging Choroidal imaging possible (w/ ICG) Well-established methodology 3

Effects: (nausea shock death) with many risk factors

4 FA / ICGA with a flip-side Invasive & dye-based! Patient Discomfort Higher Clinical Effort 5% Adverse Effects: (nausea shock death) with many risk factors (age, diabetes, allergies, organ insuffiencies, pregnancy ) 4

5 FA / ICGA with a flip-side There is a constant balance between the clinical need and the risk of the diagnosis! What if you could reduce the number of FA exams 5

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7 OCT Angiography sounds promising Presentations and Publications show so many nice images from OCT Angiography... providing fine structural details and 3D information non-invasive, quick and easy for patients & staff noncritical for sensitive patients, and allows frequent follow-ups 7

8 How does it work? Difference Bloodflow Average Structure 8

9 How does it work? Horizontal Vasculature Angio Cube Scans: 6x6 mm, 350 Ascans (17 um) 3x3 mm, 245 Ascans (12 um) Angio and Structure are complementary, you want to look at them side-by-side! 9

10 Quality Images require care at all levels Fast & Artifact-free Acquisition with Active tracking / Re-scan Reference Tracking (filtered) Amplitude & Phase Image Reconstruction Amplitude Phase Difference Zhang Q, et al., J. Biomed. Opt. 20(6), (2015) 10

11 Quality Images require care at all levels Post-Acquisition Multi-Step Motion Correction Correction of Projection Artifacts Corrected Deeper Retina 11

12 OCT-Angiography provides 3D information Choriocapillaris Slab Retina-Slab ILM to VRI- or Custom-Slab 70 um above RPE-fit Choroidor Custom-Slab Superficial Deeper Avascular 12

13 the Development will continue Quantification Larger Areas with Stitching ILM to Faster Swept-Source OCT-Angiography 70 um above RPE-fit 3x3 mm 6x6 mm 12 x12 mm Zhang Q, et al., J. Biomed. Opt. 20(6), (2015) / Dr. Philip J. Rosenfeld, BPEI / Dr. Y. Ito, Nagoya U 13

14 AngioPlex OCT Angiography simply another scan that works 14

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16 FA / OCTA how about clinical usability FA detects the presence of dye/blood OCTA detects the flow of blood It is not identical, but similar and both can be utilized to visualize vasculature, (but not leakage or pooling) Pathologies resulting in neo-vascularization, low- or non-perfusion, and occlusions can be visualized! Korobelnik J Fr Ophthalmol (2015) 16

17 FA / OCTA how about clinical aspects many Clinical Cases have already been presented and many more to come: Diabetic Retinopathy (prolific / non-prolific) (DR) Central/Branch Retinal Vessel Occlusion (BRVO/CRVO) Age-related Macular Degeneration (AMD) Polypoidal Choroidal Vasculopathy (PCV) Macular Telangiectasia (Mactel) Coats like Exudative Maculopathy Sickle Cell Maculopathy Ocular tumors Glaucoma 17

18 FA / OCTA DR + Micro-aneurysms + timely follow-up on photo-coagulation + novel combination treatment with anti-vegf + non-perfusion, ischemic areas + Visualization of Neo-vascularization - but often in periphery - limited sensitivity to aneurysms - limited cataract penetration no 100% FA replacement (yet) 18

19 FA / OCTA BRVO, CRVO, etc. + non-perfusion + detailed images of neo-vascularization + remodeling of vasculature + remodeling of vasculature + new treatment possibilities - limited in covered area & periphery - hemorrhages in acute phase - visibility of aneurysms, edema no 100% FA replacement (yet) 19

20 FA / OCTA Wet AMD & PCV + detailed visualization of CNV lesion + visualization of choroidal feeder trunk + GA acts as window to choroid + Treat and Extend follow-up with OCTA + Choroidal NV & polyps - limited in covered area - Treatment decision still triggered by Edema - Limited choroidal and small polyp visualization no 100% FA replacement (yet) 20

21 FA / OCTA Clinical benefits, today FA / ICGA is still needed! but in specific cases OCTA has already helped with differential diagnosis and improved treatment decisions and there are immediate, general benefits: non-invasive patient comfort & simplified clinical work 3D details potential improved treatment no dye risk reduction every FA replaced, helps enabling fast follow-up one last argument no doctor using OCTA wants to give it up afterwards! 21

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23 OCTA the future is bright the benefits are now, and only keep growing 23

Incorporating OCT Angiography Into Patient Care

Incorporating OCT Angiography Into Patient Care Beth A. Steele, OD, FAAO OCT A: Introduction Isolates microvascular circulation from OCT image data Axial resolution = 5 microns (i.e. fine capillaries visible)