10/17/2017. FDA Approved. Zeiss AngioPlex TM Optovue AngioVue TM

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1 Images retinal microvasculature without dye injection Displays structure and function from a single imaging system Standard of Care-2011 DFE, Fundus Photos, VF 10-2, SD-OCT, FAF, or mferg 2016-AAO Baseline DFE At 5 years Annual screening:vf 10-2, SD-OCT Additional screening: merg, FAF Marmor MF, Kellner U, Lai TY, et al. Revised recommendations on screening for chloroquinine and hydroxychloroquinine retinopathy. Ophthalmology Feb;118(2): Retinal blood supply OCTA in disease Diabetic Retinopathy AMD Venous Occlusion Mac Tel II Other causes of CNV Choroidal Tumors Glaucoma FDA Approved Zeiss AngioPlex TM Optovue AngioVue TM OCTA uses motion contrast to detect flow from OCT data Rapidly acquires multiple cross-sectional images from a single location on the retina Flow is the difference in signal between two sequential B-scans 1

2 See retinal vasculature without referring patients out of the practice Visualize signs of disease earlier and make more intelligent referrals Manage more pathology to keep patients in the practice longer Elevate the practice with state-of-the-art imaging technology Longer Data Acquisition Times needed for multiple B-scan repeats (to boost OCTA flow signal) Motion Artifacts in OCTA Images caused by patient motion, fixation shifts and microsaccades Projection Artifacts caused by shadow projection of vessels above Observing dry AMD for conversion to wet Monitoring diabetic patients Visualizing vascularization in PEDs Identifying CNV in central serous Venous Occlusions Examining glaucoma patients for vascular changes 2

3 Spaide RF, Klancnik JM, Cooney MJ, Retinal Vascular Layers Imaged by Fluorescein Angiography and Optical Coherence Tomography Angiography, JAMA Ophthalmol, 2015;133: Delineation and quantification of nonperfusion Ischemic vs non ischemic? BRVO: Risk of post segment neo and vitreous/preretinal hemorrhage? CRVO: Risk of ant segment neo and NVG? Visualization of macular ischemia Improved visualization of collaterals Depth localization of abnormalities Visualization of deep capillary telangiectasias Earlier detection of posterior segment neo 3

4 Comparison of fluorescein angiography image (a) in branch retinal vein occlusion with that of optical coherence tomography angiography (OCTA) images obtained at the superficial (b) and deep (c) retinal plexus. Ischemic area due to capillary drop out is better delineated using OCTA. However, leaking vessels due to neovascularization are not identified using OCTA. Neurodegenerative disease play a central role (loss of Muller cells) Ectatic capillaries Atrophy of the neurosensory retina Depletion of the macular pigment Dilated macular venules and arterioles with right angle bends Hyperplastic plaques of the RPE Neovascularization Multimodal Imaging of Macular Telangiectasia Type 2: Focus on Vascular Changes Using Optical Coherence Tomography Angiography Lisa Toto,1 Luca Di Antonio,1 Rodolfo Mastropasqua,2 Peter A. Mattei,1 Paolo Carpineto,1 Enrico Borrelli,1 Marco Rispoli,3 Br uno Lumbroso,3 and Leonardo Mastropasqua1 1Department of Medicine and Science of Aging, Ophthalmology Clinic, University G. d Annunzio Chieti-Pescara, Chieti, Italy 2Ophthalmology Clinic, University of Verona, Verona, Italy 3Italian Macular Center, Rome, Italy Multimodal Imaging of Macular Telangiectasia Type 2: Focus on Vascular Changes Using Optical Coherence Tomography Angiography Lisa Toto,1 Luca Di Antonio,1 Rodolfo Mastropasqua,2 Peter A. Mattei,1 Paolo Carpineto,1 Enrico Borrelli,1 Marco Rispoli,3 Bruno Lumbroso,3 and Leonardo Mastropasqua1 1Department of Medicine and Science of Aging, Ophthalmology Clinic, University G. d Annunzio Chieti-Pescara, Chieti, Italy 2Ophthalmology Clinic, University of Verona, Verona, Italy 3Italian Macular Center, Rome, Italy 4

5 Type 2 DM within 1 year 5-10% will have retinopathy Among patients with type 1 diabetes, 25%, 60% and 80% will have retinopathy after 5, 10 and 15 years of disease. Among patients with type 2 diabetes, 40% who use insulin and 24% who do not use insulin will have retinopathy at five years; the proportions will increase to 84% and 53%, respectively, at 19 years. Jason Noble MD.CMAJ Oct 19; 182(15): Sub clinical diabetic retinopathy detection Highlight and localize vascular abnormalities (IRMA, vascular loops, etc.) Detection and localization of non perfusion Detailed evaluation of FAZ Visualize vascular abnormalities within the deep plexus Differentiate IRMA from early NVE Localization of microaneurysms Early detection of PDR Precise definition of PDR Follow response to treatment IRMA 5

6 Choroidal ischemia detection/quantification Dry vs Wet and detection of CNV Quantify responsiveness to treatment Assess need for retreatment Detect quiescent (inactive) CNV membranes 6

7 Retinal OCT Thank You!! 7