OCT Angiography: The Next Step in Retinal Imaging Jonathan Zelenak D.O. Hillsdale Hospital Michigan State University
Overview Evolution of OCT How does OCT angiography work? Clinical examples Potential future applications
Zeiss Stratus Time domain Zeiss Cirrus 3000 Spectral domain Zeiss Cirrus 5000 HD Spectral domain Evolution of OCT
OCT Angiography: How it works?
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
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
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
Clinical Examples: Diabetic Retinopathy
Traditional FA vs OCT Angiography
BRAO
Peripapillary CNV in Pregnancy
Macular Telangiectasia
Retinal Artery Macroaneurysm
Retinal Artery Macroaneurysm
Hypertensive Retinopathy
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.
COOL Lab: Center for Ophthalmic Optics and Lasers Glaucoma Earlier diagnosis by detecting abnormalities in ONH perfusion and loss of microcirculation.
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.
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.
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
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. 2015 May;56(5):3287 91. 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;133:1045 52 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 2014. doi: 10.1016/j.ophtha.2014.01.034. 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 2015. 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;98:1368 1373. 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):1864 71.
Thank You!