OCT Angiography Brandon Lujan, MD Medical Director, Casey Reading Center Assistant Professor of Ophthalmology Financial Disclosures: Genentech (Consultant, Grant support, Educational training) UC Berkeley (Patent) No financial relationships with any OCT companies 2016 UCSF Ophthalmology Update Pre-Test: Which one is Correct? 1. OCTA will soon replace Fluorescein Angiography 2. OCTA frequently provides findings key to clinical decision-making David Huang, MD, PhD Yali Jia, PhD Yan Li, PhD Gangjun Liu, Ou Tan, PhD Maolong Tang, Xinbo Zhang, PhD PhD PhD 3. OCTA is a mature technology 4. OCTA is an abbreviation for Optical Coherence Tomography Angiography Acner Camino Benech, PhD Simon S. Gao, PhD Ahmed Hagag, MS Kelsey Hoffman, COA Liang Liu, MD David Poole, COT Denny Romfh, OD Omkar Thaware, OD Kathleen S. Torok, MA Jie Wang, MS Jianlong Yang, PhD Pengxiao Zang, MS 1
Superficial Retinal Capillary Plexuses Courtesy of Dave Wilson, MD Casey Eye Institute Nerve Fiber Layer Ganglion Cell Layer Radial NFL GCL INL Retinal Capillary Plexuses Intermediate Inner Nuclear Layer Deep Ern Zi Tan et al, 2012 5 2
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Optical Coherence Tomography Angiography Decorrelation Signals Simple Standard Deviation Map 4
FDA-Approved Commercial OCTA Systems Zeiss Angioplex Several more on the way... Optovue Avanti Zeiss Optovue Angioplex Avanti 45yo CRVO 20/25 5
20/25 Baseline Inject 20/20 +6W Observe 20/25 +12W Inject 20/25 +18W Inject +24W 20/16* Observe +24W: Temporal ischemia with new scotoma Inner retinal atrophy Inner and middle retinal ischemia / atrophy +18W +24W 6
OCTA OCTA Angiography Fluorescein Angiography +18W +24W Many capillaries better visualized on OCTA...but not with slow flow! Depth Encoding MacTel Type 2 Phase-Variance OCT Angiography Fluorescein Angiogram 00:37 Courtesy of Philip Rosenfeld, MD, PhD Zeiss AngioPlex Schwartz DM et al, 2014 7
Artifacts in OCTA B-scans Consequence of decorrelation "shadows" Artifacts in OCTA Slabs Consequence of decorrelation "shadows" Superficial plexus Intermediate plexus Decorrelation: Real Graph-based segmentation Real Vessels Decorrelation: Artifact Vitreous-ILM Above IPL-INL Below IPL-INL Below sopl RPE-BM Structural OCT Inner retinal flow Outer retinal flow Choroidal flow Zhang M, et al. 2016 Deep plexus Outer retina Normal Retinal Anatomy suppression by simple Slab Subtraction Graph-based segmentation Superficial plexus Real Vessels Intermediate plexus Fragment suppression by amplitude filtering: -Resolved OCTA Graph-based segmentation Superficial plexus Real Vessels Intermediate plexus Vitreous-ILM Above IPL-INL Below IPL-INL Below sopl RPE-BM Structural OCT Inner retinal flow Outer retinal flow Choroidal flow Zhang M, et al. 2016 Fragmented Deep plexus OK Outer retina Normal Retinal Anatomy Vitreous-ILM Above IPL-INL Below IPL-INL Below sopl RPE-BM Structural OCT Inner retinal flow Outer retinal flow Choroidal flow Zhang M, et al. 2016 Deep plexus Outer retina Normal Retinal Anatomy 8
PR-OCTA Details Retinal Vascular Anatomy Macular Ischemia in Non-Proliferative DR Superficial Intermediate Deep Inner Case 1 A B C D Case 2 A B C D 3 retinal plexuses show different patterns of vascular pathologies Peripapillary Parafoveal Peripheral Zhang M et al, 2016 Rapid Dynamic CNV Response to Anti-VEGF Inner retinal flow Outer retinal flow (CNV) Anti-VEGF Baseline 2 days 1 week 4 weeks Post-Test: Which one is Correct? 1. OCTA complements Fluorescein Angiography 1 st Rx 2. OCTA provides insights into disease pathogenesis 3. OCTA is a rapidly developing technology 2 nd Rx 1 day 2 weeks 6 weeks 4. OCTA is an abbreviation for Optical Coherence Tomography Angiography 5. All of the Above Huang D et al, 2015 Max response 9
Save the date! OCT ANGIOGRAPHY SUMMIT July 21-22, 2017 Portland, Oregon, USA 10