8/10/2018 T o b e disc usse d: Clinic a l I ma g ing Upda te : OCT Ang io g ra phy T e c hno lo g y in e a rly g la uc o ma de te c tio n OCT Ang io g ra phy, F undus OCT Ga ng lio n Ce ll Ana lysis 10-2 pe rime try Auto fluo re sc e nc e , a nd Be yo nd OCT A a nd g la uc o ma F undus a uto fluo re sc e nc e (FAF) CASE Y HAMM, O.D., F AAO Ultra -Wide fie ld I ma g ing UMSL COL L E GE OF OPT OME T RY ANNUAL AUG UST ACADE ME 2018 OCT F ig ure 3. d e Ca rlo T E , e t a l. A re vie w o f o ptic a l c o he re nc e AL L RE F E RE NCE S T O COMME RCI AL L Y- to mo g ra phy a ng io g ra phy (OCT A). I nt J Re tina Vitre o us . 2015;1(5). F ina nc ia l Ang io g ra phy AVAI L ABL E PRODUCT S ARE I NT E NDE D T O BE NONBI ASE D AND F OR disc lo sure (OCT A): E DUCAT I ONAL PURPOSE S. T HE RE ARE NO RE L E VANT F I NANCIAL A c linic a l upda te OR NON-F I NANCIAL RE L AT I ONSHI PS T O DI SCL OSE . OCT T e c hno lo g y: A time line Ho w d o e s OCT A wo rk? Mo tio n Co ntrast I mag ing Suc c e ssive B-sc a ns o f the sa me a re a • F F irst in irst in F F irst in irst in T T D-OCT D-OCT SD-OCT SD-OCT OCT OCT A A • Re tina l tissue re ma ins unc ha ng e d vitro 1991 vitro 1991 vivo 1993 vivo 1993 1996 1996 2006 2006 2015 2015 • Mo ve me nt (flo w) o f e rythro c yte s thro ug h the re tina l va sc ula ture is de te c te d • Ma ny diffe re nt a lg o rithms e xist to c o mpute b lo o d flo w a nd fo rmula te a thre e -dime nsio na l ima g e • Ve sse l de nsity • F lo w inde x Ka sha ni A, Che n C, Ga hm J, e t a l. Optic a l c o he re nc e to mo g ra phy a ng io g ra phy: A c o mpre he nsive re vie w o f c urre nt me tho ds a nd c linic a l a pplic a tio ns. PROGRE SS I N RE T I NAL AND E YE RE SE ARCH . 2017;60:66-100. 1
8/10/2018 Va sc ula r la ye rs c o mpa re d to histo lo g ic a l se c tio n T hre e distinc t re tina l va sc ula r la ye rs • T hre e c a pilla ry ne two rks within the re tina : • Ra dia l pe ripa pilla ry c a pillarie s (NF L ) • I nne r/ supe rfic ia l c a pilla ry ne two rk (GCL ) • Oute r/ de e p c a pilla ry ne two rk (I NL ) F ro m: Re tina l Va sc ula r L a ye rs Ima g e d b y F luo re sc e in Ang io g ra phy a nd Optic a l Co he re nc e T o mo g ra phy Ang io g ra phy. JAMA Ophtha lmo l. 2015;133(1):45-50. F ro m: Cha la m K V, Sa mb ha v K . Op tic a l Co he re nc e T o mo g ra phy Ang io g ra phy in Re tina l Dise a se s. Jo urnal o f Ophthalmic & Visio n Re se arc h . 2016;11(1):84-92. T he va rio us OCT A pla tfo rms Whic h syste m is b e st? • De Vitis L A, e t a l. (2016) Opto vue (Ang io Vue ) • AngioPle x (Ze iss) vs. AngioVue (Opto Vue ) • SSADA a lg o rithm • • Ang io Ple x: sho rte r e xe c utio n time , hig he r pe rc e nta g e o f re lia b le ima g e s with • Ze iss (Ang io Ple x) fe we r mo tio n a rtifa c ts • OMAG a lg o rithm • No t ye t c o mme rc ia lly a va ila b le : • Munk MR, e t a l. (2017) • Nide k (Ang io Sc a n) Co mpa re d fo ur de vic e s: Ze iss Cirrus, Opto Vue RT Vue , T o pc o n T rito n SS-OCT , • a nd the He ide lb e rg Spe c tra lis pro to type • He ide lb e rg (Spe c tra lis OCT 2) • No sig nific a nt diffe re nc e s in mo tio n a rtifa c ts T o pc o n DRI OCT T rito n (Swe pt So urc e ) • • Ove ra ll ra nking : Ze iss (90% ), Opto Vue (60%), T o pc o n (40%), He ide lb e rg (10%) • Ra nking s diffe re d de pe nding o n pa ra me te r b e ing e va lua te d • E a c h mo d e l ha s c e rta in stre ng ths E n fac e se g me nte d Pe rfo rming OCT A OCT A Ang io Ple x: 6 pre de fine d a ng io g ra ms Vitre o re tina l inte rfa c e (VRI ) • T wo sc a n size s Fro m IL M e xte nd ing 300µm a nte rio rly • 3x3 o r 6x6 mm Supe rfic ia l: NF L , GCL , a nd I PL • Ang io g ra phy Ana lysis De e p: I NL , OPL • T wo e n fa c e a na lyse s Ava sc ula r: Pho to re c e pto rs, RPE • AngioPle x Cho rio c a pilla ris http:/ / re tina to d a y.c o m/ 2017/ 03/ a -ro le -fo r-o c ta -in-d a ily-re tina -pra c tic e • Str uc tur e 20µm se c tio n po ste rio r to the RPE • Cro ss-se c tio na l “flo w” ima g e (ra ste r sc a n) Cho ro id 50µm se g me nt b e lo w the c ho rio c a pilla ris https:/ / www.re vie wo fo pto me try.c o m/ a rtic le / ima g ing -mo tio n-a -re vie w-o f-o c ta 2
8/10/2018 Ang io g ra phy Ana lysis A. Co lo r e n fac e OCT A sho wing a CNVM B. Cro ss se c tio n with Ma c ula 6x6 mm c o lo r c o d e s C. E n fac e o f e a c h re tina l la ye r inne r re tina o ute r F o ve a l Ava sc ula r Zo ne (F AZ) E n fac e Ana lysis Ma c ula 6x6 mm • De no te s the va sc ula r-fre e fo ve a • 400-700 µm in dia me te r Hussa in e t al. • • 660 µm (Supe rfic ia l) • 914 µm (De e p) • Pre vio usly o nly visib le with fluo re sc e in a ng io g ra phy • E nla rg e d in mic ro va sc ula r isc he mic dise a se (e x. dia b e te s) F A vs OCT A OCT Ang io g ra phy F luo re sc e in Ang io g ra phy • Pros • Pros MA’ s F A • • Blood flow over time (early/late, • Convenience, safety • Ca pilla ry pooling, leaking) • High-resolution visualization of vessel de ta il, • Better visualization in cases of architecture, ischemia no npe rfusio n very high or low flow (MA’s) OCT A • Isolation of specific layers for precise • Gold standard localization (3-D) • Cons Ability to monitor ischemia, vessel • • Potential adverse affects regression with subsequent scans • Poor visualization of 2 of the 3 Cons vascular networks (Spaide 2015) • • FA mainly shows the inner capillary • Small area analyzed network • Little to no visualization of the radial Prone to artifacts • peripapillary network, deep capillary Fro m: K ue hle we in L , e t a l. Ima g ing a re a s o f re tina l no npe rfusio n in isc he mic b ra nc h re tina l ve in o c c lusio n with network • Snapshot in time swe pt-so urc e OCT mic ro a ng io g ra phy. Ophtha lmic Surg e ry, L a se rs a nd Ima g ing Re tina . 2015;46(2):249-252 3
8/10/2018 Artifa c ts 6x6 Re tina l Ang io g ra m • I ma g e a rtifa c ts Clinic a l • Me dia o pa c itie s SPE CIF IC OCUL AR DISE ASE S • Pro je c tio n Artifa c ts utiliza tio n o f AND CONDIT I ONS • Ve sse ls fro m a b o ve CASE E XAMPL E S Mo tio n a rtifa c ts OCT A • • White line s Cho rio c a pilla ris • Blink a rtifa c ts se g me nta tio n with Bla c k line s • “g ho st ve ssle s” F AZ me a sure me nt Dia b e tic e va lua tio n & mo nito ring Va sc ula r c ha ng e s ma y b e visua lize d e a rlie r tha n o n fundus e xa m • • Hig h-re so lutio n a na lysis o f dia b e tic mic ro a ng io pa thy • Ca pilla ry no npe rfusio n, I RMA, ne o va sc ula riza tio n Mo nito ring o f dise a se • • I nc re a se d F AZ • Ma c ula r c a pilla ry pe rfusio n de nsity F AZ e nla rg e me nt a nd va sc ula r re mo de ling Qua ntifying mic ro va sc ula r c ha ng e in a dia b e tic pa tie nt Fro m: de Ca rlo T E, Chin AT , Bo nini Filho MA, e t a l. De te c tio n o f mic ro va sc ula r c ha ng e s in e ye s o f pa tie nts with dia b e te s b ut no t c linic a l dia b e tic re tino pa thy using o ptic a l c o he re nc e to mo g ra phy a ng io g ra phy. Re tina . 2015;35:2364-2370. AngioPle x Me trix™ Ide ntify pa tie nts pro g re ssing in dise a se . valuate c e ntra l mic ro va sc ula r pe rfusio n c ha ng e s. E Asse ss c ha ng e s o ve r time . Visualize c ha ng e s in F AZ size a nd g e o me try. https://www.zeiss.com He a lthy F AZ Dia b e tic e ye with c a pilla ry Dia b e tic e ye with e nla rg e d no npe rfusio n (a rro w, F AZ, va sc ula r re mo de ling a ste risks) (a rro w) 4
Recommend
More recommend
