OCT Angiography Brandon Lujan, MD Financial Disclosures: Medical - - PowerPoint PPT Presentation

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Brandon Lujan, MD

Medical Director, Casey Reading Center Assistant Professor of Ophthalmology

2016 UCSF Ophthalmology Update

OCT Angiography

Financial Disclosures:

Genentech (Consultant, Grant support, Educational training) UC Berkeley (Patent) No financial relationships with any OCT companies

Pre-Test: Which one is Correct?

• 1. OCTA will soon replace Fluorescein Angiography
• 2. OCTA frequently provides findings key to clinical

decision-making

• 3. OCTA is a mature technology
• 4. OCTA is an abbreviation for Optical Coherence

Tomography Angiography

David Huang, MD, PhD Maolong Tang, PhD Yan Li, PhD Ou Tan, PhD Xinbo Zhang, PhD Kelsey Hoffman, COA Yali Jia, PhD Kathleen S. Torok, MA Gangjun Liu, PhD Denny Romfh, OD Liang Liu, MD Simon S. Gao, PhD Jie Wang, MS David Poole, COT Ahmed Hagag, MS Acner Camino Benech, PhD Pengxiao Zang, MS Omkar Thaware, OD Jianlong Yang, PhD

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Courtesy of Dave Wilson, MD Casey Eye Institute Ganglion Cell Layer Nerve Fiber Layer Ern Zi Tan et al, 2012 Inner Nuclear Layer

Radial Intermediate Deep Superficial

Retinal Capillary Plexuses

NFL GCL INL

Retinal Capillary Plexuses

OCTA is Motion Contrast OCTA is Motion Contrast

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OCTA is Motion Contrast OCTA is Motion Contrast OCTA is Motion Contrast OCTA is Motion Contrast

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OCTA is Motion Contrast OCTA is Motion Contrast Simple Standard Deviation Map OCTA is Motion Contrast

Optical Coherence Tomography Angiography Decorrelation Signals

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FDA-Approved Commercial OCTA Systems

Zeiss Angioplex Optovue Avanti

Several more on the way...

Zeiss Angioplex Optovue Avanti

45yo CRVO 20/25

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Baseline 20/25 Inject +6W 20/20 Observe +12W +18W 20/25 20/25 Inject Inject +24W 20/16* Observe +24W: Temporal ischemia with new scotoma

Inner and middle retinal ischemia / atrophy

+18W +24W Inner retinal atrophy

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+18W +24W

OCTA

Many capillaries better visualized on OCTA ...but not with slow flow! OCTA Angiography Fluorescein Angiography

Fluorescein Angiogram 00:37 Zeiss AngioPlex Courtesy of Philip Rosenfeld, MD, PhD

Depth Encoding MacTel Type 2

Schwartz DM et al, 2014

Phase-Variance OCT Angiography

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Projection Artifacts in OCTA B-scans

Consequence of decorrelation "shadows" Decorrelation: Real Decorrelation: Artifact

Outer retina

Projection Artifacts in OCTA Slabs

Normal Retinal Anatomy

Choroidal flow Outer retinal flow Structural OCT Inner retinal flow

Projection artifacts

Deep plexus Superficial plexus Intermediate plexus

Projection artifacts Projection artifacts

Below sOPL Above IPL-INL Below IPL-INL Vitreous-ILM RPE-BM

Zhang M, et al. 2016 Real Vessels

Graph-based segmentation

Consequence of decorrelation "shadows"

Projection suppression by simple Slab Subtraction

Projection artifacts

Deep plexus Outer retina Superficial plexus Intermediate plexus

Projection artifacts Projection artifacts Real Vessels OK Fragmented Fragment

Below sOPL Above IPL-INL Below IPL-INL Vitreous-ILM RPE-BM

Graph-based segmentation

Choroidal flow Outer retinal flow Structural OCT Inner retinal flow

Normal Retinal Anatomy

Zhang M, et al. 2016 Projection artifacts Projection artifacts Projection artifacts Real Vessels

Projection suppression by amplitude filtering: Projection-Resolved OCTA

Deep plexus Outer retina Superficial plexus Intermediate plexus

Normal Retinal Anatomy

Below sOPL Above IPL-INL Below IPL-INL Vitreous-ILM RPE-BM

Graph-based segmentation

Choroidal flow Outer retinal flow Structural OCT Inner retinal flow

Zhang M, et al. 2016

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PR-OCTA Details Retinal Vascular Anatomy

Peripapillary Parafoveal Peripheral

A B C D

Case 1

Superficial Intermediate Deep Inner A B C D

Case 2

Macular Ischemia in Non-Proliferative DR

3 retinal plexuses show different patterns of vascular pathologies Zhang M et al, 2016

Rapid Dynamic CNV Response to Anti-VEGF

Huang D et al, 2015

1st Rx

Baseline 1 week 4 weeks 2 days

Anti-VEGF

6 weeks 2 weeks

Inner retinal flow Outer retinal flow (CNV)

Max response

2nd Rx

1 day

Post-Test: Which one is Correct?

• 1. OCTA complements Fluorescein Angiography
• 2. OCTA provides insights into disease pathogenesis
• 3. OCTA is a rapidly developing technology
• 4. OCTA is an abbreviation for Optical Coherence

Tomography Angiography

• 5. All of the Above

10 Save the date!

OCT ANGIOGRAPHY SUMMIT

July 21 - 22, 2017

Portland, Oregon, USA