BLOG: What’s the value of OCT angiography
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OCT angiography has emerged as a noninvasive technique for imaging the microvasculature of the retina and choroid. The first clinical studies using this innovative technology were published in 2014, and now, 5 years later, clinicians are still learning how best to use this technology. This has become my go-to technology for evaluating patients in certain situations: determining if there is evidence of juxtafoveal telangiectasia, explaining vision loss in diabetic retinopathy or looking for choroidal neovascularization in the setting of chronic central serous retinopathy, to name a few.
One of the more recent applications of OCT angiography has been in the management of patients with a pigment epithelial detachment (PED) on spectral domain OCT. We now classify these into drusenoid, serous or fibrovascular PEDs based upon the SD-OCT findings. Although the pathophysiology of PED formation is still not understood, it is thought that degenerative changes in Bruch’s membrane are related to both PED and choroidal neovascular (CNV) membrane formation. But in the situation of a PED without fluid, are we to assume there is no choroidal neovascularization?
In a retrospective study by Venkat and colleagues in OSLI Retina, researchers at the Cole Eye Institute evaluated patients with a PED by OCTA to identify CNV with both en face imaging and flow on OCTA B-scan images. First, they identified that all PED subtypes (drusenoid, serous or fibrovascular) demonstrated CNV, and there was a significant proportion of patients who did not demonstrate fluid on their OCT but did have choroidal neovascularization present. Finally, in those patients with a PED and CNV not treated, 17% progressed in subsequent visits to require treatment.
OCT angiography can be valuable at identifying CNV within PED, and these patients might benefit from tighter follow-up as a small but significant proportion progress to requiring treatment. Learn more by following the link to the article here: https://www.healio.com/ophthalmology/journals/osli/2019-10-50-10/%7Bc060de37-f199-495e-9cd6-7891de5a4d6c%7D/detection-of-choroidal-neovascular-membrane-beneath-pigment-epithelial-detachment-using-sd-octa.
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Disclosure: Singh reports he is a consultant to Zeiss, Novartis, Regeneron, Genentech and Alcon and receives grant support from Apellis and Graybug.