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      Optical Coherence Tomography Angiography in Retinal Diseases

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          Abstract

          Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging system that generates volumetric data of retinal and choroidal layers. It has the ability to show both structural and blood flow information. Split-spectrum amplitude-decorrelation angiography (SSADA) algorithm (a vital component of OCTA software) helps to decrease the signal to noise ratio of flow detection thus enhancing visualization of retinal vasculature using motion contrast. Published studies describe potential efficacy for OCTA in the evaluation of common ophthalmologic diseases such as diabetic retinopathy, age related macular degeneration (AMD), retinal vascular occlusions and sickle cell disease. OCTA provides a detailed view of the retinal vasculature, which allows accurate delineation of microvascular abnormalities in diabetic eyes and vascular occlusions. It helps quantify vascular compromise depending upon the severity of diabetic retinopathy. OCTA can also elucidate the presence of choroidal neovascularization (CNV) in wet AMD. In this paper, we review the knowledge, available in English language publications regarding OCTA, and compare it with the conventional angiographic standard, fluorescein angiography (FA). Finally, we summarize its potential applications to retinal vascular diseases. Its current limitations include a relatively small field of view, inability to show leakage, and tendency for image artifacts. Further larger studies will define OCTA's utility in clinical settings and establish if the technology may offer a non-invasive option of visualizing the retinal vasculature, enabling us to decrease morbidity through early detection and intervention in retinal diseases.

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          Most cited references28

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          Split-spectrum amplitude-decorrelation angiography with optical coherence tomography

          Amplitude decorrelation measurement is sensitive to transverse flow and immune to phase noise in comparison to Doppler and other phase-based approaches. However, the high axial resolution of OCT makes it very sensitive to the pulsatile bulk motion noise in the axial direction. To overcome this limitation, we developed split-spectrum amplitude-decorrelation angiography (SSADA) to improve the signal-to-noise ratio (SNR) of flow detection. The full OCT spectrum was split into several narrower bands. Inter-B-scan decorrelation was computed using the spectral bands separately and then averaged. The SSADA algorithm was tested on in vivo images of the human macula and optic nerve head. It significantly improved both SNR for flow detection and connectivity of microvascular network when compared to other amplitude-decorrelation algorithms.
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            Optical coherence tomography angiography of optic disc perfusion in glaucoma.

            To compare optic disc perfusion between normal subjects and subjects with glaucoma using optical coherence tomography (OCT) angiography and to detect optic disc perfusion changes in glaucoma.
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              Risk factors associated with age-related macular degeneration. A case-control study in the age-related eye disease study: Age-Related Eye Disease Study Report Number 3.

              (2000)
              To investigate possible risk factors for age-related macular degeneration (AMD) in participants in the Age-Related Eye Disease Study (AREDS). Case-control study. Of the 4757 persons enrolled in AREDS, 4519 persons aged 60 to 80 years were included in this study. The lesions associated with AMD ranged from absent in both eyes to advanced in one eye. Stereoscopic color fundus photographs of the macula were used to place participants into one of five groups, based on the frequency and severity of lesions associated with AMD. Participants with fewer than 15 small drusen served as the control group. Staged model building techniques were used to compare each of the four case groups with the control group. Increased age was a consistent finding of all four of the case groups compared with the control group, and all the following associations were age adjusted. Persons with either intermediate drusen, extensive small drusen, or the pigment abnormalities associated with AMD (group 2) were more likely to be female, more likely to have a history of arthritis, and less likely to have a history of angina. Persons with one or more large drusen or extensive intermediate drusen (group 3) were more likely to use hydrochlorothiazide diuretics and more likely to have arthritis. Hypertension, hyperopia, presence of lens opacities, and white race were also found more frequently in this group as well as in persons with neovascular AMD (group 5). Only persons in group 5 were more likely to have an increased body mass index, whereas persons with geographic atrophy (group 4) as well as those in groups 3 and 5 were more likely to have completed fewer years in school or to be smokers. Those with geographic atrophy were also more likely to use thyroid hormones and antacids. Our findings for smoking and hypertension, which have been noted in previous studies, suggest that two important public health recommendations, the avoidance of smoking and the prevention of hypertension, may reduce the risk of developing AMD. Other associations, such as those for hyperopia, lens opacities, less education, female gender, increased body mass index, and white race, which have been noted in other studies, are also seen in the AREDS population. The increased use of thyroid hormones and antacids in persons with geographic atrophy and the increased likelihood of arthritis or hydrochlorothiazide use in persons with one or more large drusen or extensive intermediate drusen have not been previously reported and need additional investigation.
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                Author and article information

                Journal
                J Ophthalmic Vis Res
                J Ophthalmic Vis Res
                JOVR
                Journal of Ophthalmic & Vision Research
                Medknow Publications & Media Pvt Ltd (India )
                2008-2010
                2008-322X
                Jan-Mar 2016
                : 11
                : 1
                : 84-92
                Affiliations
                [1] Department of Ophthalmology, University of Florida College of Medicine, Florida, USA
                Author notes
                Correspondence to: K. V. Chalam, MD, PhD. Department of Ophthalmology, University of Florida College of Medicine, 580 West 8 th Street, Tower 2, 3 rd Floor, Jacksonville, FL 32209, USA. E-mail: kchalam@ 123456jax.ufl.edu
                Article
                JOVR-11-84
                10.4103/2008-322X.180709
                4860994
                27195091
                9b5dce0e-fd14-492e-b6ae-a7e0d24c7c3a
                Copyright: © Journal of Ophthalmic and Vision Research

                This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 28 November 2015
                : 30 December 2015
                Categories
                Review Article

                Ophthalmology & Optometry
                optical coherence tomography angiography (octa),split-spectrum amplitude decorrelation angiography (ssada),diabetic retinopathy,age related macular degeneration,choroidal neovascularization

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