Next-level imaging puts optometry on front line of diabetes diagnosis Primary Care Optometry News, October 2018 Add Emerging imaging technologies are improving evaluation, diagnosis and management of patients with diabetes and leading to earlier detection. These next-level technologies fall into three buckets: high-resolution, expanded field fundus photography; OCT angiography; and widefield imaging.

Optical Coherence Tomography Angiography (OCTA) is a novel, non-invasive, dyeless imaging modality that has emerged as an indispensable tool in the fields of optometry and ophthalmology. OCTA provides three-dimensional volumetric images of the retinal and choroidal vasculature by using a motion-contrast decorrelation algorithm. This cutting-edge imaging technology has widespread clinical utility as a non-invasive alternative for visualizing microvasculature in detail, but there are no textbooks dedicated to its use and the interpretation of scans. To fill this need, Optical Coherence Tomography Angiography Atlas: A Case Study Approach , by Dr. Julie A. Rodman, is a richly illustrated, practical guide to OCTA ...

BACKGROUND AND OBJECTIVE: To evaluate the repeatability of retinal thickness and vascular density measurements using split-spectrum amplitude-decorrelation angiography (SSADA) with optical coherence tomography (OCT). PATIENTS AND METHODS: Forty patients were divided into seven categories according to their diagnosis: no retinopathy (control), retinal vein occlusion, diabetes with no retinopathy, diabetes with retinopathy, non-exudative age-related macular degeneration (AMD), exudative AMD, and epiretinal membrane. Capillary density and retinal thickness measurements were taken and evaluated for reliability by determination of statistically significant differences and coefficient of variability (CoV) between measurements. RESULTS: No significant differences ( P > .05) were found in any of the within-visit measurements ...

BACKGROUND AND OBJECTIVE: To evaluate a stereological method in optical coherence tomography (OCT) as an in vivo volume measurement of laser-induced choroidal neovascularization (L-CNV) lesion size. PATIENTS AND METHODS: Laser photocoagulation was applied in rats to rupture Bruch's membrane and induce L-CNV. In vivo OCT images of neovascular lesions were acquired with a spectral-domain OCT system at days 0, 3, 7, 10, and 14 after laser surgery. A stereological image-processing method was used to calculate lesion volumes from the OCT images. Rats were euthanized at day 14, and confocal microscopy was used to obtain accurate volume measurements of the ...

BACKGROUND AND OBJECTIVE: To evaluate anatomical changes of idiopathic macular hole (MH) after internal limiting membrane removal and after passive suction at the hole's borders using microscope-integrated intraoperative optical coherence tomography (iOCT). PATIENTS AND METHODS: Five eyes of five subjects with full-thickness idiopathic MH underwent phacoemulsification, intraocular lens implantation, pars plana vitrectomy, and internal limiting membrane (ILM) removal. iOCT was performed after ILM removal and after passive suction at the hole's borders. RESULTS: iOCT showed decreased MH diameter after ILM removal in all cases. Passive suction achieved complete apposition of borders. All cases presented successful postsurgical closure. CONCLUSIONS ...

BACKGROUND AND OBJECTIVE: To evaluate the retinal morphologic characteristics of patients with macropsia caused by epiretinal membrane (ERM) based on spectral-domain optical coherence tomography (SD-OCT). PATIENTS AND METHODS: A cross-sectional, non-interventional study was performed to compare the characteristics of retinal structures in eyes with ERM according to the presence or absence of macropsia. Twenty-six patients with ERM and macropsia were defined as the macropsia group and 26 age-matched patients with ERM without macropsia were the control group. All participants underwent a full ophthalmologic examination and SD-OCT examination. Macropsia was diagnosed and quantified using a double dot chart. The thickness of ...

The authors report the widefield montage swept-source optical coherence tomography angiography (OCTA) findings in a 36-year-old male with sympathetic ophthalmia and illustrate the presence of multiple small areas of choriocapillaris flow voids that likely correspond to areas of choriocapillaris ischemia. Using sequential imaging, the authors observed that these flow voids improved following initiating of steroid and immunosuppressive therapy and almost completely resolved following 6 months of therapy with corresponding improvement in visual acuity. This report highlights the role of widefield montage OCTA to detect these likely ischemic changes within the choriocapillaris in sympathetic ophthalmia and demonstrates that they can be ...

The authors present a case of a 29-year-old man who presented to the Department of Ophthalmology at their institution to complete a peripheral laser treatment in his left eye for familial exudative vitreoretinopathy complicated by tractional macular edema.

BACKGROUND AND OBJECTIVE: The aim of the study was to determine optical coherence tomography angiography (OCTA) findings and to identify mutations in the RS1 gene in a three-generation family with X-linked juvenile retinoschisis (XLRS). PATIENTS AND METHODS: Clinical and genetic assessments were performed in 12 family members. OCTA was performed at baseline (12 members including cases and carriers) and after acetazolamide administration (three cases). Twenty healthy subjects (20 eyes, controls) were chosen for comparison. Molecular genetic analysis of the RS1 gene was performed in all family members. RESULTS: Deep capillary plexus density was reduced in cases compared with controls ( P ...

PURPOSE: To examine extraocular rectus muscle tendons in patients with Graves' ophthalmopathy using optical coherence tomography (OCT). METHODS: This was a cross-sectional observational study conducted with 55 healthy controls, 45 patients with clinically inactive Graves' ophthalmopathy, and 12 patients with clinically active Graves' ophthalmopathy. Scanning was performed at the 3- and 9-o'clock positions. The medial rectus tendon thickness was measured at 7.2 and 9.2 mm from the limbus and the lateral rectus tendon thickness was measured at 8.5 and 10.5 mm from the limbus. RESULTS: The 9.2-mm medial rectus, 8.5-mm lateral rectus, and ...

Paracentral acute middle maculopathy (PAMM) refers to band-like hyperreflective lesions seen on spectral-domain optical coherence tomography, mostly confined to the inner nuclear layer. It has been previously demonstrated to involve the deep capillary plexus (DCP) using optical coherence tomography angiography (OCTA). A 29-year-old female presented with PAMM and was investigated using a new OCTA system that shows not just the superficial capillary plexus and DCP, but also the four vascular plexuses as previously demonstrated in histology. Using this system, involvement of the DCP was shown, but also of more superficial layers, including the intermediate capillary plexus

The authors report a case of acute Vogt-Koyanagi-Harada syndrome with massively impaired perfusion in the Sattler's layer on optical coherence tomography angiography (OCTA). The hypoperfusion fully resolved during a period of 4 weeks and correlated well with hypofluorescent spots on indocyanine green angiography. This is the first time reduced perfusion in Sattler's layer has been observed on OCTA. This finding may aid further understanding of the pathology underlying VKH syndrome and indicates that evaluation of deeper choroidal layers like Sattler's layer may be of importance for disease monitoring and predicting prognosis in choroidal diseases.

Dear Editor, We read with interest the article on optical coherence tomography angiography (OCTA) of a suspected case of choroidal hemangioma. 1 We want to humbly discuss a few facts. The authors mention that “To date, findings from optical coherence tomography angiography (OCTA) have yet to be reported for a choroidal hemangioma.” However, in 2017 we had published our findings in cases of choroidal hemangioma before and after treatment with laser. 2 In an asymptomatic patient with an incidentally detected choroidal mass multiple differential diagnoses are possible, including metastasis. It would be interesting to know how the authors excluded other ...

PURPOSE: To evaluate and compare epithelial remodeling after standard corneal cross-linking (S-CXL) and iontophoresis-assisted CXL (I-CXL) in eyes with keratoconus by anterior segment optical coherence tomography (AS-OCT). METHODS: In this prospective, observational study, AS-OCT and corneal topography were performed before and 1, 3, and 6 months after surgery. Corneal pachymetry was performed and epithelial and stromal thicknesses (central and 16 points on the 6-mm central zone) and the maximum simulated keratometry value (Kmax) were measured. RESULTS: Two groups of 30 patients (60 eyes total) with progressive keratoconus underwent S-CXL or I-CXL. Before surgery, both groups of patients presented with an ...

BACKGROUND AND OBJECTIVE: To assess the usefulness of optical coherence tomography angiography (OCTA) in cases of idiopathic choroidal neovascularization (iCNV). PATIENTS AND METHODS: Seven eyes with suspected iCNV were evaluated using OCT, OCTA, fluorescein angiography (FA), and indocyanine green angiography (ICGA) and were followed up between 3 weeks and 4 weeks following an intravitreal anti-vascular endothelial growth factor (VEGF) injection. The utility of OCTA in the diagnosis and characterization of morphology of iCNV at baseline and follow-up was assessed. RESULTS: Morphology of vasculature comprising iCNV could be detected in all cases (100%) on OCTA and in 57% cases on ICGA ...

BACKGROUND AND OBJECTIVE: To compare optical coherence tomography angiography (OCTA) images from three different devices. PATIENTS AND METHODS: This was a prospective, observational, cross-sectional study. All eyes (n = 24) were imaged thrice each time with swept-source OCT (DRI OCT Triton Plus; Topcon, Tokyo, Japan), spectral-domain OCTA (AngioVue; Optovue, Fremont, CA), and SD-OCT Angioplex (Cirrus HD-OCT 5000; Carl Zeiss Meditec, Jena, Germany). Outcome measures were foveal avascular zone (FAZ) area, vessel density, spacing between large vessels (SLV), and spacing between small vessels (SSV). They were calculated using local fractal analyses and Frangi filter. RESULTS: The vascular parameters showed good to excellent ...

The authors describe the imaging characteristics and progression of a type 2 choroidal neovascular membrane (CNV) using swept-source optical coherence tomography (SS-OCTA). A 27-year-old male presented with an active possible tubercular choroidal granuloma associated with exudative retinal detachment in the right eye. The patient received anti-tubercular drugs, oral corticosteroids, and intravitreal bevacizumab and showed complete resolution in 3 months. At the 7-month follow-up, SS-OCTA imaging revealed a type 2 CNV. SS-OCTA is a very useful tool to detect and monitor the growth of CNV in active and healed posterior uveitis without the risks of dye-based angiography.

Retinal acute toxicity may be produced by several etiologies. Iatrogenic toxicity is one of the most-feared complications related to vitreoretinal surgery. The authors report a case of retinal acute toxicity due to the use of perfluorooctane during an uneventful retinal detachment surgery done elsewhere. The aim of this report is to describe the clinical and optical coherence tomography features of this complication, which unfortunately occurred in more than 100 cases in Spain.

BACKGROUND AND OBJECTIVE: Advanced retinal imaging can improve understanding of retinal vein occlusion (RVO) pathology. The authors aimed to characterize the vascular pathology of RVO on en face optical coherence tomography (OCT) and OCT angiography (OCTA). PATIENT AND METHODS: This was a cross-sectional study including 17 eyes with RVO. The authors identified discordance between vasculature on en face OCT and flow on OCTA, which was correlated with structural findings at the corresponding location on OCT B-scans. RESULTS: Six eyes had vessels that were seen on OCT without flow on OCTA. The most clinically relevant finding was preserved inner retinal layers ...

BACKGROUND AND OBJECTIVE: To analyze the location of familial retinal arterial tortuosity (fRAT) in the three-dimensional structure of retinal capillaries. PATIENTS AND METHODS: Retrospective observational study. Twelve eyes of six patients (two of whom were brothers) were imaged by optical coherence tomography angiography (OCTA). The data from their ocular and systemic examinations were recorded. RESULTS: OCTA imaging clearly showed increased tortuosity of second- and third-order retinal arteries in all cases, visible in the superficial vascular plexus (SVP) up to the arteriole termination in the capillaries. No change was visible in the deep capillary plexus (DCP). CONCLUSIONS: OCTA shows that fRAT ...

The authors report the optical coherence tomography angiography (OCTA)-based comparative assessment of the retinal microvasculature in a rare pair of 96-year-old female monozygotic twins discordant for Alzheimer's disease (AD). Using automated mapping of the superficial capillary plexus, the authors observed that the twin with advanced AD had a significantly reduced vessel density and a larger foveal avascular zone in the superficial capillary plexus as well as a thinner choroid compared to the twin who was cognitively normal. This unique twin discordance report adds to the evidence supporting the use of retinal microvasculature changes in the superficial capillary plexus ...

The early clinical manifestations of macular infarction secondary to subconjunctival gentamicin (Gentak; Akorn, Lake Forest, IL) use in an aphakic eye were documented sequentially on swept-source optical coherence tomography (OCT) and fundus fluorescein angiography. The first recorded event after drug toxicity was macular detachment, along with disorganization of outer retinal layers in about 12 hours. The changes in inner retinal layers occurred after 36 hours had elapsed. OCT-documented initial damage to outer retinal layers could be due to the susceptibility of first order retinal neurons, followed by subsequent inner retinal layer involvement and ischemia. This helps in understanding pathogenesis of ...

Optovue recently announced that industry veteran John Hawley, senior vice president of global sales, will retire on July 1 and remain with the company in an advisory role. Hawley joined Optovue in 2008 at the beginning of its entry into the ophthalmic and optometric OCT markets as vice president of business development. Within 6 months, he was heading the U.S. organization, according to a press release from Optovue. His accomplished career spans more than 35 years in ophthalmic diagnostic instrumentation, service, sales, marketing and strategic planning. “Thirty years ago, I heard that optometry was going to be the gatekeeper ...

Swept-source optical coherence tomography angiography (SS-OCTA) was used to diagnose choroidal neovascularization (CNV) arising from a choroidal nevus. A 61-year-old woman initially presented with submacular hemorrhage. She was diagnosed with neovascular age-related macular degeneration (AMD) and received three injections of bevacizumab (Avastin; Genentech, South San Francisco, CA). At a follow-up visit, SS-OCTA showed that the CNV appeared to arise from an adjacent choroidal nevus. This is the first report of using SS-OCTA to diagnose CNV associated with a choroidal nevus masquerading as neovascular AMD.