Update on OCTAngiography Robert Chang, MD Images courtesy of Zeiss - - PDF document
Update on OCTAngiography Robert Chang, MD Images courtesy of Zeiss Additional Disclosures Consultant Aerie Consultant Allergan Consultant Genentech Consultant Sight Sciences Consultant Apple Consultant Verana Health Consultant
Robert Chang, MD
Images courtesy of Zeiss
Consultant Aerie Consultant Allergan Consultant Genentech Consultant Sight Sciences Consultant Apple Consultant Verana Health Consultant Boston Scientific Consultant 1800 Contacts Consultant Santen Consultant Smartlens Consultant Aurora Tears Technology Consultant Iridex Consultant Kali Care Consultant Healgoo
AngioPlex 3x3
Imaging Retinal Vasculature
(OMAG 2011 Ruikang Wang)
(SSADA 2012 David Huang) AngioPlex Montage 14x14
split‐spectrum amplitude decorrelation angiography (SSADA)
Visualization of flow without contrast (isolate what is moving)
phase information to detect changes in OCT signal through time of moving structures (e.g. RBC’s)
slower blood flow
OMAG ‐ Zeiss Amplitude only (SSADA) ‐‐ Optovue
particles such as red‐blood cells within sequential OCT B‐ scans performed repeatedly at the same location of the retina.
B‐scan y0 y2 y3 y1
y
Fast axis x AngioPlex Technology
AngioPlex Maps consist of reconstruction of the perfused microvasculature within the retina and choroid.
AngioPlex Maps
Key = Correction of EYE MOTION!
Superficial Retina Map
Visualization of blood flow in superficial retina.
Deep Retina Map
Visualization of blood flow in deep retina.
Avascular Retina Map
Avascular region of the retina in healthy
vascular growth.
AngioPlex Maps = 2D En Face Slice of retinal vasculature, B‐scans stacked
1 2 3
Superficial Retina Deep Retina Avascular Retina
Color Depth Retina Map
The color depth map combines superficial, deep and avascular retina maps and allows for depth visualization of retinal blood flow. Unable to do this with fluorescein angiography…
individual and population level
speckle flowgraphy all showed reduced flow in glaucoma vs. normal
Figure re 1
icial v l vascular c scular complex ( mplex (SVC) VC) O OCT a angiog iogram am ( (left) t) and 6 6 x 6-mm g mm ganglion c lion cell com complex thi x thickn knes ess map ( s map (rig ight) ) of
a typi typical glau glaucomato tous eye.
The glau e glaucoma dama mage ( (yel ellow w dash shed outl ed outline) e) was mos was mostly outs
e the central 3 3 x x 3-mm 3-mm area ( area (the he red red out
e).
KEY = KEY = lar larger scan scan are area size size t to see see more more Mini nimum u m useful si eful size 6 ze 6 x 6 mm m macula acula How However, is is the the vesse vessel dr dropout a t a cau cause se or
effect?
SD‐ OCT platform
Can be obtained frequently
assessments
hard to measure change
the circulation outside the macula
New AngioPlex ONH scan (4.5 x 4.5 mm)
Visualization of the Radial Peripapillary Capillary (RPC) Network “Perfusion Density”
Normal Eye Glaucoma Advanced Glaucoma OCTA RNFL
AngioPlex for ONH reveals blood vessels at the lamina cribrosa level and highlights late stage cupping as in the advanced glaucoma image above.
Superficial OCTA enface Superficial OCTA enface
Existing AngioPlex 8x8 New HD AngioPlex 8x8
Is OCT‐A Helpful in Clinical Practice Right Now?
Measurements?
decreases (floor effect)?
Better than RNFL for early glaucoma vs normal, based on disc and peri‐papillary vessel density and flow… Improved Diagnostic Accuracy with the Macula Superficial Vessel Density… Correlates with VF loss better than RNFL… More sensitive for advanced glaucoma cases…
Takusagawa HL et al. Ophthalmal 2017;124:1589) Yarmohammadi A et al. Ophthalmol 2018;125:578. Akil H et al. PLOS ONE 2017;12:e0170476 Liu L et al. JAMA Ophthalmol 2015;133:1045 Yarmohammadi A et al. Ophthalmol 2016;123:2498
100kHz 24µm Sampling Resolution 200kHz 15µm Sampling Resolution
The topics to be discussed include ideas and concepts under development which may be subject to 510(k) clearance and subject to change
200kHz – Increased 6mm Scan Depth 8 µm Lateral Sampling Resolution 100kHz ‐ 3mm Scan Depth 16 µm Lateral Sampling Resolution
6mm mode 3mm mode
The topics to be discussed include ideas and concepts under development which may be subject to 510(k) clearance and subject to change
Lamina Cribrosa
AngioPlex Map RPE +75 / RPE +115 Enface Map RPE +75 / RPE +115
capability
mm depth
depth