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      A review of optical coherence tomography angiography (OCTA)

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          Abstract

          Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging technique that generates volumetric angiography images in a matter of seconds. This is a nascent technology with a potential wide applicability for retinal vascular disease. At present, level 1 evidence of the technology’s clinical applications doesn’t exist. In this paper, we introduce the technology, review the available English language publications regarding OCTA, and compare it with the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA). Finally we summarize its potential application to retinal vascular diseases. OCTA is quick and non-invasive, and provides volumetric data with the clinical capability of specifically localizing and delineating pathology along with the ability to show both structural and blood flow information in tandem. Its current limitations include a relatively small field of view, inability to show leakage, and proclivity for image artifact due to patient movement/blinking. Published studies hint at OCTA’s potential efficacy in the evaluation of common ophthalmologic diseases such age related macular degeneration (AMD), diabetic retinopathy, artery and vein occlusions, and glaucoma. OCTA can detect changes in choroidal blood vessel flow and can elucidate the presence of choroidal neovascularization (CNV) in a variety of conditions but especially in AMD. It provides a highly detailed view of the retinal vasculature, which allows for accurate delineation of the foveal avascular zone (FAZ) in diabetic eyes and detection of subtle microvascular abnormalities in diabetic and vascular occlusive eyes. Optic disc perfusion in glaucomatous eyes is notable as well on OCTA. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.

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          Most cited references29

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          Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography.

          The retinal vasculature is involved in many ocular diseases that cause visual loss. Although fluorescein angiography is the criterion standard for evaluating the retina vasculature, it has risks of adverse effects and known defects in imaging all the layers of the retinal vasculature. Optical coherence tomography (OCT) angiography can image vessels based on flow characteristics and may provide improved information.
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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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              Quantitative OCT angiography of optic nerve head blood flow

              Optic nerve head (ONH) blood flow may be associated with glaucoma development. A reliable method to quantify ONH blood flow could provide insight into the vascular component of glaucoma pathophysiology. Using ultrahigh-speed optical coherence tomography (OCT), we developed a new 3D angiography algorithm called split-spectrum amplitude-decorrelation angiography (SSADA) for imaging ONH microcirculation. In this study, a method to quantify SSADA results was developed and used to detect ONH perfusion changes in early glaucoma. En face maximum projection was used to obtain 2D disc angiograms, from which the average decorrelation values (flow index) and the percentage area occupied by vessels (vessel density) were computed from the optic disc and a selected region within it. Preperimetric glaucoma patients had significant reductions of ONH perfusion compared to normals. This pilot study indicates OCT angiography can detect the abnormalities of ONH perfusion and has the potential to reveal the ONH blood flow mechanism related to glaucoma.
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                Author and article information

                Contributors
                talisa@sas.upenn.edu
                andre@romano.med.br
                nadiakwaheed@gmail.com
                jduker@tuftsmedicalcenter.org
                Journal
                Int J Retina Vitreous
                Int J Retina Vitreous
                International Journal of Retina and Vitreous
                BioMed Central (London )
                2056-9920
                15 April 2015
                15 April 2015
                2015
                : 1
                : 5
                Affiliations
                [1 ]New England Eye Center and Tufts Medical Center, Tufts University, 260 Tremont Street, Biewend Building, 9 - 11th Floor, Boston, MA 02116 USA
                [2 ]GRID grid.116068.8, ISNI 0000000123412786, Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, , Massachusetts Institute of Technology, ; Cambridge, MA 02139 USA
                [3 ]GRID grid.411249.b, ISNI 0000000105147202, Department of Ophthalmology, , Federal University of São Paulo, Escola Paulista de Medicina, ; São Paulo, Brazil
                [4 ]Retina Service, Neovista Eye Center, Americana, Brazil
                Article
                5
                10.1186/s40942-015-0005-8
                5066513
                27847598
                bdcaf2f9-f047-4e2b-8df5-e95a89b07bd4
                © de Carlo et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 6 February 2015
                : 10 March 2015
                Categories
                Review
                Custom metadata
                © The Author(s) 2015

                age-related macular degeneration,diabetic retinopathy,fluorescein angiography,glaucoma,indocyanine angiography,optical coherence tomography angiography,optic disc,retina,retinal vessel occlusion

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