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30/9/2016

COMMENTARY

IsOCTangiographygoingtochangeourlives?
FROMOSNEUROPE

PUBLICATIONEXCLUSIVE

IsOCTangiographygoingtochangeourlives?
OcularSurgeryNewsEuropeEdition,January2016
PaoloLanzetta,MD

OCTjumpedintoourlivesin1991whenHuangandcolleaguespublishedaboutanoninvasivecrosssectionalimagingtechnologyinbiological
systems.Sincethen,majoradvancementshavebeenmade.SpectraldomainandsweptsourceOCTplatformsbroughtfasterscansandhigher
resolution.Also,OCTtechnologyhasbeenproposedinconjunctionwithadaptiveoptics,whichmayallowfurtherresolution,uptoasingle
photoreceptorcell.PolarizedlightcombinedwithhighresolutionOCTscanningmayimprovecharacterizationoftheretinalpigmentepithelium.
Nodoubt,therefore,thatwiththeintroductionofOCT,assessmentoffundusstructurehasdramaticallyincreased.
AmeliorationofknowledgeonretinalfunctionisalsopossiblethankstoOCT.FunctionalultrahighresolutionOCTmayallowthe
studyofretinalresponsetolightstimulation.Quantitativeimagingoffundusbloodflowandpulsatilityofretinalandchoroidal
vasculaturehasbeenproposedwithcolorDopplerOCT.
Morerecently,anewapplication,OCTangiography(OCTA),hasbeenintroduced,basedonmotioncontrastimagingtohigh
resolutionvolumetricbloodflowinformationgeneratingangiographicimagesinafewseconds.Similarlytotheearlytimesoftime
domainOCT,manyofushavepassionatelystartedperformingOCTAinnormalandpathologicpatients.Althoughtheenthusiasm
forthisnoninvasivenewertechnologyismorethanjustified,wehavetorecognizethattherearestillmanylimitations.Obviously,
thecurrentandpotentialadvantagesofsuchanexaminationtechniquedeserveextensivededication.

Paolo
Lanzetta

OCTAiscapableofdisplayingvolumetricdataonvascularflowwithouttheinjectionofanydye,andthisisdefinitelyamajoradvancementover
traditionalangiography.ProbablythemostappropriatenameforOCTAwouldbeOCTangioflowgraphy.Infact,differentfromstandard
fluoresceinorindocyaninegreenangiography,OCTAdetectsthepresenceofbloodflow,althoughitcannotgiveanyinformationonleakageor
pooling.However,withOCTA,flowatdifferentfunduslevelssuchasthesuperficialanddeepinnerretinaandchoriocapillariscanbedifferentiated
andimaged.Indiabeticretinopathy,OCTAallowsustoclearlyvisualizethefovealavascularzone(FAZ)bothatthesuperficialanddeeplayerand
tounderstandthatmostmicroaneurysmsarelocatedinthedeepplexusandanenlargementoftheFAZismorepronouncedinthedeeplayeras
well.However,comparedwithfluoresceinangiography,thenumberofmicroaneurysmsdetectedbyOCTAislowerduetoslowbloodflow,which
maybebelowthedetectablethreshold.
AttheEuropeanInstituteofOcularMicrosurgery(IEMO)inUdine,Italy,wearetestingOCTAwiththesweptsourceDRIOCTTritonbyTopcon
usingaratiomethodcalledOCTARA(OCTangiographyratioanalysis),inwhichthefullspectrumiskeptintact,thereforepreservingtheaxial
resolution.Thisequipmentusesalongwavelengthscanninglightat1,050nm,whichallowsincreasedlightpenetrationintopigmentedtissuesand
improvedchoroidalbloodflowidentificationcomparedwithspectraldomainsources.WecomparedOCTAtostandardangiographyfindings.In
wetagerelatedmaculardegeneration,type2choroidalneovascularizationisusuallyvisibleinalmostallcases,whereastype1CNVcanbe
detectedbyOCTAscansinabout65%ofcases.
Artifactsmayincludemotionartifacts,largeretinalvesselsprojectingghostimagesontheouterretina,horizontalblacklinesduetoblinking,white
noiseattheedgesofapigmentepitheliumdetachment,andwhitedotsincasesofretinalhardexudates.
Experienceplaysapivotalroleinidentifyingpathologicalfindings,especiallyatthechoroidallevel.Also,softwareevolutionandnewalgorithms
mayallowimproveddefinitionandfewermotionartifacts.Recently,thepossibilityofassigningdifferentcolorstothedifferentlayersscannedhas
improvedthepossibilityofanalyzingthevesselsofthevariouslayers.
Insummary,OCTangioflowgraphyisheretostayandhasalreadychangedourlives.ManyphysiciansarecurrentlyperformingOCTAonaroutine
basisonallpatientswhoneedanOCTscan.ContinuoustechnologicalprogresswillcontributetokeepingourlivesverybusywithOCT
angioflowgraphy.
Formoreinformation:
PaoloLanzetta,MD,OSNEuropeEditionChairperson,canbereachedatIstitutoEuropeodiMicrochirurgiaOculare,ViaM.A.Fiducio,833100
Udine,Italyemail:paolo.lanzetta@iemo.eu.

Disclosure:Lanzettareportsnorelevantfinancialdisclosures.

http://www.healio.com/ophthalmology/imagingdiagnostics/news/print/ocularsurgerynewseuropeedition/%7Bae732f59fcf24071a401a9bc986bf40f%7D/isoctangiographygoingtochangeourlives

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