DIAGNOSTIC FOCUS

TRACK DISEASE PROGRESSION

OCTA PROVIDES DETAIL OF ANGIOGRAPHIC DATA

AMIR H. KASHANI, M.D. PHD. AND LERNIK TOROSSIAN, O.D.

OCT ANGIOGRAPHY can help in the evaluation and monitoring of patients with vascular diseases quickly and non-invasively, especially in cases in which fluorescein angiography (FA) is not possible or is contraindicated. One such system is the new AngioPlex OCT angiographer, from ZEISS. Here, we discuss this device.

OVERVIEW

The OCTA system allows for the non-invasive evaluation of the retinal vasculature by generating capillary-level detail without dye injection. Specifically, AngioPlex produces high-resolution images of layers of the retinal and choroidal vasculature via the CIRRUS 5000 HD-OCT. This enables the visualization of blood flow by detecting motion of scattering particles, such as red blood cells. In addition, each OCTA image is co-registered with an OCT retinal B-scan of the same area. Therefore, OCTA is useful in monitoring patients with diseases, such as diabetic retinopathy, AMD and retinal vein occlusion. The system utilizes FastTrac, a retinal tracking system, to reduce the affects of eye motion on the images.

AngioPlex, from ZEISS

PROCEDURE

Each scan of the retina takes about 3 to 4 seconds to complete. Scan frames of 3 x 3mm or 6 x 6mm can be selected for different fields of view; multiple images can be captured in the same session. From the technician’s perspective, the OCTA procedure is the same as SD-OCT, with a different output.

TRAINING

Staff who have used the CIRRUS OCT machine are well-equipped to use the OCTA. That said, a ZEISS representative can assist with training. Staff members can easily train subsequent users.

PRACTICE BENEFITS

OCTA provides information for macular changes associated with diabetic retinopathy and retinal vein occlusion. The images can be compared between visits and performed frequently. Ongoing experience with it will help define its clinical role.

IN PRACTICE

OCTA was not yet FDA cleared when our practice started using it. We did so in a research capacity for the past two years through an Institutional Review Board-approved research protocol. In this setting, we perform OCTA, and FA, on patients we suspect or diagnose with a retinal vascular condition.

In a majority of cases, we have been pleasantly surprised by the resolution and ease of acquisition. Because OCTA is safe, easy and fast, we have also performed the test on many patients in whom an FA is not indicated.

With FDA-cleared for clinical use, we will start using AngioPlex in more routine clinical care. The effects on practice income and insurance coverage remain to be seen.

STREAMLINE MANAGEMENT

OCTA provides high-resolution images of the retinal vasculature. Adding an OCTA like AngioPlex to your practice can help you identify and track the progression of vascular diseases. OM

	DR. KASHANI is an assistant professor of USC Eye Institute, in Los Angeles. He has received research funding and is a consultant for Carl Zeiss Meditec.
	DR. TOROSSIAN is assistant professor of clinical ophthalmology at the USC Eye Institute in Los Angeles. She can be reached at Lernik.Torossian@med.usc.edu