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.
Ultrahigh-resolution optical coherence tomography uses broadband light sources to achieve axial image resolutions on the few micron scale. Fourier domain detection methods enable more than an order of magnitude increase in imaging speed and sensitivity, thus overcoming the sensitivity limitations inherent in ultrahigh-resolution OCT using standard time domain detection. Fourier domain methods also provide direct access to the spectrum of the optical signal. This enables automatic numerical dispersion compensation, a key factor in achieving ultrahigh image resolutions. We present ultrahigh-resolution, high-speed Fourier domain OCT imaging with an axial resolution of 2.1 ìm in tissue and 16,000 axial scans per second at 1024 pixels per axial scan. Ultrahigh-resolution spectral domain OCT is shown to provide a ~100x increase in imaging speed when compared to ultrahigh-resolution time domain OCT. In vivo imaging of the human retina is demonstrated. We also present a general technique for automatic numerical dispersion compensation, which is applicable to spectral domain as well as swept source embodiments of Fourier domain OCT.
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