Don’t Overlook the Utility of OCT Angiography in These Common Disease States

When presentations covering the use of OCT angiography (OCTA) first appeared on the podium, many retina specialists correctly surmised that the modality was best suited to answering questions posed by curious academics and clinical researchers. Many of us were unsure what to make of OCTA images—and even if we had been experts in image capture and interpretation, so few of us had OCTA platforms in the clinic that such skills would be rendered moot.

Today the widespread availability of OCTA has changed the playing field. Platforms such as ZEISS CIRRUS 5000 and ZEISS CIRRUS 6000 both run ZEISS AngioPlex OCT Angiography, which allows these platforms to capture up to 100,000 A-scans per second in service of generating OCTA images that depict microvascular flow patterns.

The best part? All parties are happy when retina specialists choose OCTA. For patients, OCTA image capture is fast and comfortable. For providers, OCTA offers a new means by which to characterize anatomy, allowing a more nuanced understanding of disease. For payors, OCTA is less expensive than fluorescein angiography (FA), as outlined by the Academy in a recent memo¹.

Still, many providers curious about OCTA have yet to implement it into their workflows. If that sounds like you (or if you’re a provider looking to expand your use of OCTA), then weigh whether any or all of the below uses of OCTA could enhance your clinical care and optimize your workflow.

For many years, FA imaging produced some of the highest quality images of microvascular structures. While that remains true today (after all, the dawn of the OCTA era didn’t negatively affect the quality of FA as a technology), OCTA offers multiple advantages over FA that often make it my preferred imaging modality for many cases.

For starters, OCTA requires no dyes or injections. As small as the risk of an allergic response or injection-related complication may be during the capture of FA imaging, a provider eliminates those risks when opting for OCTA imaging.

As outlined above, OCTA imaging capture is fast. I order OCTA images and conventional OCT images in a single session without significantly disrupting my clinical workflow. Compared with the chair time FA imaging needs, the differences in efficiency become clear.

Patients, too, often prefer OCTA imaging to FA imaging. Discomforts such as nausea following FA imaging that have been documented in the literature¹ are not an issue with OCTA imaging. This overall improved patient experience, at the very least, leads to a more pleasant visit for our patients.

Now that US providers have access to treatments for geographic atrophy (GA), patients who previously saw little purpose in visiting our clinics now occupy regular appointments in our schedules. GA patients are at risk of converting to exudative disease, and the sooner we detect conversion, the more effectively we can treat it.

When patients with possible GA first visit my clinic (or when patients diagnosed with GA transfer to my care), I capture a baseline OCTA image to screen for signs of neovascularization. This occurs alongside the capture of the OCT images I use for diagnosing and characterizing GA, and takes so little time that my clinic’s workflow is not disrupted.

As patients return for care, I capture OCTA images on each visit to screen for conversion to exudative disease. Before OCTA, such thorough screening would require FA imaging, which is expensive, time-consuming, and uncomfortable for patients.

We retina specialists embrace new technology by instinct: we’re drawn to innovation in much the same way our intellectual curiosity drove us to retina in the first place. By slowly integrating OCTA imaging into our clinical protocols, we familiarize ourselves with the modality’s nuances and learn how it can best improve our clinical decision-making.

Don’t sleep on OCTA—it’s the future of retinal clinical imaging, and might just be the technology that allows you to catch nascent disease in your vulnerable patients.

^{The statements of the author reflect only his personal opinions and do not necessarily reflect the opinions of any institution with whom he is affiliated.
The author has a contractual or other financial relationship with Carl Zeiss Meditec, Inc. and has received financial support.}