As clinicians and researchers, my team and I in our lab at the New York Eye and Ear Infirmary of Mount Sinai have been enthused to follow and be part of the evolution of OCT angiography (OCTA) technology. Our work with adaptive optics has included development of quantitative tools that have contributed to the maturation of recently FDA-cleared OCTA software that provides objective measurement and analysis of blood vessel densities in the retina and optic nerve.
Among our first findings in this area was to show that quantitative mapping of macular perfusion density agrees closely with ETDRS-type clinical grading as a way to monitor the progression of diabetic retinopathy.1 In another study, we reported that quantified perfused capillary density as measured by OCTA was significantly decreased in eyes with primary open-angle glaucoma and normal-tension glaucoma compared with normal eyes.2 We have also used OCTA to study the role of the radial peripapillary capillaries in diseases such as glaucoma, the retinal vascular impact of anti-VEGF injections, and blood flow in eyes with papilledema and other forms of disc swelling. In addition, we’ve created software that displays deviation from normal macular and optic nerve capillary density, much like what is used with OCT in glaucoma.
Our research indicates that the earliest changes in many retinal diseases likely occur in the vasculature, long before we see other structural changes, such as nerve fiber layer thinning, or functional changes. Therefore, OCTA can provide insights into pathophysiology and risk factors for disease progression. Clinically, it changes our ability to monitor patients over time and detect early disease in a way we haven’t been able to previously. In the case of diabetic eye disease, for example, earlier detection is significant now that anti-VEGF therapy is FDA-approved for use in any stage of retinopathy, and we know earlier treatment can prevent vision loss.
While the latest research provides exciting evidence of OCTA’s ability to reveal retinal disease activity at an earlier stage than ever, the new software’s quantification features will make it much easier for doctors to use the technology for spotting abnormalities, assessing risk, and streamlining clinical decision-making.
1. Agemy SA, Scripsema NK, Shah CM, et al. Retinal vascular perfusion density mapping using optical coherence tomography angiography in normals and diabetic retinopathy patients. Retina. 2015;35(11):2353-63.
2. Scripsema NK, Garcia PM, Bavier RD, et al. Optical coherence tomography angiography analysis of perfused peripapillary capillaries in primary open-angle glaucoma and normal-tension glaucoma. Invest Ophthalmol Vis Sci. 2016;57(9):OCT611-OCT620.
Dr. Rosen, a vitreoretinal surgeon, is a professor of ophthalmology at the Icahn School of Medicine of Mount Sinai. He is also vice chair and director of research and director of the Retina Service at the New York Eye and Ear Infirmary.