First Author: N.Clough UK
Co Author(s): K. Kortum D. Sim
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To investigate the range of medical retinal diseases that are monitored with OCT-A in a tertiary referral centre and its impact on clinical decision making.
Outpatients clinics of Moorfields Eye Hospital, London, UK.
The database of the AngioVue OCT-A (Optovue, Fremont, California, USA) imaging system was reviewed. Scan dates on all patients with sequential scans during the period of Oct 2014 - Dec 2016 (26 months) were collected. Sequential scans as defined by two scans or greater separated by a minimum of 2 weeks. Diagnostic labels were collected from electronic medical records for these patients. In patients with proliferative diabetic retinopathy (PDR) and wet age related macular degeneration (AMD) the Heidelberg eye explorer and Topcon Imagenet databases were reviewed to establish whether concurrent fundus fluorescein angiography had been performed within 1 week of the OCT-A.
Of the 2262 patients on the database 12.7% had sequential scans, 11.6% of these had clinical information available. Common diagnostic labels were: All diabetic retinopathy (21.2%) of which 12.5% was PDR, wet AMD (11.7%), central serous retinopathy (8.3%), vein occlusion (6.4%), corneal neovascularisation (6.4%), macular telangiectasia (5.6%), idiopathic intracranial hypertension (4.9%), scleritis (3.0%), punctate inner choroidopathy (2.7%), other (28.8%). Of the 33 patients with PDR 76% had 2, 9% had 3, 9% had 4, 0 had 5 and 6% had 6 sequential OCT-A scans respectively. 33% had FFA with their first OCT-A and 18% with their second OCT-A. 1 of the 3 who had 3 sequential scans had FFA at the time of their 3rd scan. None who had 4 or 6 OCT-As had concurrent FFAs with their 4 and 6 scans. Of the 30 patients who had wet AMD 73% had 2, 20% had 3 and 7% had 4 sequential OCT-A scans respectively. 16% had FFA at the time of the 1st scan and 20% at the second scan. Only 1 had FFA at the 3rd scan and 0 at the 4th scan.
Moorfields City Road are using OCT-A for a wide variety of retinal pathologies, in particular conditions where detection and monitoring of neovascularization is paramount. In patients with PDR and consecutive OCT-A scans, the number of concurrent FFA done at the second visit reduced by almost half. In patients with wet AMD and consecutive OCT-As the number concurrent FFA done at the second visit was slightly increased. OCT-A provides a novel, non-invasive way to image the retinal vasculature and overcome some of the limitations and potential side effects of FFA. OCT-A has it’s own limitations, but as more is known about the modality it may lead to a reduction in the frequency of FFA scans.