Clinical Applications of Optical Coherence Tomography Angiography

Clinical Applications of

Optical Coherence

Tomography Angiography

ESASO Course Series

Vol. 11

Series Editors

F. Bandello Milan

B. Corcóstegui Barcelona

Clinical Applications of

Optical Coherence

Tomography Angiography

Volume Editors

F. Bandello Milan

L. Mastropasqua Chieti

G. Querques Milan

64 figures, 54 in color, and 4 tables, 2020

Library of Congress Cataloging-in-Publication Data

Names: Bandello, F. (Francesco), editor. | Mastropasqua, Leonardo, 1954-editor. | Querques, Giuseppe, editor.

Title: Clinical applications of optical coherence tomography angiography / volume editors, F. Bandello, L. Mastropasqua, G. Querques.

Other titles: ESASO course series ; v. 11. 1664-882X

Description: Basel ; New York : Karger, [2020] | Series: ESASO course series, 1664-882X ; vol. 11 | Includes bibliographical references and index. | Summary: The recent introduction of optical coherence tomography angiography (OCTA) has remarkably expanded our knowledge of different retinal, chorioretinal, and optic disc disorders. OCTA is nowadays often introduced as a routine exam in clinical practice, granting the opportunity to non-invasively investigate retinal and choroidal circulation. In this book, many major experts in posterior eye imaging share their experiences and their latest images and ideas about OCTA-- Provided by publisher.

Identifiers: LCCN 2019059082 (print) | LCCN 2019059083 (ebook) | ISBN 9783318066425 (paperback : alk. paper) | ISBN 9783318066432 (ebook)

Subjects: MESH: Eye Diseases--diagnostic imaging | Retinal Vessels--diagnostic imaging | Tomography, Optical Coherence | Fluorescein Angiography

Classification: LCC RE75 (print) | LCC RE75 (ebook) | NLM WW 141 | DDC 617.7/154--dc23

LC record available at https://lccn.loc.gov/2019059082

LC ebook record available at https://lccn.loc.gov/2019059083

Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® and MEDLINE/Pubmed.

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© Copyright 2020 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland)

www.karger.com

Printed on acid-free and non-aging paper (ISO 9706)

ISSN 1664–882X

e-ISSN 1664–8838

ISBN 978–3–318–06642–5

e-ISBN 978–3–318–06643–2

Contents

List of Contributors

Preface

Bandello, F. (Milan); Mastropasqua, L. (Chieti); Querques, G. (Milan)

Optical Coherence Tomography Angiography in Dry Age-Related Macular Degeneration

Arya, M. (Boston, MA); Saifuddin, A. (Boston, MA/Karachi); Waheed, N.K. (Boston, MA)

Optical coherence tomography angiography of choroidal melanoma and radiation retinopathy

Say, E.A.T. (Charleston, SC); Shields, C.L. (Philadelphia, PA)

Evaluation of the Choriocapillaris in Age-related Macular Degeneration

Borrelli, E. (Los Angeles, CA/Chieti); Sadda, S.R. (Los Angeles, CA)

Optical Coherence Tomography Angiography of Retinal Vascular Occlusion

Baumal, C.R. (Boston, MA)

Imaging Exudative Age-Related Macular Degeneration Using Swept Source Optical Coherence Tomography Angiography

Motulsky, E.H. (Brussels); Rosenfeld, P.J. (Miami, FL)

Diabetic Retinopathy in Optical Coherence Tomography Angiography

Hwang, T.; Jia, Y.; Huang, D. (Portland, OR)

Optical Coherence Tomography Angiography in Inherited Retinal Dystrophies

Mastropasqua, L.; Borrelli, E. (Chieti)

Optical Coherence Tomography Angiography in Idiopathic Macular Telangiectasia

Mastropasqua, R. (Bristol); Toto, L. (Chieti); Di Antonio, L. (Chieti)

Optical Coherence Tomography Angiography of Type 3 Neovascularization

Hou, K. ; Au, A. (Los Angeles, CA); Garrity, S.T. (Boston, MA); Sarraf, D. (Los Angeles, CA)

Long term evolution of Type 1 NV by Optical Coherence Tomography Angiography

Lumbroso, B.; Rispoli, M.; Savastano, M.C. (Rome)

Optical Coherence Tomography Angiography in Patients with Type 1 Diabetes without Diabetic Retinopathy

Carnevali, A. (Milan/Catanzaro); Sacconi, R. (Milan/Verona); Corbelli, E.; Querques, L.; Querques, G.; Bandello, F. (Milan)

Optical Coherence Tomography Angiography of Early Asymptomatic Type 3 Neovascularization

Sacconi, R. (Milan/Verona); Corbelli, E. (Milan); Carnevali, A. (Milan/Catanzaro); Querques, L.; Bandello, F.; Querques, G. (Milan)

Optical Coherence Tomography Angiography of Intermediate Age-Related Macular Degeneration

Corbelli, E. (Milan); Sacconi, R. (Milan/Verona); Carnevali, A. (Milan/Catanzaro); Cicinelli, M.V.; Querques, L.; Bandello, F.; Querques, G. (Milan)

Optical Coherence Tomography Angiography: Predictive Factors for Therapeutic Decisions in Exudative AMD (Treatment Criteria)

Sellam, A. (Paris); Coscas, F. (Créteil, Paris); Coscas, G. (Créteil)

Optical Coherence Tomography Angiography and Glaucoma

Mastropasqua, L.; Agnifili, L.; Fasanella, V.; Brescia, L.; Scatena, B.; Di Antonio, L. (Chieti)

Subject Index

List of Contributors

Luca Agnifili, p 123

Ophthalmology Clinic, Department of Medicine

and Science of Ageing

University G. D’Annunzio Chieti-Pescara

Via dei Vestini, 1, IT–66100 Chieti (Italy)

E-Mail l.agnifili@unich.it

Malvika Arya, p 1

Boston Image Reading Center

New England Eye Center at Tufts Medical Center

260 Tremont Street, Biewend Building, 9–11th Floor

Boston, MA 02116 (USA)

E-Mail malvika.arya@tufts.edu

Adrian Au, p 81

Retinal Disorders and Ophthalmic Genetics Division

Stein Eye Institute, David Geffen School of

Medicine at UCLA

100 Stein Plaza, Los Angeles, CA 90095 (USA)

E-Mail au@jsei.ucla.edu

Francesco Bandello, p 97, 103, 110

Department of Ophthalmology, University Vita-Salute

IRCCS Ospedale San Raffaele

Via Olgettina 60, IT–20132 Milan (Italy)

E-Mail francesco.bandello@hsr.it

Caroline R. Baumal, p 33

Department of Ophthalmology

New England Eye Center

Tufts University School of Medicine

800 Washington Street, Box 450

Boston, MA 02111 (USA)

E-Mail cbaumal@gmail.com

Enrico Borrelli, p 23, 61

Department of Ophthalmology, University Vita Salute

IRCCS Ospedale San Raffaele

Via Olgettina 60, IT–20132 Milan (Italy)

E-Mail borrelli.enrico@yahoo.com

Lorenza Brescia, p 123

Ophthalmology Clinic, Department of Medicine

and Science of Ageing

University G. D’Annunzio Chieti-Pescara

Via dei Vestini, 1, IT–66100 Chieti (Italy)

E-Mail brescia.lorenza@gmail.com

Adriano Carnevali, p 97, 103, 110

Department of Ophthalmology, University of

Magna Graecia

Viale Europa, Germaneto

IT–88100 Catanzaro (Italy)

E-Mail adrianocarnevali@live.it

Maria Vittoria Cicinelli, p 110

Department of Ophthalmology, University Vita-Salute

IRCCS Ospedale San Raffaele

Via Olgettina 60, IT–20132 Milan (Italy)

E-Mail cicinelli.mariavittoria@hsr.it

Eleonora Corbelli, p 97, 103, 110

Department of Ophthalmology, University Vita-Salute

IRCCS Ospedale San Raffaele

Via Olgettina 60, IT–20132 Milan (Italy)

E-Mail corbelli.eleonora@hsr.it

Florence Coscas, p 116

Service d’Ophtalmologie, Université Paris Est

Hôpital Intercommunal de Créteil

40, Avenue de Verdun

FR–94010 Créteil (France)

E-Mail coscas.f@gmail.com

Gabriel Coscas, p 116

Service d’Ophtalmologie, Université Paris Est

Hôpital Intercommunal de Créteil

40, Avenue de Verdun

FR–94010 Créteil (France)

E-Mail gabriel.coscas@gmail.com

Luca Di Antonio, p 68, 123

Ophthalmology Clinic, Department of Medicine

and Science of Ageing

University G. D’Annunzio Chieti-Pescara

Via dei Vestini, 1, IT–66100 Chieti (Italy)

E-Mail monsieurluca@yahoo.com

Vincenzo Fasanella, p 123

Ophthalmology Clinic, Department of Medicine

and Science of Ageing

University G. D’Annunzio Chieti-Pescara

Via dei Vestini, 1, IT–66100 Chieti (Italy)

E-Mail fasanellavincenzo@libero.it

Sean T. Garrity, p 81

New England Eye Center, Tufts University School of

Medicine

800 Washington St. #450

Boston, MA 02111 (USA)

E-Mail garrits87@gmail.com

Kirk K. Hou, p 81

Retinal Disorders and Ophthalmic Genetics Division

Stein Eye Institute, David Geffen School of

Medicine at UCLA

100 Stein Plaza, Los Angeles, CA 90095 (USA)

E-Mail kirk.hou@gmail.com

David Huang, p 53

Casey Eye Institute, Oregon Health and

Science University

515 SW Campus Dr

Portland, OR 97239 (USA)

E-Mail huangd@ohsu.edu

Thomas S. Hwang, p 53

Casey Eye Institute, Oregon Health and

Science University

515 SW Campus Dr

Portland, OR 97239 (USA)

E-Mail hwangt@ohsu.edu

Yali Jia, p 53

Casey Eye Institute, Oregon Health and

Science University

515 SW Campus Dr

Portland, OR 97239 (USA)

E-Mail jiaya@ohsu.edu

Bruno Lumbroso, p 91

Centro Italiano Macula

Via Angelo Brofferio, 7

IT–00195 Rome (Italy)

E-Mail bruno.lumbroso@gmail.com

Leonardo Mastropasqua, p 61, 123

Ophthalmology Clinic, Department of Medicine

and Science of Ageing

University G. D’Annunzio Chieti-Pescara

Via dei Vestini, 1, IT–66100 Chieti (Italy)

E-Mail mastropa@unich.it

Rodolfo Mastropasqua, p 68

Department of Ophthalmology, University of

Modena and Reggio Emilia

Via del pozzo 71

IT–41124 Modena (Italy)

E-Mail rodolfo.mastropasqua@gmail.com

Elie H. Motulsky, p 44

Department of Ophthalmology

University Hospital Center Saint-Pierre and Brugmann

Free University of Brussels

322 Rue Haute, BE–1000 Brussels, Belgium

E-Mail elmotuls@gmail.com

Lea Querques, p 97, 103, 110

Department of Ophthalmology, University Vita-Salute

IRCCS Ospedale San Raffaele

Via Olgettina 60, IT–20132 Milan (Italy)

E-Mail querques.lea@hsr.it

Giuseppe Querques, p 97, 103, 110

Department of Ophthalmology, University Vita-Salute

IRCCS Ospedale San Raffaele

Via Olgettina 60, IT–20132 Milan (Italy)

E-Mail giuseppe.querques@hotmail.it

Marco Rispoli, p 91

Centro Italiano Macula

Via Angelo Brofferio, 7

IT–00195 Rome (Italy)

E-Mail rispolimarco@gmail.com

Philip J. Rosenfeld, p 44

Department of Ophthalmology

Bascom Palmer Eye Institute

University of Miami Miller School of Medicine

900 NW 17th St., Miami, FL 33136 (USA)

E-Mail prosenfeld@miami.edu

Riccardo Sacconi, p 97, 103, 110

Department of Ophthalmology, University Vita-Salute

IRCCS Ospedale San Raffaele

Via Olgettina 60, IT–20132 Milan (Italy)

E-Mail ric.sacconi@gmail.com

Srinivas R. Sadda, p 23

Doheny Image Reading Center

Doheny Eye Institute

1355 San Pablo Street, Suite 211

Los Angeles, CA 90033 (USA)

E-Mail SSadda@doheny.org

Adnan Saifuddin, p 1

Boston Image Reading Center

New England Eye Center at Tufts Medical Center

260 Tremont Street, Biewend Building, 9–11th Floor

Boston, MA 02116 (USA)

David Sarraf, p 81

Retinal Disorders and Ophthalmic Genetics Division

Stein Eye Institute, David Geffen School of

Medicine at UCLA

100 Stein Plaza, Los Angeles, CA 90095 (USA)

E-Mail dsarraf@ucla.edu

Maria Cristina Savastano, p 91

Centro Italiano Macula

Via Angelo Brofferio, 7

IT–00195 Rome (Italy)

E-Mail crisav8@virgilio.it

Emil Anthony T. Say, p 9

Retina Service, Medical University of

South Carolina (MUSC)

167 Ashley Ave, MSC 676

Charleston SC, 29425 (USA)

E-Mail saye@musc.edu

Barbara Scatena, p 123

Ophthalmology Clinic, Department of Medicine

and Science of Ageing

University G. D’Annunzio Chieti-Pescara

Via dei Vestini, 1, IT–66100 Chieti (Italy)

E-Mail barbara.scatena87@gmail.com

Alexandre Sellam, p 116

Université Paris VI

48 Avenue Foch

FR–75116 Paris (France)

E-Mail alexandresellam@gmail.com

Carol L. Shields, p 9

Ocular Oncology Service, Wills Eye Hospital

Thomas Jefferson University

840 Walnut Street, Suite 1440

Philadelphia, PA 19107 (USA)

E-Mail carolshields@gmail.com

Lisa Toto, p 68

Ophthalmology Clinic, Department of Medicine

and Science of Ageing

University G. D’Annunzio Chieti-Pescara

Via dei Vestini, 1, IT–66100 Chieti (Italy)

E-Mail l.toto@unich.it

Nadia K. Waheed, p 1

Boston Image Reading Center

New England Eye Center at Tufts Medical Center

260 Tremont Street, Biewend Building, 9–11th Floor

Boston, MA 02116 (USA)

E-Mail nadiakwaheed@gmail.com

Bandello F, Mastropasqua L, Querques G (eds): Clinical Applications of Optical Coherence Tomography Angiography. ESASO Course Series. Basel, Karger, 2020, vol 11, pp X (DOI: 10.1159/000504737)

Preface

The recent introduction of optical coherence tomography angiography (OCTA) has remarkably expanded our knowledge of different retinal, chorioretinal, and optic disc disorders. In addition, OCTA is nowadays often introduced as a routine exam in clinical practice, which has significantly modified the approach to our patients, granting the opportunity to non-invasively investigate the retinal and choroidal circulation.

For sure, OCTA technology is not without limitations and we all are still trying to interpret the information we capture. However, there is no question that this imaging technology has modified our approach to patients.

In this book, many major experts in posterior eye imaging share their experiences and their latest images and ideas. We sincerely hope that our efforts will be useful to all of you who are interested in this new technology. In a few years, we are confident that many of the limitations of this technology will be brilliantly overcome by new hardware and software applied to OCTA imaging, thus allowing the technology to be employed widely in the patient care.

We would like to thank Karger Publishers for making this book possible, and we express our sincere gratitude to all the doctors, technicians, and nurses who share their enthusiasm and efforts with us daily.

Enjoy reading!

Francesco Bandello, Milan

Leonardo Mastropasqua, Chieti

Giuseppe Querques, Milan

Bandello F, Mastropasqua L, Querques G (eds): Clinical Applications of Optical Coherence Tomography Angiography. ESASO Course Series. Basel, Karger, 2020, vol 11, pp 1–8 (DOI: 10.1159/000485295)

______________________

Optical Coherence Tomography Angiography in Dry Age-Related Macular Degeneration

Malvika Aryaa Adnan Saifuddina, b Nadia K. Waheeda

a New England Eye Center, Tufts Medical Center, Boston, MA, USA; b The Aga Khan University Hospital, Karachi, Pakistan

______________________

Abstract

Dry age-related macular degeneration (AMD) is characterized by changes in the outer retina, retinal pigment epithelium (RPE), and choroid. Optical coherence tomography angiography (OCTA) has proven instrumental in analyzing these changes and further understanding the pathogenesis of AMD. Early and intermediate AMD have been shown to be associated with choroidal thinning, choriocapillaris (CC) alterations under drusen, and intraretinal vascular depletion. OCTA of geographic atrophy (GA), the late stage of dry AMD, has demonstrated CC loss under the lesion itself and decreased CC flow speeds around the area of atrophy, suggesting a key role of the CC in GA pathogenesis. Much still remains to be understood about dry AMD, with an ongoing debate of whether initial changes occur in the CC, RPE, or photoreceptor layer. By allowing investigation of retinal and choroidal vascular flow changes associated with dry AMD, OCTA may pave the way for improved prediction, detection, and monitoring of dry AMD disease progression.

© 2020 S. Karger AG, Basel

Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly population in developed countries, and accounts for nearly 8.7% of blindness worldwide [1]. It is estimated that 30–50 million people are affected by AMD around the world, a number only anticipated to increase in the coming years.

The pathogenesis of AMD has been linked to a multitude of factors, including increasing age, oxidative stress, inflammation, genetics, mitochondrial factors, ischemia, and environmental contributors [2, 3]. AMD is characterized by angiogenesis, drusen formation, and local complementary and inflammatory responses [4]. The inciting event of dry AMD, however, still remains to be determined. Dry AMD involves changes in the photoreceptor cells, retinal pigment epithelium (RPE), and choroid, but it is still unclear where the initial change takes place. Theories suggest that there may be a primary dysfunction of the photoreceptor cells, or that a defective RPE may lead to photoreceptor cell damage. Fairly recently, however, choroidal changes have also been discovered to be associated with the occurrence of dry AMD, an area that is still being explored with great interest [5–9].

Classification of AMD

Clinically, AMD is classified into three categories: early, intermediate, and late AMD. Normal aging may involve the formation of a few drusen, less than 63 μm in size, between the RPE and Bruch’s membrane, which have not been shown to increase the risk of development of AMD [10]. Drusen consist of hydrophobic extracellular focal deposits of lipofuscin, photoreceptor debris, and inflammatory components [11, 12]. Early AMD is characterized by drusen between 63 and 125 µm in size with no pigmentary changes. Pigmentary abnormalities, due to RPE alterations, or larger-sized drusen, at greater than 125 µm, indicate progression to intermediate AMD [13]. Overall, drusen size is an important predictive marker, as small drusen less than 63 µm are unlikely to progress to late AMD [13]. The risk of developing late AMD increases with increasing drusen size [14]. The development of neovascularization and/or geographic atrophy (GA) defines late AMD. GA, still under the umbrella of dry AMD, is characterized by subretinal drusen and loss of photoreceptors, RPE, and choriocapillaris (CC). Atrophy is usually confined to a particular region, hence the term geographic atrophy, and often a clear-cut boundary between affected RPE and adjacent normal, unaffected RPE may be visualized. GA has also been associated with outer retinal changes and atrophy and alteration of choroidal vessels [15, 16]. The presence of neovascularization in late AMD is often referred to as exudative, or wet, AMD.

Overall, both wet AMD and dry AMD are associated with poor visual outcomes. While wet AMD accounts for only 10% of patients with AMD, it is the reason for 90% of AMD-related blindness. The advent of intravitreal anti-vascular endothelial growth factor (VEGF) injections has revolutionized the treatment of wet AMD, greatly improving visual outcomes [17, 18]. However, it has been questioned whether anti-VEGF injections result in the progression to outer retinal and macular atrophy [9, 19].

Multimodal Imaging of AMD

Prior to the introduction of fundus autofluorescence, color fundus photography was the gold standard for evaluation of AMD [20, 21]. More recently, fundus autofluorescence has been used in the evaluation of patients with dry AMD, and especially to measure and to prognosticate macular atrophy [22, 23]. However, the paradigm is slowly shifting in the favor of optical coherence tomography (OCT) [20, 24]. OCT has been used to qualitatively evaluate for dry AMD, as well as to measure drusen volume, which is associated with risk of progression of dry AMD [25]. It can also be used to evaluate the characteristics of drusen that are associated with a higher risk of progression to advanced dry AMD, as well as exudative AMD [26, 27]. Moreover, OCT can also be used to look for reticular pseudodrusen (RPD), which have been associated with a higher risk of choroidal atrophy and of progression of AMD [28–30]. The en face image generated after a