31Nunes RP, Gregori G, Yehoshua Z, et al: Predicting the progression of geographic atrophy in age-related macular degeneration with SD-OCT en face imaging of the outer retina. Ophthalmic Surg Lasers Imaging Retina 2013;44:344–359.
32Yehoshua Z, Garcia Filho CA, Penha FM, et al: Comparison of geographic atrophy measurements from the OCT fundus image and the sub-RPE slab image. Ophthalmic Surg Lasers Imaging Retina 2013;44:127–132.
33Spaide RF, Koizumi H, Pozzoni MC: Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol 2008;146:496–500.
34Kanagasingam Y, Bhuiyan A, Abramoff MD, Smith RT, Goldschmidt L, Wong TY: Progress on retinal image analysis for age related macular degeneration. Prog Retin Eye Res 2014;38:20–42.
35Zhao R, Camino A, Wang J, et al: Automated drusen detection in dry age-related macular degeneration by multiple-depth, en face optical coherence tomography. Biomed Opt Express 2017;8:5049–5064.
36Lee JY, Lee DH, Lee JY, Yoon YH: Correlation between subfoveal choroidal thickness and the severity or progression of nonexudative age-related macular degeneration. Invest Ophthalmol Vis Sci 2013;54:7812–7818.
37Esmaeelpour M, Ansari-Shahrezaei S, Glittenberg C, et al: Choroid, Haller’s, and Sattler’s layer thickness in intermediate age-related macular degeneration with and without fellow neovascular eyes. Invest Ophthalmol Vis Sci 2014;55:5074–5080.
38Manjunath V, Goren J, Fujimoto JG, Duker JS: Analysis of choroidal thickness in age-related macular degeneration using spectral-domain optical coherence tomography. Am J Ophthalmol 2011;152:663–668.
39Chatziralli I, Theodossiadis G, Panagiotidis D, Pousoulidi P, Theodossiadis P: Choriocapillaris’ alterations in the presence of reticular pseudodrusen compared to drusen: study based on OCTA findings. Int Ophthalmol 2018;38:1887–1893.
40Choi W, Moult EM, Waheed NK, et al: Ultrahigh-speed, swept-source optical coherence tomography angiography in nonexudative age-related macular degeneration with geographic atrophy. Ophthalmology 2015;122:2532–2544.
41Ploner SB, Moult EM, Waheed NK, et al: Toward quantitative OCT angiography: visualizing flow impairment using variable interscan time analysis (VISTA). Retina 2016;36(suppl 1):S118–S126.
42Toto L, Borrelli E, Mastropasqua R, et al: Association between outer retinal alterations and microvascular changes in intermediate stage age-related macular degeneration: an optical coherence tomography angiography study. Br J Ophthalmol 2017;101:774–779.
43Nesper PL, Soetikno BT, Fawzi AA: Choriocapillaris nonperfusion is associated with poor visual acuity in eyes with reticular pseudodrusen. Am J Ophthalmol 2017;174:42–55.
44Arnold JJ, Sarks SH, Killingsworth MC, Sarks JP: Reticular pseudodrusen. A risk factor in age-related maculopathy. Retina 1995;15:183–191.
45Meleth AD, Mettu P, Agron E, et al: Changes in retinal sensitivity in geographic atrophy progression as measured by microperimetry. Invest Ophthalmol Vis Sci 2011;52:1119–1126.
46Sunness JS, Rubin GS, Broman A, Applegate CA, Bressler NM, Hawkins BS: Low luminance visual dysfunction as a predictor of subsequent visual acuity loss from geographic atrophy in age-related macular degeneration. Ophthalmology 2008;115:1480–1488.
47Stetson PF, Yehoshua Z, Garcia Filho CA, Portella Nunes R, Gregori G, Rosenfeld PJ: OCT minimum intensity as a predictor of geographic atrophy enlargement. Invest Ophthalmol Vis Sci 2014;55:792–800.
48Spaide RF, Fujimoto JG, Waheed NK: Image artifacts in optical coherence tomography angiography. Retina 2015;35:2163–2180.
Dr. Nadia K. Waheed
Boston Image Reading Center, New England Eye Center, Tufts Medical Center
260 Tremont Street, Biewend Building, 9–11th Floor
Boston, MA 02116 (USA)
E-Mail [email protected]
Bandello F, Mastropasqua L, Querques G (eds): Clinical Applications of Optical Coherence Tomography Angiography. ESASO Course Series. Basel, Karger, 2020, vol 11, pp 9–22 (DOI: 10.1159/000485292)
______________________
Optical Coherence Tomography Angiography of Choroidal Melanoma and Radiation Retinopathy
Emil Anthony T. Saya Carol L. Shieldsb
a Retina Service, Medical University of South Carolina (MUSC), Charleston, SC, USA; b Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
______________________
Abstract
Optical coherence tomography angiography (OCTA) has revolutionized the field of ophthalmology to the benefit of all its subspecialties. In the field of ocular oncology, much of its role has been in the evaluation of choroidal melanoma and complications of radiation. Although the role of OCTA in the identification of choroidal melanoma is mainly to determine changes in parafoveal microvasculature (capillary vascular density; CVD) rather than visualization of intratumoral vascularity, it is highly valuable in the early detection and management of radiation retinopathy. Through OCTA, eyes treated with radiation for uveal melanoma show an increased foveal avascular zone (FAZ), reduction in CVD, and reduced vessel complexity, occurring at both the superficial and deep capillary plexus even in eyes without clinical or OCT-evident signs of retinopathy. Furthermore, OCTA provides new insights into the natural history of radiation retinopathy, with irradiated eyes showing a reduction in capillary density, even before symptomatic vision loss, FAZ enlargement, or macular edema. It should be realized, however, that its inability to detect leakage, scan depth, image quality, artifacts, as well as lack of normative data are current limitations of OCTA; hence, it is not a replacement but instead should be used in conjunction with traditional intravenous fluorescein angiography.
© 2020 S. Karger AG, Basel
Choroidal melanoma is a deadly malignancy and is also the most common primary intraocular tumor in adults with increasing risk per millimeter increase in thickness [1–5]. Our continued