Optical coherence tomography angiography (OCT-A) has emerged as a non-invasive technique for imaging the microvasculature of the retina and the choroid. The first clinical studies using this innovative technology were published in 2014 and now 5 years later clinicians are still learning how best to use this technology. This has become my go-to technology for evaluating patients in certain situations – determining if there is evidence of juxtafoveal telangiectasia, explaining vision loss in diabetic retinopathy, or looking for choroidal neovascularization in the setting of chronic CSR to name a few.
One of the more recent applications of OCT angiography has been in the management of patients with a pigment epithelial detachment on SD-OCT. We now classify these into drusenoid, serous, or fibrovascular PEDs based upon the SDOCT findings. Although the pathophysiology of PED formation still not understood, it is thought that degenerative changes in Bruch’s membrane are related both to PED and choroidal neovascular membrane (CNV) formation. But in the situation of a PED without fluid, are we to assume there is no choroidal neovascularization?
In this retrospective study by Venkat et al in OSLI-Retina, researchers at the Cole Eye Institute evaluated patients with a PED by OCT-A to identify CNV with both en-face imaging and flow on OCT-A B-scan images. First, they identified that all PED subtypes (drusenoid, serous or fibrovascular) demonstrated CNV and there was a significant proportion of patients that did not demonstrate fluid on their OCT but did have choroidal neovascularization present. Finally, in those patients with a PED and CNV not treated, 17% progressed in subsequent visits to require treatment.
OCT angiography can be valuable at identifying CNV within PED and these patients might benefit from tighter follow up as a small but significant proportion progress to requiring treatment. Learn more by following the link to the article HERE.