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OCT Angiography

Majcher, Carolyn, OD, FAAO

Optometry and Vision Science: June 2018 - Volume 95 - Issue 6 - p 553
doi: 10.1097/OPX.0000000000001234

UIW Rosenberg School of Optometry San Antonio, Texas

OCT Angiography by David R. Chow and Paulo Ricardo Chaves de Oliveira is a novel text that highlights clinical utility of optical coherence tomography angiography (OCT-A). This contemporary work includes insightful contributions from more than 40 experts in the field including vitreoretinal surgeons in clinical practice as well as retinal specialists and scientists pursuing basic and applied research in OCT-A. Optical coherence tomography angiography is a noninvasive microvascular imaging technology US Food and Drug Administration approved in the United States in 2015. This innovative technology provides high-resolution, volumetric data regarding intravascular red blood cell motion. The authors do a commendable job of explaining how this technology fits within the context of modern clinical vitreoretinal disease diagnosis and management.

As anyone who has recently purchased an OCT device with angiography capabilities knows, there is an initial learning curve in conceptualizing the acquired volumetric dataset and interpreting the results especially given the lack of normative comparisons. As an invaluable resource for both the OCT-A novice and experienced user, this book not only provides a basic overview of OCT-A technology, but also outlines OCT-A features in both common and exotic ocular conditions.

The text layout is well organized and easy to follow. The first three chapters detail technical aspects of OCT-A including available systems, limitations, and artifacts. This is followed by an in-depth discussion of OCT-A applications in various vitreoretinal and choroidal diseases including diabetic retinopathy, retinal arterial and venous occlusive disorders, central serous chorioretinopathy, macular telangiectasia type 2, adult-onset foveomacular vitelliform dystrophy, high myopia, as well as neovascular and nonneovascular forms of age-related macular degeneration. Other ocular disorders including glaucoma and uveitis are also discussed. The text concludes with a chapter containing grand-rounds–type cases, which nicely summarizes the clinical take-home points. I recommend that the reader be familiar with general OCT technology and retinal vascular anatomy prior to taking on this rewarding literary adventure.

The real gems of this work that sets it apart from other texts on OCT-A are two comprehensive chapters that discuss ocular oncology and OCT-A evaluation of anterior segment vasculature, two topics of which very little has been published to date. The chapter on ocular oncology includes discussion and examples of retinal, retinal pigmented epithelium, and choroidal tumors including melanocytoma, choroidal hemangioma, and treated choroidal melanoma and metastases. The anterior segment section presents innovative OCT-A applications including monitoring for corneal graft rejection, corneal neovascularization in infectious keratitis, conjunctival bleb healing following trabeculectomy, and iris rubeosis.

In my opinion, the authors strike a good balance of evidence-based medicine and practical application. Each disease chapter begins with a summary of the disorder including a brief discussion of the epidemiology, pathophysiology, key clinical signs, and established diagnostic techniques. The authors then delve into a well-referenced presentation of OCT-A features that contain numerous high-quality, original case examples imaged with a mix of OCT-A systems. These illustrations include color fundus photographs, OCT B-scans, multiple OCT-A enface displays, and in many cases additional multimodal imaging results such as fundus autofluorescence, conventional intravenous fluorescein, and indocyanine green angiography.

Although one might expect a work of this nature to be geared toward retinal specialists and surgical ophthalmologists, I believe this text is invaluable to even the OCT-A newcomer. This book is essential to doctors who are considering purchasing or presently own an OCT-A system and are interested in or substantively involved in comanaging vitreoretinal disease. For any eye care professional seeking to incorporate OCT-A into everyday clinical practice and expand its use, this text is sure to satisfy and is one I highly recommend.

Carolyn Majcher, OD, FAAO

UIW Rosenberg School of Optometry

San Antonio, Texas

© 2018 American Academy of Optometry