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    Opportunities and challenges in the world of ophthalmology in 2018


    Thoughts on optical coherence tomography angiography (OCTA)

    Dr Augustin: Optical coherence tomography angiography (OCTA) is fast becoming an essential tool in the evaluation of retinal diseases. It removes the need to use a dye and provides immediate visualisation of the retinal and choroidal vascular bed. It also helps to visualise the superficial, deep and choroidal vascular network simultaneously. Therefore, by combining dynamic and morphology data the ‘road’ to the diagnosis becomes less complicated.

    However, image artifacts, which are common in OCTA and can lead to incorrect interpretations of images, need special attention and require further evaluation. Having a standardised way of evaluating OCTA and a clear listing of all kinds of artifacts to avoid misinterpretation of the results would be helpful. 

    Dr Hollo: OCTA in the macula area and in the peripapillary region has repeatedly been shown to have good diagnostic accuracy in glaucoma detection. In addition, a case series showed that very significant IOP reduction (at least a 50% reduction to 18 mmHg or less) in high-pressure open-angle glaucoma and ocular hypertension may lead to considerable recovery of the decreased peripapillary circulation.

    Another report presented a glaucoma case in which progressive deterioration of the visual field and thinning of the retinal nerve fibre layer was accompanied by progressive reduction of peripapillary perfusion with OCTA.

    Thus, OCTA may potentially be applicable in the follow-up of glaucoma patients. Prospective studies addressing this area, however, are not yet available. I hope that the first studies investigating the role of OCT angiography in the detection of glaucomatous progression will be available in 2018.

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