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    New technology takes invisibility cloak off in retinal imaging


    Some cases presented

    He demonstrated the efficiency of ultra-widefield FA in the case of an 80-year-old male with a sudden decrease in visual acuity. Upon presentation, visual acuity was 20/400 in the right eye.

    The “dramatic” FA image showed diffuse capillary leakage, dark spots of hypofluorescence, and areas of complete capillary dropout in the periphery encroaching on the macula that led to the diagnosis of ischemic central retinal vein occlusion.

    “This technology has been very helpful in obtaining a better sense of the overall health of the eye,” Dr. Chen said.

    Figure 2: Here is an ulta-widefield FA and OCTA image of a patient with birdshot with a choroidal neovascular membrane. OCTA offers superior details of different vascular layers of the retina that previously were not available by other imaging devices. (Images provided by Royce W. S. Chen, MD)

    A corresponding spectral-domain OCT (SD-OCT) image of the same case showed extensive macular edema present. Treatment consisted of regular intravenous injections of aflibercept (Eylea, Regeneron) and the visual acuity levels have remained stable at 20/100.

    Dr. Chen also outlined the usefulness of ultra-widefield FA in cases of diabetic retinopathy, sickle cell retinopathy, and birdshot chorioretinopathy.

    In the case of sickle cell disease, ultra-widefield FA has been extremely helpful. In the case of an 18-year-old male, the bilateral visual acuity was 20/20. “The ultra-wide FA technology captured the temporal border of the retina very well and showed the abrupt transition from the vascular to the avascular retina,” Dr. Chen reported.

    Arteriovenous anastomoses and arterial occlusions were also visible. These patients are usually asymptomatic, he pointed out. Ultra-widefield FA allows physicians to learn more about the status of the peripheral retina and how the disease progresses, even in pediatric patients.

    Dr. Chen relies on ultra-widefield FA when examining patients with uveitis. “This imaging is very useful to determine the level of disease activity, whether there is vasculitis in the more peripheral retina or in the more posterior retina, which suggests more active disease,” he said. “It can visualize areas of ischemia, cystoid macular edema, blockage from granulomatous or other uveitic lesions, choroidal neovascularization, and even the presence of floaters in the vitreous.”

    OCT angiography


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