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    OCT imaging yields better visualization

    Technology captures retinal vasculature/function, but users must consider benefits, limits

    Future increases in imaging speed will improve performance and functionality for OCT and OCT angiography (OCTA), said James Fujimoto, PhD.

    One key advancement is the extension of structural OCT to perform functional imaging, said Dr. Fujimoto, the Elihu Thomson Professor of Electrical Engineering and Computer Science, Research Laboratory of Electronics and Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA.

    He focused on OCTA, noting some of its advantages, such as visualization of the microvasculature by motion contrast from moving blood without requiring dye injection, depth-resolved images of retinal and choriocapillaris vasculature, and high-contrast images that are not obscured by dye leakage.

    At the same time, OCTA is prone to artifacts and requires considerable experience to interpret. From a technical viewpoint, OCTA requires longer imaging times and has a more limited retinal coverage than structural OCT. It also has a limited dynamic range, making it difficult to detect flow impairment, he noted.

    Ultra-high-speed, swept-source OCT and OCTA help to meet some of these challenges, Dr. Fujimoto said.

    Research instruments can operate at 400 kHz A-scan rates—four times faster than commercial instruments, he noted.

    “It’s also possible to use eye tracking and software motion correction to increase the field of view and to average multiple volumes, improving image quality,” Dr. Fujimoto said. “The question is: Will it be possible to measure differences in flow?”

    Higher speeds will enable OCTA with more and faster repeated B-scans and variable interscan time analysis (also called VISTA) to differentiate capillary flow impairment (Choi, Moult et al. Ophthalmology. 2015; Ploner S, et al. Retina. 2016). Dr. Fujimoto also pointed to several examples in patients with conditions including diabetic retinopathy, age-related macular degeneration, and geographic atrophy.

    En face Doppler OCT

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