OCT Angiography provides a new non-invasive method to visualize retinal vessels without intravenous dye. It produces higher resolution images than traditional OCT, detecting even trace amounts of exudation. However, questions remain about how to interpret and clinically apply the additional information it provides. While it can detect exudation earlier and show incomplete resolution with treatment, the implications of persistent or recurrent exudation seen on OCT Angiography are still unclear. This specific patient has barely perceptible exudation on routine OCT but cysts and fluid are visible on OCT Angiography. It is uncertain whether treatment is required given her good vision and lack of symptoms.

1. OCT Angiography:HighResolutionBScansShow PersistentandRecurrentExudation
Every diagnostic test should be evaluated with the following question:
What informationwasobtained,wasit clinicallyusefulanddiditchange the treatment plan for
the patient?
OCT Angiography introduces an innovative method to visualize vessels without the costly and
potentially dangeroususe of intravenousimagingagents.Will OCTAngiography become the standard of
care and perhaps replace the iconic use of IVFA in clinical trials? Does it add any value to the diagnosis
and treatment of Exudative ARMD? What is the value to the stakeholders in this patient experience
(patients,physicians,payersandpharmaceutical industry)? What are the different types of innovation
(sustaining versus disruptive)?
Innovationcomesintwoforms:sustaininganddisruptive. Let’s look at the former. Simply, OCT
Angiography is a sustaining innovation as the capture device has the improved capability to obtain
higherresolution ( 6 microns spacing between the adjacent B scans). The material question is how do
we interpret and use this information? Can we use this information to treat patients earlier? What is
the proper degree of exudation before we “pull the trigger” and start anti-VEGF therapy? During the
course of anti-VEGF therapy, do we really want to know that leakage resolution is incomplete? CATT
alreadyshowsthe prevalenceof suchleakage –do we really want to know that a higher resolution OCT
device furthershowsthe limitsof monotherapy? Isanyrecurrentor persistentleakage anindicationfor
retreatment?
This79 year oldWF has an occultCNV in herright eye which hasbeen treated successfully with
a treat and extend ranibizumab course with the preservation of 20/20 vision. The left eye has typical
occult IVFA leakage with a massive CNV on OCT Angiography. With routine OCT imaging, exudation is
barelyperceivable.However,onthe OCTAngiographyBscans, trace amounts of subretinal fluid as well
as intraretinal cysts can be appreciated. This patient has 20/20 vision and has no metamorphopsia.
Should the left eye be treated?
IVFA (left) shows
typical occultleakage

2. The followingquestionsmustbe answered:
Is ita mandatory to have all exudation (intraretinal andsubretinal)resolved?
Do we knowthe natural historyof persistentsubretinal orintraretinalexudation?
OCT Angiography
OCT 200 micronspace
betweenBscans
OCT Angiography –6 microns
betweenBscans