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Gloria Wu, Victor Chen, Andrew Nam, Vidhya Gunasekaran, Don Byongdo Kim, Kimberly Pham, Victoria Phan; Blood Flow in FA/ICG in Patients with Glaucoma, AMD, and Diabetes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2761.
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Retinal blood flow has been of interest to ophthalmologists treating glaucoma (Glc), diabetic retinopathy, and age-related macular degeneration (AMD). To utilize FA/ ICG angiography to assess central retinal artery and short posterior ciliary artery contribution to the retinal blood flow in patients (pts) with AMD, Glc and diabetes.
Utilizing the EHR, eClinicalWorks and Heidelberg Spectralis HRA+OCT in a retina practice, we examined the transit time of the fluorescein and indocyanine green (ICG) imaging.<br /> From 03/01/12 to 12/1/14, the CPT code of 92235 (FA) and 92040 (ICG) and ICD9 codes of 362.83 (Diabetic macular edema), 362.52 (wet AMD), 365.11 (Glc) were used to find eligible pt images. Inclusion criteria: Va = 20/15 to 20/50, clear digital imaging. Exclusion criteria: poor quality of FA or ICG.<br /> First appearance of fluorescein dye was recorded, when the central retinal artery is seen, as FA1 transit and AV phase as FAV, in the primary study eye. The first appearance of ICG dye is recorded as short posterior ciliary artery perfusion SP1 and the first appearance of dye in the 4 quadrants of the choroid as SP2. We defined Glc as pts taking glaucoma medications.
Of a total of 324 FA/ICG’s performed during 3/1/12 - 12/1/14, 52 pts met the inclusion criteria. 7 were excluded because of poor quality of the digital images. A total of 45 pts were included in the study. The transit times for the patient groups are recorded below in Table 1a.<br /> AMD, Glc, diabetes, and Glc suspect pts were then compared with controls. Pts were age-matched with controls and paired t-test statistics were calculated for the 4 transit times. Moreover, AMD patients were aged-matched with those in the AMD + Glc (AG) group. P-values for the paired t-test are shown in Table 1b.<br /> Pts with AMD alone when compared with controls have delayed transit times that are significant or near significant. Moreover, AG pts have significantly faster transit times than those with AMD alone.
To our knowledge, this is the first study of early transit of ICG in evaluating AMD pts and AG pts. The treated glaucoma pts have, on average, shorter transit times than those with only AMD suggesting that treatment with pressure lowering agents may play a role in flow in the short posterior ciliary artery circulation. More studies need to be done evaluating ICG data in our retina and glaucoma patients to further elucidate blood flow in our patients.
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