September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Quantitative OCT Angiography of Choroidal Neovascularization under Pro Re Nata Treatment
Author Affiliations & Notes
  • Steven T Bailey
    Ophthalmology , Casey Eye Institute/OHSU, Portland, Oregon, United States
  • Simon S. Gao
    Ophthalmology , Casey Eye Institute/OHSU, Portland, Oregon, United States
  • Thomas S Hwang
    Ophthalmology , Casey Eye Institute/OHSU, Portland, Oregon, United States
  • Christina J Flaxel
    Ophthalmology , Casey Eye Institute/OHSU, Portland, Oregon, United States
  • Andreas Lauer
    Ophthalmology , Casey Eye Institute/OHSU, Portland, Oregon, United States
  • David Huang
    Ophthalmology , Casey Eye Institute/OHSU, Portland, Oregon, United States
  • Yali Jia
    Ophthalmology , Casey Eye Institute/OHSU, Portland, Oregon, United States
  • Footnotes
    Commercial Relationships   Steven Bailey, Optovue, Inc (F); Simon Gao, None; Thomas Hwang, None; Christina Flaxel, None; Andreas Lauer, None; David Huang, Carl Zeiss Meditec, Inc. (P), Optovue, Inc (F), Optovue, Inc (I), Optovue, Inc (P), Optovue, Inc (R); Yali Jia, Optovue, Inc (F), Optovue, Inc (P)
  • Footnotes
    Support  R01 EY023285, R01 EY024544, DP3 DK104397, P30 EY010572, and unrestricted grant from Research to Prevent Blindness
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2162. doi:
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      Steven T Bailey, Simon S. Gao, Thomas S Hwang, Christina J Flaxel, Andreas Lauer, David Huang, Yali Jia; Quantitative OCT Angiography of Choroidal Neovascularization under Pro Re Nata Treatment. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2162.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To use choroidal neovascularization (CNV) area as a metric to assess CNV response to treatment in age-related macular degeneration (AMD).

Methods : Prospective study of seven eyes from seven participants with treatment naïve CNV that underwent OCT angiography scans at baseline and monthly visits while under a pro re nata (PRN) anti-VEGF treatment regimen. Spectral OCT (RTVue-XR Avanti, Optovue) acquired 3×3 mm macular scans. Split-Spectrum Amplitude-Decorrelation Angiography (SSADA) algorithm was used to compute blood flow. The outer retinal angiograms were defined as the maximum flow projection between outer plexiform layer and Bruch's membrane. Projection artifacts in the outer retina were removed by subtracting a Gaussian filtered version of the inner retinal angiogram. CNV was automatically identified in outer retina using saliency detection, and CNV area was quantified by thresholding and a level set method to refine the CNV boundaries. Two scans were acquired at each visit and within-visit repeatability was assessed by coefficient of variation (CV).

Results : Within-visit CNV area repeatability was 8.6% CV. Six of seven eyes showed initial reduction in CNV area while under treatment. In one eye, initial CNV area measurement was incomplete due to subretinal hemorrhage (SRH), and the apparent CNV area increased while under treatment; after resolution of SRH, CNV area stabilized (Fig. 1A). In another case, CNV area decreased during initial treatments and then remained stable without treatment (Fig. 1B). In a third example, CNV area increased preceding fluid accumulation on structural OCT (Fig. 1C).

Conclusions : CNV area can be automatically measured by saliency-based algorithm with excellent repeatability. This metric can be useful in monitoring treatment response. In some cases, increase in CNV area may precede recurrence of fluid on structural OCT, serving as an earlier indicator for the need for treatment.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Figure 1. Changes in CNV area over time in 3 example cases of anti-VEGF PRN treatment regimen (bars = difference between 2 measurements made in the same visit). Shaded areas represent when treatment was given. A, CNV area increases after two months as SRH resolves, then stabilizes. B, CNV area decreases and remains static without treatment. C, CNV area initially decreases with treatment. Treatment is withheld and CNV growth precedes the need for treatment at month 6.

Figure 1. Changes in CNV area over time in 3 example cases of anti-VEGF PRN treatment regimen (bars = difference between 2 measurements made in the same visit). Shaded areas represent when treatment was given. A, CNV area increases after two months as SRH resolves, then stabilizes. B, CNV area decreases and remains static without treatment. C, CNV area initially decreases with treatment. Treatment is withheld and CNV growth precedes the need for treatment at month 6.

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