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Manuel Amador, Amit Meshi, Tiezhu Lin, Kunny C Dans, Kevin Chen, William R Freeman; Effect of Fasting and Food Ingestion On Quality of Oral Fluorescein Angiography. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1508.
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In the era of spectral-domain optical coherence tomography (SD-OCT), there are fewer intravenous (IV) fluorescein angiographic studies being performed as retinal anatomy is seen well using only SD-OCT. Despite the ability to image vascular flow and function, IV fluorescein angiography (FA) carries the risk of adverse effects and patient inconvenience. We have used oral FA in many patients to mitigate this risk and noticed variable fine image quality. The purpose of this study was to evaluate the quality of oral FA in relationship to meals and to determine if fasting improved absorption speed and therefore quality.
This is a retrospective review of patients undergoing oral FA and SD-OCT for retinal disease. Only patients who, on different occasions had fasted overnight, and on another occasion, had eaten the morning before imaging were studied. The fasting vs. non-fasting images of the same patient were compared and analyzed for different image quality parameters by two masked retina specialists. Parameters included and graded were branch retinal vessel identification, foveal avascular zone (FAZ) visualization and definition of retina vessels (Figure 1). Based on these characteristics an angiography quality score was developed. Information about pre-oral FA meals, fasting time and body mass index were derived from the chart and patient parameters.
Fifty patients (100 eyes) were analyzed. Overall, intergrader agreement was moderate to good for all parameters with Kappas averaging 0.58. Patients who fasted had better angiography quality scores than patients who did not fast (mean±SD, 2.59±0.6 vs 2.07±0.9, p = 0.001). When imaging was performed under fasting conditions, oral FA was approximately 26% faster (time to fluorescein dye appearance) than the non-fasting exam (mean±SD, minutes: 18.7±6.9 vs 25.14±8.1, p = 0.0001).
Fasting oral FA provided better quality images as well as faster optimal imaging times compared to the non-fasting exam. Although FA use in era of SD-OCT has become less frequent, oral FA does delineate diffuse retinal edema and perfusion over broad areas and if the quality is good, is an excellent adjunctive examination at essentially no risk compared to IV FA.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Figure 1. Retinal parameters and grading.
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