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Ben Szirth, Ashley Ooms, Albert S Khouri; Integration of OCTA in Community-Based Screening Programs for Vision-Threatening Diseases. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3039.
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© ARVO (1962-2015); The Authors (2016-present)
Nearly half of people with vision-threatening diseases (VTDs) (age-related macular degeneration [AMD], diabetic retinopathy [DR], glaucoma) are unaware they have either one or multiple forms of VTDs. Known VTD cases number around 36 million in the United States and could reach 58 million in the next 20 years. With 5.6 ophthalmologists per 100,000 individuals, this translates to 29 million persons with untreated VTDs who could benefit from early detection and management of these conditions.
Tele-Ocular Screening Program Services (TOPS) is a mobile community-based screening program that uses conventional clinical instruments: visual acuity chart, noncontact automated refraction, noncontact intraocular tonometry, and CR-2 PLUS AF (Canon, Japan) 45° nonmydriatic color and fundus autofluorescence (FAF) retinal camera with a minimum pupillary dilation of 3.2 mm. We integrated Canon HS-100 OCTA (optical coherence tomography with angiography) with 3-µm resolution to evaluate the benefit of value-added technology for triaging and increasing referral to the appropriate subspecialty. No mydriatic agents were used.
A total of 132 individuals (45% male; age range, 18−83 years) were screened at various community centers in the Newark, New Jersey, metro area in 2018. TOPS uncovered ocular findings in 34 individuals (26%), all of whom were unaware of their condition. Color photography alone yielded a 13% pickup rate for VTDs. Adding FAF increased detection to 19%. OCTA added 3 minutes to our screening time of 6 minutes and increased our pickup rate by 7% (to 26%). VTDs detected included: AMD, 6 cases; DR, 9; DR with macular edema, 5; branch vein occlusion, 1; optic nerve head drusen, 3; and glaucoma, 12. OCTA was most helpful in 15 follow-ups (44%), displaying automatically generated slopes (ascending/descending) in retinal edema (Fig.).
Glaucoma detection benefited most (35%) from use of OCTA referrals directly to subspecialists. OCTA was most useful in detecting wet AMD, DR, and glaucoma as well as combined VTD of DR and glaucoma. Early pickup and referral to the appropriate subspecialty can trigger clinically appropriate intervention leading to preservation of vision.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Figure. Participant with dual VTDs. (A) Right eye: DR.
(B) Left eye: Glaucoma. Note descending slope in bottom left graph.
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