Retinal Vascular Layers Imaged by Fluorescein Angiography and Optical Coherence Tomography Angiography

TLDR

The retinal vasculature is implicated in many ocular diseases, and although fluorescein angiography is the standard diagnostic tool, it carries adverse effect risks and fails to image all retinal vascular layers. This study investigates whether optical coherence tomography (OCT) angiography can more comprehensively image retinal vascular layers compared with conventional fluorescein angiography. Using split‑spectral amplitude decorrelation angiography (SSADA) on five overlapping B‑scan OCT angiography images (216 A‑scans each) in 12 healthy eyes, the authors dissected retinal vessel layers and compared them with fluorescein angiograms. OCT angiography successfully visualized the radial peripapillary capillary network and all retinal vascular layers, whereas fluorescein angiography could not fully image these networks, and the inner plexus accounted for about 95 % of the vascular signal in SSADA scans, demonstrating OCT angiography’s superior layer resolution and potential clinical impact.

Abstract

The retinal vasculature is involved in many ocular diseases that cause visual loss. Although fluorescein angiography is the criterion standard for evaluating the retina vasculature, it has risks of adverse effects and known defects in imaging all the layers of the retinal vasculature. Optical coherence tomography (OCT) angiography can image vessels based on flow characteristics and may provide improved information.To investigate the ability of OCT angiography to image the vascular layers within the retina compared with conventional fluorescein angiography.In this study, performed from March 14, 2014, through June 24, 2014, a total of 5 consecutive, overlapping B-scan OCT angiography images composed of 216 A-scans were obtained at 216 discrete positions within a region of interest, typically a 2 × 2-mm area of the retina. The flow imaging was based on split-spectrum amplitude decorrelation angiography (SSADA), which can dissect layers of vessels in the retina. These distinct layers were compared with the fluorescein angiograms in 12 healthy eyes from patients at a private practice retina clinic to evaluate the ability to visualize the radial peripapillary capillary network. The proportion of the inner vs outer retinal vascular layers was estimated by 3 masked readers and compared with conventional fluorescein angiograms of the same eyes.Outcome measures were visualization of the radial peripapillary capillary network in the fluorescein and SSADA scans and the proportion of the inner retinal vascular plexus vs the outer retinal capillary plexus as seen in SSADA scans that would match the fluorescein angiogram.In none of the 12 eyes could the radial peripapillary capillary network be visualized completely around the nerve head by fluorescein angiography, whereas the network was readily visualized in the SSADA scans. The fluorescein angiograms were matched, with a mean proportion of the inner vascular plexus being 95.3% (95% CI, 92.2%-97.8%) vs 4.7% (95% CI, 2.6%-5.7%) for the outer capillary plexus from the SSADA scans.Fluorescein angiography does not image the radial peripapillary or the deep capillary networks well. However, OCT angiography can image all layers of the retinal vasculature without dye injection. Therefore, OCT angiography, and the findings generated, have the potential to affect clinical evaluation of the retina in healthy patients and patients with disease.