Diagnosis: OCT part 2 and OCT Angiography (OCTA)

Mark H. Nelson

Oct 29, 2023 — 1 min read

When we look at an OCT, we look at a cross section of the retina as shown in the left photo. The right photo is the cross section of the macula at the level of the bright green line shown on the left. (1) denotes a relatively normal retina. (2) represents retinal leakage (and thickening) within the retina or intraretinal edema (3) presents neovascularization or abnormal vessels below the retina that are the source of leakage, i.e. wet or exudative macular degeneration (ARMD) and (4) represents a different type of exudative macular degeneration with leakage under the retina. It is not important to understand the different layers of the retina and/or the degrees of leakage but to recognize that the OCT is the most critical test we do in order to diagnose, treat, and follow exudative macular degeneration.

This represents OCT Angiography or OCTA. It is a major advancement on the technology of OCT. Not only can you see the cross section of the macula (on the right) but it actually will show the abnormal neovascularization (vessels responsible for exudation in exudative ARMD) as seen on the left. Not every eye care professional has this device. It is currently not reimbursed by insurance but it adds valuable information in the management of Exudative ARMD especially in patients who have persistent leakage despite multiple injections of anti-VEGF agents.

Exudative ARMD - Treatment Principles

Prior to the introduction of anti-VEGF drugs in 2006, the prognosis for patients with Exudative ARMD was not good. A small number of patients who were treated with thermal laser (prior to 2000) or PDT laser (after 2000) were lucky to have vision stabilized - better vision was not obtained.

What are the causes of vision loss?

Let's take an intermission prior to discussing Exudative ARMD. Obviously the most important concept of macular disease is vision loss. We all know that good vision was the norm in youth. We all know it becomes a challenge as we age. Here are the four reasons for vision loss: 1.

Diagnosis: Dry (Nonexudative ) versus Wet (Exudative) ARMD

Before delving into the finer details, let's look at couple of simple things. Dry ARMD is not the same as dry eyes, i.e. the tearing of dry eyes is in the front of the eye and has nothing to do with 'leakage' in the back part of the eye.

Diagnosis: Imaging Dyes (IVFA and ICG)

If your doctor finds leakage, or exudation, under your retina and the diagnosis of Exudative Age-Related Macular Degeneration (ARMD) is made, he/she may inject an imaging dye into your vein and take photos of the macula/retina. This test is critical to determine what type of Exudative ARMD you

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Exudative ARMD - Treatment Principles

What are the causes of vision loss?

Diagnosis: Dry (Nonexudative ) versus Wet (Exudative) ARMD

Diagnosis: Imaging Dyes (IVFA and ICG)