Light from the exploring arm is reflected, absorbed or scattered as it passes through the structures of the posterior retina. This technology utilizes a light beam that is split into an exploring arm and a reference arm to generate an image. Though original clinical OCT units were based on time domain detection, spectral domain OCT (SD-OCT) is now the clinical standard. This non-invasive imaging technique changed the clinical management of many retinal diseases. This novel imaging modality allowed for detailed visualization of the posterior retina in a cross sectional fashion. In 1991 optical coherence tomography (OCT) was described in the literature. This review will offer a basic toolkit for OCTA interpretation in clinical practice and explore its utility in assessing retinal pathology. Though scientifically novel and relevant to the understanding of ocular pathophysiology, these studies often reference language and metrics that remain inaccessible to clinical ophthalmologists. ![]() A large body of literature emerged to describe vascular findings on OCTA. Investigational groups explored the utility of OCTA in a wide range of ocular pathologies including age related macular degeneration (AMD), diabetic retinopathy (DR), and uveitis. Prior to its commercial release, OCTA was available as a research tool. OCTA offered in vivo visualization of the retinal microvasculature in a depth-resolved fashion, without the need for time-consuming dye administration. These imaging modalities generated a 2-dimensional en face view of the retinal vasculature and did not allow for the individual visualization of retinal capillary plexuses. Prior to OCTA, fluorescein angiography (FA) and indocyanine green angiography (ICGA) were the mainstay modalities for retinovascular visualization. This technology allowed for the visualization of retinal microvasculature in vivo. Optical coherence tomography angiography (OCTA) first became commercially available in 2014. This review provides a toolkit for successful image interpretation in a clinical setting. OCTA is evolving from a scientific tool to a clinical imaging device. Lastly, the use of OCTA for the clinical interpretation of retinal pathology, such as diabetic retinopathy and age-related macular degeneration, is discussed. Slabs offered in standard OCTA devices are reviewed, and clinical uses for each slab are outlined. OCTA has the unique ability among retinovascular imaging modalities to individually visualize each retinal plexus. New methods and best practices to prevent image artifacts are discussed. The review begins with a summary of OCTA technology and artifacts that arise from image acquisition. This review provides an overview of OCTA imaging and details tips for successful interpretation. ![]() While countless publications detail OCTA’s use for the study of retinal microvasculature, few studies outline OCTA’s clinical utility. Over time, more clinical practices have adopted OCTA imaging. This technology has been commercially available since 2014, however, much of its use has been limited to the research setting. Optical coherence tomography angiography (OCTA) can image the retinal vasculature in vivo, without the need for contrast dye.
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