Traditional FA confirmed the presence of the CNVM (Figures 5A-C.)
The patient was referred to the retina clinic and is currently receiving his second of three scheduled Avastin (bevacizumab, Genentech/Roche) injections OS. The OCTA will be repeated one month after his third injection.
A 50-year-old African-American male presented to our clinic for the first time. He had a history of type 2 diabetes for 20 years, and his last A1c was elevated at 8.7 percent. His current medications included insulin and liraglutide for diabetes.
He was treated approximately six months ago by an outside retinal specialist with a series of injections for his right eye and was told he did not need more. However, the patient reported that his vision in the right eye was decreased since the injections, and it was not clear to him why.
Best-corrected vision was 20/50 OD and 20/20 OS. Dilated fundus exam revealed scattered dot/blot hemorrhages and cotton wool spots (CWS) with no obvious edema on clinical exam. The left eye also revealed scattered dot/blot hemes and CWS, fewer that the right eye, with several exudates near the fovea, again with no edema on clinical exam (Figures 6A,B).
OCT confirmed flat maculae OU with no evidence of edema (Figures 7A,B), ruling out diabetic macula edema (DME) as the cause for the vision reduction OD. Therefore, an OCTA and traditional FA were scheduled to evaluate the cause of the reduced acuity OD.
The 3.00 mm x 3.00 mm OCTA revealed an enlarged foveal avascular zone (FAZ) in the right eye, signifying macula ischemia and the cause of the decreased acuity. The FAZ OS was also slightly enlarged, but much smaller when compared to the OD. The traditional FA was deferred because we decided it would not add to the clinical picture or the treatment of the patient.
The patient will be seen again in three months because currently there is no treatment for his macula ischemia.
How OCTA can help
These two cases illustrate how OCTA can be helpful in an optometry practice. The ability to examine the vasculature of the eye without dye is a major breakthrough in retinal care.
By using this technology, we are able to take better care of our patients with retinal disease, make smarter referrals, or be able to hold on to our patients, knowing a referral is not needed.
1. Pacurariu RI. Low incidence of side effects following intravenous fluorescein angiography. Ann Ophthalmol. 1982 Jan;14(1):32-6.