Hybrid intravascular imaging: recent advances, technical considerations, and current applications in the study of plaque pathophysiology.

Cumulative evidence from histology-based studies demonstrate that the currently available intravascular imaging techniques have fundamental limitations that do not allow complete and detailed evaluation of plaque morphology and pathobiology, limiting the ability to accurately identify high-risk plaques. To overcome these drawbacks, new efforts are developing for data fusion methodologies and the design of hybrid, dual-probe catheters to enable accurate assessment of plaque characteristics, and reliable identification of high-risk lesions. Today several dual-probe catheters have been introduced including combined near infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), that is already commercially available, IVUS-optical coherence tomography (OCT), the OCT-NIRS, the OCT-near infrared fluorescence (NIRF) molecular imaging, IVUS-NIRF, IVUS intravascular photoacoustic imaging and combined fluorescence lifetime-IVUS imaging. These multimodal approaches appear able to overcome limitations of standalone imaging and provide comprehensive visualization of plaque composition and plaque biology. The aim of this review article is to summarize the advances in hybrid intravascular imaging, discuss the technical challenges that should be addressed in order to have a use in the clinical arena, and present the evidence from their first applications aiming to highlight their potential value in the study of atherosclerosis.

Trends in use of ancillary glaucoma tests for patients with open-angle glaucoma from 2001 to 2009.

PURPOSE: To assess trends in the use of ancillary diagnostic tests in the evaluation of patients with open-angle glaucoma (OAG) and glaucoma suspects over the past decade. DESIGN: Retrospective, longitudinal cohort analysis. PARTICIPANTS: A total of 169 917 individuals with OAG and 395 721 individuals with suspected glaucoma aged ≥40 years enrolled in a national United States managed care network between 2001 and 2009. METHODS: Claims data were analyzed to assess trends in visual field (VF) testing, fundus photography (FP), and other ocular imaging (OOI) testing for patients with OAG or suspected glaucoma between 2001 and 2009. Repeated-measures logistic regression was performed to identify differences in the odds of undergoing these procedures in 2001, 2005, and 2009 and whether differences exist for patients under the exclusive care of optometrists versus ophthalmologists. MAIN OUTCOME MEASURES: Odds and annual probabilities of undergoing VF testing, FP, and OOI for OAG from 2001 to 2009. RESULTS: For patients with OAG, the odds of undergoing VF testing decreased by 36% from 2001 to 2005, by 12% from 2005 to 2009, and by 44% from 2001 to 2009. By comparison, the odds of having OOI increased by 100% from 2001 to 2005, by 24% from 2005 to 2009, and by 147% from 2001 to 2009. Probabilities of undergoing FP were relatively low (13%-25%) for both provider types and remained fairly steady over the decade. For patients cared for exclusively by optometrists, the probability of VF testing decreased from 66% in 2001 to 44% in 2009. Among those seen exclusively by ophthalmologists, the probability of VF testing decreased from 65% in 2001 to 51% in 2009. The probability of undergoing OOI increased from 26% in 2001 to 47% in 2009 for patients of optometrists and from 30% in 2001 to 46% in 2009 for patients of ophthalmologists. By 2008, patients with OAG receiving care exclusively by optometrists had a higher probability of undergoing OOI than VF testing. CONCLUSIONS: From 2001 to 2009, OOI increased dramatically whereas VF testing declined considerably. Because OOI has not been shown to be as effective at detecting OAG or disease progression compared with VF testing, increased reliance on OOI technology, in lieu of VF testing, may be detrimental to patient care.

Fluorescein angiography versus optical coherence tomography angiography: FA vs OCTA Italian Study.

PURPOSE: To assess the current role of fluorescein angiography after the introduction of optical coherence tomography angiography in real-life clinical practice. METHODS: This was a multicentric retrospective observational study to evaluate the number of fluorescein angiography and optical coherence tomography angiography procedures performed by different devices from January 2013 to December 2018. The centers involved were Centro Italiano Macula (Rome), and ophthalmology departments of University "G. D'Annunzio" Chieti-Pescara (Chieti) and "Azienda Ospedaliero Universitaria Careggi" (Florence). RESULTS: Out of 19,898 total fluorescein angiography procedures performed in the observation period, 3444 (17.3%) were in 2013, 3972 (19.9%) were in 2014, 3601 (18.1%) were in 2015, 3407 (17.2%) were in 2016, 3285 (16.5%) were in 2017, and 2189 (11%) were in 2018. Out of 7949 optical coherence tomography angiography procedures performed in the observation period, none were performed in 2013, 550 (6.9%) were in 2014, 908 (11.5%) were in 2015, 2098 (26.4%) were in 2016, 2090 (26.3%) were in 2017, and 2303 (28.9%) were in 2018. CONCLUSION: Fluorescein angiography procedures were performed less often after the introduction of optical coherence tomography angiography technology. The ease, speed, and safety of the optical coherence tomography angiography procedure in everyday clinical practice have facilitated more optical coherence tomography angiography application compared to fluorescein angiography in recent years. In the future, we will probably evaluate the different pathologies that still need an evaluation by fluorescein angiography.

Trends in optical coherence tomography angiography use in university clinic and private practice setting between 2014-2018.

BACKGROUND: The aim was to assess the trends in optical coherence tomography angiography (OCTA) use compared with fluorescein angiography (FA). METHODS: A bilateral patient's exam on a single day was considered one examination. A total of 3680 and 700 OCTA examinations and 3387 and 439 FA examinations were performed between 2014 and 2018 in a university clinic and private practice, respectively. A regression analysis was completed. RESULTS: The use of OCTA procedures grew 17-fold from 2015 till 2018. In a university clinic, ultrawide-field FA accounted for 2% of all FA examinations performed in 2015, and its use increased to 68% in 2018 while the number of narrow-field FA examinations dropped from 617 in 2014 to 220 in 2018. This decrease inversely correlated with the rise of diabetic retinopathy cases diagnosed with FA (R= -0.86, p= 0.02). In private practice, the increase in the use of OCTA was a primary driver of the decline of the FA use from 127 in 2015 to 27 in 2018, while the number of OCTA examinations was 344 in 2018 (R= -0.99, p= 0.06). CONCLUSION: The results of the study indicate that OCTA is a valuable tool capable of replacing FA in some selected cases.

[Indications for fluorescein angiography and optical coherence tomography angiography (OCTA) in medical retina: Changes from 2015 and 2018]. / Indications d'angiographie à la fluorescéine et d'OCT-angiographie en consultation de rétine médicale : comparaison entre 2015 et 2018.

INTRODUCTION: Non-invasive multimodal imaging, including optical coherence tomography angiography (OCTA), has demonstrated high sensitivity and specificity for the management of retinal diseases. Since the availability of OCTA in 2015, we have developed a policy of "as little fluorescein angiography as possible". In this study, we describe the rate of OCTA and fluorescein angiography (FA) performed and their indications. METHODS: Retrospective descriptive single-centre study. Chart review of patients examined for retinal disorders by one medical retina specialist between January 2015 and June 2018. RESULTS: 3487 patients were examined for a retinal disease. The charts of 651 of these patients (1170 eyes) were randomly selected for analysis (study group). The mean age in the study group was 72 years (60% female). Overall, OCTA and FA were performed in 49.4% and 6.5% of the studied eyes respectively. After the first year, the rate of FA decreased to 2%. The main indications for OCTA were age-related macular degeneration (AMD): 50%, central serous chorioretinopathy (CSC): 12% and retinal vascular occlusion: 10%. The most frequent indications for FA were AMD: 49%, diabetic retinopathy (DR): 18% and CSC: 14%. FA was performed in 16%, 11% and 10% of eyes diagnosed with DR, CSC and AMD respectively (P<0.05). CONCLUSION: In routine practice, OCTA was performed in half of the eyes examined for a retinal disorder. The overall rate of FA was 6.5% and dropped to 2% after the first year of OCTA use. DR was the main disorder still requiring FA.

Trends in Retina Specialist Imaging Utilization from 2012 to 2016 in the United States Medicare Fee-for-Service Population.

PURPOSE: To characterize temporal trends and regional variance in retinal imaging utilization in the United States Medicare fee-for-service population from 2012-2016. DESIGN: Cross-sectional, retrospective database analysis. METHODS: This study addresses office or operating-room based retinal imaging. Our study population included retina specialists, defined as ophthalmologists performing either intravitreal anti-vascular endothelial growth factor injections or posterior segment laser photocoagulation and no neodymium-doped yttrium aluminum garnet laser capsulotomy. We recorded fundus photography, optical coherence tomography (OCT), intravenous fluorescein angiography (IVFA), indocyanine-green angiography, and ophthalmic ultrasound (B-scan) billed in the Medicare fee-for-service population from 2012-2016. Imaging obtained on any platform or device was eligible for inclusion (eg, posterior pole imaging vs ultrawidefield imaging). The main outcome measure was the relative utilization of retinal imaging modalities. RESULTS: National relative utilization of OCT increased from 61.5% in 2012 to 70.5% in 2016 (P < .001), while IVFA fell from 20.9% to 15.1% over the same interval (P < .001). Fundus photography decreased from 14.6% in 2012 to 11.7% in 2016 (P < .001). By 2016, the Midwest region had the highest relative utilization of OCT (75.2%) and lowest of IVFA (12.0%), while the West region had the lowest OCT (68.4%) and highest IVFA (17.0%). CONCLUSIONS: Among retina specialists, OCT usage increased while the utilization of fundus photography and IVFA has declined. The Midwest region had the highest utilization of OCT and lowest of IVFA.

[The use of indocyanine green angiography in differential diagnosis in intraocular tumors]. / Zastosowanie angiografii indocyjaninowej w diagnostyce róznicowej guzów wewnatrzgalkowych.

The author presents current opinions about the usefulness of indocyanine green angiography in differential diagnosis of choroidal tumors: melanomas, naevi, haemangiomas and choroidal metastasis.

[Prospects of using fluorescein angiography with oral administration of fluorescein in children]. / Perspektivy ispol'zovaniia fliuorestsentnoi angiografii u detei pri peroral'nom primenenii fliuorestseina.

Search for the subjective methods for the diagnosis of diseases of the fundus oculi in children necessitates the development of new methods. The authors are investigating the possibility of fluorescent angiography with oral administration of fluorescein with due consideration for the allergologic history and other conditions that may be contraindications against intravenous administration of the agent to children. Fluorescent angiography was carried out in 15 children aged 4 to 15. The procedure was well tolerated, no complications were recorded.

Imaging in retina units: changes observed during the last 12 years.

PURPOSE: The last decade has seen many improvements in the imaging of the choroids, retina, and vitreous. However, there are no available data about changes in the practice of imaging in retina units. The present study was therefore undertaken to document the 12-year changes in this practice in retina units in France, particularly the relative changes in the distribution of the different imaging methods. METHODS: This retrospective study was performed in 4 different retina units considered to be representative of retina units in France. They comprise 2 departments of ophthalmology in university-based hospitals in Paris and Nantes, one in a non-university-based general hospital in Orleans, and one private tertiary care clinical center located in Paris. The annual numbers for the different retinal imaging methods performed in the 4 units between 2000 and 2011 were recorded, analyzed, and compared. RESULTS: The total of images performed increased during the last decade, from 16,084 in 2000 to 76,318 in 2011. The distribution of the imaging techniques performed each year changed significantly during this period (p<0.0001, χ² test): the share of fluorescein angiography decreased from 78.7% in 2000 to 7.0% in 2011. During this period, the share of indocyanine green angiography also dropped from 11.3% to 1.3%. The share of optical coherence tomography increased from 26.4% in 2003 to 53.4% in 2012. CONCLUSIONS: The present study documents the increasing share of noninvasive imaging and the decreasing share of angiography in retina units over the last 12 years.

Diabetic retinopathy: current and new treatment options.

Diabetes mellitus has become a major health concern worldwide and its incidence is projected to increase. Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are considered the most sight-threatening ocular complications in these patients. Pivotal studies, such as the Early Treatment Diabetic Retinopathy Study (ETDRS) and the Diabetic Retinopathy Study (DRS), have established macular and pan-retinal laser as the gold-standard of treatment for these complications. The recent discovery of the vascular endothelial growth factor (VEGF) and its role in the development of proliferative disease, has led to a movement towards treating PDR and DME with anti-angiogenic medications alone or in conjunction with the gold-standard of care. Due to the severity of the diabetic ocular complications and the rising incidence of diabetes worldwide, it is important for the non-ophthalmologist care provider to be informed of the new treatments available for these conditions in an effort to better guide their patients. In this review, I will discuss the importance of these new methods of treatment as well as the significance of systemic glucose control, vitreous surgery and laser photocoagulation.

Update on the imaging techniques in the diagnosis of diabetic retinopathy.

Diabetic retinopathy is one of the leading causes of vision loss worldwide. Fluorescein angiogram still plays a primary role in its diagnosis but new non-invasive technologies as optical coherence tomography, fundus autofluorescence and microperimetry are gaining popularity in the last years. Anatomical changes found with these devices have been widely described but their correlation with visual function needs to be assessed and several features have been proposed as indicators of visual prognosis. The aim of this paper is to give a scope of the actual role of these techniques in the evaluation of retinal impairment secondary to diabetes.

Bevacizumab subconjuntival y su efectividad en la regresión de la neovascularización corneal evaluado mediante angiografía fluoresceínica de segmento anterior / Subconjunctival bevacizumab effectiveness in corneal neovascularization regression evaluated with anterior segment fluorescein angiography

Objetivo: evaluar objetivamente mediante el uso de angiografía de segmento anterior la reducción del grado de neovascularización corneal con la aplicación de bevacizumab subconjuntival. Diseño: serie de casos con intervención. Metodología: nueve ojos con neovascularización corneal estromal secundaria a diferentes condiciones se sometieron a la realización de angiografía fluoresceínica de segmento anterior; cuatro semanas después se aplicaron 3 dosis de bevacizumab subconjuntival limbar de 2,5 mg/0,1cc cada una sobre el cuadrante comprometido con un intervalo de un mes entre cada aplicación. Cuatro semanas después se realizó una nueva angiografía. Las fotos pre-aplicación y post aplicación fueron analizadas por 3 evaluadores. Se definió como mejoría si había una mejoría ≥30%, basado en una escala de mejoría de 0 a 10. Resultados: se encontró un alto rango de variabilidad en la regresión de la neovascularización corneal (entre 3% y 92%) con un promedio de mejoría del 41% y posibilidad de falla de 44,4% independientemente de su etiología. Se obtuvieron pobres resultados en presencia de cuerpos extraños en córnea (segmentos intraestromales o suturas corneales) con una mejoría entre 3% y 7%. Pacientes sin cuerpo extraño en córnea obtuvieron una mejoría promedio de la neovascuarización corneal del 70%. No hubo efectos secundarios sistémicos o locales. Conclusion: el uso del bevacizumab subconjuntival como terapia antiangiogénica es una alternativa con buena tasa de efectividad en pacientes con neovascularización corneal sin presencia de cuerpos extraños corneales.

Purpose: to assess corneal stromal neovascularization accurately and its improvement by using anterior segment fluorescein angiography imaging after subconjunctival bevacizumab injection. Design: interventional case series. Methodology: an anterior segment fluorescein angiography was performed in nine eyes with stromal neovascularization secondary to different etiologies. Patients underwent subconjunctival bevacizumab injections, each one receiving three injections containing 2,5mg/0,1ml bevacizumab each, at monthly intervals. Four weeks after the last injection was applied, a new anterior segment fluorescein angiography was done; pre and post-treatment angiographies were analyzed by three ophthalmologists. A favorable outcome was defined as an improvement of 30% in corneal neovascularization based on a previously established score from 0 to 10. Results: findings were variable, with corneal neovascularization improving between 3% and 92% (mean improvement 41%) for all eyes included, and a 44,4% chance of failure. Poor results were obtained from eyes that had some type of intracorneal foreign body such as intracorneal ring segments (ICRS) and corneal sutures with an improvement range from 3% to 7% whereas eyes with no foreign bodies had a mean reduction in corneal neovascularization of 70%. No side effects were reported. Conclusions: subconjunctival Bevacizumab use as antiangiogenic therapy is an alternative with a high success rate in patients without intracorneal foreign bodies, although it is clearly not as effective in patients with foreing body-induced neovascularization.

Recent developments in indocyanine green angiography.

For the past year, indocyanine green angiography has been applied to evaluation of choroidal neovascularization, pigment epithelial detachment, retinal vascular disorders, and choroidal diseases and tumors. These applications have expanded the potential use of this technique. The relative safety of indocyanine green angiography has contributed to its continued wide-spread application.

[Telemedicine in Ophthalmology: A Useful Tool in Store-and-Forward Counselling?]. / Telemedizin in der Augenheilkunde: Ein Hilfsmittel in der konsiliarischen Mitbeurteilung?

Side by side with the progress in computers and imaging, telemedicine has already been used successfully in a large number of specialties of medicine. But high-quality images are not always suitable for transfer via modem because of their file size. The present experimental study was conducted to determine the effects of image compression by the JPEG algorithm on image quality and on the reliability of diagnosis after compression. Digital photographs of the retina were taken and the JPEG compressed images assessed by an experienced ophthalmologist. The present study showed a high reliability of diagnosis and a good agreement between the observations taken at the patient and at the computer. For this reason, JPEG image compression algorithm is suitable for reducing image size for producing high-quality images manageable for transmitting via modem in a store-and-forward teleophthalmological system.

Fluorescein angiography. Practical role in the office management of macular diseases.

Office fluorescein angiography allows optimum management of patients with macular diseases. A skilled office staff is essential. The receptionist obtains pertinent information from patients and schedules prompt appointments. Excellent angiography by photographer-technicians allows the physician to plan the best course of management. The skills of photographers can be developed through in-service training, certification programs, and participation in professional meetings. For the ophthalmologist who treats CNV but does not do fluorescein angiography, a referral service can be helpful. Ophthalmologists who do not treat CNV should refer patients with suspected CNV directly to an experienced laser surgeon for angiography and management. Future developments in office fluorescein angiography should include improved cameras and videoangiography.