UPFRONT

A Vision of the Future

PETER K. KAISER, MD

This issue of Retinal Physician highlights several exciting new uses of optical coherence tomography. The first is OCT angiography, which is hitting the mainstream with the approval by the Food and Drug Administration of two devices that can obtain “angiograms” using only light — Optovue’s (Fremont, CA) AngioVue and Carl Zeiss Meditec’s (Dublin, CA) AngioPlex. A case series by Michael Javaheri, MD, appears on page 58 of this issue.

The technology of each device is different, and what they image may also be different. It is important to understand the differences in image acquisition, as well as possible artifacts in interpreting these images.

Unlike fluorescein angiography, imaging of “flow” with OCTA is based on the level of the retina/choroid that is being evaluated by the mathematical algorithms. All of the vessels are not imaged at once.

Using reconstruction techniques, the operator can obtain a three-dimensional glimpse of all vessels or a color-coded view of different vessels. However, unlike FA, they are not available at the same time.

If you are lucky enough to have one of these devices, you are facing a very interesting coding dilemma. Although the term angiography is included in the test, no dye is injected. The fluorescein (or indocyanine green for that matter) angiography code includes the Relative Value Units for dye injection, developing the film, storing the film, etc.

Because most of us have digital systems, these costs are no longer valid. This fact has not gone unnoticed by the Relative Value Scale Update Agreement, and the FA reimbursement has become progressively smaller, so for now, there is no increase in RVU over traditional OCT to perform these tests.

The second new use of OCT discussed in this issue is intraoperative OCT. In much the same way that OCT has changed our management of retinal disease in the clinic, OCT in the operating room may change how we work in the OR. Did we peel that membrane? Did we close or open a hole? Is there fluid or traction remaining? And more importantly, does knowing this information lead to better outcomes?

This imaging modality is currently being studied at the Cole Eye Institute and other institutions. On page 42 of this issue, Paula Pecen, MD, of Cole updates readers on the latest data on the use of intraoperative OCT.

It is an exciting time in the development and evolution of OCT. As better light sources are added, and detector devices become faster, it is exciting to think how far we might be able to take this technology.