Utility of Optical Coherence Tomographic Angiography in Neuro-Ophthalmic Practice

Noninvasive ophthalmic imaging and quantification of the optic nerve and retina using near-infrared optical coherence tomography (OCT) have become an integral part of neuro-ophthalmic practice. Advances in OCT have allowed 3D mapping of the optic nerve and retinal microvascular using OCT angiography (OCTA) at micrometer precision. In this review, we discuss the utility of OCTA in neuro-ophthalmic and neurologic conditions with particular focus on current applications, needed progress, and integration into neuro-ophthalmic practice.

Evidence was acquired from PubMed searches.

OCTA ocular imaging allows for qualitative and quantitative assessments of the microvasculature in the papillary, peripapillary, and macular regions in select retinal and subretinal layers. OCTA has been used in a number of neuro-ophthalmic disease contexts. Most OCTA studies highlight attenuation of vascular density in pathologic conditions with some overlapping patterns of microvascular changes. OCTA has also been applied in neurologic conditions presenting with a normal-appearing disc. There is a significant degree of overlap in the OCTA findings in these conditions, and the number of comparative studies are limited.

OCTA has high potential to serve diagnostic and prognostic roles in neuro-ophthalmology. Future work that focuses on longitudinal evaluation of specific OCTA biomarkers includes comparative conditions with clinical overlap and uses functional correlative analyses that will promote the utility of OCTA in neuro-ophthalmic practice.