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Art Gel Eye Drop is usually taken when needed. Use the number of drops as advised by your doctor. Wait for at least 5-10 minutes before delivering any other medication in the same eye to avoid dilution. Do not use a bottle if the seal is broken before you open it. Always wash your hands and do not touch the end of the dropper. This could infect your eye. This medicine may require long-term use and can be taken safely for as long as you need it.

The most common side effects of using this medicine include eye irritation (including burning and discomfort), eye pain, eye itching, and visual disturbance. They are usually temporary and disappear with time. However, let your doctor know if they persist or get worse. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can do it safely. Consult your doctor if your condition does not improve or if the side effects bother you.

This medicine is not likely to affect or be affected by other medicines you use but tell your doctor if you have ever had glaucoma. Do not use it while wearing soft contact lenses and talk to your doctor if you develop an eye infection while using it.

As with standard structural OCT technology, OCT-A segmentation errors are often unavoidable especially in cases of retinal pathology.

Manual segmentation correction options and the functionality of these tools are becoming increasingly sophisticated. Some devices provide the option of &#;auto-propagating&#; changes made on one B-scan to adjacent slices.

Finally, other features including change analysis (and instrument differences in their ability to align and register follow-up scans against baseline, the presentation of these findings and associated analyses/reporting functions), an anterior segment or glaucoma module may also interest certain practitioners.

In short, OCT-A is a complex, rapidly evolving technology. In addition to reviewing the technical specifications of a brochure, prospective users are encouraged to ask device representatives to demonstrate the usefulness and ease of use of the associated OCT-A software before buying.

Case 1: Polypoidal choroidal vasculopathy

A 70-year-old Asian male with a known history of central serous chorioretinopathy in his left eye returned for a scheduled follow-up assessment. He reported a clear view on the Amsler grid and denied any new visual or ocular symptoms.

Entering unaided visual acuities were significantly reduced, especially in the left eye, at 6/9.5 right eye and 6/30 (improved to 6/15 with pinhole) left eye. The right retina appeared healthy. The left eye showed hypopigmentary abnormalities at the superior macula with associated subfoveal subretinal fluid. OCT-A showed choroidal neovascularisation (including a polypoidal lesion coincident with a notched pigment epithelial detachment and connecting branching vascular network) just above and temporal to the left macula (Figure 2).

Outcome

The patient was referred and seen promptly by a retinal specialist, who performed both fluorescein and indocyanine green angiography to confirm the presence of occult choroidal neovascularisation and associated polypoidal lesions. He was diagnosed with polypoidal choroidal vasculopathy and treated immediately via intravitreal therapy using Eylea and will be followed closely.

Key lesson

OCT-A in conjunction with structural OCT imaging is a useful screening tool for distinguishing proliferative from non-proliferative disease, including polypoidal features

Case 2: Abnormal retinal neovascularisation

A 48-year-old female was referred for further investigation of a lesion in her right eye, first noted and managed some 20 years ago by an ophthalmologist overseas. She reported systemic hypertension and was otherwise in good general health. She denied any new changes in her vision.

Unaided visual acuities were 6/9.5-2 (improved to 6/9.5 with pinhole) right eye and 6/7.5+2 left eye. Examination showed a right visually significant epiretinal membrane, likely longstanding in nature and secondary to former chorioretinitis or uveitis. There was associated fibrosis, foveoschisis and disruption of the subfoveal ellipsoid zone, explaining the reduced visual acuity. Abnormal retinal neovascularisation was also observed among the superotemporal midperiphery with no obvious signs of retinal vascular occlusion or vasculitis (Figure 3).

The left posterior eye was unremarkable.

Outcome

The patient was referred non-urgently to an ophthalmologist. The ophthalmologist reported that the cause of the abnormal retinal neovascularisation was deemed unclear; however, wide field Optos retinal angiography was performed to assess the full extent of retinal ischemia and treatment options including sectoral panretinal laser treatment with or without intraocular anti-VEGF injections were presented.

The option of epiretinal membrane peel surgery was also discussed with the patient on the presumption that surgery would be to protect her existing level of vision and prevent future, sight threatening vitreous haemorrhage, tractional retinal detachment or further worsening of the ERM.

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Key lesson

OCT-A forms a useful screening tool for abnormal retinal vasculature but is currently limited by field of view.

Case 3: Sub-clinical disease

A 55-year-old asymptomatic female in good health, taking prescription medication for rosacea only, was referred for a macular assessment.

Entering unaided visual acuities were 6/7.5 right eye and 6/6 left eye. Amsler grid testing was unremarkable in both eyes and Mars contrast sensitivity was similarly within normal limits at 1.76 log units in each eye. Fundus examination showed focal RPE pigmentary abnormalities at the left inferotemporal macula with no associated drusen, and a corresponding flat irregular pigment epithelium detachment using structural OCT and underlying thick choroid. OCT-A at baseline did not show any convincing evidence of neovascularisation.

Outcome

The patient was followed regularly for the next two years. Follow up assessments showed the development and eventual resolution of associated subretinal fluid and possible macular neovascularisation using OCT-A. The patient will continue ongoing monitoring and have her images regularly reviewed virtually by an ophthalmologist.

Key lesson

OCT-A can be a helpful monitoring tool especially of &#;sub-clinical&#; disease, such as non-exudative macular neovascularisation.

In this fast-paced technological world, eyecare professionals face ever-increasing pressure to apply the newest, &#;latest and greatest&#; gadget to patient care. Clinical testing, including ocular imaging and OCT-A, can be used for disease diagnosis, screening, and monitoring.5 This brief case series highlights the value and emerging role of OCT-A in optometric practice.

Disclosures: The author has no conflicts to declare.

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References

1. Tan ACS, Tan GS, Denniston AK et al. An overview of the clinical applications of optical coherence tomography angiography. Eye (Lond) ; 32: 262-286.

2. Spaide RF, Fujimoto JG, Waheed NK et al. Optical coherence tomography angiography. Prog Retin Eye Res ; 64: 1-55.

3. Spaide RF, Fujimoto JG, Waheed NK. Image Artifacts in Optical Coherence Tomography Angiography. Retina ; 35: -.

4. Campbell JP, Zhang M, Hwang TS et al. Detailed Vascular Anatomy of the Human Retina by Projection-Resolved Optical Coherence Tomography Angiography. Sci Rep ; 7: .

5. Power M, Fell G, Wright M. Principles for high-quality, high-value testing. Evid Based Med ; 18: 5-10.

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