Optical Coherence Tomography Angiography: A 2023 Focused Update on Age-Related Macular Degeneration

Abstract

Optical coherence tomography angiography (OCTA) has extensively enhanced our comprehension of eye microcirculation and of its associated diseases. In this narrative review, we explored the key concepts behind OCTA, as well as the most recent evidence in the pathophysiology of age-related macular degeneration (AMD) made possible by OCTA. These recommendations were updated since the publication in 2020, and are targeted for 2023. Importantly, as a future perspective in OCTA technology, we will discuss how artificial intelligence has been applied to OCTA, with a particular emphasis on its application to AMD study.

Keywords: 3D OCTA; Age-related macular degeneration; Artificial intelligence; Geographic atrophy; Non-exudative macular neovascularization; Optical coherence tomography angiography; Quiescent neovascularization; Subclinical neovascularization; Type 3 macular neovascularization.

Fig. 1

Three-dimensional optical coherence tomography angiography of a 80-years-old male patient affected by type 3 MNV showing two neovessels connecting the deep capillary plexus to the RPE/sub-RPE space. MNV macular neovascularization, RPE retinal pigment epithelium

Fig. 2

(A–D) Optical coherence tomography angiography of a 75-year-old male patient affected by non-exudative quiescent type 1 macular neovascularization. (A) Baseline OCTA B-scan (left) and en-face (right) at RPE level. Confluent DEPs present detectable flow, representing non-exudative type 1 MNV. (B–D) OCTA B-scan (left) and en-face (right) at RPE level after 6 months (B), 12 months (C), and 18 months (D) did not detect activation signs, thus showing non-exudative quiescent MNV. MNV macular neovascularization, RPE retinal pigment epithelium, DEP pigment epithelium detachments, OCTA optical coherence tomography angiography

Fig. 3

(A–C) Optical coherence tomography angiography (OCTA) of a 71-year-old female patient affected by type 3 macular neovascularization (T3 MNV) in the fellow eye of a unilateral T3 MNV. A Baseline OCTA B-scan (left) and en-face (right) at deep capillary plexus level. Intraretinal hyperreflective foci (HRF) show detectable flow with no exudation, representing preclinical stage of T3 MNV (nascent T3 MNV), and overlay confluent pigment epithelium detachments (DEPs) with no contact with retinal pigment epithelium (RPE). Yellow panel: B-scan magnification. Blue panel: en-face magnification, with a blue arrow indicating pathological vascular network. (B) 3-month follow-up OCTA B-scan (left) and en-face (right) at RPE level. HRF has grown toward RPE space and connected to DEP, developing exudative signs of overt MNV (blue arrow). (C) 6-month follow-up OCTA B-scan (left) and en-face (right) at retinal pigment epithelium (RPE) level. T3 neovascularization (blue arrow) displays evident signs of activation (intraretinal cysts)