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OCT and Imaging in Central Nervous System Diseases pp 523–544Cite as

Optical Coherence Tomography Angiography in Neurology and Neuro-Ophthalmology

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Abstract

Optical coherence tomography angiography (OCT-A) is a recent advancement in retinal imaging that uses high-speed OCT and advanced processing algorithms to generate en face angiographic images of the retinal and choroidal microcirculation, utilizing the non-invasive motion-contrast of intra-luminal erythrocyte flow. This chapter offers a review of the recent translational and clinical applications of OCT-A in the fields of neurology and neuro-ophthalmology, focusing on non-glaucomatous optic neuropathies and other central neurological disorders.

In Alzheimer’s dementia and Parkinson’s disease, retinal microvascular loss detected by OCT-A may be a sensitive indicator of progressive vascular impairment that precedes neuronal death. OCT-A findings in multiple sclerosis suggest vascular involvement in the inflammatory disease process, leading to ischemia of neural tissues. Migraine with aura patients show a decreased retinal perfusion bilaterally with OCT-A, implying a systemic vascular involvement that may explain their increased risk for cardiovascular disease.

OCT-A studies on non-arteritic anterior ischemic optic neuropathy suggest that peripapillary microvascular attenuation is secondary to an initial transient ischemic insult in the short posterior ciliary arteries, causing optic nerve edema that propogates anteriorly, in turn compressing the retinal microvasculature. OCT-A has allowed insight into the suspected vasculopathy associated with Leber’s hereditary optic neuropathy, which may be due to mitochondrial dysfunction influencing endothelial cell and vascular smooth muscle viability. Superficial optic nerve head drusen may cause focal areas of poor superficial retinal perfusion as detected by OCT-A, which may in turn lead to nerve fiber ischemia and rarefaction.

OCT-A shows promise in becoming an important tool for researchers and clinicians in their multimodal approach in detecting pathological changes, monitoring disease progression and evaluating response to treatment in these disorders.

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Authors and Affiliations

  1. Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA

    Alexander Pinhas, Valerie I. Elmalem, Maria Castanos Toral, Davis B. Zhou, Jorge S. Andrade Romo, Alexander Barash & Richard B. Rosen

  2. Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn, NY, USA

    Alexander Pinhas

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  1. Alexander Pinhas
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Editors and Affiliations

  1. University of Warmia and Mazury, Olsztyn, Poland

    Andrzej Grzybowski

  2. Studio Oculistico d’Azeglio, Bologna, Italy

    Piero Barboni

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Pinhas, A. et al. (2020). Optical Coherence Tomography Angiography in Neurology and Neuro-Ophthalmology. In: Grzybowski, A., Barboni, P. (eds) OCT and Imaging in Central Nervous System Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-26269-3_24

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  • DOI: https://doi.org/10.1007/978-3-030-26269-3_24

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26268-6

  • Online ISBN: 978-3-030-26269-3

  • eBook Packages: MedicineMedicine (R0)

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