Financial Interests:OHSU and Dr. D. Huang have a significant financial interest in Optovue, a company that may have a commercial interest in the results of this research and technology. This potential individual conflict of interest has been reviewed and managed by OHSU.Optovue, Inc.: stock options, patent royalty, grants

History of OCT Angiography

David Huang, MD, PhDPeterson Professor of Ophthalmology Professor of Biomedical EngineeringCasey Eye Institute, Oregon Health & Science UniversityPortland, Oregon

Ophthalmic OCTA Development Time Line

Ruikang WangOHSUOMAG

US Patent 9013555

Zeiss

Prototype

ZeissClinical Studies

Yali Jia, David HuangOHSU

SSADAUS Patent App 2013/024594

Optovue

Prototype

OptovueClinical Studies

AngioVueProductLaunch

(international)

AngioAnalyticsSoftware

Topcon

Prototype

Topcon Clinical Studies

Heidelberg

Prototype

HeidelbergClinical Studies

2011 2012 2013 2014 2015 2016

AngioVue FDA

approval

AngioPlexFDA Approval

& Launch

SS-OCT AngioProductLaunch

OCTA Integrated in

Spectralis

Makita S, Hong Y, Yamanari M, Yatagai T, Yasuno Y. Optical coherence angiography. Optics Express 2006; 14:7821.

Wang RK et al. Three dimensional optical angiography. Optics Express 2007; 15:4083.

OCT Images

FD-OCT2006

Jay Wei1992-2003

CZM;

OCT Invented

1991 at MIT

Development1992-1996 in

CZMTD-OCT

1996-2004

Optovue Founded

2003

Cornea, GCC, TCP, 2008-2013

OCTA2014

Optovue History of OCT Technology Innovation

2003-PresentOptovue

2 high-resolution OCT B-frames

M-B frames(N=2)

Split spectrum (M=11)

I (a.

u.)

𝜆 (nm)

~45 nm

840

I (a.

u.)

𝜆 (nm)840

~11 nm

11 decorrelation frames

11 pairs low-resolution OCT amplitude frames

averaged decorrelation

, , 1

,2 2

, , 1

, ,, 1

1 1, ,2 2

( 1 , 1 1)

m n m nm n

m n m n

A x z A x zD x z

A x z A x z

m M n N

1

,1 1

1 11

N M

m nn m

DN M

111111

11

111111

11

11 fold increase in # of image frames – no increase in scan time

Split-Spectrum Amplitude Decorrelation Angiography (SSADA)

Jia Y, Tan O, Tokayer J, Potsaid BM, Wang Y, Liu JJ, Kraus MF, Subhash H, Fujimoto JG, Hornegger J, Huang D. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography. Opt Express 2012;20:4710

X-fast & Y-fastorthogonal registrationX-fast Tracking & registration

Avanti 70 kHz SD-OCT & AngioVueMotion Correction Technology (MCT)Video tracking. Optovue, Inc.

Kraus M., Potsaid B., et. al., Motion correction in OCT volumes on a per A-scan basis using orthogonal scan patterns. Biomedical Optics Express 2012, 3:1182

Orthogonal Registration + Tracking

Choroidal Neovascularization Treatment Response

Huang D, Jia Y, Rispoli M, Tan O, Lumbroso B. Retina 2015; 35:2260

1st Treatment

2nd Treatment

3rd Treatment

Before 2 days 1 week 4 weeksAflibercept

1 day 6 weeks2 weeks

1 day 1 week

CNV reopens

Inner retinal flow Outer retinal flow (CNV)

CNV closes

6×6 mm OCT Angiogram

B1

2.75mm

Avascular Area = 0.87 mm2

FA A2

Non-Proliferative DR

B2 C2

0.87 mm2

Macular Avascular Area in Diabetic Retinopathy

Normal (n = 12) Diabetic Retinopathy (n = 12) P-value

Parafoveal Vessel Density (%) 88.8 ± 4.6 77.0 ± 7.0 <0.001

Perifoveal Vessel Density (%) 91.0 ± 3.6 80.7 ± 5.1 <0.001

FAZ Area (mm2) 0.18 ± 0.05 0.33 ± 0.19 0.057

Avascular Area (mm2) 0.19 ± 0.06 1.00 ± 0.27 <0.001100% sensitive100% specific

Hwang T, Gao SS, Liu L, Lauer AK, Bailey ST, Flaxel CJ, Wilson DJ, Huang D, Jia Y. Automated quantification of macular ischemia using OCT angiography in diabetic retinopathy. JAMA Ophthalm 2016; 21:1

OCTA Commercialization Challenges

Clinical acceptance take time for killer apps to become standard of

care FDA approval – delays innovations Needs new CPT procedure code

CPT 92134 (retinal OCT) pays $44 both eyes Needs to pay more to justify cost of faster OCT

hardware and novel software