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Invited Commentary
September 2018

Improving Access—but Not Outcomes—With Iris Optical Coherence Tomography Angiography

Author Affiliations
  • 1Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts
  • 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
JAMA Ophthalmol. 2018;136(9):1045-1046. doi:10.1001/jamaophthalmol.2018.2748

Throughout the past 2 decades, the exquisite, real-time ocular imaging attainable with optical coherence tomography (OCT) has transformed the practice of ophthalmology. Further increases in processing speed have led to the introduction of OCT angiography (OCT-A).1 Preliminary work has shown that it is possible to use OCT-A to characterize the vasculature of the iris.1 The current standard for assessing anterior segment circulation is iris angiography, but this approach has substantial drawbacks, most notably the need to administer an intravenous contrast agent, such as fluorescein or indocyanine green. In this issue of JAMA Ophthalmology, Velez and colleagues2 explore the potentially transformative idea of using OCT-A to appraise anterior segment ischemia (ASI), a rare but potentially vision-threatening complication of complex strabismus surgery. However, will iris OCT-A enhance the safety or quality of care for patients undergoing strabismus surgery?

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