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Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Biomedical Optics".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 28198

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Special Issue Editors

Dr. Aniruddha Agarwal

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Guest Editor

1. Vitreoretina Surgeon and Uveitis Specialist, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
2. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
Interests: cataract surgery; clinical ophthalmology; eye diseases; optical coherence tomography; oct; glaucoma; retinal diseases; eyes; macular degeneration; clinical trials

Dr. Kelvin Yi Chong Teo

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Guest Editor

1. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
2. Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
Interests: ophthalmology

Dr. Ilaria Testi

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Guest Editor

Moorfields Eye Hospital NHS Foundation Trust, London, UK
Interests: medical retina; uveitis

Dr. Alessandro Marchese

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Guest Editor

IRCCS Ospedale San Raffaele, Milan, Italy
Interests: OCT; optical coherence tomography; retinal diseases; retinal imaging; retina; clinical ophthalmology; eye diseases; macular degeneration; retinal degeneration; uveitis

Special Issue Information

Dear Colleagues,

Several vitreoretinal and choroidal pathologies need detailed assessment so that the correct diagnosis can be established, and appropriate therapy can be instituted. Using imaging techniques such as optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA), we can obtain near-histological images of the retina and choroid, which helps to provide insights into disease pathogenesis and management.

Great advances have occurred in the field of imaging of medical retinal diseases and uveitis in recent years. New imaging modalities have made possible both a better understanding of the pathogenesis of the diseases and a more accurate assessment of the severity of the disease and the level of inflammation, and hence, they have contributed to an improvement in patients’ management. Multimodal imaging, that is, the use of several techniques such as conventional fluorescein angiography (FA), fundus autofluorescence, indocyanine green angiography (IGC), near-infrared imaging, OCT, OCTA, and widefield angiographic techniques, has become an essential task in the clinics.

Each of the techniques provides valuable and complementary clinical data that allow a global assessment of the condition. Further clinical research is needed to obtain the greatest benefit from multimodal imaging. We believe that the Special Issue “Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid” will be of great interest to many potential authors and will allow gathering an important number of studies that will certainly result in progress in this field.

Dr. Aniruddha Agarwal
Dr. Kelvin Yi Chong Teo
Dr. Ilaria Testi
Dr. Alessandro Marchese
Guest Editors

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Published Papers (11 papers)

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13 pages, 1376 KiB

Open AccessArticle

Artificial Intelligence-Assisted Processing of Anterior Segment OCT Images in the Diagnosis of Vitreoretinal Lymphoma

by Fabrizio Gozzi, Marco Bertolini, Pietro Gentile, Laura Verzellesi, Valeria Trojani, Luca De Simone, Elena Bolletta, Valentina Mastrofilippo, Enrico Farnetti, Davide Nicoli, Stefania Croci, Lucia Belloni, Alessandro Zerbini, Chantal Adani, Michele De Maria, Areti Kosmarikou, Marco Vecchi, Alessandro Invernizzi, Fiorella Ilariucci, Magda Zanelli, Mauro Iori and Luca Cimino Show full author list Hide full author list

Diagnostics 2023, 13(14), 2451; https://doi.org/10.3390/diagnostics13142451 - 23 Jul 2023

Cited by 5 | Viewed by 1942

Abstract

Anterior segment optical coherence tomography (AS-OCT) allows the explore not only the anterior chamber but also the front part of the vitreous cavity. Our cross-sectional single-centre study investigated whether AS-OCT can distinguish between vitreous involvement due to vitreoretinal lymphoma (VRL) and vitritis in uveitis. We studied AS-OCT images from 28 patients (11 with biopsy-proven VRL and 17 with differential diagnosis uveitis) using publicly available radiomics software written in MATLAB. Patients were divided into two balanced groups: training and testing. Overall, 3260/3705 (88%) AS-OCT images met our defined quality criteria, making them eligible for analysis. We studied five different sets of grey-level samplings (16, 32, 64, 128, and 256 levels), finding that 128 grey levels performed the best. We selected the five most effective radiomic features ranked by the ability to predict the class (VRL or uveitis). We built a classification model using the xgboost python function; through our model, 87% of eyes were correctly diagnosed as VRL or uveitis, regardless of exam technique or lens status. Areas under the receiver operating characteristic curves (AUC) in the 128 grey-level model were 0.95 [CI 0.94, 0.96] and 0.84 for training and testing datasets, respectively. This preliminary retrospective study highlights how AS-OCT can support ophthalmologists when there is clinical suspicion of VRL. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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12 pages, 1284 KiB

Open AccessArticle

Alterations in Macular Microvasculature in Pterygium Patients Measured by OCT Angiography

by Yingjun Cai, Zhenkai Wu, Ruolan Yuan, Pingbao Wang, Huizhuo Xu, Yi Xu, Xueyan Yao, Hua Wang and Jing Zou

Diagnostics 2023, 13(9), 1603; https://doi.org/10.3390/diagnostics13091603 - 30 Apr 2023

Viewed by 1667

Abstract

Previous studies have reported an association between pterygia and maculopathy, yet the underlying mechanisms and alterations to the macular microvasculature in pterygium patients have yet to be fully elucidated. Our study conducted an analysis of macular superficial vessel length density (VLD) and vessel perfusion density (VPD) to establish associations between the conjunctival and macular microvasculature in patients with unilateral and bilateral pterygia. We revealed a loss of macular microvasculature in the outer nasal (ON) region in both unilateral and bilateral pterygium patients. VLD was significantly decreased in both pterygium groups in the ON region, and VPD was notably lower in bilateral pterygium patients in the same area. Furthermore, in unilateral pterygium patients, the vessel percent pixel coverage (PPC) of the pterygium and the area of the pterygium exhibited a negative correlation with VLD in the ON region. Multiple stepwise linear regression models indicated that the PPC could best predict VLP in the ON region. Taken together, our findings suggest that patients with pterygia may be more susceptible to macular diseases, and this may be due to a compensatory increase in blood perfusion via the anterior ciliary artery. These results underscore the importance of managing maculopathy in patients with pterygia. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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14 pages, 994 KiB

Open AccessArticle

Does the Presence of the Cilioretinal Artery Affect the Incidence, Clinical Picture and Progression of Age-Related Macular Degeneration?

by Elżbieta Krytkowska, Aleksandra Grabowicz, Krzysztof Safranow and Anna Machalińska

Diagnostics 2023, 13(9), 1593; https://doi.org/10.3390/diagnostics13091593 - 29 Apr 2023

Cited by 1 | Viewed by 2020

Abstract

The aims of this study were to analyze the relationship between the presence of the cilioretinal artery (CRA) and the incidence, severity and progression of age-related macular degeneration (AMD) and to estimate the influence of the CRA on choroidal and retinal parameters. A total of 287 patients with AMD and 110 healthy controls were enrolled in the study. CRA occurrence was determined using color fundus images. AMD progression was assessed after 3 years. There was no difference in the incidence of CRA between the AMD and control groups (23.34% vs. 24.55%; p = 0.8). Lower-stage AMD was more frequently observed in eyes with the CRA than in eyes without the artery (p = 0.016). The CRA did not influence disease progression (p = 0.79). The CRA did not influence retinal and choroidal thickness and volume parameters or the retinal vessel caliber and functionality in either the AMD or control groups. There was no relationship between CRA presence and CFH Y402H and ARMS2 A69S risk variants. The results did not show a protective effect of the CRA on the incidence and progression of AMD. The CRA may affect the severity of AMD; however, the mechanism of this phenomenon is unclear. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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12 pages, 2793 KiB

Open AccessArticle

Retinal Vascular Tortuosity Index Change after Idiopathic Epiretinal Membrane Surgery: Does Internal Limiting Membrane Peeling Affect Retinal Vascular Tortuosity?

by Özge Yanık, Pınar Aydın Ellialtıoğlu, Sibel Demirel, Figen Batıoğlu and Emin Özmert

Diagnostics 2023, 13(4), 797; https://doi.org/10.3390/diagnostics13040797 - 20 Feb 2023

Cited by 2 | Viewed by 1788

Abstract

Background: Idiopathic epiretinal membrane (iERM) surgery is one of the most commonly performed vitreoretinal surgeries, and the issue of internal limiting membrane (ILM) peeling in ERM surgery is still controversial. The aims of this study are to evaluate the changes in retinal vascular tortuosity index (RVTI) after pars plana vitrectomy for the iERM using optical coherence tomography angiography (OCTA) and to assess whether ILM peeling has an additional effect on RVTI reduction. Methods: This study included25 eyes of 25 iERM patients who underwent ERM surgery. The ERM was removed without ILM peeling in 10 eyes (40.0%), and the ILM was peeled in addition to the ERM in 15 eyes (60.0%). The existence of the ILM after ERM peeling was checked with second staining in all eyes. Best corrected visual acuity (BCVA) and 6 × 6 mm en-face OCTA images were recorded before surgery and at the first month postoperatively. A skeleton model of the retinal vascular structure was created following Otsu binarization of en-face OCTA images using ImageJ software (1.52U). RVTI was calculated as the ratio of each vessel length to its Euclidean distance on the skeleton model using the Analyze Skeleton plug-in. Results: The mean RVTI declined from 1.220 ± 0.017 to 1.201 ± 0.020 (p = 0.036) in eyes with ILM peeling and from 1.230 ± 0.038 to 1.195 ± 0.024 in eyes without ILM peeling (p = 0.037). There was no difference between the groups in terms of postoperative RVTI (p = 0.494). A statistically significant correlation was found between postoperative RVTI and postoperative BCVA (rho = 0.408, p = 0.043). Conclusions: The RVTI is an indirect indicator of the traction created by the iERM on retinal microvascular structures, and it was effectively reduced after iERM surgery. The postoperative RVTIs were similar in cases who underwent iERM surgery with or without ILM peeling. Therefore, ILM peeling may not have an additive effect on the loosening of microvascular traction and thus may be reserved for recurrent ERM surgeries. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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9 pages, 3006 KiB

Open AccessArticle

Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity

by Miguel Santos, Inês Leal, Tiago Morais Sarmento, Sofia Sousa Mano, Patrícia José and Sara Vaz-Pereira

Diagnostics 2023, 13(3), 445; https://doi.org/10.3390/diagnostics13030445 - 26 Jan 2023

Cited by 2 | Viewed by 2308

Abstract

Hydroxychloroquine (HCQ) ocular toxicity is rare but severe, and progression can occur even after termination of therapy. Case reports have suggested that a bull’s eye maculopathy detected by near-infrared reflectance (NIR) may indicate early HCQ toxicity. This retrospective cross-sectional study evaluated patients treated with HCQ who underwent routine screening with optical coherence tomography (OCT), fundus autofluorescence (FAF) and 10-2 perimetry. NIR images captured alongside OCT were subsequently graded independently by 2 masked graders for the presence of bull’s eye maculopathy, and the result was compared to the outcome of the screening. A total of 123 participants (246 eyes) were included, and 101 (90%) were female. The patients’ mean age was 55.2 ± 13.8 years. The mean time of HCQ usage was 84.0 ± 72.3 months, and the mean weekly dose was 2327 ± 650 mg. Two eyes showed toxicity in all 3 routine screening exams, with one patient suspending HCQ. The prevalence of bull´s eye lesions in NIR was 13% (33 eyes) with substantial intergrader agreement, a 71.3% specificity and 88.0% negative predictive value for HCQ toxicity. We suggest that NIR changes may be a sign of early HCQ toxicity. The detection of NIR bull´s eye lesions may warrant an increased screening frequency. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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20 pages, 11285 KiB

Open AccessArticle

Spectral Domain Optical Coherence Tomography Findings in Vision-Threatening Rhino-Orbital Cerebral Mucor Mycosis—A Prospective Analysis

by Ankur Singh, Preeti Diwaker, Akanksha Agrawal, Aniruddha Agarwal, Jolly Rohatgi, Ramandeep Singh, Gopal Krushna Das, Pramod Kumar Sahoo and Vinod Kumar Arora

Diagnostics 2022, 12(12), 3098; https://doi.org/10.3390/diagnostics12123098 - 8 Dec 2022

Viewed by 1774

Abstract

Rhino-orbital cerebral mucor mycosis is a rare disease entity, where retinal involvement is described in the literature mostly as CRAO. However, pathological studies have shown mucor invading the choroid and retina with a neutrophilic reaction. So, it is pertinent that retinal inflammation secondary to invading mucor has some role in microstructural changes seen in the vitreous and retina of these patients. This novel study aims to describe the vitreal and retinal features of patients with vision-threatening rhino-orbital cerebral mucor mycosis and how they evolve on spectral domain optical coherence tomography (SD-OCT). This study shall also provide insight into the pathophysiology of these vitreoretinal manifestations by in vitro analysis of the exenterated orbital content. Fifteen eyes of fifteen patients with vision-threatening ROCM treated with standard care were enrolled in this study and underwent complete ophthalmic examination, serial colour fundus photography, and SD-OCT for both qualitative and quantitative analysis, at baseline and follow-up visits. SD-OCT on serial follow-up revealed thickening and increased inner-retinal reflectivity at presentation followed by thinning of both, other features such as the loss of the inner-retinal organized layer structure, external limiting membrane (ELM) disruption, necrotic spaces in the outer retina, and hyperreflective foci. Vitreous cells with vitreous haze were also seen. There was a significant reduction in CMT, inner and outer retinal thickness, total retinal thickness (all p < 0.05) with time, the quantum of reduction concentrated primarily to the inner retina. In summary, in vivo and in vitro analysis revealed that early microstructural changes were primarily a result of retinal infarctions secondary to thrombotic angioinvasion. With the late microstructural changes, there was possible sequelae of retinal infarction with some contribution from the inflammation, resulting from mucor invading the choroid and retina. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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Review

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15 pages, 3412 KiB

Open AccessReview

Optical Coherence Tomography in Inflammatory and Neoplastic Lesions Deforming the Choroidal Profile

by Elena Bolletta, Luca De Simone, Marco Pellegrini, Chiara Preziosa, Valentina Mastrofilippo, Chantal Adani, Pietro Gentile, Fabrizio Gozzi and Luca Cimino

Diagnostics 2023, 13(12), 1991; https://doi.org/10.3390/diagnostics13121991 - 7 Jun 2023

Cited by 2 | Viewed by 2344

Abstract

The choroid is the main part of the uvea, the vascular layer of the eye that lies between the retina and the sclera. The high vascular component of the choroid makes this structure susceptible to inflammation in multisystemic diseases, as well as the most common site of metastasis in the eye. Therefore, the choroid is involved in many pathological conditions, from uveitis to intraocular tumors. Differentiating between inflammatory and neoplastic lesions deforming the choroidal profile can sometimes be challenging. In addition, scleral disorders can also deform the choroidal profile. Choroidal imaging includes ophthalmic ultrasonography, indocyanine green angiography, and optical coherence tomography (OCT). Recent advances in choroidal imaging techniques, such as enhanced depth imaging optical coherence tomography (EDI-OCT) and swept-source optical coherence tomography (SS-OCT), have facilitated an in-depth analysis of the choroid. The purpose of this review article is to report on and highlight the most common OCT findings to help in the differential diagnosis between inflammatory and neoplastic lesions deforming the choroidal profile. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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17 pages, 4788 KiB

Open AccessReview

New Concepts for the Diagnosis of Polypoidal Choroidal Vasculopathy

by Jinzhi Zhao, Priya R Chandrasekaran, Kai Xiong Cheong, Mark Wong and Kelvin Teo

Diagnostics 2023, 13(10), 1680; https://doi.org/10.3390/diagnostics13101680 - 9 May 2023

Cited by 6 | Viewed by 2584

Abstract

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD) that is characterized by a branching neovascular network and polypoidal lesions. It is important to differentiate PCV from typical nAMD as there are differences in treatment response between subtypes. Indocyanine green angiography (ICGA) is the gold standard for diagnosing PCV; however, ICGA is an invasive detection method and impractical for extensive use for regular long-term monitoring. In addition, access to ICGA may be limited in some settings. The purpose of this review is to summarize the utilization of multimodal imaging modalities (color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and fundus autofluorescence (FAF)) in differentiating PCV from typical nAMD and predicting disease activity and prognosis. In particular, OCT shows tremendous potential in diagnosing PCV. Characteristics such as subretinal pigment epithelium (RPE) ring-like lesion, en face OCT-complex RPE elevation, and sharp-peaked pigment epithelial detachment provide high sensitivity and specificity for differentiating PCV from nAMD. With the use of more practical, non-ICGA imaging modalities, the diagnosis of PCV can be more easily made and treatment tailored as necessary for optimal outcomes. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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25 pages, 3690 KiB

Open AccessReview

Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases

by Chung-Ting Wang, Yin-Hsi Chang, Gavin S. W. Tan, Shu Yen Lee, R. V. Paul Chan, Wei-Chi Wu and Andrew S. H. Tsai

Diagnostics 2023, 13(8), 1461; https://doi.org/10.3390/diagnostics13081461 - 18 Apr 2023

Cited by 2 | Viewed by 3448

Abstract

Indirect ophthalmoscopy and handheld retinal imaging are the most common and traditional modalities for the evaluation and documentation of the pediatric fundus, especially for pre-verbal children. Optical coherence tomography (OCT) allows for in vivo visualization that resembles histology, and optical coherence tomography angiography (OCTA) allows for non-invasive depth-resolved imaging of the retinal vasculature. Both OCT and OCTA were extensively used and studied in adults, but not in children. The advent of prototype handheld OCT and OCTA have allowed for detailed imaging in younger infants and even neonates in the neonatal care intensive unit with retinopathy of prematurity (ROP). In this review, we discuss the use of OCTA and OCTA in various pediatric retinal diseases, including ROP, familial exudative vitreoretinopathy (FEVR), Coats disease and other less common diseases. For example, handheld portable OCT was shown to detect subclinical macular edema and incomplete foveal development in ROP, as well as subretinal exudation and fibrosis in Coats disease. Some challenges in the pediatric age group include the lack of a normative database and the difficulty in image registration for longitudinal comparison. We believe that technological improvements in the use of OCT and OCTA will improve our understanding and care of pediatric retina patients in the future. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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14 pages, 4251 KiB

Open AccessReview

Optical Coherence Tomography Angiography (OCT-A) in Uveitis: A Literature Review and a Reassessment of Its Real Role

by Carl P. Herbort, Jr., Masaru Takeuchi, Ioannis Papasavvas, Ilknur Tugal-Tutkun, Alireza Hedayatfar, Yoshihiko Usui, Pinar C. Ozdal and Cristhian A. Urzua

Diagnostics 2023, 13(4), 601; https://doi.org/10.3390/diagnostics13040601 - 7 Feb 2023

Cited by 6 | Viewed by 2647

Abstract

Background: The global and precise follow-up of uveitis has become possible with the availability of dual fluorescein (FA) and indocyanine green angiography (ICGA) since the mid-1990s. Progressively, additional non-invasive imaging methods have emerged, bringing value-added precision to the imaging appraisal of uveitis, including, among others, optical coherence tomography (OCT), enhanced-depth imaging OCT (EDI-OCT) and blue light fundus autofluorescence (BAF). More recently, another complementary imaging method, OCT-angiography (OCT-A), further allowed retinal and choroidal circulation to be imaged without the need for dye injection. Purpose: The purpose of this review was aimed at examining the evidence in published reports indicating whether OCT-A could possibly replace dye angiographic methods, as well as the real practical impact of OCT-A. Methods: A literature search in the PubMed database was performed using the terms OCT-angiography and uveitis, OCTA and uveitis and OCT-A and uveitis. Case reports were excluded. Articles were classified into technical reports, research reports and reviews. Articles in the two latter categories were analyzed in a more detailed, individual fashion. Special attention was paid to whether there were arguments in favor of an exclusive rather than complementary use of OCT-A. Furthermore, a synthesis of the main practical applications of OCT-A in the management of uveitis was attempted. Results: Between 2016 (the year of the first articles) and 2022, 144 articles containing the search terms were identified. After excluding case report articles, 114 articles were retained: 4 in 2016, 17 in 2017, 14 in 2018, 21 in 2019, 14 in 2020, 18 in 2021 and 26 in 2022. Seven articles contained technical information or consensus-based terminology. Ninety-two articles could be considered as clinical research articles. Of those, only two hinted in their conclusions that OCT-A could hypothetically replace dye methods. The terms mostly used to qualify the contribution of the articles in this group were “complementary to dye methods”, “adjunct”, “supplementing” and other similar terms. Fifteen articles were reviews, none of which hinted that OCT-A could replace dye methods. The situations where OCT-A represented a significant practical contribution to the practical appraisal of uveitis were identified. Conclusion: To date, no evidence was found in the literature that OCT-A can replace the classic dye methods; however, it can complement them. Promoting the possibility that non-invasive OCT-A can substitute the invasive dye methods is deleterious, giving the elusive impression that dye methods are no longer inevitable for evaluating uveitis patients. Nevertheless, OCT-A is a precious tool in uveitis research. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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7 pages, 1555 KiB

Open AccessInteresting Images

Unilateral Tamoxifen-Induced Retinopathy as a Consequence of Breast Cancer Treatment—Multimodal Imaging Value

by Paulina Szabelska, Katarzyna Paczwa, Joanna Ciszewska, Radosław Różycki and Joanna Gołębiewska

Diagnostics 2023, 13(7), 1250; https://doi.org/10.3390/diagnostics13071250 - 27 Mar 2023

Cited by 2 | Viewed by 4783

Abstract

Tamoxifen is a drug used in breast cancer therapy, which inhibits the division of neoplastic cells targeting estrogen receptors. The drug is generally well-tolerated and its use does not cause serious side-effects. The standard dose of the drug is 20 mg once a day for 3 to 5 years. Available epidemiological data have shown that the incidence of ocular toxicity of tamoxifen ranges between 0.9% and 12.0% and increases with higher tamoxifen dose. A rare known complication of tamoxifen use is the development of retinopathy. We present a case of 57-year-old woman presented to an ophthalmologist with decreased visual acuity in her right eye. She has been treated with tamoxifen 20 mg daily for 7 years for breast cancer. Clinical examination and multimodal imaging methods help confirm the diagnosis of unilateral tamoxifen associated retinopathy (TAR). Optical coherence tomography angiography (OCTA) was crucial in the diagnostic process and differential diagnosis, especially in differentiating it from type 2 macular telangiectasias. The correct diagnosis of TAR is very important in deciding the treatment option of tamoxifen. Based on our diagnosis, the oncologist recommended another course of treatment. Tamoxifen therapy was discontinued and switched to letrozole 2.5 mg once a day. The patient attends ophthalmological examination regularly. Visual acuity, OCT and OCTA results remain stable. Full article

(This article belongs to the Special Issue Advances in Optical Coherence Tomography and Optical Coherence Tomography Angiography in Diseases of the Retina and Choroid)

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