Reflectance-based projection-resolved optical coherence tomography angiography [Invited]

Optical coherence tomography angiography (OCTA) is limited by projection artifacts from the superficial blood vessels onto deeper layers. We have recently described projection-resolved (PR) OCTA that solves the ambiguity between in situ flow and flow projection along each axial scan and suppresses the artifact on both en face and cross-sectional angiograms. While this method significantly improved the depth resolution of OCTA, the vascular integrity of the deeper layers was not fully preserved. In this study, we propose a novel reflectance-based projection-resolved (rbPR) OCTA algorithm which uses OCT reflectance to enhance the flow signal and suppress the projection artifacts in 3-dimensional OCTA. We demonstrated quantitatively that rbPR improved the vascular connectivity and improved the discrimination of the deeper plexus angiograms in healthy eyes, compared to prior PR-OCTA method. We also demonstrated qualitatively that rbPR removes flow projection artifacts more completely from the outer retinal slab in the eyes with age-related macular degeneration, and preserves vascular integrity of the intermediate and deep capillary plexuses in the eyes with diabetic retinopathy. Additionally, this method improves the resolution of the choriocapillaris and demonstrates details comparable to scanning electron microscopy.