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Zou J, Liu K, Li F, Xu Y, Shen L, Xu H. Combination of optical coherence tomography (OCT) and OCT angiography increases diagnostic efficacy of Parkinson's disease. Quant Imaging Med Surg 2020; 10:1930-1939. [PMID: 33014726 DOI: 10.21037/qims-20-460] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background To assess the diagnostic efficacy of optical coherence tomography (OCT) and OCT angiography (OCTA) in Parkinson's disease (PD). Methods OCT was used to obtain macular parameters and peripapillary retinal nerve fiber layer (RNFL) thickness. The macular superficial retinal vessel and foveal avascular zone (FAZ) were quantified with OCTA. The area under the receiver operating characteristic curve (AUC) indicated the diagnostic efficacy of the parameters. Results Thirty-five eyes from 35 PD patients and 35 eyes from 35 age-matched healthy subjects who served as controls were evaluated. The mean RNFL thickness overall and the thicknesses of the other three quadrants were similar in PD patients compared with controls (P≥0.358). The RNFL thickness at the temporal quadrant, total macular volume (TMV), macular retinal thickness (MRT), and ganglion cell-inner plexiform layer complex (GCL-IPL) thickness were reduced in the eyes of PD patients (P≤0.046). There was no difference between the CMT of PD patients compared with control subjects (P=0.163). The vessel length density (VLD) in the central, inner and full regions; vessel perfusion density (VPD) in all regions; and the FAZ circularity index in PD patients were significantly lower than in controls (P≤0.049). The AUC of the VLD in PD in the central, inner and full regions were 0.712, 0.728, and 0.650, respectively; The VPD in the central, inner and full region were 0.711, 0.756, and 0.682, respectively. The mean RNFL thickness in the temporal quadrant, TMV and MRT revealed an AUC of 0.718, 0.693 and 0.699, respectively. The VPD in the outer region, FAZ circularity and GCL-IPL thickness did not have diagnostic ability in distinguishing PD from normal eyes (P≥0.05). The AUCs of a combination of the VLD in the inner region and TMV, the VLD in the inner region and MRT, the VPD in the inner region and TMV, and the VPD in the inner region and MRT, were 0.843, 0.849, 0.849, and 0.848, respectively (P≤0.001). Conclusions Decreased OCT and OCTA parameters were detected in the eyes of PD patients. Combined non-invasive measurements of OCT and OCTA had better diagnostic ability than either alone, and may provide an additional biomarker for PD progression.
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Affiliation(s)
- Jing Zou
- Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Changsha, China
| | - Kangcheng Liu
- Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Changsha, China
| | - Fangling Li
- Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Changsha, China
| | - Yi Xu
- Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Changsha, China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Huizhuo Xu
- Eye Center of Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Ophthalmology, Changsha, China
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Li X, Xie J, Zhang L, Cui Y, Zhang G, Chen X, Wang J, Zhang A, Huang T, Meng Q. Identifying Microvascular and Neural Parameters Related to the Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2020; 61:39. [PMID: 32441757 PMCID: PMC7405728 DOI: 10.1167/iovs.61.5.39] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose To identify microvascular and neural parameters related to the severity of diabetic retinopathy (DR) by using optical coherence tomography angiography in patients with type 2 diabetes. Methods This cross-sectional study included 110 eyes (63 patients) with no DR, 46 eyes (33 patients) with mild nonproliferative DR, 36 eyes (23 patients) with moderate nonproliferative DR, 36 eyes (22 patients) with severe nonproliferative DR, and 31 eyes (19 patients) with proliferative DR. The optical coherence tomography angiography images were processed to quantify the foveal avascular zone parameters, macular vessel density (VD), retinal thickness, peripapillary VD, retinal nerve fiber layer thickness, and ganglion cell complex thickness. A LASSO-based continuation ratio model was used to select the most clinically relevant parameters for predicting the stage of DR. Results The regression model identified a set of regional parameters for each scanning pattern that identified the DR severity, including foveal avascular zone perimeter; FD-300; temporal perifoveal superficial capillary plexus VD and retinal thickness; temporal and nasal parafoveal deep capillary plexus VD; peripapillary VD in the temporal superior, nasal inferior, and temporal inferior sectors; temporal superior and nasal inferior retinal nerve fiber layer thickness; ganglion cell complex thickness; and FLV, which changed significantly with the progression of DR. Furthermore, two combined blocks exhibited different sensitive parameters to differentiate between the groups based on DR severity. Similar results were obtained in eyes without diabetic macular edema. Conclusions We identified microvascular and neural parameters related to the severity of DR using optical coherence tomography angiography, suggesting their potential clinical application for better screening and staging of DR.
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Gerhard G, Chua J, Tan B, Wong D, Schmidl D, Schmetterer L. Retinal Neurovascular Coupling in Diabetes. J Clin Med 2020; 9:jcm9092829. [PMID: 32882896 PMCID: PMC7565465 DOI: 10.3390/jcm9092829] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/23/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022] Open
Abstract
Neurovascular coupling, also termed functional hyperemia, is one of the physiological key mechanisms to adjust blood flow in a neural tissue in response to functional activity. In the retina, increased neural activity, such as that induced by visual stimulation, leads to the dilatation of retinal arterioles, which is accompanied by an immediate increase in retinal and optic nerve head blood flow. According to the current scientific view, functional hyperemia ensures the adequate supply of nutrients and metabolites in response to the increased metabolic demand of the neural tissue. Although the molecular mechanisms behind neurovascular coupling are not yet fully elucidated, there is compelling evidence that this regulation is impaired in a wide variety of neurodegenerative and vascular diseases. In particular, it has been shown that the breakdown of the functional hyperemic response is an early event in patients with diabetes. There is compelling evidence that alterations in neurovascular coupling precede visible signs of diabetic retinopathy. Based on these observations, it has been hypothesized that a breakdown of functional hyperemia may contribute to the retinal complications of diabetes such as diabetic retinopathy or macular edema. The present review summarizes the current evidence of impaired neurovascular coupling in patients with diabetes. In this context, the molecular mechanisms of functional hyperemia in health and disease will be covered. Finally, we will also discuss how neurovascular coupling may in future be used to monitor disease progression or risk stratification.
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Affiliation(s)
- Garhöfer Gerhard
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria; (G.G.); (D.S.)
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.); (D.W.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.); (D.W.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.); (D.W.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria; (G.G.); (D.S.)
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria; (G.G.); (D.S.)
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (B.T.); (D.W.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute for Health Technologies, Nanyang Technological University, Singapore 308232, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, CH-4031 Basel, Switzerland
- Correspondence: ; Tel.: +43-1-40400-29810
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Sandhu HS, Elmogy M, Taher Sharafeldeen A, Elsharkawy M, El-Adawy N, Eltanboly A, Shalaby A, Keynton R, El-Baz A. Automated Diagnosis of Diabetic Retinopathy Using Clinical Biomarkers, Optical Coherence Tomography, and Optical Coherence Tomography Angiography. Am J Ophthalmol 2020; 216:201-206. [PMID: 31982407 DOI: 10.1016/j.ajo.2020.01.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/29/2019] [Accepted: 01/10/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To determine if combining clinical, demographic, and imaging data improves automated diagnosis of nonproliferative diabetic retinopathy (NPDR). DESIGN Cross-sectional imaging and machine learning study. METHODS This was a retrospective study performed at a single academic medical center in the United States. Inclusion criteria were age >18 years and a diagnosis of diabetes mellitus (DM). Exclusion criteria were non-DR retinal disease and inability to image the macula. Optical coherence tomography (OCT) and OCT angiography (OCTA) were performed, and data on age, sex, hypertension, hyperlipidemia, and hemoglobin A1c were collected. Machine learning techniques were then applied. Multiple pathophysiologically important features were automatically extracted from each layer on OCT and each OCTA plexus and combined with clinical data in a random forest classifier to develop the system, whose results were compared to the clinical grading of NPDR, the gold standard. RESULTS A total of 111 patients with DM II were included in the study, 36 with DM without DR, 53 with mild NPDR, and 22 with moderate NPDR. When OCT images alone were analyzed by the system, accuracy of diagnosis was 76%, sensitivity 85%, specificity 87%, and area under the curve (AUC) was 0.78. When OCT and OCTA data together were analyzed, accuracy was 92%, sensitivity 95%, specificity 98%, and AUC 0.92. When all data modalities were combined, the system achieved an accuracy of 96%, sensitivity 100%, specificity 94%, and AUC 0.96. CONCLUSIONS Combining common clinical data points with OCT and OCTA data enhances the power of computer-aided diagnosis of NPDR.
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Dai Y, Zhou H, Chu Z, Zhang Q, Chao JR, Rezaei KA, Wang RK. Microvascular Changes in the Choriocapillaris of Diabetic Patients Without Retinopathy Investigated by Swept-Source OCT Angiography. Invest Ophthalmol Vis Sci 2020; 61:50. [PMID: 32232345 PMCID: PMC7401698 DOI: 10.1167/iovs.61.3.50] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose To investigate the microvascular changes in macular retina and choriocapillaris (CC) in diabetic eyes without retinopathy using swept-source optical coherence tomography angiography (SS-OCTA). Methods A commercial SS-OCTA system was used to collect 6 × 6-mm macular scans from patients. Three depth-resolved retinal slabs and a CC slab were segmented by a validated semiautomated algorithm. Retinal vessel area density, vessel skeleton density, and nonperfusion area were calculated on segmented retinal slabs. Foveal avascular zone was automatically measured based on en face image of the whole retinal layer. For CC quantification, the percentage of flow deficits (FD%) and the flow deficit (FD) sizes were measured. Results Sixteen eyes from 16 diabetic patients without clinically detectable retinopathy and 16 eyes from 16 age-matched nondiabetic controls were included. There was no significant difference between the two groups in all retinal vessel quantitative parameters (all P > 0.05). However, the mean FD% and mean FD sizes were significantly increased in CC in the central 1.0-mm disk (P = 0.011 and P = 0.017, respectively), the central 1.5-mm rim (P = 0.003 and P = 0.009, respectively), the central 2.5-mm rim (P = 0.018 and P = 0.020, respectively), and the entire 5.0-mm disk (P = 0.009 and P = 0.008, respectively) in diabetic eyes compared with controls. Conclusions CC perfusion in the macula is decreased in diabetic patients without retinopathy as compared to age-matched normal controls. Decreased CC perfusion in the macula may be an early indicator of otherwise clinically undetectable diabetic vasculopathy.
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Chua J, Sim R, Tan B, Wong D, Yao X, Liu X, Ting DSW, Schmidl D, Ang M, Garhöfer G, Schmetterer L. Optical Coherence Tomography Angiography in Diabetes and Diabetic Retinopathy. J Clin Med 2020; 9:E1723. [PMID: 32503234 PMCID: PMC7357089 DOI: 10.3390/jcm9061723] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Diabetic retinopathy (DR) is a common complication of diabetes mellitus that disrupts the retinal microvasculature and is a leading cause of vision loss globally. Recently, optical coherence tomography angiography (OCTA) has been developed to image the retinal microvasculature, by generating 3-dimensional images based on the motion contrast of circulating blood cells. OCTA offers numerous benefits over traditional fluorescein angiography in visualizing the retinal vasculature in that it is non-invasive and safer; while its depth-resolved ability makes it possible to visualize the finer capillaries of the retinal capillary plexuses and choriocapillaris. High-quality OCTA images have also enabled the visualization of features associated with DR, including microaneurysms and neovascularization and the quantification of alterations in retinal capillary and choriocapillaris, thereby suggesting a promising role for OCTA as an objective technology for accurate DR classification. Of interest is the potential of OCTA to examine the effect of DR on individual retinal layers, and to detect DR even before it is clinically detectable on fundus examination. We will focus the review on the clinical applicability of OCTA derived quantitative metrics that appear to be clinically relevant to the diagnosis, classification, and management of patients with diabetes or DR. Future studies with longitudinal design of multiethnic multicenter populations, as well as the inclusion of pertinent systemic information that may affect vascular changes, will improve our understanding on the benefit of OCTA biomarkers in the detection and progression of DR.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Ralene Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
| | - Xinyu Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
| | - Daniel S. W. Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; (J.C.); (R.S.); (B.T.); (D.W.); (X.Y.); (X.L.); (D.S.W.T.); (M.A.)
- Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- Institute of Health Technologies, Nanyang Technological University, Singapore 639798, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (D.S.); (G.G.)
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, CH-4031 Basel, Switzerland
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Dai W, Chee ML, Majithia S, Teo CL, Thakur S, Cheung N, Rim TH, Tan GS, Sabanayagam C, Cheng CY, Tham YC. Agreement in Measures of Macular Perfusion between Optical Coherence Tomography Angiography Machines. Sci Rep 2020; 10:8345. [PMID: 32433483 PMCID: PMC7239842 DOI: 10.1038/s41598-020-65243-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022] Open
Abstract
We evaluated the agreements in foveal avascular zone (FAZ) area and vessel density (VD) parameters (within the superficial capillary plexus region), between two widely used optical coherence tomography angiography machines. Participants who attended the Singapore Malay Eye Study III between 29th March and 6th August 2018, were enrolled in this study. Participants underwent fovea-centered 6×6-mm macular cube scan, using both AngioVue and Cirrus HDOCT machines. Scans were analyzed automatically using built-in review software of each machine. 177 eyes (95 participants) without retinal diseases were included for final analysis. Mean FAZ area was 0.38 ± 0.11 mm2 and 0.30 ± 0.10 mm2, based on AngioVue and Cirrus HDOCT, respectively. Mean parafoveal VD was 0.50 ± 0.04 in Angiovue, and 0.43 ± 0.04 in Cirrus HDOCT. Cirrus HDOCT measurements were consistently lower than those by AngioVue, with a mean difference of −0.08 (95% limits of agreement [LOA], −0.30–0.13) mm2 for FAZ area, and −0.07 (95% LOA, −0.17–0.03) for parafoveal VD. Intraclass correlation coefficients for FAZ area and parafoveal VD were 0.33 and 0.07, respectively. Our data suggest that agreements between AngioVue and Cirrus HDOCT machines were poor to fair, thus alternating use between these two machines may not be recommended especially for follow up evaluations.
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Affiliation(s)
- Wei Dai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Miao-Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Cong Ling Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Gavin S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.
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Yoshikawa Y, Shoji T, Kanno J, Ibuki H, Weinreb RN, Araie M, Shinoda K. Glaucomatous vertical vessel density asymmetry of the temporal raphe detected with optical coherence tomography angiography. Sci Rep 2020; 10:6845. [PMID: 32322012 PMCID: PMC7176726 DOI: 10.1038/s41598-020-63931-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 04/08/2020] [Indexed: 11/21/2022] Open
Abstract
Changes in retinal vasculature and ocular circulation may play an important role in the glaucoma development and progression. We evaluated the vertical asymmetry across the temporal raphe of the deep retinal layer vessel density, using swept-source optical coherence tomography angiography (SS-OCTA), and its relationship with the central visual field (VF) loss. Thirty-four eyes of 27 patients with open-angle glaucoma were included. SS-OCTA macular scanning was performed within a 3 × 3 mm (300 × 300 pixels) volume, centred on the fovea. The relationships between the vertical asymmetrical deep retinal vessel density reduction (ADRVD) across the temporal raphe and various ocular parameters were analysed. Twenty-two glaucomatous eyes with ADRVDs had central VF loss. Contrarily, ADRVDs were not found in any of the 12 eyes without central VF loss. Thirteen eyes (59.1%) with central VF loss had ADRVDs topographically corresponding to the central VF loss and macular ganglion cell complex thinning. The glaucomatous eyes with ADRVDs exhibited inferior rather than superior central VF loss (P = 0.032). Thus, ADRVD specifically indicates the glaucomatous central visual loss. Further analysis of ADRVD may improve our understanding on glaucoma pathogenesis, offering new treatment insights.
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Affiliation(s)
- Yuji Yoshikawa
- Saitama Medical University, Department of Ophthalmology, Saitima, Japan
| | - Takuhei Shoji
- Saitama Medical University, Department of Ophthalmology, Saitima, Japan.
| | - Junji Kanno
- Saitama Medical University, Department of Ophthalmology, Saitima, Japan
| | - Hisashi Ibuki
- Saitama Medical University, Department of Ophthalmology, Saitima, Japan
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
| | - Makoto Araie
- Saitama Medical University, Department of Ophthalmology, Saitima, Japan.,Kanto Central Hospital of Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Kei Shinoda
- Saitama Medical University, Department of Ophthalmology, Saitima, Japan
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Heisler M, Karst S, Lo J, Mammo Z, Yu T, Warner S, Maberley D, Beg MF, Navajas EV, Sarunic MV. Ensemble Deep Learning for Diabetic Retinopathy Detection Using Optical Coherence Tomography Angiography. Transl Vis Sci Technol 2020; 9:20. [PMID: 32818081 PMCID: PMC7396168 DOI: 10.1167/tvst.9.2.20] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose To evaluate the role of ensemble learning techniques with deep learning in classifying diabetic retinopathy (DR) in optical coherence tomography angiography (OCTA) images and their corresponding co-registered structural images. Methods A total of 463 volumes from 380 eyes were acquired using the 3 × 3-mm OCTA protocol on the Zeiss Plex Elite system. Enface images of the superficial and deep capillary plexus were exported from both the optical coherence tomography and OCTA data. Component neural networks were constructed using single data-types and fine-tuned using VGG19, ResNet50, and DenseNet architectures pretrained on ImageNet weights. These networks were then ensembled using majority soft voting and stacking techniques. Results were compared with a classifier using manually engineered features. Class activation maps (CAMs) were created using the original CAM algorithm and Grad-CAM. Results The networks trained with the VGG19 architecture outperformed the networks trained on deeper architectures. Ensemble networks constructed using the four fine-tuned VGG19 architectures achieved accuracies of 0.92 and 0.90 for the majority soft voting and stacking methods respectively. Both ensemble methods outperformed the highest single data-type network and the network trained on hand-crafted features. Grad-CAM was shown to more accurately highlight areas of disease. Conclusions Ensemble learning increases the predictive accuracy of CNNs for classifying referable DR on OCTA datasets. Translational Relevance Because the diagnostic accuracy of OCTA images is shown to be greater than the manually extracted features currently used in the literature, the proposed methods may be beneficial toward developing clinically valuable solutions for DR diagnoses.
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Affiliation(s)
- Morgan Heisler
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sonja Karst
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julian Lo
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Zaid Mammo
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy Yu
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Simon Warner
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Maberley
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mirza Faisal Beg
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Eduardo V Navajas
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marinko V Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
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60
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Yao X, Alam MN, Le D, Toslak D. Quantitative optical coherence tomography angiography: A review. Exp Biol Med (Maywood) 2020; 245:301-312. [PMID: 31958986 PMCID: PMC7370602 DOI: 10.1177/1535370219899893] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
As a new optical coherence tomography (OCT) modality, OCT angiography (OCTA) provides a noninvasive method to detect microvascular distortions correlated with eye conditions. By providing unparalleled capability to differentiate individual plexus layers in the retina, OCTA has demonstrated its excellence in clinical management of diabetic retinopathy, glaucoma, sickle cell retinopathy, diabetic macular edema, and other eye diseases. Quantitative OCTA analysis of retinal and choroidal vasculatures is essential to standardize objective interpretations of clinical outcome. Quantitative features, including blood vessel tortuosity, blood vessel caliber, blood vessel density, vessel perimeter index, fovea avascular zone area, fovea avascular zone contour irregularity, vessel branching coefficient, vessel branching angle, branching width ratio, and choroidal vascular analysis have been established for objective OCTA assessment. Moreover, differential artery–vein analysis has been recently demonstrated to improve OCTA performance for objective detection and classification of eye diseases. In this review, technical rationales and clinical applications of these quantitative OCTA features are summarized, and future prospects for using these quantitative OCTA features for artificial intelligence classification of eye conditions are discussed.
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Affiliation(s)
- Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Minhaj N Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Devrim Toslak
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology, Antalya Training and Research Hospital, Antalya 07030, Turkey
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You QS, Chan JCH, Ng ALK, Choy BKN, Shih KC, Cheung JJC, Wong JKW, Shum JWH, Ni MY, Lai JSM, Leung GM, Cheung CMG, Wong TY, Wong IYH. Macular Vessel Density Measured With Optical Coherence Tomography Angiography and Its Associations in a Large Population-Based Study. Invest Ophthalmol Vis Sci 2020; 60:4830-4837. [PMID: 31747685 DOI: 10.1167/iovs.19-28137] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigate macular perfusion and the systemic and ocular associations in a population-based setting. Methods In this cross-sectional study, 2018 adults residing in Hong Kong underwent detailed ophthalmic examinations after consenting to participate. Macular perfusion was measured with optical coherence tomography angiography (OCTA) using the split-spectrum amplitude decorrelation angiography algorithm. The parafoveal flow index and vessel area density were quantified using automated custom-built software. Results Of the 2018 participants, the OCTA measurements were available for 1940, and 1631 (84.1%) had good quality scans. The right eyes of these 1631 participants (43.1% men) were included for final analysis. Mean age was 49.8 years (range, 18-92 years). Mean global macular vessel density was 47.3% and 55.1% for the superficial and deep retinal layers, respectively. In multivariate analysis, lower superficial vessel density remained significantly associated with lower signal strength index (SSI; P < 0.001, standardized β = 0.607) and male sex (P < 0.001, β = 0.162), and borderline associated with older age (P = 0.09, β = -0.045) and longer axial length (AL; P = 0.09, β = -0.037), while lower deep layer vessel density was significantly associated with lower SSI (P < 0.001, standardized β = 0.667), longer AL (P < 0.001, β = -0.097), and higher creatinine (P < 0.001, β = -0.072). Conclusions This large population-based study provided normative OCTA data of macular vessel density and demonstrated that a lower superficial retinal vessel density was significantly associated with lower SSI and male sex, while a lower deep layer retinal vessel density was significantly associated with lower SSI, longer AL, and higher level of creatinine. These associations must be considered when interpreting clinical quantitative OCTA data.
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Affiliation(s)
- Qi Sheng You
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.,Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing.,Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States
| | - Jonathan C H Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Alex L K Ng
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bonnie K N Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kendrick C Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Janice J C Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jasper K W Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jennifer W H Shum
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael Y Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jimmy S M Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Gabriel M Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | | | - Ian Y H Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.,Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong
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Guo M, Zhao M, Cheong AMY, Dai H, Lam AKC, Zhou Y. Automatic quantification of superficial foveal avascular zone in optical coherence tomography angiography implemented with deep learning. Vis Comput Ind Biomed Art 2019; 2:21. [PMID: 32240395 PMCID: PMC7099561 DOI: 10.1186/s42492-019-0031-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
An accurate segmentation and quantification of the superficial foveal avascular zone (sFAZ) is important to facilitate the diagnosis and treatment of many retinal diseases, such as diabetic retinopathy and retinal vein occlusion. We proposed a method based on deep learning for the automatic segmentation and quantification of the sFAZ in optical coherence tomography angiography (OCTA) images with robustness to brightness and contrast (B/C) variations. A dataset of 405 OCTA images from 45 participants was acquired with Zeiss Cirrus HD-OCT 5000 and the ground truth (GT) was manually segmented subsequently. A deep learning network with an encoder-decoder architecture was created to classify each pixel into an sFAZ or non-sFAZ class. Subsequently, we applied largest-connected-region extraction and hole-filling to fine-tune the automatic segmentation results. A maximum mean dice similarity coefficient (DSC) of 0.976 ± 0.011 was obtained when the automatic segmentation results were compared against the GT. The correlation coefficient between the area calculated from the automatic segmentation results and that calculated from the GT was 0.997. In all nine parameter groups with various brightness/contrast, all the DSCs of the proposed method were higher than 0.96. The proposed method achieved better performance in the sFAZ segmentation and quantification compared to two previously reported methods. In conclusion, we proposed and successfully verified an automatic sFAZ segmentation and quantification method based on deep learning with robustness to B/C variations. For clinical applications, this is an important progress in creating an automated segmentation and quantification applicable to clinical analysis.
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Affiliation(s)
- Menglin Guo
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen University Xili Campus, Room 208, Block A2,, Taoyuan Street, Shenzhen, 518055, China
| | - Mei Zhao
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Allen M Y Cheong
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Houjiao Dai
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen University Xili Campus, Room 208, Block A2,, Taoyuan Street, Shenzhen, 518055, China
| | - Andrew K C Lam
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
| | - Yongjin Zhou
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen University Xili Campus, Room 208, Block A2,, Taoyuan Street, Shenzhen, 518055, China.
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Sun Z, Tang F, Wong R, Lok J, Szeto SKH, Chan JCK, Chan CKM, Tham CC, Ng DS, Cheung CY. OCT Angiography Metrics Predict Progression of Diabetic Retinopathy and Development of Diabetic Macular Edema: A Prospective Study. Ophthalmology 2019; 126:1675-1684. [PMID: 31358386 DOI: 10.1016/j.ophtha.2019.06.016] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To prospectively determine the relationship of OCT angiography (OCTA) metrics to diabetic retinopathy (DR) progression and development of diabetic macular edema (DME). DESIGN Prospective, observational study. PARTICIPANTS A total of 205 eyes from 129 patients with diabetes mellitus followed up for at least 2 years. METHODS All participants underwent OCTA with a swept-source OCT device (DRI-OCT Triton, Topcon, Inc, Tokyo, Japan). Individual OCTA images of superficial capillary plexus (SCP) and deep capillary plexus (DCP) were generated by IMAGEnet6 (Basic License 10). After a quality check, automated measurements of foveal avascular zone (FAZ) area, FAZ circularity, vessel density (VD), and fractal dimension (FD) of both SCP and DCP were then obtained. MAIN OUTCOME MEASURES Progression of DR and development of DME. RESULTS Over a median follow-up of 27.14 months (interquartile range, 24.16-30.41 months), 28 of the 205 eyes (13.66%) developed DR progression. Of the 194 eyes without DME at baseline, 17 (8.76%) developed DME. Larger FAZ area (hazard ratio [HR], 1.829 per SD increase; 95% confidence interval [CI], 1.332-2.512), lower VD (HR, 1.908 per SD decrease; 95% CI, 1.303-2.793), and lower FD (HR, 4.464 per SD decrease; 95% CI, 1.337-14.903) of DCP were significantly associated with DR progression after adjusting for established risk factors (DR severity, glycated hemoglobin, duration of diabetes, age, and mean arterial blood pressure at baseline). Lower VD of SCP (HR, 1.789 per SD decrease; 95% CI, 1.027-4.512) was associated with DME development. Compared with the model with established risk factors alone, the addition of OCTA metrics improved the predictive discrimination of DR progression (FAZ area of DCP, C-statistics 0.723 vs. 0.677, P < 0.001; VD of DCP, C-statistics 0.727 vs. 0.677, P = 0.001; FD of DCP, C-statistics 0.738 vs. 0.677, P < 0.001) and DME development (VD of SCP, C-statistics 0.904 vs. 0.875, P = 0.036). CONCLUSIONS The FAZ area, VD, and FD of DCP predict DR progression, whereas VD of SCP predicts DME development. Our findings provide evidence to support that OCTA metrics improve the evaluation of risk of DR progression and DME development beyond traditional risk factors.
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Affiliation(s)
- Zihan Sun
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raymond Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jerry Lok
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Jason C K Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Eye Hospital, Hong Kong Special Administrative Region, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Danny S Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Tey KY, Teo K, Tan ACS, Devarajan K, Tan B, Tan J, Schmetterer L, Ang M. Optical coherence tomography angiography in diabetic retinopathy: a review of current applications. EYE AND VISION 2019; 6:37. [PMID: 31832448 PMCID: PMC6859616 DOI: 10.1186/s40662-019-0160-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/14/2019] [Indexed: 01/09/2023]
Abstract
Background Diabetic retinopathy (DR) is a leading cause of vision loss in adults. Currently, the standard imaging technique to monitor and prognosticate DR and diabetic maculopathy is dye-based angiography. With the introduction of optical coherence tomography angiography (OCTA), it may serve as a potential rapid, non-invasive imaging modality as an adjunct. Main text Recent studies on the role of OCTA in DR include the use of vascular parameters e.g., vessel density, intercapillary spacing, vessel diameter index, length of vessels based on skeletonised OCTA, the total length of vessels, vascular architecture and area of the foveal avascular zone. These quantitative measures may be able to detect changes with the severity and progress of DR for clinical research. OCTA may also serve as a non-invasive imaging method to detect diabetic macula ischemia, which may help predict visual prognosis. However, there are many limitations of OCTA in DR, such as difficulty in segmentation between superficial and deep capillary plexus; and its use in diabetic macula edema where the presence of cystic spaces may affect image results. Future applications of OCTA in the anterior segment include detection of anterior segment ischemia and iris neovascularisation associated with proliferative DR and risk of neovascular glaucoma. Conclusion OCTA may potentially serve as a useful non-invasive imaging tool in the diagnosis and monitoring of diabetic retinopathy and maculopathy in the future. Future studies may demonstrate how quantitative OCTA measures may have a role in detecting early retinal changes in patients with diabetes.
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Affiliation(s)
- Kai Yuan Tey
- Hobart Clinical School, Level 3, 43 Collins Street, Hobart, TAS 7000 Australia
| | - Kelvin Teo
- 2Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751 Singapore
| | - Anna C S Tan
- 2Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751 Singapore
| | - Kavya Devarajan
- 3Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
| | - Bingyao Tan
- 3Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
| | - Jacqueline Tan
- 3Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
| | - Leopold Schmetterer
- 3Singapore Eye Research Institute, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856 Singapore
| | - Marcus Ang
- 4Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751; Duke-NUS Medical School, 8 College Rd, Singapore, 169857 Singapore
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65
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Laotaweerungsawat S, Psaras C, Liu X, Stewart JM. OCT Angiography Assessment of Retinal Microvascular Changes in Diabetic Eyes in an Urban Safety-Net Hospital. Ophthalmol Retina 2019; 4:425-432. [PMID: 31926950 DOI: 10.1016/j.oret.2019.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine whether quantitative OCT angiography (OCTA) parameters can be used to distinguish among eyes at various stages of diabetic retinopathy (DR) in an urban safety-net hospital population. DESIGN Prospective cross-sectional study. PARTICIPANTS Three hundred twenty-nine eyes from 329 patients were included in this study: 90 nondiabetic patients, 170 diabetic patients without DR, 57 diabetic patients with mild to moderate nonproliferative DR (NPDR), and 12 diabetic patients with severe NPDR to proliferative DR. METHODS Patients underwent OCTA imaging and ultra-widefield fundus photography at Zuckerberg San Francisco General Hospital and Trauma Center between April and October 2018. For participants with diabetes, imaging was classified according to DR severity by a telemedicine reading center. Eight OCTA parameters were analyzed. Perfusion density and vessel length density (VD) were examined from both the superficial capillary plexus (SCP) and deep capillary plexus. The other 4 parameters were examined only from the SCP. Total extrafoveal avascular area (tEAA) was based on the area of absent capillary vessels. Foveal avascular zone (FAZ)-related metrics consisted of FAZ area, FAZ circularity index, and FAZ acircularity index. MAIN OUTCOME MEASURES Area under the receiver operating characteristic curve (AUC) for OCTA parameters to distinguish among groups according to DR severity. RESULTS All OCTA parameters demonstrated a significant relationship with DR severity (P < 0.05). No significant difference was found when comparing nondiabetic participants versus diabetic participants without retinopathy. The FAZ area was the only metric that demonstrated a significant difference between genders: mean of 0.29±0.12 mm2 in men and 0.34±0.13 mm2 in women (P < 0.001). Receiver operating characteristic curve analyses showed that tEAA had the highest AUC when comparing various stages of the disease. CONCLUSIONS In this urban, public hospital population, quantification of retinal vascular findings with OCTA imaging was a useful means of distinguishing patients according to DR severity. Because these results were similar to those of other tertiary referral centers, it would be reasonable to perform further DR-related OCTA studies in this population and expect generalizable results.
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Affiliation(s)
- Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California; Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Catherine Psaras
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, California
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
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Wang F, Saraf SS, Zhang Q, Wang RK, Rezaei KA. Ultra-Widefield Protocol Enhances Automated Classification of Diabetic Retinopathy Severity with OCT Angiography. Ophthalmol Retina 2019; 4:415-424. [PMID: 31982390 DOI: 10.1016/j.oret.2019.10.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/25/2019] [Accepted: 10/31/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess the diagnostic usefulness of retinal nonperfusion to classify eyes based on diabetic retinopathy (DR) severity on OCT angiography (OCTA) and determine whether wider field of view (FOV) OCTA protocols enhance the diagnostic usefulness of retinal nonperfusion in the classification of DR severity. DESIGN Retrospective cross-sectional study. PARTICIPANTS Diabetic patients undergoing ultra-widefield (UWF) OCTA imaging at 1 academic retina practice. METHODS Ultra-widefield OCTA images with 100° FOV were obtained from 60 eyes. Eyes were grouped as those with diabetes without retinopathy (DWR), those with nonproliferative diabetic retinopathy (NPDR), or those with proliferative diabetic retinopathy (PDR). The ratio of nonperfusion (RNP) was expressed as the percent area of capillary nonperfusion within the FOV. The RNP was obtained in the FOV 100° image and concentric sectors encompassing 10°, 10° to 30°, 30° to 50°, and 50° to 100°. MAIN OUTCOME MEASURES Mean RNP among DR groups, mean RNP measured among FOV sectors, and area under the curve (AUC) of the receiver operating characteristics when using RNP as a cutoff value to distinguish between DR groups. RESULTS Mean RNP from the FOV 50° to 100° sector was different among all groups: DWR, 14.6±5.1%; NPDR, 27.5±7.5%; and PDR, 41.5±19.1% (P < 0.01). Within each DR group, field of view from 50° to 100° measured higher RNP than all other sectors (P < 0.01). Field of view from 50° to 100° showed the highest optimal sensitivity and specificity to distinguish NPDR from DWR with an RNP cutoff value of 21.2% (89.5% and 88.2%; AUC, 0.944) and PDR from NPDR with an RNP cutoff value of 31.6% (79.2% and 78.9%; AUC, 0.752). CONCLUSIONS Ratio of nonperfusion on average is higher in more severe DR. The most peripheral sector of the widefield OCTA (FOV 50°-100°) showed on average higher RNP and showed more diagnostic usefulness in determining DR severity compared with more central sectors and the FOV 100 image as a whole.
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Affiliation(s)
- FuPeng Wang
- Department of Bioengineering, University of Washington, Seattle, Washington; College of Information Science and Engineering, Ocean University of China, Qingdao, China
| | - Steven S Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Kasra A Rezaei
- Department of Ophthalmology, University of Washington, Seattle, Washington.
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Xu X, Chen C, Ding W, Yang P, Lu H, Xu F, Lei J. Automated quantification of superficial retinal capillaries and large vessels for diabetic retinopathy on optical coherence tomographic angiography. JOURNAL OF BIOPHOTONICS 2019; 12:e201900103. [PMID: 31309729 DOI: 10.1002/jbio.201900103] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/25/2019] [Accepted: 07/14/2019] [Indexed: 06/10/2023]
Abstract
Optical coherence tomography angiography (OCTA) is a relatively new technique with capillary-level resolution, which has shown great potential for the diagnosis of diabetic retinopathy (DR). A fully automatic algorithm for the quantitative measurement of microcirculatory changes in sight-threatening DR is presented. The foveal avascular zone (FAZ) segmentation was improved with a graph-theoretic method and the large vessels and capillaries were separately identified and analyzed. The method was evaluated in healthy and diabetic eyes with various stages of retinopathy. Results showed that, compared with the healthy group, the diabetic group showed a significantly larger large vessel density, but a significantly smaller capillary density (P < .001). Circularity of FAZ was significantly smaller while nonperfusion area was significantly larger in the diabetic group. The combined variable of all image metrics reached an area under the ROC of 0.853 (95% CI, 0.784-0.923) for mild to moderate nonproliferative DR and 0.950 (95% CI, 0.922-0.979) for proliferative DR. Microvascular and FAZ changes with various DR stages can be accurately delineated using the developed automatic program. Quantitative metrics on OCTA serve as potential biomarkers for the staging of DR.
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Affiliation(s)
- Xiayu Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, PR China
| | - Cheng Chen
- Department of Ophthalmology, Xi'an No.1 Hospital, Xi'an, PR China
| | - Wenxiang Ding
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, PR China
| | - Peiwei Yang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, PR China
| | - Huiqin Lu
- Department of Ophthalmology, Xi'an No.1 Hospital, Xi'an, PR China
| | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, PR China
| | - Jianqin Lei
- Department of Ophthalmology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
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Arthur E, Elsner AE, Sapoznik KA, Papay JA, Muller MS, Burns SA. Distances From Capillaries to Arterioles or Venules Measured Using OCTA and AOSLO. Invest Ophthalmol Vis Sci 2019; 60:1833-1844. [PMID: 31042789 PMCID: PMC6892442 DOI: 10.1167/iovs.18-25294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To investigate distances from retinal capillaries to arterioles or venules noninvasively. Methods An adaptive optics scanning laser ophthalmoscope (AOSLO) and optical coherence tomography angiography (OCTA) imager acquired detailed maps of retinal vasculature. Using OCTA, we quantified the distance from the edge of an arteriole or venule to the middle of the nearest capillaries (periarteriole or perivenule capillary-free zones, respectively) within the superficial vascular plexus of 20 young healthy subjects with normal axial lengths. These distances were compared to AOSLO images for three subjects. We tested the relation between the peripheral capillary-free zones and FAZ horizontal, vertical, effective diameters, and asymmetry indices in the deep vascular plexus. We examined enlargement with OCTA of capillary-free zones in a type 2 diabetic patient. Results The periarteriole capillary-free zone (67.2 ± 25.3 μm) was readily visible and larger than the perivenule capillary-free zone (42.7 ± 14.4 μm), F(1, 998) = 771, P < 0.0001. The distance from foveal center (P = 0.003) and diameter (P = 0.048) were predictive of perivenule capillary-free zone values. OCTA and AOSLO corresponded for arterioles. FAZ effective diameter was positively associated with asymmetry indices, r = 0.49, P = 0.028, but not peripheral capillary-free zones, although focal enlargements were found in a diabetic patient. Conclusions For normal retinas, periarteriole and perivenule capillary-free zones are readily visible with OCTA and AOSLO. Periarteriole capillary-free zones were larger, consistent with arterioles carrying oxygen rich blood that diffuses to support the retina.
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Affiliation(s)
- Edmund Arthur
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | - Ann E Elsner
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | - Kaitlyn A Sapoznik
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | - Joel A Papay
- Indiana University School of Optometry, Bloomington, Indiana, United States
| | | | - Stephen A Burns
- Indiana University School of Optometry, Bloomington, Indiana, United States
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Hsieh YT, Alam MN, Le D, Hsiao CC, Yang CH, Chao DL, Yao X. OCT Angiography Biomarkers for Predicting Visual Outcomes after Ranibizumab Treatment for Diabetic Macular Edema. Ophthalmol Retina 2019; 3:826-834. [PMID: 31227330 PMCID: PMC6921516 DOI: 10.1016/j.oret.2019.04.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 04/12/2023]
Abstract
PURPOSE To correlate quantitative OCT angiography (OCTA) biomarkers with clinical features and to predict the extent of visual improvement after ranibizumab treatment for diabetic macular edema (DME) with OCTA biomarkers. DESIGN Retrospective, longitudinal study in Taiwan. PARTICIPANTS Fifty eyes of 50 patients with DME and 22 eyes of 22 healthy persons, with the exception of cataract and refractive error, from 1 hospital. METHODS Each eye underwent OCT angiography (RTVue XR Avanti System with AngioVue software version 2017.1; Optovue, Fremont, CA), and 3×3-mm2 en face OCTA images of the superficial layer and the deep layer were obtained at baseline and after 3 monthly injections of ranibizumab in the study group. OCT angiography images also were acquired from the control group. MAIN OUTCOME MEASURES Five OCTA biomarkers, including foveal avascular zone (FAZ) area (FAZ-A), FAZ contour irregularity (FAZ-CI), average vessel caliber (AVC), vessel tortuosity (VT), and vessel density (VD), were analyzed comprehensively. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) also were obtained. Student t tests were used to compare the OCTA biomarkers between the study group and the control group. Linear regression models were used to evaluate the correlations between the baseline OCTA biomarkers and the changes of BCVA and CRT after treatment. RESULTS Eyes with DME had larger AVC, VT, FAZ-A, and FAZ-CI and lower VD than those in the control group (P < 0.001 for all). After the loading ranibizumab treatment, these OCTA biomarkers improved but did not return to normal levels. Among all biomarkers, higher inner parafoveal VD in the superficial layer at baseline correlated most significantly with visual gain after treatment in the multiple regression model with adjustment for CRT and ellipsoid zone disruption (P < 0.001). To predict visual improvement, outer parafoveal VD in the superficial layer at the baseline showed the largest area under the receiver operating characteristic curve (0.787; P = 0.004). No baseline OCTA biomarkers showed any significant correlation specifically with anatomic improvement. CONCLUSIONS For eyes with DME, parafoveal VD in the superficial layer at baseline was an independent predictor for visual improvement after the loading ranibizumab treatment.
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Affiliation(s)
- Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Minhaj Nur Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Chia-Chieh Hsiao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Daniel L Chao
- Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, San Diego, California
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology 2019; 127:P66-P145. [PMID: 31757498 DOI: 10.1016/j.ophtha.2019.09.025] [Citation(s) in RCA: 314] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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71
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Hagag AM, Wang J, Lu K, Harman G, Weleber RG, Huang D, Yang P, Pennesi ME, Jia Y. Projection-Resolved Optical Coherence Tomographic Angiography of Retinal Plexuses in Retinitis Pigmentosa. Am J Ophthalmol 2019; 204:70-79. [PMID: 30849344 DOI: 10.1016/j.ajo.2019.02.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To use projection-resolved optical coherence tomographic angiography (PR-OCTA) to characterize the microvascular changes in 3 distinct retinal plexuses in retinitis pigmentosa (RP) patients. DESIGN Prospective cross-sectional study. METHODS A commercial 70-kHz spectral-domain optical coherence tomography (OCT) system was used to acquire 6-mm macular scans from RP patients and age-matched healthy participants at a tertiary academic center. Blood flow was detected using a commercial version of split-spectrum amplitude-decorrelation angiography (SSADA) algorithm. The PR-OCTA algorithm was used to suppress projection artifacts and resolve microvasculature in 3 plexuses around the macula. Vessel density was calculated from en face OCTA of the parafoveal and perifoveal regions in each of the 3 plexuses, as well as the all-plexus inner retinal slab. Inner and outer retinal thicknesses were measured form structural OCT scans. Generalized estimating equations and Spearman's rank correlation statistical methods were used. RESULTS Forty-four eyes from 26 RP patients and 34 eyes from 26 healthy subjects were included. Significant reduction in vessel density was detected in the perifovea but not the parafovea of inner retinal slab of RP patients (P = .001 and P = .56, respectively) compared to controls. We also found deeper retinal plexuses (intermediate and deep capillary plexuses, ICP and DCP) were primarily damaged by RP, compared to superficial vascular complex (SVC). Significant thickening of the inner retina and thinning of the outer retina were also observed. Strong correlation was found between the vessel density in the perifoveal ICP and DCP and outer retinal thickness in RP patients with no history of cystoid macular edema. CONCLUSIONS PR-OCTA enables the detection of microvascular changes in the perifoveal regions of the ICP and DCP in RP, with relative sparing of the SVC. OCT and OCTA parameters might be able to provide better understanding of the pathophysiology of the disease, as well as monitoring disease progression and the response to experimental treatments.
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72
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Wang B, Camino A, Pi S, Guo Y, Wang J, Huang D, Hwang TS, Jia Y. Three-dimensional structural and angiographic evaluation of foveal ischemia in diabetic retinopathy: method and validation. BIOMEDICAL OPTICS EXPRESS 2019; 10:3522-3532. [PMID: 31360604 PMCID: PMC6640826 DOI: 10.1364/boe.10.003522] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 05/05/2023]
Abstract
Optical coherence tomography angiography (OCTA) allows us to noninvasively investigate foveal ischemia, a key feature of diabetic retinopathy (DR). However, the sizes of the foveal avascular zone (FAZ) have a significant variation in normal population, preventing the objective assessment of pathological enlargement of FAZ due to capillary dropout. Based on the relationship between FAZ and ganglion cell complex (GCC) thickness in normal eyes, we defined a theoretical baseline FAZ (tbFAZ) on structural OCT and measured 2D and 3D vessel density in its vicinity on the simultaneously acquired OCTA in normal and diabetic eyes. We found that the structure-based tbFAZ was a reliable reference to identify foveal ischemia and that the 3D vessel density demonstrated ischemia more effectively than the 2D method. The proposed 3D para-FAZ vessel density correlates well with DR severity and potentially is a useful diagnostic biomarker, especially in the early stages of DR.
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Affiliation(s)
- Bingjie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Acner Camino
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Shaohua Pi
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yukun Guo
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S. Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
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Yao Y, Du J, Li R, Zhao L, Luo N, Zhai JY, Long L. Association between ICAM-1 level and diabetic retinopathy: a review and meta-analysis. Postgrad Med J 2019; 95:162-168. [PMID: 31109934 DOI: 10.1136/postgradmedj-2018-136102] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 03/11/2019] [Accepted: 03/31/2019] [Indexed: 12/14/2022]
Abstract
Elevated levels of proinflammatory markers are evident in patients with diabetic retinopathy (DR) and are associated with disease progression and prognosis. Intercellular adhesion molecule-1 (ICAM-1) is involved in inflammation and acts as a local intensifying signal in the pathological processes associated with chronic eye inflammation. The aim of this systematic review and meta-analysis was to investigate the relationship between ICAM-1 level and DR. Online electronic databases were searched to retrieve all relevant articles published before December 2017. The standard mean difference (SMD) and their 95% CI were included and then pooled with a random effects model. Subgroup analysis and metaregression analysis were applied to explore the sources of heterogeneity, and publication bias was calculated to assess the quality of pooled studies. A total of 11 articles, containing 428 patients with DR and 789 healthy controls, were included in this meta-analysis. The results indicated a significant increase in ICAM-1 level in the DR group compared with the control group (SMD: 1.20, 95%CI 0.83 to 1.57, p<0.001). Subgroup analyses and metaregression analysis indicated that publication year, region, study method, diabetes mellitus type, Newcastle-Ottawa Scale and sample size were not the potential sources of heterogeneity. The results of this current meta-analysis indicated that the increased level of ICAM-1 generally exists in the patients with DR and it may associated with the severity of DR. However, large-scale and high-quality studies are required to confirm this finding in the future.
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Affiliation(s)
- Yang Yao
- Xi'an First Hospital Affiliated to Xi'an Medical University, Xi'an, China
| | - Junhui Du
- Department of Ophthalmology, Xi'an Ninth Hospital, Medical College of Xi'an Jiaotong University, Xi'an, Shanxi 710054, China
| | - Rong Li
- Xi'an First Hospital Affiliated to Xi'an Medical University, Xi'an, China
| | - Lei Zhao
- Department of Ophthalmology, The First Affiliated Hospital, Xi'an Medical University, Xi'an, Shaanxi 710077, China
| | - Na Luo
- Xi'an First Hospital Affiliated to Xi'an Medical University, Xi'an, China
| | - Jing Ya Zhai
- Department of Ophthalmology, Xi'an Ninth Hospital, Medical College of Xi'an Jiaotong University, Xi'an, Shanxi 710054, China
| | - Lihui Long
- Xi'an First Hospital Affiliated to Xi'an Medical University, Xi'an, China
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Hu Z, Su Y, Xie P, Chen L, Ji J, Feng T, Wu S, Liang K, Liu Q. OCT angiography-based monitoring of neovascular regression on fibrovascular membrane after preoperative intravitreal conbercept injection. Graefes Arch Clin Exp Ophthalmol 2019; 257:1611-1619. [PMID: 31053944 DOI: 10.1007/s00417-019-04315-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/26/2019] [Accepted: 04/01/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To quantify the preoperative neovascular change pattern on the fibrovascular membrane (FVM) within 7 days after intravitreal injection of conbercept (IVC) using optical coherence tomography angiography (OCTA) in proliferative diabetic retinopathy (PDR). METHODS Prospective, observational study of PDR patients with visible FVM receiving or not receiving IVC. Neovascular changes were assessed by OCTA pre-IVC and 1, 3, 5, and 7 days post-IVC. Vessel skeleton density (SD) and vessel density (VD) were quantified by an intensity-based optical microangiography algorithm. The interclass correlation coefficient (ICC) was calculated to assess the agreement between measurements. The SD and VD were compared between follow-ups using repeated-measures analysis in the IVC group. RESULTS The ICC was 0.992 (95% confidence interval [CI]: 0.982-0.996) for SD and 0.926 (95% CI: 0.838-0.912) for VD of neovascularization. The neovascularization on FVM significantly regressed in the IVC group (n = 16) compared with no IVC (n = 8) (p = 0.001 for SD and p < 0.001 for VD). The comparisons between consecutive follow-ups showed a statistically significant reduction in SD and VD at 1 and 3 days post-IVC. However, from day 3 onward, the SD and VD remained unchanged. There was no development or progression of tractional retinal detachment within the 7-day period after IVC. CONCLUSION OCTA-based quantification of the neovascularization on FVM in PDR is feasible, with high inter-reader agreement. The regression of neovascularization reaches a plateau 3 days after IVC. CLINICAL TRIAL REGISTRATION This trial is registered with the Chinese Clinical Trial Registry ( http://www.chictr.org.cn , registration number ChiCTR-IPR-17014160).
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Affiliation(s)
- Zizhong Hu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Yun Su
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Ping Xie
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Lu Chen
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Jiangdong Ji
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Ting Feng
- School of Electronic and Optic Engineering, Nanjing University of Science and Technology, Nanjing, 21000, China
| | - Shaowei Wu
- School of Electronic and Optic Engineering, Nanjing University of Science and Technology, Nanjing, 21000, China
| | - Kang Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China.
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Le D, Alam M, Miao BA, Lim JI, Yao X. Fully automated geometric feature analysis in optical coherence tomography angiography for objective classification of diabetic retinopathy. BIOMEDICAL OPTICS EXPRESS 2019; 10:2493-2503. [PMID: 31149381 PMCID: PMC6524582 DOI: 10.1364/boe.10.002493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 05/10/2023]
Abstract
This study is to establish quantitative features of vascular geometry in optical coherence tomography angiography (OCTA) and validate them for the objective classification of diabetic retinopathy (DR). Six geometric features, including total vessel branching angle (VBA: θ), child branching angles (CBAs: α1 and α2), vessel branching coefficient (VBC), and children-to-parent vessel width ratios (VWR1 and VWR2), were automatically derived from each vessel branch in OCTA. Comparative analysis of heathy control, diabetes with no DR (NoDR), and non-proliferative DR (NPDR) was conducted. Our study reveals four quantitative OCTA features to produce robust DR detection and staging classification: (ANOVA, P<0.05), VBA, CBA1, VBC, and VWR1.
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Affiliation(s)
- David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- These authors contributed equally to this work
| | - Minhaj Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- These authors contributed equally to this work
| | | | - Jennifer I. Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
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Onishi AC, Fawzi AA. An overview of optical coherence tomography angiography and the posterior pole. Ther Adv Ophthalmol 2019; 11:2515841419840249. [PMID: 30984909 PMCID: PMC6448101 DOI: 10.1177/2515841419840249] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Indexed: 11/30/2022] Open
Abstract
Optical coherence tomography angiography is a relatively new, noninvasive technology that has revolutionized imaging of the retinal and choroidal microvasculature. This technology is based on the detection of movement or changes that represent moving red cells in sequential optical coherence tomography scans. As with other established imaging technologies, it has unique benefits as well as certain disadvantages, which include a limited field of view and vulnerability to imaging artifacts. However, software and hardware improvements are continually evolving to mitigate these limitations. Optical coherence tomography angiography has been used to gain a better understanding of microvascular changes across a spectrum of ocular diseases including diabetic retinopathy, age-related macular degeneration, glaucoma, and retinal vein occlusions. In this article, we review algorithms and techniques commonly utilized in optical coherence tomography angiography systems and compare optical coherence tomography angiography to fluorescein angiography, the current gold standard for imaging the retinal vasculature. In addition, we provide an overview of important optical coherence tomography angiography findings in a variety of ocular diseases. Although the clinical role of this technology is still poorly defined, optical coherence tomography angiography has the potential to become an invaluable tool in the diagnosis and monitoring of vascular pathologies.
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Affiliation(s)
- Alex C Onishi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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77
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Koulisis N, Moysidis SN, Yonekawa Y, Dai YL, Burkemper B, Wood EH, Lertjirachai I, Todorich B, Khundkar TZ, Chu Z, Wang RK, Williams GA, Drenser KA, Capone A, Trese MT, Nudleman E. Correlating Changes in the Macular Microvasculature and Capillary Network to Peripheral Vascular Pathologic Features in Familial Exudative Vitreoretinopathy. Ophthalmol Retina 2019; 3:597-606. [PMID: 31277801 DOI: 10.1016/j.oret.2019.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the macular microvasculature in patients with familial exudative vitreoretinopathy (FEVR) using OCT angiography (OCTA) and to assess for peripheral vascular changes using widefield fluorescein angiography (WFA). DESIGN Multicenter, retrospective, comparative, observational case series. PARTICIPANTS We identified 411 patients with FEVR, examined between September 2014 and June 2018. Fifty-seven patients with FEVR and 60 healthy controls had OCTA images of sufficient quality for analysis. METHODS Custom software was used to assess for layer-specific, quantitative changes in vascular density and morphologic features on OCTA by way of vessel density (VD), skeletal density (SD), fractal dimension (FD), vessel diameter index (VDI), and foveal avascular zone (FAZ). Widefield fluorescein angiography images were reviewed for peripheral vascular changes including capillary dropout, late-phase angiographic posterior and peripheral vascular leakage (LAPPEL), vascular dragging, venous-venous shunts, and arteriovenous shunts. MAIN OUTCOME MEASURES Macular microvascular parameters on OCTA and peripheral angiographic findings on WFA. RESULTS OCT angiography analysis of 117 patients (187 eyes; 92 FEVR patients and 95 control participants) demonstrated significantly reduced VD, SD, and FD and greater VDI in patients with FEVR compared with controls in the nonsegmented retina, superficial retinal layer (SRL), and deep retinal layer (DRL). The FAZ was larger compared with that in control eyes in the DRL (P < 0.0001), but not the SRL (P = 0.52). Subanalysis by FEVR stage showed the same microvascular changes compared with controls for all parameters. Widefield fluorescein angiography analysis of 95 eyes (53 patients) with FEVR demonstrated capillary nonperfusion in all eyes: 47 eyes (49.5%) showed LAPPEL, 32 eyes (33.7%) showed vascular dragging, 30 eyes (31.6%) had venous-venous shunts, and 33 eyes (34.7%) had arteriovenous shunts. Decreasing macular VD on OCTA correlated with increasing peripheral capillary nonperfusion on WFA. Decreasing fractal dimension on OCTA correlated with increasing LAPPEL severity on WFA. CONCLUSIONS Patients with FEVR demonstrated abnormalities in the macular microvasculature and capillary network, in addition to the peripheral retina. The macular microvascular parameters on OCTA may serve as biomarkers of changes in the retinal periphery on WFA.
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Affiliation(s)
- Nicole Koulisis
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stavros N Moysidis
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan
| | - Yoshihiro Yonekawa
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Yi Ling Dai
- William Beaumont School of Medicine, Oakland University, Rochester, Michigan
| | - Bruce Burkemper
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Edward H Wood
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan
| | - Itsara Lertjirachai
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan; Department of Ophthalmology, Srinakharinwirot University, Bangkok, Thailand
| | - Bozho Todorich
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan
| | - Tahsin Z Khundkar
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - George A Williams
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan
| | - Kimberly A Drenser
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan
| | - Antonio Capone
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan
| | - Michael T Trese
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan
| | - Eric Nudleman
- Department of Ophthalmology, Shiley Eye Institute and Jacobs Retina Center, University of California, San Diego, La Jolla, California.
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Díaz M, Novo J, Cutrín P, Gómez-Ulla F, Penedo MG, Ortega M. Automatic segmentation of the foveal avascular zone in ophthalmological OCT-A images. PLoS One 2019; 14:e0212364. [PMID: 30794594 PMCID: PMC6386246 DOI: 10.1371/journal.pone.0212364] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/31/2019] [Indexed: 01/25/2023] Open
Abstract
Angiography by Optical Coherence Tomography (OCT-A) is a non-invasive retinal imaging modality of recent appearance that allows the visualization of the vascular structure at predefined depths based on the detection of the blood movement through the retinal vasculature. In this way, OCT-A images constitute a suitable scenario to analyze the retinal vascular properties of regions of interest as is the case of the macular area, measuring the characteristics of the foveal vascular and avascular zones. Extracted parameters of this region can be used as prognostic factors that determine if the patient suffers from certain pathologies (such as diabetic retinopathy or retinal vein occlusion, among others), indicating the associated pathological degree. The manual extraction of these biomedical parameters is a long, tedious and subjective process, introducing a significant intra and inter-expert variability, which penalizes the utility of the measurements. In addition, the absence of tools that automatically facilitate these calculations encourages the creation of computer-aided diagnosis frameworks that ease the doctor’s work, increasing their productivity and making viable the use of this type of vascular biomarkers. In this work we propose a fully automatic system that identifies and precisely segments the region of the foveal avascular zone (FAZ) using a novel ophthalmological image modality as is OCT-A. The system combines different image processing techniques to firstly identify the region where the FAZ is contained and, secondly, proceed with the extraction of its precise contour. The system was validated using a representative set of 213 healthy and diabetic OCT-A images, providing accurate results with the best correlation with the manual measurements of two experts clinician of 0.93 as well as a Jaccard’s index of 0.82 of the best experimental case in the experiments with healthy OCT-A images. The method also provided satisfactory results in diabetic OCT-A images, with a best correlation coefficient with the manual labeling of an expert clinician of 0.93 and a Jaccard’s index of 0.83. This tool provides an accurate FAZ measurement with the desired objectivity and reproducibility, being very useful for the analysis of relevant vascular diseases through the study of the retinal micro-circulation.
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Affiliation(s)
- Macarena Díaz
- Department of Computer Science, University of A Coruña, A Coruña, Spain
- CITIC-Research Center of Information and Communication Technologies, University of A Coruña, A Coruña, Spain
- * E-mail:
| | - Jorge Novo
- Department of Computer Science, University of A Coruña, A Coruña, Spain
- CITIC-Research Center of Information and Communication Technologies, University of A Coruña, A Coruña, Spain
| | - Paula Cutrín
- Complejo Hospitalario Unversitario de Santiago, Santiago de Compostela, Spain
| | - Francisco Gómez-Ulla
- Complejo Hospitalario Unversitario de Santiago, Santiago de Compostela, Spain
- Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | - Manuel G. Penedo
- Department of Computer Science, University of A Coruña, A Coruña, Spain
- CITIC-Research Center of Information and Communication Technologies, University of A Coruña, A Coruña, Spain
| | - Marcos Ortega
- Department of Computer Science, University of A Coruña, A Coruña, Spain
- CITIC-Research Center of Information and Communication Technologies, University of A Coruña, A Coruña, Spain
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Lynch G, Romo JSA, Linderman R, Krawitz BD, Mo S, Zakik A, Carroll J, Rosen RB, Chui TYP. Within-subject assessment of foveal avascular zone enlargement in different stages of diabetic retinopathy using en face OCT reflectance and OCT angiography. BIOMEDICAL OPTICS EXPRESS 2018; 9:5982-5996. [PMID: 31065407 PMCID: PMC6491024 DOI: 10.1364/boe.9.005982] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/27/2018] [Accepted: 10/28/2018] [Indexed: 05/04/2023]
Abstract
Enlargement of the foveal avascular zone (FAZ) due to progressive capillary nonperfusion is associated with visual deterioration in patients with diabetic retinopathy. The FAZ area has long been considered an important clinical marker of advancing retinopathy. However, a large body of literature shows that the FAZ area varies considerably in healthy eyes, resulting in substantial overlap between controls and diabetics, thus reducing its discriminatory value. In this study, within-subject FAZ area enlargement was obtained by the comparison of the structural FAZ area to the functional FAZ area using simultaneously-acquired, corresponding en face OCT reflectance and OCT angiography images. Our study suggests that en face OCT reflectance images provide useful anatomic baselines of structural FAZ morphology prior to the onset of disease. Measurements of within-subject FAZ area enlargement appear to be a more sensitive method for identifying the onset of diabetic retinopathy as compared to using OCT angiographic measurements of FAZ alone.
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Affiliation(s)
- Giselle Lynch
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th St., Suite 500, S. Bldg., New York, NY, 10003, USA
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Jorge S. Andrade Romo
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th St., Suite 500, S. Bldg., New York, NY, 10003, USA
| | - Rachel Linderman
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
| | - Brian D. Krawitz
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th St., Suite 500, S. Bldg., New York, NY, 10003, USA
| | - Shelley Mo
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th St., Suite 500, S. Bldg., New York, NY, 10003, USA
| | - Amir Zakik
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th St., Suite 500, S. Bldg., New York, NY, 10003, USA
| | - Joseph Carroll
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, 925 N. 87th St., Milwaukee, WI, 53226, USA
| | - Richard B. Rosen
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th St., Suite 500, S. Bldg., New York, NY, 10003, USA
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Toco Y. P. Chui
- Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th St., Suite 500, S. Bldg., New York, NY, 10003, USA
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
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80
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Linderman RE, Muthiah MN, Omoba SB, Litts K, Tarima S, Visotcky A, Kim JE, Carroll J. Variability of Foveal Avascular Zone Metrics Derived From Optical Coherence Tomography Angiography Images. Transl Vis Sci Technol 2018; 7:20. [PMID: 30280005 PMCID: PMC6166903 DOI: 10.1167/tvst.7.5.20] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/10/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To characterize sources of inter- and intrasubject variability in quantitative foveal avascular zone (FAZ) metrics. Methods Two 3×3-mm optical coherence tomography angiography scans (centered on the fovea) were acquired in both eyes of 175 subjects. An image of the superficial plexus was extracted from each scan and segmented twice by a single observer. Four quantitative FAZ morphology metrics (area, axis ratio, acircularity, major horizontal axis angle) were calculated, and a variance components analysis was performed. Results Mean (±SD) age was 27.9 ± 11.9 years, and 55% were female. Area had the largest amount of variance resulting from intersubject differences (93.1%). In contrast, there was large interocular variance for axis ratio, acircularity, and major horizontal axis angle (55.0%, 53.7%, 70.7%, respectively), though only axis ratio showed significant asymmetry between fellow eyes (P < 0.05). Neither repeated images from the same eye nor repeated segmentation on the same image were significant sources of variance. Conclusions Metrics of FAZ morphology show excellent repeatability and reliability. Excluding FAZ area, there was a high amount of variance attributed to interocular differences for the other FAZ metrics; therefore, the fellow eye should not be considered a control for FAZ studies when using these metrics. Translational Relevance Vision scientists must be prudent when choosing FAZ metrics, as they display varying degrees of within-subject differences relative to between-subject differences. It seems likely that different metrics will be best suited for different tasks, such as monitoring small changes over time within a single subject or assessing whether a given FAZ is abnormal.
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Affiliation(s)
- Rachel E Linderman
- Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manickam N Muthiah
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah B Omoba
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katie Litts
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sergey Tarima
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alexis Visotcky
- Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Judy E Kim
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Carroll
- Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.,Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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81
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Chen L, Zhang X, Gan Y, Liu B, Zhang Y, Wen F. Retinal pigment epithelium hyperplasia overlying pigment epithelial detachment in age-related macular degeneration can masquerade as neovascularization on optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2018; 256:2283-2291. [PMID: 30229304 PMCID: PMC6224014 DOI: 10.1007/s00417-018-4138-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/11/2018] [Accepted: 09/05/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose To report the image artifacts due to retinal pigment epithelium (RPE) hyperplasia overlying retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD), which can masquerade as neovascularization on optical coherence tomography angiography (OCTA). Methods A hospital-based, retrospective, and cross-sectional study. Twenty-two eyes from 16 patients with non-vascularized PED related to AMD were included in this study. All patients were examined by OCTA, spectral-domain optical coherence tomography, fluorescence angiography, and indocyanine green angiography. Vascular flow signals (VFS) on both the outer retinal slab of en face OCTA and cross-sectional OCTA and their correspondence with RPE hyperplasia were evaluated. Results Fifteen eyes (68.2%) showed VFS on both the outer retina slab of en face OCTA and cross-sectional OCTA, all corresponding to the RPE hyperplasia overlying PED. Among them, 12 eyes with lump RPE hyperplasia outside foveal avascular zone (FAZ) all showed obvious VFS on the outer retina slab of OCTA, and 3 eyes with scattered RPE hyperplasia outside FAZ showed VFS fragments. Of note, 4 eyes had accompanied RPE hyperplasia inside FAZ, and 7 eyes without RPE hyperplasia overlying PED showed no corresponding VFS on the outer retina slab of OCTA. Additionally, a round-like dark band at the edge of PED was observed in the outer retina slab on en face OCTA in 17 eyes (77.3%). Conclusions RPE hyperplasia overlying PED in AMD can masquerade as neovascularization on OCTA. To avoid misdiagnosis and unnecessary treatment, this RPE hyperplasia-related image artifact should be considered when interpreting OCTA images.
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Affiliation(s)
- Ling Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Road, Guangzhou, 510060, China
| | - Xiongze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Road, Guangzhou, 510060, China
| | - Yuhong Gan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Road, Guangzhou, 510060, China
| | - Bing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Road, Guangzhou, 510060, China
| | - Yuxin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Road, Guangzhou, 510060, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Road, Guangzhou, 510060, China.
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