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Crincoli E, Sacconi R, Querques L, Querques G. OCT angiography 2023 update: focus on diabetic retinopathy. Acta Diabetol 2024; 61:533-541. [PMID: 38376579 DOI: 10.1007/s00592-024-02238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
Optical coherence tomography angiography (OCTA) has become part of the clinical practice and its growing applications are in continuous development. Coherently with the growing concern about the human and economic cost of diabetes, diabetic retinopathy (DR) was the most popular topic for OCTA studies in the past year. The analysis of the literature reveals that applications of OCTA in DR are in continuous growth. In particular, ultrawide field (UWF) OCTA and artificial intelligence (AI) based on OCTA images are affirming as the new frontiers of scientific research in the field. Diagnostic accuracy of AI methods based on OCTA is equal or superior to the one based on OCT methods and also bears potential to detect systemic associations. UWF OCTA is noninvasive method that is reaching similar accuracy of FA in detection of neovascularization and intraretinal microvascular abnormalities (IRMAs) and has allowed better characterization of microvascular peripherical changes in DR. Lastly, deep capillary plexus (DCP) characteristics seem to play a pivotal role in the development of diabetic macular edema (DME) and refinement of biomarkers for different phenotypes of DME and diabetic macular ischemia (DMI) is currently on its way.
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Affiliation(s)
- Emanuele Crincoli
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
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Ashrafkhorasani M, Habibi A, Nittala MG, Corradetti G, Emamverdi M, Sadda SR. Peripheral retinal lesions in diabetic retinopathy on ultra-widefield imaging. Saudi J Ophthalmol 2024; 38:123-131. [PMID: 38988777 PMCID: PMC11232752 DOI: 10.4103/sjopt.sjopt_151_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/03/2023] [Indexed: 07/12/2024] Open
Abstract
Peripheral retinal imaging plays a crucial role in the diagnosis, management, and prognosis of diabetic retinopathy (DR). Traditional fundus imaging techniques have limited coverage of the retina, resulting in missed peripheral lesions. The advent of ultra-widefield (UWF) imaging has revolutionized the assessment of the peripheral retina. UWF imaging modalities provide comprehensive visualization of the retina, enabling the detection of peripheral lesions without the need for mydriasis. Integration of UWF imaging with other modalities, including fluorescein angiography (FA), indocyanine green angiography, pseudocolor imaging, and fundus autofluorescence, further enhances our understanding of peripheral retinal lesions. UWF imaging has demonstrated improved detection of DR lesions and presumably more accurate management of DR compared to traditional fundus photography and dilated fundus examination. UWF-FA and UWF-optical coherence tomography angiography have emerged as valuable tools for assessing retinal and choroidal vascular abnormalities, nonperfusion areas, neovascularization, and microvascular abnormalities. The presence and increasing extent of predominantly peripheral lesions detected using UWF FA are associated with a higher risk of DR progression and proliferative DR. UWF imaging provides a comprehensive evaluation of DR severity, aiding in more accurate risk stratification and treatment decision-making. Overall, UWF imaging modalities have significantly advanced our understanding of peripheral retinal lesions in DR, facilitating early detection and targeted management for better visual outcomes.
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Affiliation(s)
- Maryam Ashrafkhorasani
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Abbas Habibi
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Muneeswar G. Nittala
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
| | - Giulia Corradetti
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mehdi Emamverdi
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Srinivas R. Sadda
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Yang KO, Lee JM, Shin Y, Yoon IY, Choi JW, Lee WJ. Diagnosis of Glaucoma Based on Few-Shot Learning with Wide-Field Optical Coherence Tomography Angiography. Biomedicines 2024; 12:741. [PMID: 38672097 PMCID: PMC11048300 DOI: 10.3390/biomedicines12040741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 04/28/2024] Open
Abstract
This study evaluated the utility of incorporating deep learning into the relatively novel imaging technique of wide-field optical coherence tomography angiography (WF-OCTA) for glaucoma diagnosis. To overcome the challenge of limited data associated with this emerging imaging, the application of few-shot learning (FSL) was explored, and the advantages observed during its implementation were examined. A total of 195 eyes, comprising 82 normal controls and 113 patients with glaucoma, were examined in this study. The system was trained using FSL instead of traditional supervised learning. Model training can be presented in two distinct ways. Glaucoma feature detection was performed using ResNet18 as a feature extractor. To implement FSL, the ProtoNet algorithm was utilized to perform task-independent classification. Using this trained model, the performance of WF-OCTA through the FSL technique was evaluated. We trained the WF-OCTA validation method with 10 normal and 10 glaucoma images and subsequently examined the glaucoma detection effectiveness. FSL using the WF-OCTA image achieved an area under the receiver operating characteristic curve (AUC) of 0.93 (95% confidence interval (CI): 0.912-0.954) and an accuracy of 81%. In contrast, supervised learning using WF-OCTA images produced worse results than FSL, with an AUC of 0.80 (95% CI: 0.778-0.823) and an accuracy of 50% (p-values < 0.05). Furthermore, the FSL method using WF-OCTA images demonstrated improvement over the conventional OCT parameter-based results (all p-values < 0.05). This study demonstrated the effectiveness of applying deep learning to WF-OCTA for glaucoma diagnosis, highlighting the potential of WF-OCTA images in glaucoma diagnostics. Additionally, it showed that FSL could overcome the limitations associated with a small dataset and is expected to be applicable in various clinical settings.
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Affiliation(s)
- Kyoung Ok Yang
- Department of Artificial Intelligence, Hanyang University, Seoul 04763, Republic of Korea;
| | - Jung Min Lee
- Department of Ophthalmology, Hanyang University Seoul Hospital, Seoul 04763, Republic of Korea;
| | - Younji Shin
- Department of Electrical Engineering, Hanyang University, Seoul 04763, Republic of Korea; (Y.S.); (I.Y.Y.)
| | - In Young Yoon
- Department of Electrical Engineering, Hanyang University, Seoul 04763, Republic of Korea; (Y.S.); (I.Y.Y.)
| | - Jun Won Choi
- Department of Electrical Engineering, Hanyang University, Seoul 04763, Republic of Korea; (Y.S.); (I.Y.Y.)
- Department of Electrical and Computer Engineering, College of Liberal Studies, Seoul National University, Seoul 08826, Republic of Korea
| | - Won June Lee
- Department of Ophthalmology, Hanyang University Seoul Hospital, Seoul 04763, Republic of Korea;
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
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Gawęcki M, Kiciński K. Advantages of the Utilization of Wide-Field OCT and Wide-Field OCT Angiography in Clinical Practice. Diagnostics (Basel) 2024; 14:321. [PMID: 38337837 PMCID: PMC10855083 DOI: 10.3390/diagnostics14030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Wide-field (WF) retinal imaging is becoming a standard diagnostic tool for diseases involving the peripheral retina. Technological progress elicited the advent of wide-field optical coherence tomography (WF-OCT) and WF-OCT angiography (WF-OCTA) examinations. This review presents the results of studies that analyzed the implementation of these procedures in clinical practice and refers to them as traditional and ultra-wide-field fluorescein angiography (UWF-FA). A PUBMED search was performed using the terms WF-OCT OR WF-OCTA OR UWF-FA AND the specific clinical entity, and another search for diabetic retinopathy (DR), retinal vein occlusion (RVO), Coats disease, peripheral retinal telangiectasia, peripheral retinal degeneration, lattice degeneration, and posterior vitreous detachment. The analysis only included the studies in which the analyzed field of view for the OCT or OCTA exam was larger than 55 degrees. The evaluation of the extracted studies indicates that WF imaging with OCT and OCTA provides substantial information on retinal disorders involving the peripheral retina. Vascular diseases, such as DR or RVO, can be reliably evaluated using WF-OCTA with results superior to standard-field fluorescein angiography. Nevertheless, UWF-FA provides a larger field of view and still has advantages over WF-OCTA concerning the evaluation of areas of non-perfusion and peripheral neovascularization. Detailed information on the vascular morphology of peripheral changes should be obtained via WF-OCTA and not angiographic examinations. WF-OCT can serve as a valuable tool for the detection and evaluation of vitreoretinal traction, posterior vitreous detachment, and peripheral retinal degeneration, and guide therapeutic decisions on a patient's eligibility for surgical procedures.
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Affiliation(s)
- Maciej Gawęcki
- Dobry Wzrok Ophthalmological Clinic, 80-822 Gdansk, Poland
- Department of Ophthalmology, Pomeranian Hospitals, 84-120 Wejherowo, Poland;
| | - Krzysztof Kiciński
- Department of Ophthalmology, Pomeranian Hospitals, 84-120 Wejherowo, Poland;
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Murata T, Hirano T, Mizobe H, Toba S. OCT-angiography based artificial intelligence-inferred fluorescein angiography for leakage detection in retina [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:5851-5860. [PMID: 38021144 PMCID: PMC10659810 DOI: 10.1364/boe.506467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023]
Abstract
Optical coherence tomography angiography (OCTA) covers most functions of fluorescein angiography (FA) when imaging the retina but lacks the ability to depict vascular leakage. Based on OCTA, we developed artificial intelligence-inferred-FA (AI-FA) to delineate leakage in eyes with diabetic retinopathy (DR). Training data of 19,648 still FA images were prepared from FA-photo and videos of 43 DR eyes. AI-FA images were generated using a convolutional neural network. AI-FA images achieved a structural similarity index of 0.91 with corresponding real FA images in DR. The AI-FA generated from OCTA correctly depicted vascular occlusion and associated leakage with enough quality, enabling precise DR diagnosis and treatment planning. A combination of OCT, OCTA, and AI-FA yields more information than real FA with reduced acquisition time without risk of allergic reactions.
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Affiliation(s)
- Toshinori Murata
- Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Takao Hirano
- Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Hideaki Mizobe
- Canon Inc. 30-2, Shimomaruko 3-chome, Ohta-ku, Tokyo 146-8501, Japan
| | - Shuhei Toba
- Canon Inc. 30-2, Shimomaruko 3-chome, Ohta-ku, Tokyo 146-8501, Japan
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Yang Y, Li F, Liu T, Jiao W, Zhao B. Comparison of widefield swept-source optical coherence tomographic angiography and fluorescein fundus angiography for detection of retinal neovascularization with diabetic retinopathy. BMC Ophthalmol 2023; 23:315. [PMID: 37438731 DOI: 10.1186/s12886-023-03073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND To compare vitreous angiomosaic images (VAMIs), obtained by widefield swept-source optical coherence tomographic angiography (wfSS-OCTA) and the image of fluorescein fundus angiography (FFA) in the identification of retinal neovascularization (NV) in patients with diabetic retinopathy (DR). METHODS In this prospective observational study, severe non-proliferative diabetic retinopathy (NPDR) or proliferative DR (PDR) patients were included. All patients underwent FFA and wfSS-OCTA. The number of NVs identified by wfSS-OCTA VAMIs using five fixations 12 × 12 mm montage scans and the resembling FFA images were compared. RESULTS Fifty-three eyes of 29 patients were enrolled. NVs were detected in 25 eyes by using FFA, including 9 NVs of the disc (NVDs) and 72 NVs elsewhere (NVEs), and in 29 eyes by OCTA, including 11 NVDs and 90 NVEs. The detection rate of NV and NVD of OCTA was comparable to that of FFA (p > 0.05), and the level of agreement was excellent (κ = 0.850, κ = 0.754). Using FFA as the gold standard, the sensitivity for detection of NV by OCTA was 100.0%, specificity was 85.7%, the positive-predictive value was 86.2%, and the negative-predictive value was 100.0%. Compared with FFA, OCTA was superior in terms of the number of NVEs identified (p = 0.024). When we excluded images of patients treated with anti-vascular endothelial growth factor (VEGF) intravitreal therapy for < 3 months, OCTA was comparable to FFA in terms of the number of NVEs discovered (p = 0.203), with excellent agreement (intraclass correlation coefficient = 0.941). CONCLUSIONS WfSS-OCTA is an independent non-invasive alternative to FFA for NV discovery, NVD detection, and individual NVE identification, particularly in patients with PDR who have a history of prior treatment with anti-VEGF.
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Affiliation(s)
- Yanyan Yang
- Department of Ophthalmology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong, China
- Department of Ophthalmology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Fengjiao Li
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tingting Liu
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Wanzhen Jiao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
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Shah PN, Mishra DK, Falahat P, Fischer L, Guzman G, Terheyden JH, Holz FG, Krohne TU, Finger RP, Wintergerst MWM. Inter-Rater Reliability of Proliferative Diabetic Retinopathy Assessment on Wide-Field OCT-Angiography and Fluorescein Angiography. Transl Vis Sci Technol 2023; 12:13. [PMID: 37432848 DOI: 10.1167/tvst.12.7.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Purpose To assess inter-rater reliability in the detection of proliferative diabetic retinopathy (PDR) changes using wide-field optical coherence tomography angiography (WF-OCTA) versus fluorescein angiography (FA). Methods This retrospective, cross-sectional study included patients with severe nonproliferative and PDR. Images were acquired with 12 × 12 mm WF-OCTA and FA with a 55° lens. Images were cropped to represent the exact same field of view. Qualitative (detection of neovascularization at the disc [NVD] and elsewhere [NVE], enlarged foveal avascular zone [FAZ], vitreous hemorrhage [VH]) and quantitative analyses (FAZ area, horizontal, vertical, and maximum FAZ diameter) were performed by 2 masked graders using ImageJ. Inter-rater reliability was calculated using unweighted Cohen's kappa coefficient (κ) for qualitative analyses and intraclass correlation coefficients (ICC) for quantitative analyses. Results Twenty-three eyes of 17 patients were included. Inter-rater reliability was higher for FA than for WF-OCTA in qualitative analyses: κ values were 0.65 and 0.78 for detection of extended FAZ, 0.83 and 1.0 for NVD, 0.78 and 1.0 for NVE, and 0.19 and 1 for VH for WF-OCTA and FA, respectively. In contrast, inter-rater reliability was higher for WF-OCTA than for FA in the quantitative analyses: ICC values were 0.94 and 0.76 for FAZ size, 0.92 and 0.79 for horizontal FAZ diameter, 0.82 and 0.72 for vertical FAZ diameter, and 0.88 and 0.82 for maximum FAZ diameter on WF-OCTA and FA, respectively. Conclusions Inter-rater reliability of FA is superior to WF-OCTA for qualitative analyses whereas inter-rater reliability of WF-OCTA is superior to FA for quantitative analyses. Translational Relevance The study highlights the specific merits of both imaging modalities in terms of reliability. FA should be preferred for qualitative parameters, whereas WF-OCTA should be preferred for quantitative parameters.
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Affiliation(s)
- Payal N Shah
- Department of Vitreoretinal and Ocular Oncology, Sankara Eye Hospital, Kundalahalli Gate, Bangalore, India
| | - Divyansh K Mishra
- Department of Vitreoretinal and Ocular Oncology, Sankara Eye Hospital, Kundalahalli Gate, Bangalore, India
| | - Peyman Falahat
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Lars Fischer
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Gabriela Guzman
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Tim U Krohne
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
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The heyday of optical coherence tomography angiography is just around the corner. Graefes Arch Clin Exp Ophthalmol 2023; 261:337-338. [PMID: 36322215 DOI: 10.1007/s00417-022-05879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
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