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Chucair-Elliott AJ, Ocañas SR, Pham K, Machalinski A, Plafker S, Stout MB, Elliott MH, Freeman WM. Age- and sex- divergent translatomic responses of the mouse retinal pigmented epithelium. Neurobiol Aging 2024; 140:41-59. [PMID: 38723422 PMCID: PMC11173338 DOI: 10.1016/j.neurobiolaging.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
Aging is the main risk factor for age-related macular degeneration (AMD), a retinal neurodegenerative disease that leads to irreversible blindness, particularly in people over 60 years old. Retinal pigmented epithelium (RPE) atrophy is an AMD hallmark. Genome-wide chromatin accessibility, DNA methylation, and gene expression studies of AMD and control RPE demonstrate epigenomic/transcriptomic changes occur during AMD onset and progression. However, mechanisms by which molecular alterations of normal aging impair RPE function and contribute to AMD pathogenesis are unclear. Here, we specifically interrogate the RPE translatome with advanced age and across sexes in a novel RPE reporter mouse model. We find differential age- and sex- associated transcript expression with overrepresentation of pathways related to inflammation in the RPE. Concordant with impaired RPE function, the phenotypic changes in the aged translatome suggest that aged RPE becomes immunologically active, in both males and females, with some sex-specific signatures, which supports the need for sex representation for in vivo studies.
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Affiliation(s)
- Ana J Chucair-Elliott
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
| | - Sarah R Ocañas
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Kevin Pham
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Adeline Machalinski
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Scott Plafker
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Michael B Stout
- Aging & Metabolism Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Michael H Elliott
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Willard M Freeman
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK, USA.
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Vallino V, Berni A, Coletto A, Serafino S, Bandello F, Reibaldi M, Borrelli E. Structural OCT and OCT angiography biomarkers associated with the development and progression of geographic atrophy in AMD. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06497-8. [PMID: 38689123 DOI: 10.1007/s00417-024-06497-8] [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: 01/12/2024] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Geographic atrophy (GA) is an advanced, irreversible, and progressive form of age-related macular degeneration (AMD). Structural optical coherence tomography (OCT) and OCT angiography (OCTA) have been largely used to characterize this stage of AMD and, more importantly, to define biomarkers associated with the development and progression of GA in AMD. METHODS Articles pertaining to OCT and OCTA biomarkers related to the development and progression of GA with relevant key words were used to search in PubMed, Researchgate, and Google Scholar. The articles were selected based on their relevance, reliability, publication year, published journal, and accessibility. RESULTS Previous reports have highlighted various OCT and OCTA biomarkers linked to the onset and advancement of GA. These biomarkers encompass characteristics such as the size, volume, and subtype of drusen, the presence of hyperreflective foci, basal laminar deposits, incomplete retinal pigment epithelium and outer retinal atrophy (iRORA), persistent choroidal hypertransmission defects, and the existence of subretinal drusenoid deposits (also referred to as reticular pseudodrusen). Moreover, biomarkers associated with the progression of GA include thinning of the outer retina, photoreceptor degradation, the distance between retinal pigment epithelium and Bruch's membrane, and choriocapillaris loss. CONCLUSION The advent of novel treatment strategies for GA underscores the heightened need for prompt diagnosis and precise monitoring of individuals with this condition. The utilization of structural OCT and OCTA becomes essential for identifying distinct biomarkers associated with the initiation and progression of GA.
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Affiliation(s)
- Veronica Vallino
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Alessandro Berni
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Coletto
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Sonia Serafino
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy.
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy.
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Rosenfeld PJ, Shen M, Trivizki O, Liu J, Herrera G, Hiya FE, Li J, Berni A, Wang L, El-Mulki OS, Cheng Y, Lu J, Zhang Q, O'Brien RC, Gregori G, Wang RK. Rediscovering Age-Related Macular Degeneration with Swept-Source OCT Imaging: The 2022 Charles L. Schepens, MD, Lecture. Ophthalmol Retina 2024:S2468-6530(24)00187-8. [PMID: 38641006 DOI: 10.1016/j.oret.2024.04.012] [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: 01/06/2024] [Revised: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE Swept-source OCT angiography (SS-OCTA) scans of eyes with age-related macular degeneration (AMD) were used to replace color, autofluorescence, infrared reflectance, and dye-based fundus angiographic imaging for the diagnosis and staging of AMD. Through the use of different algorithms with the SS-OCTA scans, both structural and angiographic information can be viewed and assessed using both cross sectional and en face imaging strategies. DESIGN Presented at the 2022 Charles L. Schepens, MD, Lecture at the American Academy of Ophthalmology Retina Subspecialty Day, Chicago, Illinois, on September 30, 2022. PARTICIPANTS Patients with AMD. METHODS Review of published literature and ongoing clinical research using SS-OCTA imaging in AMD. MAIN OUTCOME MEASURES Swept-source OCT angiography imaging of AMD at different stages of disease progression. RESULTS Volumetric SS-OCTA dense raster scans were used to diagnose and stage both exudative and nonexudative AMD. In eyes with nonexudative AMD, a single SS-OCTA scan was used to detect and measure structural features in the macula such as the area and volume of both typical soft drusen and calcified drusen, the presence and location of hyperreflective foci, the presence of reticular pseudodrusen, also known as subretinal drusenoid deposits, the thickness of the outer retinal layer, the presence and thickness of basal laminar deposits, the presence and area of persistent choroidal hypertransmission defects, and the presence of treatment-naïve nonexudative macular neovascularization. In eyes with exudative AMD, the same SS-OCTA scan pattern was used to detect and measure the presence of macular fluid, the presence and type of macular neovascularization, and the response of exudation to treatment with vascular endothelial growth factor inhibitors. In addition, the same scan pattern was used to quantitate choriocapillaris (CC) perfusion, CC thickness, choroidal thickness, and the vascularity of the choroid. CONCLUSIONS Compared with using several different instruments to perform multimodal imaging, a single SS-OCTA scan provides a convenient, comfortable, and comprehensive approach for obtaining qualitative and quantitative anatomic and angiographic information to monitor the onset, progression, and response to therapies in both nonexudative and exudative AMD. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Gissel Herrera
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Farhan E Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jianqing Li
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Alessandro Berni
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Omar S El-Mulki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Yuxuan Cheng
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Jie Lu
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Qinqin Zhang
- Research and Development, Carl Zeiss Meditec, Inc., Dublin, California
| | - Robert C O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington; Department of Ophthalmology, University of Washington, Seattle, Washington
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Mahmoudi A, Lindenberg S, Corradetti G, Emamverdi M, Oncel D, Oncel D, Baek J, Farahani A, Almidani L, He Y, Abbasgholizadeh R, Saju SM, Lee WK, Wykoff CC, Sarraf D, Freund KB, Sadda SR. Predictive Factors Influencing the Evolution of Acquired Vitelliform Lesions in Intermediate Age-Related Macular Degeneration Eyes. Ophthalmol Retina 2024:S2468-6530(24)00177-5. [PMID: 38599379 DOI: 10.1016/j.oret.2024.04.003] [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: 02/27/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE In this study, we identify risk factors that predict the progression of acquired vitelliform lesions (AVLs) over time. DESIGN Retrospective cohort study. SUBJECTS One hundred sixty-three eyes of 132 patients with a diagnosis of intermediate age-related macular degeneration (iAMD) with AVL. METHODS This retrospective study evaluated consecutive eyes with AMD from a retina clinic population and included 1181 patients and 2362 eyes. After excluding cases with associated geographic atrophy, macular neovascularization (MNV), vitreomacular traction, and those with <2 years of follow-up data, the final analysis cohort consisted of 163 eyes (132 patients) with ≥1 AVL. The first available visit in which an AVL was evident was considered the baseline visit, and follow-up data were collected from a visit 2 years (± 3 months) later. Progression outcomes at the follow-up visit were classified into 6 categories: resorbed, collapsed, MNV, stable, increasing, and decreasing. Subsequently, we analyzed the baseline characteristics for each category and calculated odds ratios (ORs) to predict these various outcomes. MAIN OUTCOME MEASURES The study focused on identifying predictive factors influencing the evolution of AVL in iAMD eyes. RESULTS In total, 163 eyes with AVL had follow-up data at 2 years. The collapsed group demonstrated a significantly greater baseline AVL height and width compared with other groups (P < 0.001). With regard to qualitative parameters, subretinal drusenoid deposits (SDDs) and intraretinal hyperreflective foci (IHRF) at the eye level, AVL located over drusen, and IHRF and external limiting membrane disruption over AVL were significantly more prevalent in the collapsed group compared with other groups (P < 0.05 for all comparisons). Odds ratios for progressing to atrophy after 2 years of follow-up, compared with the resorbed group, were significant for SDD (OR, 2.82; P = 0.048) and AVL height (OR, 1.016; P = 0.006). CONCLUSIONS The presence of SDDs and greater AVL height significantly increases the risk of developing atrophy at the location of AVL after 2 years of follow-up. These findings may be of value in risk prognostication and defining patient populations for inclusion in future early intervention trials aimed at preventing progression to atrophy. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alireza Mahmoudi
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sophiana Lindenberg
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mehdi Emamverdi
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Deniz Oncel
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Damla Oncel
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jiwon Baek
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea
| | - Alireza Farahani
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Louay Almidani
- Doheny Eye Institute, Los Angeles, California; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ye He
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Rouzbeh Abbasgholizadeh
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Stanley M Saju
- Retina Consultants of Texas, Retina Consultants of America, Houston, Texas
| | - Won Ki Lee
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Republic of South Korea
| | - Charles C Wykoff
- Department of Ophthalmology, Nune Eye Hospital, Seoul, Republic of South Korea
| | - David Sarraf
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Opthalmology, NYU Grossman School of Medicine, New York, New York
| | - Srinivas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California.
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Liu M, Wang Y, Li H, Zhao Y, Ma M, Xu S, Wei X, Xu R, Tian R, Zhou X, Wu H. Differences in choroidal responses to near work between myopic children and young adults. EYE AND VISION (LONDON, ENGLAND) 2024; 11:12. [PMID: 38561862 PMCID: PMC10986059 DOI: 10.1186/s40662-024-00382-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Near work is generally considered as a risk factor for myopia onset and progression. This study aimed to investigate the choroidal responses to a brief-period of near work in children and young adults. METHODS Thirty myopic medical students (aged 18-28 years) and 30 myopic children (aged 8-12 years) participated in this study. The submacular total choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI) and choriocapillaris flow deficit (CcFD), as well as subfoveal choroidal thickness (SFCT) were measured with swept-source optical coherence tomography/optical coherence tomography angiography (SS-OCT/OCTA) before and immediately after 20 min, 40 min, 60 min of near work at a distance of 33 cm. RESULTS In adults, 20 min of near work induced a significant reduction in SFCT (- 5.1 ± 6.5 μm), LA [(- 19.2 ± 18.6) × 103 μm2], SA [(- 8.2 ± 12.6) × 103 μm2] and TCA [(- 27.4 ± 24.9) × 103 μm2] (all P < 0.01). After 40 min of near work, LA was still reduced [(- 9.4 ± 18.3) × 103 μm2], accompanied with a decreased CVI (- 0.39% ± 0.70%) and an increased CcFD (0.30% ± 0.78%) (all P < 0.05). After 60 min of near work, CVI was still reduced (- 0.28% ± 0.59%), and CcFD was still increased (0.37% ± 0.75%) (all P < 0.05). In children, 20 min of near work induced a significant increase in CcFD (0.55% ± 0.64%), while 60 min of near work induced increases in SA [(7.2 ± 13.0) × 103 μm2] and TCA [(9.7 ± 25.3) × 103 μm2] and a reduction in CVI (- 0.28% ± 0.72%) (all P < 0.05). Children exhibited lower near work-induced LA and TCA reduction than adults, with a mean difference of - 0.86% and - 0.82%, respectively (all P < 0.05). CONCLUSIONS The temporal characteristics and magnitude of changes of choroidal vascularity and choriocapillaris perfusion during near work was not identical between children and adults. The initial response to near work was observed in choriocapillaris in children, whereas it was observed in the medium- and large-sized vessels in adults. TRIAL REGISTRATION Clinical Trial Registry (ChiCTR), ChiCTR2000040205. Registered on 25 November 2020, https://www.chictr.org.cn/bin/project/edit?pid=64501 .
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Affiliation(s)
- Mengqi Liu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yuanyuan Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Haoer Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yunpeng Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Min Ma
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Shihan Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiaohuan Wei
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ruiyan Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ruikang Tian
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiangtian Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China.
| | - Hao Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Alagorie AR, Corradetti G, Byon I, Tiosano L, Ji Y, Nittala M, Velaga S, Nassisi M, Verma A, Sadda SR. Impact of slab selection on the relationship between choriocapillaris flow deficits and enlargement rate of geographic atrophy. Eye (Lond) 2024; 38:847-852. [PMID: 37865725 DOI: 10.1038/s41433-023-02788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 08/27/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023] Open
Abstract
OBJECTIVE To evaluate the effect of changing slab position on the correlation between choriocapillaris (CC) flow deficits (FD) in eyes with geographic atrophy (GA) and yearly enlargement rate (yER) of GA. METHODS OCT and OCTA images obtained on Cirrus HD-OCT device were collected from patients with GA. Each patient underwent OCTA scan at baseline and two OCT scans, one at baseline and one after at least 12 months. GA was delineated on en-face fundus image to calculate yER. OCTA images were generated from three 10 µm thick slabs 11, 21 and 31 µm posterior to RPE-fit line. 100 µm-wide concentric rings were generated around GA to calculate FD% in each ring which was correlated with yER. RESULTS For the 11-21 µm slab, FD% was not significantly correlated with yER for any of the rings (p > 0.05). For the 21-31 and 31-41 µm slab, FD% of rings located in the 600 µm region around GA was significantly correlated with yER (p < 0.05). However, in all slab locations, there was no significant correlation between yER and CC FD% of rings located beyond the 600 µm region (p > 0.05). CONCLUSIONS Slab selection for quantification of CC FD% may have a significant impact on quantitative results in eyes with GA.
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Affiliation(s)
- Ahmed Roshdy Alagorie
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Giulia Corradetti
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Iksoo Byon
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Liran Tiosano
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yongsok Ji
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Muneeswar Nittala
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Swetha Velaga
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Marco Nassisi
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Aditya Verma
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Srinivas R Sadda
- Doheny Eye Institute, Pasadena, CA, USA.
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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7
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Mahmoudi A, Manafi N, Corradetti G, Gupta Nittala M, Emamverdi M, Trejo Corona S, Wykoff CC, Sarraf D, Sadda SR. Risk factors for development of hyper-reflective foci overlying drusen in eyes with intermediate age-related macular degeneration. Br J Ophthalmol 2024:bjo-2023-324098. [PMID: 38325906 DOI: 10.1136/bjo-2023-324098] [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: 06/14/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
AIMS The aim of this study is to assess baseline characteristics of drusen preceding the development of intraretinal hyper-reflective foci (IHRF) in eyes with intermediate age-related macular degeneration (AMD). METHODS In this retrospective case-control study, longitudinal optical coherence tomography (OCT) volume data from eyes with intermediate AMD in a retina clinic population were screened. All drusen that developed overlying IHRF were marked. A random number generator was used to select for further grading three drusen that did not develop IHRF. RESULTS Ninety eyes (from 72 patients), including 140 drusen with overlying IHRF and 270 IHRF- drusen, were analysed. Greater drusen height, basal drusen width and overlying ellipsoid zone (EZ) and external limiting membrane disruption were associated with a significantly greater risk for IHRF development (p≤0.001). Regression analysis revealed EZ disruption increased these odds by 4.1 (p≤0.001). Each 10-µm increase in drusen height and width increased the odds by 34% (p≤0.001) and 3% (p: 0.005), respectively. Each 100-µm increase in distance from the fovea decreased the odds by 10% (p: 0.013). CONCLUSIONS The presence of overlying EZ disruption and a greater drusen height substantially increased the risk for IHRF development, whereas drusen further from the fovea indicated reduced risk. Given the importance of IHRF as a biomarker for AMD progression, these findings may be of value in defining patient populations for future early intervention trials.
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Affiliation(s)
- Alireza Mahmoudi
- Doheny Eye Institute, Pasadena, California, USA
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA
| | - Navid Manafi
- Doheny Eye Institute, Pasadena, California, USA
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA
| | - Giulia Corradetti
- Doheny Eye Institute, Pasadena, California, USA
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA
| | - Muneeswar Gupta Nittala
- Doheny Eye Institute, Pasadena, California, USA
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA
| | - Mehdi Emamverdi
- Doheny Eye Institute, Pasadena, California, USA
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA
| | | | | | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute,University of California Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, Pasadena, California, USA
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA
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8
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Lee YJ, Hwang SY, Yun C. Flow Void Analysis Using Different Thresholding Methods on a Choriocapillaris Optical Coherence Tomography Angiography Image Complemented with a Structural En Face Image. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:34-41. [PMID: 38104595 PMCID: PMC10869421 DOI: 10.3341/kjo.2023.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To investigate the flow characteristics using different thresholding methods on a choriocapillaris optical coherence tomography angiography (OCTA) image complemented with a structural En Face image. METHODS The 42 choriocapillaris OCTA images from healthy subjects were obtained with swept-source OCTA device and the 3 × 3-mm area OCTA images were processed with ImageJ. Using a raw choriocapillaris OCTA image and structural En Face image, we adjusted the different structural signal intensity. Then, the raw images and adjusted images were binarized with a global threshold and an auto local threshold using the Phansalkar method at 1- or 2-intercapillary distance. Then, the mean area, number, and size of the flow void, were compared among the images using different thresholding methods. RESULTS Mean flow void area, number, and size were different according to the different binarization method both in raw and adjusted images (all p < 0.001). The mean flow void area analyzed with global threshold method were well correlated with those with auto local threshold method both in raw and adjusted images (all intraclass correlations, >0.929). CONCLUSIONS Flow void features varied according to the different binarization methods but showed good correlation. The flow void characteristics according to the different binarization methods should be considered for the analysis of the choriocapillaris OCTA images complemented with a structural En Face image.
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Affiliation(s)
- Young Joo Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Soon-Young Hwang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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9
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Yang Q, Zhang T, Wu Y, Liang Q, Zhao W, Liu R, Jin X. Progress in the Application of Microneedles in Eye Disorders and the Proposal of the Upgraded Microneedle with Spinule. Pharm Res 2024; 41:203-222. [PMID: 38337104 DOI: 10.1007/s11095-024-03658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE In the local administration methods for treating eye diseases, the application of microneedles has great potential due to the shortcomings of low efficacy and significant side effects of local administration preparations. This article provides ideas for the research on the application of ophthalmic microneedle in the treatment of eye diseases. RESULTS This article analyzes the physiological structures of the eyes, ocular diseases and its existing ocular preparations in sequence. Finally, this article reviews the development and trends of ocular microneedles in recent years, and summarizes and discusses the drugs of ocular microneedles as well as the future directions of development. At the same time, according to the inspiration of previous work, the concept of "microneedle with spinule" is proposed for the first time, and its advantages and limitations are discussed in the article. CONCLUSIONS At present, the application of ocular microneedles still faces multiple challenges. The aspects of auxiliary devices, appearance, the properties of the matrix materials, and preparation technology of ophthalmic microneedle are crucial for their application in the treatment of eye diseases.
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Affiliation(s)
- Qiannan Yang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Tingting Zhang
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yujie Wu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qianyue Liang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Wanqi Zhao
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Rui Liu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China.
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China.
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China.
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Xin Jin
- Military Medicine Section, Logistics University of People's Armed Police Force, 1 Huizhihuan Road, Tianjin, 300309, Dongli District, China.
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10
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Zhou SW, Zhang Y, Noam N, Rabinovitch D, Bar D, Yousif BS, O'Brien R, Hiya FE, Lin Y, Berni A, Gregori G, Wang RK, Rosenfeld PJ, Trivizki O. The Impact of Carotid Endarterectomy on Choriocapillaris Perfusion. Invest Ophthalmol Vis Sci 2023; 64:42. [PMID: 38153750 PMCID: PMC10756242 DOI: 10.1167/iovs.64.15.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/03/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose The impact of carotid endarterectomy (CEA) on choriocapillaris (CC) perfusion was investigated using swept-source optical coherence tomography angiography (SS-OCTA) imaging before and after surgery in patients with clinically significant carotid artery stenosis (CAS). Methods In this prospective observational study, patients with clinically significant CAS undergoing unilateral CEA had SS-OCTA imaging performed in both eyes before and within 1 week after surgery. The percent CC flow deficits (CC FD%) and CC thickness were assessed using previously validated algorithms. Multivariable regression analysis was conducted to evaluate the impact of variables on the change in CC measurements. Results A total of 112 eyes from 56 patients with an average age of 72.6 ± 6.9 years were enrolled. At baseline, significantly higher CC FD% and thinner CC thickness were observed on the surgical side (eyes ipsilateral to the side of CEA) versus the nonsurgical side (eyes contralateral to the side of CEA) (P = 0.001 and P = 0.03, respectively). Following CEA, a significant reduction in CC FD% and a significant increase in CC thickness were detected on the surgical as compared with the nonsurgical side (P = 0.008 and P = 0.01, respectively). Smoking status positively affected CC FD% change (coefficient of variation [CV] = 0.84, P = 0.01) on the surgical side and negatively affected CC thickness change on both the surgical side (CV = -0.382, P = 0.009) and the nonsurgical side (CV = -0.321, P = 0.04). The degree of stenosis demonstrated a positive influence on CC FD% change (CV = 0.040, P = 0.02) on the surgical side. Conclusions Unilateral CEA on the side of clinically significant CAS increases carotid blood flow, which further results in improved CC perfusion.
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Affiliation(s)
- Sandy W. Zhou
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, Tan Tock Seng Hospital, National Health Group Eye Institute, Singapore
| | - Yi Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Natalie Noam
- Department of Vascular Surgery, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - David Rabinovitch
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Davidov Bar
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Basheer S. Yousif
- Department of Vascular Surgery, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
| | - Robert O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Farhan E. Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Yufen Lin
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Alessandro Berni
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, Tel Aviv Medical Center, University of Tel Aviv, Tel Aviv, Israel
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11
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Viggiano P, Costanzo E, Giannini D, Fragiotta S, De Geronimo D, Giorno P, Picconi F, Frontoni S, Varano M, Parravano M. In vivo assessment of associations between photoreceptors structure and macular perfusion in type 1 diabetes. Br J Ophthalmol 2023; 107:1672-1679. [PMID: 36126103 DOI: 10.1136/bjo-2022-321617] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/09/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To explore the potential relationships between macular vascular network and different adaptive optics (AO) metrics in patients with type 1 diabetes mellitus (DM1) with no signs (NoDR) or mild non-proliferative diabetic retinopathy (NPDR). DESIGN Observational cross-sectional study. METHODS Forty eyes of consecutive patients with DM1 (12 NoDR and 28 NPDR) and 10 healthy age-matched control subjects were included. All patients and controls were imaged using AO retinal camera and PLEX Elite 9000 optical coherence tomography (OCT) angiography (OCTA). The AO outcome measures to evaluate the cone photoreceptor mosaic characteristics were as follows: (1) Cone density (CD); (2) Linear Dispersion Index (LDi) and (3) Heterogeneity Packing Index (HPi). The OCTA outcome measures included: (1) superficial capillary plexus (SCP) perfusion density (PD); (2) deep capillary plexus (DCP) PD and (3) the choriocapillaris (CC) flow deficit percentage (FD%). RESULTS NPDR group exhibited a close relationship between cone metrics and CC FD. Notably, CC FD% increase along with LDi (p=0.035), while the increasing CC FD% were associated with reducing CD (p=0.042) and the HPi (p=0.017). Furthermore, the OCTA parameters, including PD SCP and DCP, showed a significant negative correlation with CD. CONCLUSIONS Our results demonstrated the relationship between macular perfusion at both retinal and choroidal levels and the cone mosaic in patients with DM1 interpolating swept-source-OCTA and AO metrics. In NPDR eyes, the photoreceptor damage was accompanied by CC insufficiency since the early stages of the disease.
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Affiliation(s)
| | | | | | - Serena Fragiotta
- Department of Medicine and Surgery, UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Paola Giorno
- Ophthalmology, IRCCS-Fondazione Bietti, Rome, Italy
| | - Fabiana Picconi
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita Fatebenefratelli Hospital, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita Fatebenefratelli Hospital, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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12
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Cheng W, Wang W, Song Y, Lin F, Duan Y, Xie L, Jin K, Weinreb RN, Zhang X. Choriocapillaris and progressive ganglion cell-inner plexiform layer loss in non-glaucomatous eyes. Br J Ophthalmol 2023; 107:1638-1644. [PMID: 35977800 DOI: 10.1136/bjo-2022-321277] [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: 02/10/2022] [Accepted: 07/31/2022] [Indexed: 11/04/2022]
Abstract
AIMS To explore the relationship between choriocapillaris (CC) flow deficit percentage (FD%) and ganglion cell-inner plexiform layer (GCIPL) thickness in a population-based sample of non-glaucomatous eyes. METHODS This is a longitudinal cohort study and prospective cross-sectional study. Non-glaucoma Chinese subjects aged 18 years or older were enrolled. All participants underwent a detailed ophthalmic examination, including swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography. Average, inner average, outer average and nine Early Treatment Diabetic Retinopathy Study sub-regions of GCIPL thickness and CC FD% were measured. The correlation between CC FD% and GCIPL was assessed using a linear regression model, and the relationship between the rate of change of GCIPL thickness and CC FD% was further validated in a 2year longitudinal study. RESULTS In the cross-sectional study including 3514 participants (3514 non-glaucoma eyes), a higher CC FD% was significantly associated with a thinner GCIPL (β=-0.32; 95% CI -0.43 to -0.21; p<0.001). Further, in a longitudinal study (453 eyes of 453 participants), a faster increase in CC FD% was found to be significantly associated with a faster decrease in GCIPL thickness (β=-0.10; 95% CI -0.17 to -0.03; p=0.004) after adjusting for age, sex, axial length and image quality score. CONCLUSIONS This is the first time to show that CC FD% and GCIPL thickness were correlated in both cross-sectional and longitudinal studies of non-glaucomatous individuals, which may potentially provide further insights on the role of CC perfusion in glaucoma development and progression.
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Affiliation(s)
- Weijing Cheng
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - Yunhe Song
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - Fengbin Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - Yongbo Duan
- Southern Medical University, Guangzhou, Guangdong, China
| | - Liu Xie
- Yiyang Central Hospital, Yiyang, Hunan Province, China
| | - Kai Jin
- Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | | | - Xiulan Zhang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
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13
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Lal B, Alonso-Caneiro D, Read SA, Carkeet A. Changes in retinal and choroidal optical coherence tomography angiography indices among young adults and children over 1 year. Clin Exp Optom 2023:1-8. [PMID: 37848182 DOI: 10.1080/08164622.2023.2259907] [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: 05/15/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
CLINICAL RELEVANCE Optical coherence tomography angiography (OCT-A) indices are likely to change across time and optometrists should be aware of the variability expected during childhood development and in healthy adults. BACKGROUND Cross-sectional studies have shown that OCT-A indices are associated with age in adults and children. The aim of this study is to investigate longitudinal changes in retinal and choroidal OCT-A indices over 1 year among healthy children and young adults. METHODS This prospective longitudinal study captured macular OCT-A and OCT scans, and biometry measures at baseline and 1-year follow-up for 22 adults (18-30 years; -6.87 to +0.37 D) and 21 children (6-15 years; -5.75 to +0.25 D). Superficial and deep retinal layer, choriocapillaris and deep choroidal en face OCT-A images were analysed to extract magnification-corrected vascular indices in foveal, parafoveal and perifoveal regions. The retinal indices included foveal avascular zone metrics, perfusion, and vessel density. Flow deficit number, size, and density were extracted from choriocapillaris and perfusion density from deep choroid. Associations between annual changes in the OCT-A indices and axial length and baseline refraction were also studied. RESULTS Among children, significant reductions were noted only in parafoveal superficial retinal and foveal and perifoveal deep retinal layer indices over 1 year (p < 0.05). Choroidal OCT-A indices in children and both retinal and choroidal OCT-A indices in adults did not show significant changes. Myopia was associated with a larger reduction in the perifoveal retinal OCT-A indices in children, and with increases in sub-foveal and sub-parafoveal choroidal indices in adults. There were associations between OCT-A indices and axial length changes but differently in adults and children. CONCLUSIONS Significant changes were noted in retinal OCT-A indices over 1 year among children but not adults. In comparison, choroidal OCT-A indices in adults and children showed a stable morphology over this period of time.
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Affiliation(s)
- Barsha Lal
- Centre for Vision and Eye Research, Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - David Alonso-Caneiro
- School of Science, Technology and Engineering, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Scott A Read
- Centre for Vision and Eye Research, Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Andrew Carkeet
- Centre for Vision and Eye Research, Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
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14
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Sazhnyev Y, Sin TN, Ma A, Chang E, Huynh L, Roszak K, Park S, Choy K, Farsiu S, Moshiri A, Thomasy SM, Yiu G. Choroidal Changes in Rhesus Macaques in Aging and Age-Related Drusen. Invest Ophthalmol Vis Sci 2023; 64:44. [PMID: 37773500 PMCID: PMC10547013 DOI: 10.1167/iovs.64.12.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023] Open
Abstract
Purpose Choroidal vascular changes occur with normal aging and age-related macular degeneration (AMD). Here, we evaluate choroidal thickness and vascularity in aged rhesus macaques to better understand the choroid's role in this nonhuman primate model of AMD. Methods We analyzed optical coherence tomography (OCT) images of 244 eyes from 122 rhesus macaques (aged 4-32 years) to measure choroidal thickness (CT) and choroidal vascularity index (CVI). Drusen number, size, and volume were measured by semiautomated annotation and segmentation of OCT images. We performed regression analyses to determine any association of CT or CVI with age, sex, and axial length and to determine if the presence and volume of soft drusen impacted these choroidal parameters. Results In rhesus macaques, subfoveal CT decreased with age at 3.2 µm/y (R2 = 0.481, P < 0.001), while CVI decreased at 0.66% per year (R2 = 0.257, P < 0.001). Eyes with soft drusen exhibited thicker choroid (179.9 ± 17.5 µm vs. 162.0 ± 27.9 µm, P < 0.001) and higher CVI (0.612 ± 0.051 vs. 0.577 ± 0.093, P = 0.005) than age-matched control animals. Neither CT or CVI appeared to be associated with drusen number, size, or volume in this cohort. However, some drusen in macaques were associated with underlying choroidal vessel enlargement resembling pachydrusen in human patients with AMD. Conclusions Changes in the choroidal vasculature in rhesus macaques resemble choroidal changes in human aging, but eyes with drusen exhibit choroidal thickening, increased vascularity, and phenotypic characteristics of pachydrusen observed in some patients with AMD.
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Affiliation(s)
- Yevgeniy Sazhnyev
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
- Department of Ophthalmology, California Northstate University, College of Medicine, Elk Grove, California, United States
| | - Tzu-Ni Sin
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
| | - Anthony Ma
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
- Department of Ophthalmology, California Northstate University, College of Medicine, Elk Grove, California, United States
| | - Ellie Chang
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
| | - Leon Huynh
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
| | - Karolina Roszak
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
| | - Sangwan Park
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
| | - Kevin Choy
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
| | - Sara M. Thomasy
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, United States
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15
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Hormel TT, Jia Y. OCT angiography and its retinal biomarkers [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:4542-4566. [PMID: 37791289 PMCID: PMC10545210 DOI: 10.1364/boe.495627] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 10/05/2023]
Abstract
Optical coherence tomography angiography (OCTA) is a high-resolution, depth-resolved imaging modality with important applications in ophthalmic practice. An extension of structural OCT, OCTA enables non-invasive, high-contrast imaging of retinal and choroidal vasculature that are amenable to quantification. As such, OCTA offers the capability to identify and characterize biomarkers important for clinical practice and therapeutic research. Here, we review new methods for analyzing biomarkers and discuss new insights provided by OCTA.
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Affiliation(s)
- Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
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16
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Verma A, Magesan K, Mahalingam M, T A, Sadda SR, Corradetti G, Alagorie AR, Gnanaraj R, Sen P. Age-Related Alterations of the Macular Choroid in Healthy Eyes Assessed by Swept-Source Optical Coherence Tomography Angiography. Ophthalmic Surg Lasers Imaging Retina 2023; 54:526-534. [PMID: 37642439 DOI: 10.3928/23258160-20230728-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To analyze age-related changes in the choroid in healthy eyes using swept-source optical coherence tomography angiography (SS-OCTA). PATIENTS AND METHODS This was a cross-sectional, prospective, observational study enrolling 222 eyes of 116 healthy participants. SS-OCTA images were captured using the PLEX Elite 9000 (Carl Zeiss Meditec) with a 6 x 6 mm pattern centered on the fovea. Subfoveal choroidal thickness (CT) and choroidal volume (CV) were generated automatically through manufacturer tools available in the Advanced Retinal Imaging (ARI) hub network. Choroidal vascularity index (CVI) and choriocapillaris flow deficits (CCFD) were computed using ImageJ. RESULTS CV was found to be significantly higher in women than men. Overall, there was a significant positive correlation between CVI and CCFD, and a significant negative correlation between CT and CV with age. The relationship, however, was more complex, as a decade-wise analysis showed that CT and CV increased until the second decade, followed by a decrease until the sixth decade, and then an increase again in the seventh and eighth decades. CVI was highest in the seventh decade. In contrast, CCFD increased consistently with age and in all the Early Treatment of Diabetic Retinopathy Study (ETDRS) rings. CONCLUSION The choroidal blood flow and its thickness reduces as the age advances. While the choroidal flow deficits show a consistent increase with age and the distance from the foveal center, the relationship of other parameters with age is more complex. Having a normative database from healthy subjects is imperative for understanding the changes taking place in diseased states. Choroidal parameters can show significant variations with age. These differences are not uniform or consistent with age, highlighting the importance of a normative reference database to assess the significance of choroidal alterations associated with disease. [Ophthalmic Surg Lasers Imaging Retina 2023;54:526-534.].
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17
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Shen M, Li J, Shi Y, Zhang Q, Liu Z, Zhou H, Lu J, Cheng Y, Chu Z, Zhou X, Liu J, Jiang X, Wang L, Laiginhas R, de Sisternes L, Vanner EA, Feuer WJ, Wang RK, Gregori G, Rosenfeld PJ. Decreased Central Macular Choriocapillaris Perfusion Correlates With Increased Low Luminance Visual Acuity Deficits. Am J Ophthalmol 2023; 253:1-11. [PMID: 37142175 PMCID: PMC10626399 DOI: 10.1016/j.ajo.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/13/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Correlations between low luminance visual acuity deficits (LLVADs) and central choriocapillaris perfusion deficits were investigated to help explain how increases in LLVAD scores at baseline predict annual growth rates of geographic atrophy (GA). DESIGN Prospective cross-sectional study. METHODS Photopic luminance best-corrected visual acuity (PL-BCVA) and low luminance BCVA (LL-BCVA) were measured using the Early Treatment Diabetic Retinopathy Study chart. LL-BCVA was measured using a 2.0-log unit neutral density filter. LLVADs were calculated as the difference between PL-BCVA and LL-BCVA. Within a fovea-centered 1-mm circle, the percentage of choriocapillaris flow deficits (CC FD%), drusen volume, optical attenuation coefficient (OAC) elevation volume, and outer retinal layer (ORL) thickness were assessed. RESULTS In all 90 eyes (30 normal eyes; 31 drusen-only eyes; 29 non-foveal GA eyes), significant correlations were found between the central CC FD% and PL-BCVA (r = -0.393, P < .001), LL-BCVA (r = -0.534, P < .001), and the LLVAD (r = 0.439, P < .001). Central cube root (cubrt) drusen volume, cubrt OAC elevation volume, and ORL thickness were correlated with PL-BCVA, LL-BCVA, and LLVADs (all P < .05). Stepwise regression models showed that central cubrt OAC elevation volume and ORL thickness were associated with PL-BCVA (R2 = 0.24, P < .05); central CC FD%, cubrt OAC elevation volume, and ORL thickness were associated with LL-BCVA (R2 = 0.44, P < .01); and central CC FD% and ORL thickness were associated with LLVAD (R2 = 0.24, P < .01). CONCLUSIONS The significant correlations between central CC FD% and LLVAD support the hypothesis that the ability of LLVAD to predict the growth of GA is mediated through a decrease in macular choriocapillaris perfusion.
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Affiliation(s)
- Mengxi Shen
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jianqing Li
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yingying Shi
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Qinqin Zhang
- Research and Development (Q.Z., L.D.), Carl Zeiss Meditec, Inc., Dublin, California, USA
| | - Ziyu Liu
- Department of Bioengineering (Z. L., H.Z., J.L., Y.C., Z.C., X.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Hao Zhou
- Department of Bioengineering (Z. L., H.Z., J.L., Y.C., Z.C., X.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Jie Lu
- Department of Bioengineering (Z. L., H.Z., J.L., Y.C., Z.C., X.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Yuxuan Cheng
- Department of Bioengineering (Z. L., H.Z., J.L., Y.C., Z.C., X.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Zhongdi Chu
- Department of Bioengineering (Z. L., H.Z., J.L., Y.C., Z.C., X.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Xiao Zhou
- Department of Bioengineering (Z. L., H.Z., J.L., Y.C., Z.C., X.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Jeremy Liu
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xiaoshuang Jiang
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Liang Wang
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rita Laiginhas
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luis de Sisternes
- Research and Development (Q.Z., L.D.), Carl Zeiss Meditec, Inc., Dublin, California, USA
| | - Elizabeth A Vanner
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - William J Feuer
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruikang K Wang
- Department of Bioengineering (Z. L., H.Z., J.L., Y.C., Z.C., X.Z., R.K.W.), University of Washington, Seattle, Washington, USA; Department of Ophthalmology (R.K.W.), University of Washington, Seattle, Washington, USA
| | - Giovanni Gregori
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology (M.S., J.L., Y.S., J.L., X.J., L.W., R.L., E.A.V., W.J.F., G.G., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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18
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Kar D, Corradetti G, Swain TA, Clark ME, McGwin G, Owsley C, Sadda SR, Curcio CA. Choriocapillaris Impairment Is Associated With Delayed Rod-Mediated Dark Adaptation in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2023; 64:41. [PMID: 37768273 PMCID: PMC10540875 DOI: 10.1167/iovs.64.12.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose Progress toward treatment and prevention of age-related macular degeneration (AMD) requires imaging end points that relate to vision. We investigated choriocapillaris flow signal deficits (FD%) and visual function in eyes of individuals aged ≥60 years, with and without AMD. Methods One eye of each participant in the baseline visit of the Alabama Study on Early Age-Related Macular Degeneration 2 (ALSTAR2; NCT04112667) was studied. AMD presence and severity was determined using the Age-Related Eye Disease Study (AREDS) grading system. FD% was quantified using macular spectral domain optical coherence tomography angiography (OCTA) scans. Vision tests included rod-mediated dark adaptation (RMDA), best-corrected visual acuity, and contrast sensitivity (photopic and mesopic), and microperimetric light sensitivity (scotopic, mesopic, and photopic). Presence of subretinal drusenoid deposits (SDD) was determined using multimodal imaging. Results In 410 study eyes of 410 participants (mean [SD] age = 71.7 years [5.9]), FD% was higher in early AMD (mean [SD] = 54.0% [5.5], N = 122) and intermediate AMD (59.8% [7.4], N = 92), compared to normal (52.1% [5.3], N = 196) eyes. Among visual functions evaluated, RMDA showed the strongest association with FD% (r = 0.35, P < 0.0001), followed by contrast sensitivity (r = -0.22, P < 0.0001). Eyes with SDD had worse FD% (58.3% [7.4], N = 87), compared to eyes without SDD (53.4% [6.0], N = 323, P = < 0.0001). Conclusions Choriocapillaris FD% were associated with AMD severity and with impaired vision, especially RMDA. Reduced metabolic transport and exchange across the choriocapillaris-Bruch's membrane retinal pigment epithelium (RPE) complex, a causal factor for high-risk soft drusen formation, also may impair photoreceptor sustenance from the circulation. This includes retinoid resupply, essential to dynamic rod function.
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Affiliation(s)
- Deepayan Kar
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Thomas A. Swain
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Mark E. Clark
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Gerald McGwin
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - SriniVas R. Sadda
- Doheny Eye Institute, Los Angeles, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, California, United States
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Sun KX, Xiang YG, Zhang T, Yi SL, Xia JY, Yang X, Zheng SJ, Ji Y, Wan WJ, Hu K. Evaluation of childhood developing via optical coherence tomography-angiography in Qamdo, Tibet, China: A prospective cross-sectional, school-based study. World J Clin Cases 2023; 11:5479-5493. [PMID: 37637695 PMCID: PMC10450379 DOI: 10.12998/wjcc.v11.i23.5479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/11/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Optical coherence tomography angiography (OCTA) is a new and reliable machine used to evaluate retinal structure and macular perfusion in children. The use of OCTA under bad condition such as high altitude, low atmospheric oxygen, and low humidity, in children is rarely. AIM To quantify the macular micro-vasculature in healthy children of various ages using OCTA in Qamdo. METHODS Design: Prospective cross-sectional, school-based study. Three hundred and forty-seven normal students from 9 schools in 4 different areas in Qamdo were included. OCTA was performed on a 3 mm × 3 mm area centered on the macular region and macular cube 512 × 128 showed details in macular. Early treatment of diabetic retinopathy study Vessel Flow Density (VD) of the macular central vascular plexus density (CVD), inner vascular plexus density (IVD), full vascular plexus density (FVD), and the size of the foveal avascular zone (FAZ) were measured. All these results corrected by t/s = 3.382 × 0.01306 × (axial length-1.82). The differences were compared among various ages, sexes and living environments. RESULTS The mean FAZ area in all eyes was 0.27 mm2 ± 0.12 mm2. The mean foveal thickness (MFT) in the macular cube was 227.64 μm ± 23.51 μm. Compared with girls, boys had a lager FAZ (P = 0.0029). Among the different age groups, MFT (P < 0.001) and FVD (P < 0.0001), IVD (P < 0.0001), and CVD (P = 0.0050) increased with age. FAZ areas were not correlated with age (P = 0.8853) or others (MFT, area). CONCLUSION OCTA can use to evaluate macular perfusion in children. Our data bridge the gap between structural OCT and perfusion density in children in high altitude. Even though these were not a longitudinal study, it may provide us with hints about retina development during puberty and clinical implications of OCTA in children.
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Affiliation(s)
- Ke-Xin Sun
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yong-Guo Xiang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Tong Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 400016, China
| | - Sheng-Lan Yi
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jiu-Yi Xia
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin Yang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shi-Jie Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yan Ji
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wen-Juan Wan
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ke Hu
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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20
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Cabral D, Fradinho AC, Zhang Y, Zhou H, Ramtohul P, Ramakrishnan MS, Pereira T, Wang RK, Freund KB. Quantitative assessment of choriocapillaris flow deficits and type 1 macular neovascularization growth in age-related macular degeneration. Sci Rep 2023; 13:8572. [PMID: 37236984 DOI: 10.1038/s41598-023-35080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
During the past 15 years, new treatment paradigms for neovascular age-related macular degeneration (nvAMD) have evolved due to the advent of intravitreal anti-vascular endothelial growth factor (VEGF) therapy and rapid advances in retinal imaging. Recent publications describe eyes with type 1 macular neovascularization (MNV) as showing more resistance to macular atrophy than eyes with other lesion types. We sought to explore whether the perfusion status of the native choriocapillaris (CC) surrounding type 1 MNV influences its pattern of growth. To evaluate this effect, we analyzed a case series of 22 eyes from 19 nvAMD patients with type 1 MNV exhibiting growth on swept-source optical coherence tomography angiography (SS-OCTA) over a minimum follow-up of 12 months. We observed an overall weak correlation between type 1 MNV growth and CC flow deficits (FDs) average size (τ = 0.17, 95% CI [- 0.20, 0.62]) and a moderate correlation with CC FD % (τ = 0.21, 95% CI [- 0.16, 0.68]). Type 1 MNV was located beneath the fovea in most of the eyes (86%) and median visual acuity was 20/35 Snellen equivalent. Our results support that type 1 MNV recapitulates areas of CC blood flow impairment while serving to preserve foveal function.
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Affiliation(s)
- Diogo Cabral
- Vitreous Retina Macula Consultants of New York, 950 Third Ave, New York, NY, 10022, USA
- iNOVA4Health, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Ana C Fradinho
- iNOVA4Health, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Yi Zhang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, 950 Third Ave, New York, NY, 10022, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Meera S Ramakrishnan
- Vitreous Retina Macula Consultants of New York, 950 Third Ave, New York, NY, 10022, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Telmo Pereira
- iNOVA4Health, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, 950 Third Ave, New York, NY, 10022, USA.
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA.
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21
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Zheng F, Deng X, Zhang Q, He J, Ye P, Liu S, Li P, Zhou J, Fang X. Advances in swept-source optical coherence tomography and optical coherence tomography angiography. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2023; 3:67-79. [PMID: 37846376 PMCID: PMC10577875 DOI: 10.1016/j.aopr.2022.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 10/18/2023]
Abstract
Background The fast development of swept-source optical coherence tomography (SS-OCT) and swept-source optical coherence tomography angiography (SS-OCTA) enables both anterior and posterior imaging of the eye. These techniques have evolved from a research tool to an essential clinical imaging modality. Main text The longer wavelength and faster speed of SS-OCT and SS-OCTA facilitate better visualization of structure and vasculature below pigmented tissue with a larger field of view of the posterior segment and 360-degree visualization of the anterior segment. In the past 10 years, algorithms dealing with OCT and OCTA data also vastly improved the image quality and enabled the automated quantification of OCT- and OCTA-derived metrics. This technology has enriched our current understanding of healthy and diseased eyes. Even though the high cost of the systems currently limited the widespread use of SS-OCT and SS-OCTA at the first beginning, the gap between research and clinic practice got obviously shortened in the past few years. Conclusions SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift toward more widespread adoption of new imaging technology in clinical practice.
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Affiliation(s)
- Fang Zheng
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofeng Deng
- State Key Lab of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, China
| | - Qi Zhang
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jingliang He
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Panpan Ye
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Shan Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Li
- State Key Lab of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, China
| | - Jian Zhou
- TowardPi (Beijing) Medical Technology Ltd, Shanghai, China
| | - Xiaoyun Fang
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
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22
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Li J, Liu Z, Lu J, Shen M, Cheng Y, Siddiqui N, Zhou H, Zhang Q, Liu J, Herrera G, Hiya FE, Gregori G, Wang RK, Rosenfeld PJ. Decreased Macular Choriocapillaris Perfusion in Eyes With Macular Reticular Pseudodrusen Imaged With Swept-Source OCT Angiography. Invest Ophthalmol Vis Sci 2023; 64:15. [PMID: 37052925 PMCID: PMC10103727 DOI: 10.1167/iovs.64.4.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Purpose To determine if macular reticular pseudodrusen (RPD) were associated with markers of impaired macular choroidal perfusion, we investigated measurements of macular choriocapillaris (CC) flow deficits (FDs), CC thickness, and mean choroidal thickness (MCT) in eyes with macular RPD compared with normal eyes and eyes with soft drusen. Methods Eyes with intermediate age-related macular degeneration (iAMD) and normal eyes underwent 6 × 6 mm swept-source optical coherence tomography angiography (SS-OCTA) imaging to diagnose macular RPD, occupying over 25% of the fovea-centered 5 mm diameter circle, and measure outer retinal layer (ORL) thickness, CC FDs, CC thickness, MCT, and choroidal vascularity index (CVI) using previously published strategies within the same fovea-centered 5 mm circle. Results Ninety eyes were included; 30 normal eyes, 30 eyes with soft drusen, and 30 eyes with macular RPD. The RPD eyes showed higher macular CC FDs than normal eyes (P < 0.001) and soft drusen eyes (P = 0.019). Macular CC thickness was decreased in RPD eyes compared with normal eyes (P < 0.001) and soft drusen eyes (P = 0.016). Macular MCT in RPD eyes was thinner than normal eyes (P = 0.005) and soft drusen eyes (P < 0.001). No statistically and clinically significant differences were found in the ORL thickness and CVI measurements between RPD eyes and the other two groups (all P > 0.05). Conclusions Eyes with macular RPD had decreased macular CC perfusion, decreased CC thickness, and decreased MCT measurements compared with normal and soft drusen eyes, suggesting that RPD may result from impaired choroidal perfusion.
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Affiliation(s)
- Jianqing Li
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ziyu Liu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Jie Lu
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Yuxuan Cheng
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Nadia Siddiqui
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Qinqin Zhang
- Research and Development, Carl Zeiss Meditec, Inc., Dublin, California, United States
| | - Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Gissel Herrera
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Farhan E Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
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23
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Lake SR, Bottema MJ, Lange T, Williams KA, Reynolds KJ. Swept-Source OCT Mid-Peripheral Retinal Irregularity in Retinal Detachment and Posterior Vitreous Detachment Eyes. Bioengineering (Basel) 2023; 10:bioengineering10030377. [PMID: 36978768 PMCID: PMC10044997 DOI: 10.3390/bioengineering10030377] [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: 02/10/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Irregularities in retinal shape have been shown to correlate with axial length, a major risk factor for retinal detachment. To further investigate this association, a comparison was performed of the swept-source optical coherence tomography (SS OCT) peripheral retinal shape of eyes that had either a posterior vitreous detachment (PVD) or vitrectomy for retinal detachment. The objective was to identify a biomarker that can be tested as a predictor for retinal detachment. Eyes with a PVD (N = 88), treated retinal detachment (N = 67), or retinal tear (N = 53) were recruited between July 2020 and January 2022 from hospital retinal clinics in South Australia. The mid-peripheral retina was imaged in four quadrants with SS OCT. The features explored were patient age, eye axial length, and retinal shape irregularity quantified in the frequency domain. A discriminant analysis classifier to identify retinal detachment eyes was trained with two-thirds and tested with one-third of the sample. Retinal detachment eyes had greater irregularity than PVD eyes. A classifier trained using shape features from the superior and temporal retina had a specificity of 84% and a sensitivity of 48%. Models incorporating axial length were less successful, suggesting peripheral retinal irregularity is a better biomarker for retinal detachment than axial length. Mid-peripheral retinal irregularity can identify eyes that have experienced a retinal detachment.
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Affiliation(s)
- Stewart R Lake
- Flinders Institute for Health and Medical Research, GPO Box 2100, Adelaide 5001, Australia
- Medical Device Research Institute, College of Science and Engineering, Flinders University, GPO Box 2100, Adelaide 5001, Australia
| | - Murk J Bottema
- Medical Device Research Institute, College of Science and Engineering, Flinders University, GPO Box 2100, Adelaide 5001, Australia
| | - Tyra Lange
- Medical Device Research Institute, College of Science and Engineering, Flinders University, GPO Box 2100, Adelaide 5001, Australia
| | - Keryn A Williams
- Flinders Institute for Health and Medical Research, GPO Box 2100, Adelaide 5001, Australia
| | - Karen J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, GPO Box 2100, Adelaide 5001, Australia
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24
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Loewinger AS, Pfau M, Herrmann P, Holz FG, Pfau K. Choriocapillaris Flow Signal Impairment in Patients With Pseudoxanthoma Elasticum. Invest Ophthalmol Vis Sci 2023; 64:21. [PMID: 36809302 PMCID: PMC9946047 DOI: 10.1167/iovs.64.2.21] [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] [Indexed: 02/23/2023] Open
Abstract
Purpose To quantify choriocapillaris flow alterations in patients with pseudoxanthoma elasticum (PXE) in pre-atrophic stages and its association with structural changes of the choroid and outer retina. Methods Thirty-two eyes of 21 patients with PXE and 35 healthy eyes of 35 controls were included. The density of choriocapillaris flow signal deficits (FDs) was quantified on 6 × 6-mm optical coherence tomography angiography (OCTA) images. Spectral-domain optical coherence tomography (SD-OCT) images were analyzed for thicknesses of the choroid and outer retinal microstructure and correlated with choriocapillaris FDs in the respective Early Treatment Diabetic Retinopathy Study subfield. Results The multivariable mixed model analysis for choriocapillaris FDs revealed significantly higher FDs associated with the group (PXE patients vs. controls +13.6; 95% confidence interval [CI] 9.87-17.3; P < 0.001), with increasing age (+0.22% per year; 95% CI 0.12-0.33; P < 0.001), and with retinal location (significantly higher FDs in nasal compared to temporal subfields). Choroidal thickness (CT) did not differ significantly between both groups (P = 0.078). The CT and choriocapillaris FDs were inversely correlated (-1.92 µm per %FDs; interquartile range -2.81 to -1.03; P < 0.001). Larger values of the choriocapillaris FDs were associated with significant thinning of the overlying photoreceptor layers (outer segments: -0.21 µm per %FDs, P < 0.001; inner segments: -0.12 µm per %FDs, P = 0.001; outer nuclear layer: -0.72 µm per %FDs; P < 0.001). Conclusions Patients with PXE display significant alterations of the choriocapillaris on OCTA even in pre-atrophic stages and in the absence of significant choroidal thinning. The analysis favors choriocapillaris FDs over choroidal thickness as a potential early outcome measure for future interventional trials in PXE. Further, increased FDs in nasal compared to temporal locations mirror the centrifugal spread of Bruch's membrane calcification in PXE.
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Affiliation(s)
| | - Maximilian Pfau
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany,Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Bethesda, Maryland, United States
| | - Philipp Herrmann
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Frank G. Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Kristina Pfau
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany,Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, United States
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Berlin A, Cabral D, Chen L, Messinger JD, Balaratnasingam C, Mendis R, Ferrara D, Freund KB, Curcio CA. Histology of type 3 macular neovascularization and microvascular anomalies in treated age-related macular degeneration: a case study. OPHTHALMOLOGY SCIENCE 2023; 3:100280. [PMID: 36970117 PMCID: PMC10033755 DOI: 10.1016/j.xops.2023.100280] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
Purpose To investigate intraretinal neovascularization and microvascular anomalies by correlating in vivo multimodal imaging with corresponding ex vivo histology in a single patient. Design A case study comprising clinical imaging from a community-based practice, and histologic analysis at a university-based research laboratory (clinicopathologic correlation). Participants A White woman in her 90s treated with numerous intravitreal anti-VEGF injections for bilateral type 3 macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). Methods Clinical imaging comprised serial infrared reflectance, eye-tracked spectral-domain OCT, OCT angiography, and fluorescein angiography. Eye tracking, applied to the 2 preserved donor eyes, enabled the correlation of clinical imaging signatures with high-resolution histology and transmission electron microscopy. Main Outcome Measures Histologic/ultrastructural descriptions and diameters of vessels seen in clinical imaging. Results Six vascular lesions were histologically confirmed (type 3 MNV, n = 3; deep retinal age-related microvascular anomalies [DRAMAs], n = 3). Pyramidal (n = 2) or tangled (n = 1) morphologies of type 3 MNV originated at the deep capillary plexus (DCP) and extended posteriorly to approach without penetrating persistent basal laminar deposit. They did not enter the subretinal pigment epithelium (RPE)-basal laminar space or cross the Bruch membrane. Choroidal contributions were not found. The neovascular complexes included pericytes and nonfenestrated endothelial cells, within a collagenous sheath covered by dysmorphic RPE cells. Deep retinal age-related microvascular anomaly lesions extended posteriorly from the DCP into the Henle fiber and the outer nuclear layers without evidence of atrophy, exudation, or anti-VEGF responsiveness. Two DRAMAs lacked collagenous sheaths. External and internal diameters of type 3 MNV and DRAMA vessels were larger than comparison vessels in the index eyes and in aged normal and intermediate AMD eyes. Conclusions Type 3 MNV vessels reflect specializations of source capillaries and persist during anti-VEGF therapy. The collagenous sheath of type 3 MNV lesions may provide structural stabilization. If so, vascular characteristics may be useful in disease monitoring in addition to fluid and flow signal detection. Further investigation with longitudinal imaging before exudation onset will help determine if DRAMAs are part of the type 3 MNV progression sequence. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Choroidal Vascular Density Quantification in High Myopia with or without Choroidal Neovascularization Using Optical Coherence Tomography Angiography. J Ophthalmol 2023; 2023:1504834. [PMID: 36713357 PMCID: PMC9883103 DOI: 10.1155/2023/1504834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/13/2022] [Accepted: 11/24/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose The aim of this study was to analyze choroidal vascular density alteration in high myopia with or without choroidal neovascularization by using optical coherence tomography angiography (OCTA). Methods This was a cross-sectional, observational study that included 60 high-myopia eyes. All the participants had comprehensive ophthalmic assessments with visual acuity, intraocular pressure, slit lamp-assisted biomicroscopy, color fundus photography, axial length, optometry, and OCTA. Age, sex, and comorbidities were collected from their medical charts. Univariate and multiple analyses were made to compare the age, spherical equivalent, choroidal vascular density, gender, and choroidal thickness between normal and patients with choroidal neovascularization. Results 60 eyes with high myopia were included in our study, including 30 eyes with choroidal neovascularization and 30 eyes without choroidal neovascularization or other fundus pathology. The mean age of high myopic patients was older in the choroidal neovascularization group than in the normal group (48.43 ± 19.06 years vs. 28.83 ± 9.92 years, p < 0.01). The mean choroidal thickness of high myopic patients was thinner in the neovascularization group than in the normal group (68.81 ± 48.81 μm vs. 137.80 ± 66.33 μm, p < 0.01). The mean choroidal vascular density in the normal group was greater than in the choroidal neovascularization group (82.43 ± 8.73 vs. 67.54 ± 12.56, p < 0.01). There was no significant difference in spherical equivalent between the choroidal neovascularization group and the normal group (-10.56 ± 2.97D vs. -11.93 ± 3.38D, p = 0.11). Multivariate analysis showed that after adjusting for covariates, less choroidal vascular density and older age were independent factors associated with choroidal neovascularization in the high myopic eye. Conclusion Decreased choroidal vascular density and older age played an important role in the development of choroidal neovascularization in high myopic eyes. OCTA may help us to identify the highly myopic patients that need to intervene.
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Cheng W, Song Y, Gao X, Lin F, Li F, Wang P, Hu K, Li H, Li Y, Chen L, Jonas JB, Wang W, Zhang X. Axial Length and Choriocapillaris Flow Deficits in Non-pathological High Myopia. Am J Ophthalmol 2022; 244:68-78. [PMID: 35970207 DOI: 10.1016/j.ajo.2022.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To examine the relationship between axial length (AL) and choriocapillaris (CC) flow deficits percentage (FD%) in non-pathological highly myopic eyes. DESIGN Prospective cross-sectional study. METHODS This study included Chinese patients with non-pathological high myopia, which was defined by an AL of > 26 mm and a META-PM classification grade of <2. Swept-source optical coherence tomography angiography was used to obtain 6 × 6 mm images of the macular CC. The CC FD% was measured in the fovea, parafovea, and perifovea subfields. RESULTS A total of 1017 individuals (1017 eyes) with a mean age of 35.95 ± 14.11 years were included. After adjusting for age, sex, intraocular pressure, body mass index, systolic blood pressure, and image quality score, the overall CC FD% increased by 0.27% (95% CI 0.02, 0.52; P = .034) for each mm increase in AL. Among subfields, longer AL was associated with a higher CC FD% in the perifovea (β = 0.53, 95% CI 0.30, 0.77; P < .001), and was not associated with a higher CC FD% in the parafovea (β = 0.08, 95% CI -0.26, 0.42; P = .652) and fovea (β = 0.001, 95% CI -0.50, 0.50; P = .999). CONCLUSIONS The CC FD% increased with a longer AL in high myopia in the perifovea region but not in the fovea and parafovea fields. These findings may be of interest in elucidating the etiology of myopic axial elongation.
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Affiliation(s)
- Weijing Cheng
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Yunhe Song
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Xinbo Gao
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Fengbin Lin
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Fei Li
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Peiyuan Wang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Kun Hu
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Hao Li
- Ophthalmology Department, Guizhou Provincial People's Hospital, Guiyang, China (H.L)
| | - Yingjie Li
- Department of Ophthalmology, The First Hospital of Nanchang City, Nanchang, China (Y.L)
| | - Lina Chen
- Department of Ophthalmology, The People's Third Hospital of Dalian, Dalian Medical University, Dalian, China (L.C)
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany (J.B.J); Institute of Molecular and Clinical Ophthalmology Basel, Switzerland (J.B.J)
| | - Wei Wang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z).
| | - Xiulan Zhang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z).
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Hyper- and hypo-perfusion of choriocapillaris in the eyes with pachychoroid pigment epitheliopathy. Graefes Arch Clin Exp Ophthalmol 2022; 261:981-988. [PMID: 36434143 DOI: 10.1007/s00417-022-05877-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the changes in choriocapillaris vessel density (VD) in eyes with pachychoroid pigment epitheliopathy (PPE) using swept-source optical coherence tomography (OCT) angiography (OCTA). METHODS This study included 83 eyes with PPE and 42 control eyes. We collected OCT and OCTA parameters, including central point thickness, subfoveal choroidal thickness (SFChT), and choriocapillaris VD of the fovea (CC fovea) and parafovea. The parafoveal area was divided into superior, nasal, inferior, and temporal choriocapillaris areas. Maximum (CC max) and minimum (CC min) choriocapillaris VD were defined as the highest and lowest values among the four parafoveal subfield VDs, respectively. We analyzed the average choriocapillaris VD, CC max, CC min, CC fovea, and the difference between CC max and CC min (CC delta) individually and compared all the parameters between PPE and control eyes. RESULTS CC max (56.0% ± 1.7%) was significantly higher and CC min (50.9% ± 2.0%) significantly lower in eyes with PPE than in control eyes (CC max, 55.3% ± 1.0%, P = 0.006; CC min, 51.5% ± 1.3%, P = 0.046). The CC delta value (5.0% ± 2.1%) and SFChT (389.9 ± 129.9 μm) were also significantly higher in eyes with PPE than in the control group (3.7% ± 1.5%, P < 0.001; 268.2 ± 102.2 μm, P < 0.001; respectively). CONCLUSIONS Choriocapillaris VD showed higher variability (hyperperfusion and hypoperfusion) in eyes with PPE than in control eyes. Choriocapillaris hypoperfusion may precede the development of PPE; however, choriocapillaris hyperperfusion is associated with projection artifacts.
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Choroidal Vasculature Changes in Age-Related Macular Degeneration: From a Molecular to a Clinical Perspective. Int J Mol Sci 2022; 23:ijms231912010. [PMID: 36233311 PMCID: PMC9570412 DOI: 10.3390/ijms231912010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/26/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
The contribution of choroidal vasculature to the pathogenesis of age-related macular degeneration (AMD) has been long debated. The present narrative review aims to discuss the primary molecular and choroidal structural changes occurring with aging and AMD with a brief overview of the principal multimodal imaging modalities and techniques that enable the optimal in vivo visualization of choroidal modifications. The molecular aspects that target the choroid in AMD mainly involve human leukocyte antigen (HLA) expression, complement dysregulation, leukocyte interaction at Bruch’s membrane, and mast cell infiltration of the choroid. A mechanistic link between high-risk genetic loci for AMD and mast cell recruitment has also been recently demonstrated. Recent advances in multimodal imaging allow more detailed visualization of choroidal structure, identifying alterations that may expand our comprehension of aging and AMD development.
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Lee SC, Rusakevich AM, Amin A, Tran S, Emami-Naeini P, Moshiri A, Park SS, Yiu G. Long-Term Retinal Vascular Changes in Age-Related Macular Degeneration Measured Using Optical Coherence Tomography Angiography. Ophthalmic Surg Lasers Imaging Retina 2022; 53:529-536. [DOI: 10.3928/23258160-20220919-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lun K, Sim YC, Chong R, Wong D, Tan B, Husain R, Aung T, Sng CCA, Schmetterer L, Chua J. Investigating the macular choriocapillaris in early primary open-angle glaucoma using swept-source optical coherence tomography angiography. Front Med (Lausanne) 2022; 9:999167. [PMID: 36213634 PMCID: PMC9532514 DOI: 10.3389/fmed.2022.999167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction There has been a growing interest in the role of vascular factors in glaucoma. Studies have looked at the characteristics of macular choriocapillaris in patients with glaucoma but with conflicting results. Our study aims to use swept-source optical coherence tomography angiography (SS-OCTA) to evaluate macular choriocapillaris metrics in normal participants and compare them with patients with early primary open-angle glaucoma (POAG) (mean deviation better than −6dB). Methods In this prospective, observational, cross-sectional study, 104 normal controls (157 eyes) and 100 patients with POAG (144 eyes) underwent 3 mm × 3mm imaging of the macula using the Plex Elite 9000 (Zeiss Meditec, Dublin, CA, USA). Choriocapillaris OCTA images were extracted from the device’s built-in review software and were subsequently evaluated for the density and size of choriocapillaris flow deficits. Results After adjusting for confounding factors, the density of flow deficits was independently higher in those aged 53 years and above (P ≤ 0.024) whereas the average flow deficit size was significantly larger in those aged 69 years and above (95% CI = 12.39 to 72.91; P = 0.006) in both normal and POAG patients. There were no significant differences in the density of flow deficits (P = 0.453) and average flow deficit size (P = 0.637) between normal and POAG participants. Conclusion Our study found that macular choriocapillaris microvasculature on SS-OCTA is unaltered by subjects with POAG. This suggests that OCTA macular choriocapillaris may not be potentially helpful in differentiating early glaucoma from healthy eyes.
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Affiliation(s)
- Katherine Lun
- Department of Ophthalmology, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yin Ci Sim
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Rachel Chong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Damon Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Bingyao Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Rahat Husain
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Tin Aung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Chelvin C. A. Sng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Jacqueline Chua
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Jacqueline Chua,
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Mulfaul K, Russell JF, Voigt AP, Stone EM, Tucker BA, Mullins RF. The Essential Role of the Choriocapillaris in Vision: Novel Insights from Imaging and Molecular Biology. Annu Rev Vis Sci 2022; 8:33-52. [PMID: 36108103 PMCID: PMC9668353 DOI: 10.1146/annurev-vision-100820-085958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
The choriocapillaris, a dense capillary network located at the posterior pole of the eye, is essential for supporting normal vision, supplying nutrients, and removing waste products from photoreceptor cells and the retinal pigment epithelium. The anatomical location, heterogeneity, and homeostatic interactions with surrounding cell types make the choroid complex to study both in vivo and in vitro. Recent advances in single-cell RNA sequencing, in vivo imaging, and in vitro cell modeling are vastly improving our knowledge of the choroid and its role in normal health and in age-related macular degeneration (AMD). Histologically, loss of endothelial cells (ECs) of the choriocapillaris occurs early in AMD concomitant with elevated formation of the membrane attack complex of complement. Advanced imaging has allowed us to visualize early choroidal blood flow changes in AMD in living patients, supporting histological findings of loss of choroidal ECs. Single-cell RNA sequencing is being used to characterize choroidal cell types transcriptionally and discover their altered patterns of gene expression in aging and disease. Advances in induced pluripotent stem cell protocols and 3D cultures will allow us to closely mimic the in vivo microenvironment of the choroid in vitro to better understand the mechanism leading to choriocapillaris loss in AMD.
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Affiliation(s)
- Kelly Mulfaul
- Department of Ophthalmology and Visual Sciences and the Institute for Vision Research, The University of Iowa, Iowa City, Iowa, USA;
| | - Jonathan F Russell
- Department of Ophthalmology and Visual Sciences and the Institute for Vision Research, The University of Iowa, Iowa City, Iowa, USA;
| | - Andrew P Voigt
- Department of Ophthalmology and Visual Sciences and the Institute for Vision Research, The University of Iowa, Iowa City, Iowa, USA;
| | - Edwin M Stone
- Department of Ophthalmology and Visual Sciences and the Institute for Vision Research, The University of Iowa, Iowa City, Iowa, USA;
| | - Budd A Tucker
- Department of Ophthalmology and Visual Sciences and the Institute for Vision Research, The University of Iowa, Iowa City, Iowa, USA;
| | - Robert F Mullins
- Department of Ophthalmology and Visual Sciences and the Institute for Vision Research, The University of Iowa, Iowa City, Iowa, USA;
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Computerized Texture Analysis of Optical Coherence Tomography Angiography of Choriocapillaris in Normal Eyes of Young and Healthy Subjects. Cells 2022; 11:cells11121934. [PMID: 35741063 PMCID: PMC9221889 DOI: 10.3390/cells11121934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
Computerized texture analysis uses higher-order mathematics to identify patterns beyond what the naked eye can recognize. We tested its feasibility in optical coherence tomography angiography imaging of choriocapillaris. Our objective was to determine sets of parameters that provide coherent and consistent output when applied to a homogeneous, healthy group of patients. This observational cross-sectional study involved 19 eyes of 10 young and healthy Caucasian subjects. En-face macular optical coherence tomography angiography of superficial choriocapillaris was obtained by the RTVue-XR Avanti system. Various algorithms were used to extract texture features. The mean and standard deviation were used to assess the distribution and dispersion of data points in each metric among eyes, which included: average gray level, gray level yielding 70% threshold and 30% threshold, balance, skewness, energy, entropy, contrast, edge mean gradient, root-mean-square variation, and first moment of power spectrum, which was compared between images, showing a highly concordant homology between all eyes of participants. We conclude that computerized texture analysis for en-face optical coherence tomography angiography images of choriocapillaris is feasible and provides values that are coherent and tightly distributed around the mean in a homogenous, healthy group of patients. Homology of blob size among subjects may represent a “repeat pattern” in signal density and thus a perfusion in the superficial choriocapillaris of healthy young individuals of the same ethnic background.
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Impact of signal strength on quantitative retinal and choriocapillaris flow measurement from optical coherence tomography angiography. Sci Rep 2022; 12:4692. [PMID: 35304582 PMCID: PMC8933462 DOI: 10.1038/s41598-022-08781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
We evaluated the impact of signal strength (SS) on quantitative measurements from optical coherence tomography (OCTA). Twenty healthy-volunteers were included. A neutral density filter (NDF) was attached to spectral-domain OCTA (SD-OCTA) and swept-source OCTA (SS-OCTA). All subjects were imaged with both devices three times using three different conditions: no filter, NDF0.3, and NDF0.6. For SD-OCTA, SS decreased from 10.0 to 8.2 and 4.0 with the NDF0.3 and 0.6, respectively. The vessel density (VD) and vessel length density (VLD) of the superficial capillary plexus (SCP) decreased when SS decreased from 10 to 8.2, but no further decrease when SS changed from 8.2 to 4.0. The flow metrics of the deep capillary plexus (DCP) did not change. For SS-OCTA, SS decreased from 10 to 9.5 and 7.2. The VD and VLD of the SCP and DCP decreased when SS decreased, except for the VD of the DCP when SS changed from 10 to 9.5. The choriocapillaris flow deficits significantly increased along with the decrease in SS. Quantitative flow parameters were significantly affected by a small change in SS and were most conspicuous in the SCP and choriocapillaris. These finding highlight the importance of high and consistent SS in quantitative OCTA studies.
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Cicinelli MV, Ritter M, Tausif H, Ghossein C, Aschauer C, Laccone F, Nagel M, Jampol LM, Gill MK. Characterization of Choriocapillaris and Choroidal Abnormalities in Alport Syndrome. Transl Vis Sci Technol 2022; 11:23. [PMID: 35311929 PMCID: PMC8944388 DOI: 10.1167/tvst.11.3.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To analyze the characteristics of the choriocapillaris and the choroid in patients with Alport syndrome (AS) and investigate their clinical and demographic associations. Methods Multicenter, cross-sectional study. Forty-two eyes with AS were consecutively enrolled. A cohort of 33 healthy eyes was included as controls. Demographics and medical history were collected for each participant. Each eye underwent 3 × 3 swept-source optical coherence tomography angiography (PLEX Elite 9000 2.0; Carl Zeiss Meditec, Dublin, CA, USA) and spectral-domain OCT (Spectralis HRA2; Heidelberg Engineering, Heidelberg, Germany). Choriocapillaris flow deficit (FD) number, mean FD size, total FD area, FD density, subfoveal choroidal thickness (CT), total CT, and choroidal vascularity index (CVI) were compared between AS and control eyes. Factors associated with the FD density and the CVI in AS were explored with multivariable linear mixed models. Results There was high intragroup variability in choriocapillaris and choroidal measurements in patients with AS. Choriocapillaris FD in patients with AS were more numerous compared to controls (P = 0.02). FD density in eyes with AS increased with older age (estimate = 0.31% for each year; 95% confidence interval [CI], 0.06−0.57; P = 0.02) and was higher in patients with a history of kidney transplant (estimate = 9.66% in case of positive history; 95% CI, 3.52−15.8; P = 0.006). The CVI was lower in eyes with dot maculopathy (estimate = −3.30% if present; 95% CI, −6.38 to −0.21; P = 0.04) and anterior lenticonus (estimate = −6.50% if present; 95% CI, −10.99 to −2.00; P = 0.006). Conclusions Patients with AS with kidney involvement requiring transplant may present with more severe choriocapillaris impairment. Lower choroidal vascularity was found in the presence of other ocular structural abnormalities. Translational Relevance An increased load of choriocapillaris flow deficits on optical coherence tomography angiography was found in patients with Alport syndrome who also had severe kidney disease requiring transplant.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Markus Ritter
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Hassan Tausif
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cybele Ghossein
- Division of Nephrology and Hypertension, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Constantin Aschauer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Franco Laccone
- Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Mato Nagel
- Centre for Nephrology and Metabolic Medicine, Weisswasser, Germany
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Manjot K Gill
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Rosenfeld PJ, Trivizki O, Gregori G, Wang RK. An Update on the Hemodynamic Model of Age-Related Macular Degeneration. Am J Ophthalmol 2022; 235:291-299. [PMID: 34509436 DOI: 10.1016/j.ajo.2021.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To provide an update on the hemodynamic model of age-related macular degeneration (AMD). DESIGN Evidence-based perspective. METHODS Review of the literature and experience of the authors. RESULTS Choroidal hemodynamics are not the primary cause of AMD as proposed by Ephraim Friedman in 1997. However, evidence is accumulating to suggest that choroidal perfusion is an important environmental influence that contributes to our understanding of disease progression in this complex genetic disorder. Although early and intermediate AMD seem to be influenced to a large extent by the underlying genetics, the asymmetry of disease progression to the later stages of AMD cannot be explained by genetics alone. The progression of disease and the asymmetry of this progression seem to correlate with abnormalities in choroidal perfusion that can be documented by optical coherence tomography. These perfusion abnormalities in the setting of a thickened Bruch's membrane are thought to exacerbate the impaired nutritional exchange between the retinal pigment epithelium and the choriocapillaris. We propose that the genetic susceptibility to develop AMD combined with age-related changes in macular choroidal hemodynamics, such as increasing choriocapillaris perfusion deficits and decreasing choroidal vascular densities, play an important role in disease progression and may help to explain the asymmetry between eyes, particularly in the later stages of AMD. CONCLUSIONS This updated hemodynamic model of AMD focuses on disease progression and highlights the importance of age-related changes in the choroidal circulation as a major environmental influence on disease severity in eyes that are genetically susceptible to develop AMD.
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Affiliation(s)
- Philip J Rosenfeld
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA.
| | - Omer Trivizki
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA; Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University (O.T.), Tel Aviv, Israel and the Department of Bioengineering (R.K.W.) and Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Giovanni Gregori
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA
| | - Ruikang K Wang
- Department of Ophthalmology (R.K.W.), University of Washington, Seattle, Washington, USA
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Cheng W, Song Y, Lin F, Jin L, Wang Z, Jonas JB, Wang W, Zhang X. Choriocapillaris Flow Deficits in Normal Chinese Imaged by Swept-Source Optical Coherence Tomographic Angiography. Am J Ophthalmol 2022; 235:143-153. [PMID: 34582767 DOI: 10.1016/j.ajo.2021.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the ocular and systemic determinants of the choriocapillaris flow deficits percentage (CC FD%) in normal eyes. DESIGN Observational cross-sectional study. METHODS Healthy Chinese participants without ocular or systemic diseases underwent detailed ophthalmic evaluations, including swept-source optical coherence tomography angiography (SS-OCTA) with 6- × 6-mm macular choriocapillaris images. The CC FD% was assessed in circular regions with diameters of 1.0 and 5.0 mm, rings with 1.0- to 2.5-mm diameters, and rings with 2.5- to 5.0-mm diameters. RESULTS The study included 830 individuals (mean ± SD age 58.66 ± 8.75 years). CC FD% (mean ± SD 22.05% ± 1.13%) was the lowest in the 2.5- to 5.0-mm ring, followed by the 1.0- to 2.5-mm ring, and highest in the 1.0-mm circle. In multivariable analysis, a higher CC FD% was associated with older age (β = 0.16 [95% confidence interval {CI}] 0.08-0.24, P < .001), higher intraocular pressure (β = 0.34 [95% CI 0.25-0.42], P < .001), higher serum concentrations of high-density lipoprotein cholesterol (β = 0.24 [95% CI 0.17-0.32], P < .001), and lower image quality score (β = -0.22 [95% CI -0.30 to -0.14], P < .001). CC FD% was also independent of axial length. CONCLUSIONS In healthy adult Chinese individuals, a higher CC FD% was associated with older age, higher intraocular pressure, and higher high-density lipoprotein cholesterol serum concentration. These factors may influence clinical assessments of the choriocapillaris. The lack of an association between CC FD% and axial length is consistent with similar findings for Bruch membrane thickness, macular retinal thickness, and macular retinal pigment epithelium cell density.
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Affiliation(s)
- Weijing Cheng
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunhe Song
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fengbin Lin
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ling Jin
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhenyu Wang
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jost B Jonas
- and the Department of Ophthalmology (J.B.J.), Medical Faculty Mannheim, Heidelberg University, Germany
| | - Wei Wang
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Xiulan Zhang
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Zouache MA. Variability in Retinal Neuron Populations and Associated Variations in Mass Transport Systems of the Retina in Health and Aging. Front Aging Neurosci 2022; 14:778404. [PMID: 35283756 PMCID: PMC8914054 DOI: 10.3389/fnagi.2022.778404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
Aging is associated with a broad range of visual impairments that can have dramatic consequences on the quality of life of those impacted. These changes are driven by a complex series of alterations affecting interactions between multiple cellular and extracellular elements. The resilience of many of these interactions may be key to minimal loss of visual function in aging; yet many of them remain poorly understood. In this review, we focus on the relation between retinal neurons and their respective mass transport systems. These metabolite delivery systems include the retinal vasculature, which lies within the inner portion of the retina, and the choroidal vasculature located externally to the retinal tissue. A framework for investigation is proposed and applied to identify the structures and processes determining retinal mass transport at the cellular and tissue levels. Spatial variability in the structure of the retina and changes observed in aging are then harnessed to explore the relation between variations in neuron populations and those seen among retinal metabolite delivery systems. Existing data demonstrate that the relation between inner retinal neurons and their mass transport systems is different in nature from that observed between the outer retina and choroid. The most prominent structural changes observed across the eye and in aging are seen in Bruch’s membrane, which forms a selective barrier to mass transfers at the interface between the choroidal vasculature and the outer retina.
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Inner and Outer Choroidal changes in the Fellow Eye of Patients with Unilateral Central Serous Chorioretinopathy. Retina 2022; 42:1238-1247. [DOI: 10.1097/iae.0000000000003452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nesper PL, Fawzi AA. NEW METHOD FOR REDUCING ARTIFACTUAL FLOW DEFICITS CAUSED BY COMPENSATION TECHNIQUES IN THE CHORIOCAPILLARIS WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2022; 42:328-335. [PMID: 34653115 PMCID: PMC8776592 DOI: 10.1097/iae.0000000000003313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To mitigate artifactual choriocapillaris flow deficits in optical coherence tomography angiography, which are a side effect of inverse structural optical coherence tomography compensation. METHODS In a modified algorithm, we set pixels in the original structural optical coherence tomography that were greater than one SD above the mean intensity (hyperreflective regions) to the mean pixel intensity of the image to remove hyporeflective regions in the inverse slab. We compared this algorithm to the original using flow deficit density and multiscale structural similarity index obtained from three distinct thresholding methods (local Phansalkar, global MinError (I), and global Li). RESULTS We included 16 eyes of 16 healthy subjects (31.1 ± 6.9 years, 10 females). Using the modified optical coherence tomography correction, flow deficit density was lower compared with the original algorithm using Phansalkar (P < 0.001) but higher using Li thresholding (P = 0.049). Multiscale structural similarity index was increased after applying the modified algorithm with all three thresholding methods (P < 0.001), indicating a closer relationship to the original optical coherence tomography angiography scan. CONCLUSION We demonstrate a new method that significantly reduced the introduction of artifactual flow deficits in the choriocapillaris during postprocessing. Given the improved multiscale structural similarity index, we believe our algorithm more accurately represents the choriocapillaris.
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Affiliation(s)
- Peter L Nesper
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Rinella NT, Zhou H, Wong J, Zhang Q, Nattagh K, Porco TC, Wang RK, Schwartz DM, Duncan JL. Correlation Between Localized Choriocapillaris Perfusion and Macular Function in Eyes with Geographic Atrophy. Am J Ophthalmol 2022; 234:174-182. [PMID: 34437870 DOI: 10.1016/j.ajo.2021.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To test the hypothesis that choriocapillaris perfusion correlates with visual function in geographic atrophy (GA). DESIGN Cross-sectional, single-center study. METHODS We imaged choriocapillaris flow using 6 × 6-mm swept-source optical coherence tomography angiography scans and measured retinal sensitivity using fundus-guided microperimetry in the central 20° in 18 eyes of 12 patients with GA and 7 eyes of 4 healthy persons. Optical coherence tomography angiography scans were divided into a grid and microperimetry results were superimposed using retinal vascular landmarks. The main outcome measure correlated choriocapillaris flow deficit with retinal sensitivity at each localized region. Robust linear mixed effects regression compared flow deficit or sensitivity with distance from the fovea. The Pearson r correlation described the relationship between flow deficit or retinal sensitivity and distance from the GA border. RESULTS Choriocapillaris flow deficit was significantly greater in patients with GA than in healthy persons (mean ± SD: 24.2% ± 7.9% vs 7.9% ± 2.3%; P = .0015) and retinal sensitivity was significantly lower in patients with GA than in healthy persons (mean difference ± SD: -17.0 ± 1.2 dB; P < .001). In GA, choriocapillaris flow deficit decreased (r = -0.40; 95% CI: -0.54 to -0.27) and retinal sensitivity increased (r = +0.63; 95% CI: 0.30 to 0.81) with distance from the GA margin. Choriocapillaris flow deficits inversely correlated with retinal sensitivity (r = -0.61; 95% CI: -0.75 to -0.42). CONCLUSIONS Choriocapillaris flow and retinal sensitivity improved with distance from the GA margin. Choriocapillaris flow deficit was inversely correlated with sensitivity, supporting the hypothesis that choriocapillaris perfusion correlated with macular function.
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Affiliation(s)
- Nicholas T Rinella
- From the Department of Ophthalmology (N.T.R., J.W., K.N., T.C.P., D.M.S., J.L.D.), University of California, San Francisco, California, USA
| | - Hao Zhou
- Department of Bioengineering (H.Z., Q.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Jessica Wong
- From the Department of Ophthalmology (N.T.R., J.W., K.N., T.C.P., D.M.S., J.L.D.), University of California, San Francisco, California, USA
| | - Qinqin Zhang
- Department of Bioengineering (H.Z., Q.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Khashayar Nattagh
- From the Department of Ophthalmology (N.T.R., J.W., K.N., T.C.P., D.M.S., J.L.D.), University of California, San Francisco, California, USA
| | - Travis C Porco
- From the Department of Ophthalmology (N.T.R., J.W., K.N., T.C.P., D.M.S., J.L.D.), University of California, San Francisco, California, USA; Francis I. Proctor Foundation (T.C.P.), University of California, San Francisco, California, USA
| | - Ruikang K Wang
- Department of Bioengineering (H.Z., Q.Z., R.K.W.), University of Washington, Seattle, Washington, USA
| | - Daniel M Schwartz
- From the Department of Ophthalmology (N.T.R., J.W., K.N., T.C.P., D.M.S., J.L.D.), University of California, San Francisco, California, USA
| | - Jacque L Duncan
- From the Department of Ophthalmology (N.T.R., J.W., K.N., T.C.P., D.M.S., J.L.D.), University of California, San Francisco, California, USA.
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Corvi F, Corradetti G, Sadda SR. Comparison Between Different Segmentation Strategies for the Choriocapillaris Using Optical Coherence Tomography Angiography. Ophthalmic Surg Lasers Imaging Retina 2021; 52:642-649. [PMID: 34908487 DOI: 10.3928/23258160-20211123-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the relationship between retinal pigment epithelium (RPE) and RPE fit-based segmentations of the choriocapillaris (CC) and its expected anatomic location. PATIENTS AND METHODS Consecutive healthy participants' eyes were imaged with optical coherence tomography angiography (PLEX Elite) with 3 × 3-mm and 6 × 6-mm scan. Ground-truth images were generated using 16-μm-thick slabs starting from 4 μm below the automatically segmented Bruch's membrane (BM) band. A series of slabs positioned below the RPE band and RPE fit were also generated, and CC flow deficit percentage was compared with the ground-truth segmentation. RESULTS Twenty-six eyes of 26 participants were analyzed. For both scans, the 21 to 37-μm slab offset from the RPE band most closely matched the BM-based ground-truth slab with mean differences of 0.78% and 0.36%. CONCLUSION The CC flow deficit percentage from the RPE band correlated strongly with BM-based CC slabs, with the closest approximation observed with slab offset 21 to 37 μm from the RPE band centerline. [Ophthalmic Surg Lasers Imaging. 2021;52:642-649.].
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Sun G, Chen C, Jiang J, Yi Z, Wang X, Miao Q, Xu A, He L. NEW INSIGHTS INTO THE ASSOCIATION BETWEEN CHOROIDAL VESSELS AND CHORIOCAPILLARIS IN NORMAL EYES. Retina 2021; 41:2612-2619. [PMID: 34173364 DOI: 10.1097/iae.0000000000003238] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the relationship between large-sized and medium-sized choroidal vessels and choriocapillaris using the three-dimensional choroidal vascularity index (3D CVI) and percentage of flow deficits (FD%). METHODS Prospective observational study. The main outcome measures included choroidal volume parameters (3D CVI, mean choroidal thickness, total choroidal volume, choroidal luminal volume, and choroidal stromal volume), choriocapillaris parameters (FD%, average area of FD, and FD count), and age and axial length. RESULTS A total of 63 healthy individuals with an average age of 40.60 ± 12.32 years were included in this study. Univariate analysis showed that FD% (R = 0.295, P = 0.019) and area of FD (R = 0.276, P = 0.028) were significantly positively associated with 3D CVI, and FD count was negatively associated with 3D CVI (R = -0.297, P = 0.018). After adjusting for age and axial length, a significant correlation between FD% and 3D CVI (R = 0.264, P = 0.039) and between area of FD and 3D CVI remained (R = 0.267, P = 0.037). However, no significant correlation was found between FD count and 3D CVI after adjusting for axial length (R = -0.220, P = 0.085). CONCLUSION In healthy individuals, choroidal vessel dilatation as suggested by elevated 3D CVI may lead to decreased choriocapillaris perfusion, which was correlated with an enlarged area of FD in choriocapillaris.
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Affiliation(s)
- Gongpeng Sun
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
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Wu H, Sugano Y, Itagaki K, Kasai A, Shintake H, Sekiryu T. The characteristics of choriocapillaris flow void in the unilateral polypoidal choroidal vasculopathy fellow eyes. Sci Rep 2021; 11:23059. [PMID: 34845281 PMCID: PMC8629998 DOI: 10.1038/s41598-021-02377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
To evaluate the morphological characteristics of flow void (FV) in the fellow eyes of the unilateral polypoidal choroidal vasculopathy (PCV). Fifty PCV fellow eyes (PCVF) and 31 age-matched normal ocular circulation controls were recruited in this retrospective study. The number of FV was analyzed according to the size in a centered 5 × 5 mm swept source optical coherence tomography angiography scans. We used indocyanine green angiography images to determine whether choroidal vascular hyperpermeability (CVH) has occurred. For the PCVF, the prevalence rate of CVH was 70% (35 of 50) The number of FVs was significantly lower in 400-25,000 μm2 (P = 0.005), 400-500 μm2 (P = 0.001), 525-625 μm2 (P = 0.001) and 650-750 μm2 (P = 0.018). compared to the controls. And showed no difference in size from 775 to 1125 μm2 between the two groups. The area under the receiver operating characteristic curve of PCVF with CVH and controls was 0.94 (95% CI 0.88-1.00) (P < 0.001). We found that the number of small FVs was significantly lower in the PCV fellow eyes than that in the eyes with control group.
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Affiliation(s)
- Huajui Wu
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Yukinori Sugano
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Kanako Itagaki
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Akihito Kasai
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Hiroaki Shintake
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, Japan.
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Correlations among age, sex, axial length, and subfoveal choroidal thickness in the choriocapillaris structure analyzed using multiple en face image averaging optical coherence tomography angiography. PLoS One 2021; 16:e0259880. [PMID: 34780537 PMCID: PMC8592481 DOI: 10.1371/journal.pone.0259880] [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: 04/23/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To analyze the structure of the choriocapillaris in healthy eyes by using averaged en face images acquired using swept source optical coherence tomography angiography and to examine the changes in the macular profile in relation to age, sex, axial length, and choroidal thickness. Methods This prospective, cross-sectional study included 81 eyes of 81 subjects without ophthalmologic or systemic diseases who underwent a full ophthalmologic examination, including 3 × 3-mm macular optical coherence tomography angiography. Four to nine choriocapillaris en face images were registered and averaged. The averaged images were then binarized and analyzed. Results The averaged choriocapillaris images showed a continuous capillary meshwork, whereas the unaveraged images had a granular appearance. The mean total area and size of flow voids were 0.99 ± 0.20 mm2 and 567.8 ± 201.5 μm2, respectively, and these values correlated positively with age (p = 0.002, R = 0.336 and p = 0.026, R = 0.247, respectively). Age-related gains in the mean total area and flow void size were 4.20 × 10−3 mm2 and 3.07 μm2 per year, respectively. However, the mean total area and flow void size had no significant correlation with axial length, subfoveal choroidal thickness, or sex. Conclusions Multiple averaged en face swept source optical coherence tomography angiography is more effective than a single optical coherence tomography angiography scan for better visualizing the choriocapillaris. The total area and size of flow voids within a 3 × 3-mm macular area positively correlated with age. This technique can be useful for investigating the changes arising in macular diseases.
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Progression of choriocapillaris flow deficits in clinically stable intermediate age-related macular degeneration. Eye (Lond) 2021; 35:2991-2998. [PMID: 33414537 PMCID: PMC8526707 DOI: 10.1038/s41433-020-01298-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/17/2020] [Accepted: 11/05/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the choriocapillaris (CC) flow deficit (FD) in eyes with stable intermediate age-related macular degeneration (AMD) eyes over 12 months of follow-up. METHODS Thirty four patients with intermediate AMD were prospectively enrolled and evaluated by swept-source optical coherence tomography (SS-OCT) and OCT-angiography (OCTA) using the PLEX-Elite 9000. A 6 × 6 mm foveal-centered scan was used for both modalities and the study eyes were scanned twice to allow subsequent averaging. En face OCTA CC slabs (31-41 µm below the RPE-band) were exported and compensated for signal attenuation. Two compensated CC en-face images were registered and averaged prior to binarization and CC FD computation. The CC FD of the entire 6 × 6 macular region was quantified at baseline and at 12-months. The presence of high-risk features, namely intraretinal hyper-reflective foci (HRF), subretinal drusenoid deposits (SDD), and hyporeflective-core-drusen, were evaluated using SS-OCT volume scans. RESULTS Among the 34 eyes, 25 eyes from 25 patients were noted on exam and OCT to remain stable as intermediate AMD at 12-months without the development of late AMD. Eleven eyes had high-risk features at baseline compared to 14 eyes at the end of the follow-up (p = 0.094). The mean ± SD FD% across the whole 6 × 6 macular region at baseline was 19.32 ± 4.64% and significantly increased to 28.62 ± 4.71% at the end of the study (p = 0.001). The CC FD progressed significantly both in non-HR and HR-eyes. CONCLUSIONS Choriocapillaris flow impairment significantly deteriorated over one year in relatively stable intermediate AMD. This might suggest that underlying progression of CC dysfunction occurs before structural changes appears on OCT and lead to the progression to late-stage AMD.
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Xu A, Sun G, Duan C, Chen Z, Chen C. Quantitative Assessment of Three-Dimensional Choroidal Vascularity and Choriocapillaris Flow Signal Voids in Myopic Patients Using SS-OCTA. Diagnostics (Basel) 2021; 11:diagnostics11111948. [PMID: 34829297 PMCID: PMC8618547 DOI: 10.3390/diagnostics11111948] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose: To compare the choroidal vascularity of large- and middle-sized choroidal vessels and choriocapillaris (CC) perfusion in patients with different degrees of myopia using swept-source optical coherence tomography angiography (SS-OCTA). Methods: One hundred and thirteen people with myopia were enrolled. SS-OCTA was performed to analyze the choroidal vascularity and CC perfusion. Three-dimensional (3D) choroidal vascularity index (CVI) and choroidal luminal volumes (LV) were obtained by artificial intelligence segmentation of the choroidal lumen in Volume OCT images. CC perfusion was assessed by flow signal voids (FSVs). Results: In the macular, multiple linear regression model showed that choroidal thickness (CT), total choroidal volume, LV, and choroidal stromal volume were negatively correlated with axis length (AL), respectively (all p < 0.001). Three dimensional CVI was negatively associated with AL (p < 0.05). FSV% was positively correlated with age only (p < 0.001). Additionally, after adjustment for age and AL, FSV% had a significant negative correlation with CT (p < 0.05). Conclusion: Choroidal vascularity decreases gradually with increasing severity of myopia. The decrease of CC blood perfusion was related to a higher severity of myopia and the thinning of choroid.
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Affiliation(s)
| | | | | | - Zhen Chen
- Correspondence: (Z.C.); (C.C.); Tel.: +86-130-7276-5173 (C.C.)
| | - Changzheng Chen
- Correspondence: (Z.C.); (C.C.); Tel.: +86-130-7276-5173 (C.C.)
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Shen LL, Sun M, Ahluwalia A, Park MM, Young BK, Del Priore LV. Local Progression Kinetics of Geographic Atrophy Depends Upon the Border Location. Invest Ophthalmol Vis Sci 2021; 62:28. [PMID: 34709347 PMCID: PMC8558522 DOI: 10.1167/iovs.62.13.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose To assess the influence of lesion morphology and location on geographic atrophy (GA) growth rate. Methods We manually delineated GA on color fundus photographs of 237 eyes in the Age-Related Eye Disease Study. We calculated local border expansion rate (BER) as the linear distance that a point on the GA border traveled over 1 year based on a Euclidean distance map. Eye-specific BER was defined as the mean local BER of all points on the GA border in an eye. The percentage area affected by GA was defined as the GA area divided by the total retinal area in the region. Results GA enlarged 1.51 ± 1.96 mm2 in area and 0.13 ± 0.11 mm in distance over 1 year. The GA area growth rate (mm2/y) was associated with the baseline GA area (P < 0.001), perimeter (P < 0.001), lesion number (P < 0.001), and circularity index (P < 0.001); in contrast, eye-specific BER (mm/y) was not significantly associated with any of these factors. As the retinal eccentricity increased from 0 to 3.5 mm, the local BER increased from 0.10 to 0.24 mm/y (P < 0.001); in contrast, the percentage of area affected by GA decreased from 49.3% to 2.3%. Conclusions Using distance-based measurements allows GA progression evaluation without significant confounding effects from baseline GA morphology. Local GA progression rates increased as a function of retinal eccentricity within the macula which is opposite of the trend for GA distribution, suggesting that GA initiation and enlargement may be mediated by different biological processes.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Mengyuan Sun
- Institute of Cardiovascular Diseases, Gladstone Institute, San Francisco, California, United States
| | - Aneesha Ahluwalia
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Michael M Park
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Lucian V Del Priore
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
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Longitudinal choriocapillaris changes in the presence of reticular pseudodrusen. Sci Rep 2021; 11:18227. [PMID: 34521974 PMCID: PMC8440680 DOI: 10.1038/s41598-021-97771-w] [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: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 01/15/2023] Open
Abstract
To determine longitudinal changes in choriocapillaris (CC) measures in eyes with reticular pseudodrusen (RPD) using optical coherence tomography angiography (OCTA). In this observational prospective study, 20 patients with exclusively RPD and no other alteration due to age-related macular degeneration were included. Eight RPD patients were re-examined at 5-year follow-up. Multimodal imaging was performed at baseline and at 5-year follow-up. OCTA CC images were analyzed for number, size and total area of flow deficits (FD), mean signal intensity, signal intensity standard deviation and kurtosis of signal intensity distribution in the ring area between a circle of 4 mm diameter and a circle of 6 mm diameter and in the superior ring quadrant. Area affected by RPD increased from 19.36 ± 8.39 mm2 at baseline to 37.77 ± 9.03 mm2 at 5-year follow-up. At baseline, percent of CC FD area was greater in RPD eyes (quadrant: p < 0.001; ring: p < 0.001) compared to controls. Besides, RPD eyes revealed a lower mean intensity signal (quadrant: p < 0.001; ring: p < 0.001). Evaluation of CC parameters suggested significant group × time interaction effects for CC FD (p = 0.04) and mean intensity signal (p = 0.004), in that RPD eyes presented increased CC FD and decreased mean intensity signal at follow-up. OCTA CC decorrelation signal further decreases in RPD patients over 5 years in both RPD-affected and RPD-unaffected macular areas.
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SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGE COMPENSATION OF THE CHORIOCAPILLARIS INDUCES ARTIFACTS. Retina 2021; 40:1865-1872. [PMID: 32453067 DOI: 10.1097/iae.0000000000002866] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze swept-source optical coherence angiography slab images acquired at the default level for the choriocapillaris from the Zeiss PLEX Elite 9000 before and after using a previously described imaging compensation technique. METHODS Eyes of normal subjects, in their 20 seconds and 30 seconds, were evaluated. Angiographic slab images, 20 µm in thickness, were taken at the default location of 29 to 49 µm below the retinal pigment epithelium. These images were evaluated, as were images that underwent a published compensation technique that adjusts for light penetration to the sampled layer. Each set of images was threshold at 1 SD below the mean. Visual comparison of the swept-source optical coherence angiography images along with a quantitative analysis using a novel parameter known as multiscale structural similarity index, a measure of image similarity, was performed. RESULTS Eleven eyes of 11 subjects were evaluated. The default location, 29 µm to 49 µm below the retinal pigment epithelium, showed the granular choriocapillaris appearance. Visual comparison showed that the compensation technique altered the appearance of the thresholded images, creating the appearance of new deficits while causing others to disappear. The mean multiscale structural similarity index for the original versus thresholded images and original versus thresholded compensated was 0.49 and 0.34, respectively, representing a statistically significant difference. CONCLUSION The findings of this study show that the use of a commonly used imaging compensation technique can have undesired effects on the image, and its use should be carefully considered. A model explaining the cause of such changes in the choriocapillaris swept-source optical coherence angiography images is presented.
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