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Agarwal A, Corvi F, Kumar Menia N, Aggarwal K, Erckens RJ, Berendschot TTJM, Webers CAB, Invernizzi A, Gupta V, Sadda S. Choriocapillaris Flow Deficit in Tubercular Serpiginous-Like Choroiditis with and without Paradoxical Worsening. Ocul Immunol Inflamm 2024; 32:898-904. [PMID: 36328764 DOI: 10.1080/09273948.2022.2140296] [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: 12/05/2021] [Revised: 09/15/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The aim is to analyze automated quantification of choriocapillaris flow deficit (CCFD) on swept-source (SS)-optical coherence tomography angiography (OCTA) in tubercular serpiginous-like choroiditis (TBSLC). METHODS In this prospective study, automated CCFD calculations were performed on SS-OCTA and compared with CCFD areas on indocyanine green angiography (ICGA). Patients were divided into two groups based on the occurrence of paradoxical worsening (PW). RESULTS Twenty-nine eyes (29 subjects; 18 males; mean age: 33±12 years) were included. The mean CCFD at baseline was 34.9 ± 4.3% on OCTA in eyes without PW and 35.4 ± 5.0% on SS-OCTA with PW (p = .77). At 4 and 12 weeks, CCFD on SS-OCTA improved to 30.6 ± 3.9% and 28.0 ± 4.2% (p < .001) without PW, respectively, and increased to 42.9 ± 4.4% and 48.8 ± 4.1% (p < .001) with PW, respectively. The SS-OCTA CCFD correlated well with ICGA (r = 0.48; p < .001). CONCLUSIONS Automated quantitative serial assessment of CCFD on SS-OCTA can serve as a useful biomarker of disease activity in eyes with TBSLC.
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Affiliation(s)
| | - Federico Corvi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nitin Kumar Menia
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Bilaspur, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Ahalia Eye Care, Abu Dhabi, UAE
| | - Roel J Erckens
- Maastricht University Medical Centre+, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- Maastricht University Medical Centre+, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Carroll A B Webers
- Maastricht University Medical Centre+, University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Vishali Gupta
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - SriniVas Sadda
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Deng XY, Liu H, Zhang ZX, Li HX, Wang J, Chen YQ, Mao JB, Sun MZ, Shen LJ. Retinal vascular morphological characteristics in diabetic retinopathy: an artificial intelligence study using a transfer learning system to analyze ultra-wide field images. Int J Ophthalmol 2024; 17:1001-1006. [PMID: 38895683 PMCID: PMC11144771 DOI: 10.18240/ijo.2024.06.03] [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: 08/29/2023] [Accepted: 01/31/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To investigate the morphological characteristics of retinal vessels in patients with different severity of diabetic retinopathy (DR) and in patients with or without diabetic macular edema (DME). METHODS The 239 eyes of DR patients and 100 eyes of healthy individuals were recruited for the study. The severity of DR patients was graded as mild, moderate and severe non-proliferative diabetic retinopathy (NPDR) according to the international clinical diabetic retinopathy (ICDR) disease severity scale classification, and retinal vascular morphology was quantitatively analyzed in ultra-wide field images using RU-net and transfer learning methods. The presence of DME was determined by optical coherence tomography (OCT), and differences in vascular morphological characteristics were compared between patients with and without DME. RESULTS Retinal vessel segmentation using RU-net and transfer learning system had an accuracy of 99% and a Dice metric of 0.76. Compared with the healthy group, the DR group had smaller vessel angles (33.68±3.01 vs 37.78±1.60), smaller fractal dimension (Df) values (1.33±0.05 vs 1.41±0.03), less vessel density (1.12±0.44 vs 2.09±0.36) and fewer vascular branches (206.1±88.8 vs 396.5±91.3), all P<0.001. As the severity of DR increased, Df values decreased, P=0.031. No significant difference between the DME and non-DME groups were observed in vascular morphological characteristics. CONCLUSION In this study, an artificial intelligence retinal vessel segmentation system is used with 99% accuracy, thus providing with relatively satisfactory performance in the evaluation of quantitative vascular morphology. DR patients have a tendency of vascular occlusion and dropout. The presence of DME does not compromise the integral retinal vascular pattern.
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Affiliation(s)
- Xin-Yi Deng
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Hui Liu
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei 230026, Anhui Province, China
| | - Zheng-Xi Zhang
- Department of Retina, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Han-Xiao Li
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Jun Wang
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Yi-Qi Chen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Jian-Bo Mao
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Ming-Zhai Sun
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei 230026, Anhui Province, China
| | - Li-Jun Shen
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
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Akıdan M, Erol MK, Gedik B, Doğan ME, Başol I, Süren E. Changes in Outcomes of Macular Optical Coherence Tomography Angiography Following Surgery for Optic Disc Pit Maculopathy. Diagnostics (Basel) 2024; 14:874. [PMID: 38732289 PMCID: PMC11082969 DOI: 10.3390/diagnostics14090874] [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: 03/01/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE we aimed to report on the optical coherence tomography angiography (OCTA) outcomes of eight patients with optic disc pit maculopathy (ODP-M) who were treated with 23-gauge pars plana vitrectomy (PPV). METHODS We examined sixteen eyes of eight patients-eight eyes with ODP-M and eight healthy fellow eyes. Fundus color photography, fundus autofluorescence, fundus fluorescein angiography, optical coherence tomography (OCT), and OCTA were performed. The vascular density, choriocapillaris blood flow (CCBF), and foveal avascular zone (FAZ) were analyzed using OCTA. Moreover, the correlation between the best-corrected visual acuity (BCVA) and macular OCTA parameters was assessed. RESULTS Compared with the healthy fellow eyes, the eyes with ODP-M preoperatively were found to have decreased BCVA, superficial capillary plexus (SCP) vascular density (i.e., total, foveal, parafoveal, and perifoveal), deep capillary plexus (DCP) vascular density (i.e., total, parafoveal, and perifoveal), and CCBF but a significantly increased FAZ (p < 0.05). When the eyes with ODP-M were analyzed pre- and postoperatively at month 12 after surgery, the BCVA, SCP vascular density (i.e., perifoveal), and CCBF had significantly increased, and the FAZ had significantly decreased (p < 0.05). When the eyes with ODP-M were compared with the healthy fellow eyes postoperatively at month 12, the BCVA, SCP, and DCP vascular density parameters had increased, along with CCBF, and the FAZ had decreased in eyes with ODP-M, though not to the levels of the healthy fellow eyes (p < 0.05). Moreover, a positive correlation was found between the postoperative BCVA and SCP total vascular density (p < 0.05). CONCLUSION The BCVA and macular OCTA parameters improved in eyes with ODP-M at month 12 following surgery. However, the BCVA and OCTA of the eyes operated on did not reach the levels of the healthy fellow eyes, possibly due to impaired choroidal blood flow (CBF) recovery and the presence of a larger FAZ. In summary, OCTA seems to be useful for assessing qualitative and quantitative perioperative microvascular changes.
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Affiliation(s)
- Melih Akıdan
- Department of Ophthalmology, Antalya Akseki State Hospital, 07630 Antalya, Turkey
| | - Muhammet Kazım Erol
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (M.K.E.); (E.S.)
| | - Birumut Gedik
- Department of Ophthalmology, Antalya Serik State Hospital, 07500 Antalya, Turkey;
| | | | - Ibrahim Başol
- Department of Ophthalmology, Antalya City Hospital, 07100 Antalya, Turkey;
| | - Elçin Süren
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey; (M.K.E.); (E.S.)
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Dan AO, Mocanu CL, Bălășoiu AT, Tănasie CA, Puiu I, Târtea AE, Sfredel V. Correlations between Retinal Microvascular Parameters and Clinical Parameters in Young Patients with Type 1 Diabetes Mellitus: An Optical Coherence Tomography Angiography Study. Diagnostics (Basel) 2024; 14:317. [PMID: 38337833 PMCID: PMC10855750 DOI: 10.3390/diagnostics14030317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES In the current study, we investigated the correlations between retinal microvascular parameters using optical coherence tomography angiography (OCTA) and clinical parameters for a group of 69 young patients with type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS This retrospective, exploratory study enrolled 69 patients between 5 years old and 30 years old who met the inclusion criteria. All the study participants underwent a comprehensive ophthalmic examination and OCTA scans for the evaluation of the retinal microcirculation. The retinal OCTA parameters were correlated with the following clinical parameters: the patient's age at the onset of the disease, the duration of T1DM, the BMI at the time of enrollment in the study, the HbA1C values at onset, the mean values of HbA1C over the period of monitoring the disease and the degree of DKA at onset. RESULTS For the study group, the foveal avascular zone (FAZ) area and perimeter correlated positively with the mean value of HbA1C (Pearson correlation, Sig.2-Tailed Area: 0.044; perimeter: 0.049). The total vessel density in the superficial capillary plexus (SCP) correlated negatively with the duration of T1DM, based on the superior and inferior analyzed areas (Spearman correlation, Sig.2-Tailed SCP in total region: 0.002; SCP in the superior region: 0.024; SCP in the inferior region: 0.050). The foveal thickness also correlated negatively with the levels of diabetic ketoacidosis (DKA) at onset (Spearman correlation, Sig.2-Tailed: 0.034) and the levels of HbA1C at onset (Spearman correlation, Sig.2-Tailed: 0.047). Further on, the study patients were distributed into two groups according to the duration of the disease: group 1 included 32 patients with a duration of T1DM of less than 5 years, and group 2 included 37 patients with a duration of T1DM of more than 5 years. Independent t-tests were used to compare the OCTA retinal parameters for the two subgroups. While the FAZ-related parameters did not show significant statistical differences between the two groups, the vessel densities in both the SCP and DCP were significantly lower in group 2. CONCLUSIONS Our data suggest that specific alterations in OCTA imaging biomarkers correlate with various clinical parameters: the FAZ area and perimeter increase with higher mean values of HbA1C, leading to poor metabolic control. Moreover, the SCP total vessel density decreases as the duration of T1DM increases. Regarding the vessel densities in the SCP and the DCP, they decrease with a duration of the disease of more than 5 years.
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Affiliation(s)
- Alexandra Oltea Dan
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.O.D.)
| | - Carmen Luminița Mocanu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andrei Teodor Bălășoiu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Cornelia Andreea Tănasie
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.O.D.)
| | - Ileana Puiu
- Department of Pediatrics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Anca Elena Târtea
- Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Veronica Sfredel
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.O.D.)
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Jung JJ, Lim SY, Chan X, Sadda SR, Hoang QV. Correlation of Diabetic Disease Severity to Degree of Quadrant Asymmetry in En Face OCTA Metrics. Invest Ophthalmol Vis Sci 2022; 63:12. [PMID: 35943732 PMCID: PMC9379327 DOI: 10.1167/iovs.63.9.12] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine if diabetic retinopathy (DR) severity affects quadrant asymmetry (QA) of optical coherence tomography angiography (OCTA) metrics differentially. Methods Ninety eyes (60 patients) with no diabetes mellitus (DM) (n = 39) or varying levels of DR (n = 51) had OCTA images (3 × 3 mm, Cirrus5000) acquired five times and averaged. The vessel length density (VLD) and perfusion density (PD) of the superficial retinal layer (SRL) and deep retinal layer (DRL) were measured. QA was defined as the maximum minus minimum value among four parafoveal Early Treatment Diabetic Retinopathy quadrants, and compared with DR severity by linear regression including fixed effects for each individual and eye. Results The mean patient age was 55.5 years (range, 24–88 years) and 60% were male. Comparing severe nonproliferative DR or proliferative DR versus no DM/DR eyes, QA was significantly higher for SRL VLD, and PD (+0.67 ± 0.16 and +0.014 ± 0.003; P < 0.001) and DRL VLD, and PD (+1.25 ± 0.16 and +0.032 ± 0.003; P < 0.001). When comparing mild or moderate nonproliferative DR versus no DM/DR, the DRL VLD, and PD were significantly higher (+0.51 ± 0.13 and +0.015 ± 0.003; P < 0.001). For every step increase in DR severity, there was a +0.20 QA for SRL VLD, +0.004 SRL PD, +0.33 DRL VLD and +0.009 DRL PD (P < 0.001). Regression analysis comparing intraquadrant effect on DR severity demonstrated that the superior quadrant was most affected for all OCTA metrics. Conclusions DR severity affects VLD and PD more asymmetrically across Early Treatment Diabetic Retinopathy quadrants with a linear increase in QA for each worsening level of DR. Individual intraeye metrics such as QA can accurately quantify DR severity without concerns for intereye variabilities that could affect the reproducibility and reliability of OCTA quantification.
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Affiliation(s)
- Jesse J Jung
- East Bay Retina Consultants Inc., Oakland, California, United States.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Shen Yi Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Xavier Chan
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Srinivas R Sadda
- Doheny Eye Institute, Los Angeles, California, United States.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York, United States
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Law VK, Lam AK. Effect of caffeine on superficial retinal vasculature of the macula in high myopes using optical coherence tomography angiography - A pilot study. JOURNAL OF OPTOMETRY 2022; 15:210-218. [PMID: 35637106 PMCID: PMC9237592 DOI: 10.1016/j.optom.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/13/2021] [Accepted: 06/18/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE To monitor effect of caffeine on vasculature of the inner retina of high myopes METHODS: This was a crossover, self-control, randomized trial. Healthy young high myopes were recruited to take 200 mg of caffeine capsule and placebo capsule, randomly assigned in two visits separated by at least one week. Superficial retinal vasculature in terms of vessel length density (VD) and perfusion area density (PD) was captured and monitored using a spectral domain optical coherence tomography angiography (OCTA) machine. After baseline measurements, blood pressure (BP), intraocular pressure (IOP), and subfoveal choroidal thickness (ChT) were also monitored at 30-min intervals till 3 h. RESULTS Eighteen subjects (6 male, 24.3 ± 3.1 years) completed the study. After taking the caffeine capsule, there was a significant increase in BP (p < 0.01), and reduction in ChT (p < 0.01), with no change in IOP (p = 0.36). VD demonstrated a trend of reduction at the central 1-mm circle, and 1-3 mm annulus (p < 0.01) following the ETDRS grid. Reduction trend of PD appeared at the central 1-mm circle, 1-3 mm annulus, and the entire 3-mm circle (p < 0.01). Compared with baseline, VD and PD reductions were significant 180 min after taking the caffeine capsule at the central 1-mm circle, but the reduction was small (VD: by 1mm-1; PD: by 1%). Changes in other regions were not significant. CONCLUSIONS The current study found significant reduction in VD and PD after taking 200 mg of caffeine capsule. Such a small amount of alteration may be clinically irrelevant.
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Affiliation(s)
- Victoria Km Law
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Andrew Kc Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Lu ES, Cui Y, Le R, Zhu Y, Wang JC, Laíns I, Katz R, Lu Y, Zeng R, Garg I, Wu DM, Eliott D, Vavvas DG, Husain D, Miller JW, Kim LA, Miller JB. Detection of neovascularisation in the vitreoretinal interface slab using widefield swept-source optical coherence tomography angiography in diabetic retinopathy. Br J Ophthalmol 2022; 106:534-539. [PMID: 33355148 PMCID: PMC9092312 DOI: 10.1136/bjophthalmol-2020-317983] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 11/11/2022]
Abstract
AIMS To compare the efficacy of diabetic retinal neovascularisation (NV) detection using the widefield swept-source optical coherence tomography angiography (WF SS-OCTA) vitreoretinal interface (VRI) Angio slab and SS-OCT VRI Structure slab. METHODS A prospective, observational study was performed at Massachusetts Eye and Ear from January 2019 to June 2020. Patients with proliferative diabetic retinopathy (PDR), patients with non-proliferative diabetic retinopathy and patients with diabetes but without diabetic retinopathy were included. All patients were imaged with WF SS-OCTA using the 12×12 mm Angio scan protocol centred on the fovea and optic disc. The en-face SS-OCTA VRI Angio slab and SS-OCT VRI Structure slab were evaluated for the presence or absence of NV. SS-OCTA B-scan was used to classify NV according to cross-sectional morphology (forward, tabletop or flat). All statistical analyses were performed using SPSS V.26.0. RESULTS One hundred and forty-two eyes of 89 participants were included in the study. VRI Angio detected NV at higher rates compared with VRI Structure (p<0.05). Combining VRI Angio and Structure improved detection rates compared with VRI Angio alone (p<0.05). Due to segmentation errors of the internal limiting membrane, NV with flat morphological classification had lower rates of detection on VRI Angio compared with NV with forward and tabletop morphology (p<0.05). CONCLUSIONS WF SS-OCTA 12×12 mm VRI Angio and SS-OCT VRI Structure imaging centred on the fovea and optic disc detected NV with high sensitivity and low false positives. The VRI slab may be useful to diagnose and monitor PDR in clinical practice.
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Affiliation(s)
- Edward S Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Ying Cui
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Rongrong Le
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ying Zhu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jay C Wang
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Inês Laíns
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Raviv Katz
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Yifan Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Itika Garg
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - David M Wu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Dean Eliott
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Joan W Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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8
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Kushner-Lenhoff S, Kogachi K, Mert M, Chu Z, Shahidzadeh A, Palejwala NV, Wolfe J, Itty S, Drenser KA, Capone A, Dugel PU, Moshfeghi AA, Ameri H, Daskivich LP, Wang RK, Kashani AH. Capillary density and caliber as assessed by optical coherence tomography angiography may be significant predictors of diabetic retinopathy severity. PLoS One 2022; 17:e0262996. [PMID: 35081154 PMCID: PMC8791516 DOI: 10.1371/journal.pone.0262996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/10/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To validate retinal capillary density and caliber associations with diabetic retinopathy (DR) severity in different clinical settings. METHODS This cross-sectional study assessed retinal capillary density and caliber in the superficial retinal layer of 3-mm OCTA scans centered on the fovea. Images were collected from non-diabetic controls and subjects with mild or referable DR (defined DR worse than mild DR) between February 2016 and December 2019 at secondary and tertiary eye care centers. Vessel Skeleton Density (VSD), a measure of capillary density, and Vessel Diameter Index (VDI), a measure of vascular caliber, were calculated from these images. Discriminatory performance of VSD and VDI was evaluated using multivariable logistic regression models predicting DR severity with adjustments for sex, hypertension, and hyperlipidemia. Area under the curve (AUC) was estimated. Model performance was evaluated in two different cohorts. RESULTS This study included 594 eyes from 385 subjects. Cohort 1 was a training cohort of 509 eyes including 159 control, 155 mild non-proliferative DR (NPDR) and 195 referable DR eyes. Cohort 2 was a validation cohort consisting of 85 eyes including 16 mild NPDR and 69 referable DR eyes. In Cohort 1, addition of VSD and VDI to a model using only demographic data significantly improved the model's AUC for discrimination of eyes with any DR severity from controls (0.91 [95% CI, 0.88-0.93] versus 0.80 [95% CI, 0.76-0.83], p < 0.001) and eyes with referable DR from mild NPDR (0.90 [95% CI, 0.86-0.93] versus 0.69 [95% CI, 0.64-0.75], p < 0.001). The transportability of this regression model was excellent when implemented in Cohort 2 for the referable DR versus mild NPDR comparison. The odds ratio of having any DR compared to control subjects, and referable DR compared to mild DR decreased by 15% (95% CI: 12-18%), and 13% (95% CI: 10-15%), respectively, for every 0.001 unit increase in VSD after adjusting for comorbidities. CONCLUSION OCTA-derived capillary density has real world clinical value for rapidly assessing DR severity.
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Affiliation(s)
- Sam Kushner-Lenhoff
- Department of Ophthalmology, UW Medicine Eye Institute, University of Washington, Seattle, Washington, United States of America
| | - Kaitlin Kogachi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Melissa Mert
- Preventative Medicine, Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, California, United States of America
| | - Zhongdi Chu
- Department of Biomedical Therapeutics, University of Washington, Seattle, Washington, United States of America
| | - Anoush Shahidzadeh
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California, Los Angeles, California, United States of America
| | - Neal V. Palejwala
- Retinal Consultants of Arizona, Phoenix, Arizona, United States of America
| | - Jeremy Wolfe
- Associated Retinal Consultants, Oakland University of William Beaumont School of Medicine, Royal Oak, Michigan, United States of America
| | - Sujit Itty
- Retinal Consultants of Arizona, Phoenix, Arizona, United States of America
| | - Kimberly A. Drenser
- Associated Retinal Consultants, Oakland University of William Beaumont School of Medicine, Royal Oak, Michigan, United States of America
| | - Antonio Capone
- Associated Retinal Consultants, Oakland University of William Beaumont School of Medicine, Royal Oak, Michigan, United States of America
| | - Pravin U. Dugel
- Retinal Consultants of Arizona, Phoenix, Arizona, United States of America
| | - Andrew A. Moshfeghi
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California, Los Angeles, California, United States of America
| | - Hossein Ameri
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California, Los Angeles, California, United States of America
| | - Lauren P. Daskivich
- Department of Ophthalmology, USC Roski Eye Institute, University of Southern California, Los Angeles, California, United States of America
- Ophthalmic Services and Eye Health Programs, Los Angeles County Department of Health Services, Los Angeles, California, United States of America
| | - Ruikang K. Wang
- Department of Biomedical Therapeutics, University of Washington, Seattle, Washington, United States of America
| | - Amir H. Kashani
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Impact of image averaging on vessel detection using optical coherence tomography angiography in eyes with macular oedema and in healthy eyes. PLoS One 2021; 16:e0257859. [PMID: 34679094 PMCID: PMC8535424 DOI: 10.1371/journal.pone.0257859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/11/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose To assess the repeatability of multiple automatic vessel density (VD) measurements and the effect of image averaging on vessel detection by optical coherence tomography angiography (OCTA). Methods An observational study was conducted in a series of healthy volunteers and patients with macular oedema. Five sequential OCTA images were acquired for each eye using the OptoVue HD device. The effect of the averaging of the 5 acquisitions on vessel detection was analysed quantitatively using a pixel-by-pixel automated analysis. In addition, two independent retina experts qualitatively assessed the change in vessel detection in averaged images segmented in 9 boxes and compared to the first non-averaged image. Results The automatic VD measurement in OCTA images showed a good repeatability with an overall mean intra-class correlation coefficient (ICC) of 0.924. The mean ICC was higher in healthy eyes compared to eyes with macular oedema (0.877 versus 0.960; p < 0.001) and in the superficial vascular plexus versus the deep vascular complex (0.967 versus 0.888; p = 0.001). The quantitative analysis of the effect of the averaging showed that averaged images had a mean gain of 790.4 pixels/box, located around or completing interruptions in the vessel walls, and a mean loss of 727.2 pixels/box. The qualitative analysis of the averaged images showed that 99.6% of boxes in the averaged images had a gain in vessel detection (i.e., vessels detected in the averaged image but not in the non-averaged image). The loss of pixels was due to a reduction in background noise and motion artifacts in all cases and no case of loss of vessel detection was observed. Conclusion The automatic VD measurement using the OptoVue HD device showed a good repeatability in 5 acquisitions in a row setting. Averaging images increased vessel detection, and in about a third of boxes, decreased the background noise, both in healthy eyes and, in a greater proportion, in eyes with macular oedema.
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