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Girgis JM, Saukkonen D, Hüther A, Alibhai AY, Moult EM, Abu-Qamar O, Fujimoto JG, Baumal CR, Witkin AJ, Duker JS, Waheed NK. Optical Coherence Tomography Angiography Analysis Toolbox: A Repeatable and Reproducible Software Tool for Quantitative Optical Coherence Tomography Angiography Analysis. Ophthalmic Surg Lasers Imaging Retina 2023; 54:114-122. [PMID: 36780632 DOI: 10.3928/23258160-20230206-01] [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: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this article is to demonstrate the optical coherence tomography angiography (OCTA) Analysis Toolkit (OAT), a custom-designed software package, as a repeatable and reproducible tool for computing OCTA metrics across different devices. MATERIALS AND METHODS Fourteen participants were imaged using three devices. Foveal avascular zone, vessel index, vessel length index, and vessel diameter index were calculated using the OAT. Repeatability and reproducibility were assessed using the coefficient of variation and interclass correlation coefficient (ICC). RESULTS Analysis of identical images demonstrated perfect levels of repeatability for all metrics (coefficient of variation 0%), which was a consequence of the software being deterministic (ie, producing the same outputs for the same inputs). Foveal avascular zone ICC values were in the excellent-to-good range (ICC > 0.6) for all devices. All values for vessel index (VI), vessel length index, and vessel diameter index fell in the good-to-fair (ICC > 0.4) or excellent-to-good range, except for vessel index analysis in the Cirrus device (ICC = 0.34). CONCLUSIONS The OAT appears to be a reliable tool that may enable comparison between OCTA data sets acquired on different imaging instruments, thereby facilitating a more consistent approach to OCTA analysis. [Ophthalmic Surg Lasers Imaging Retina 2023;54:114-122.].
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Lentzsch A, Schöllhorn L, Schnorr C, Siggel R, Liakopoulos S. Comparison of swept-source versus spectral-domain optical coherence tomography angiography for detection of macular neovascularization. Graefes Arch Clin Exp Ophthalmol 2021; 260:113-119. [PMID: 34226972 PMCID: PMC8763780 DOI: 10.1007/s00417-021-05229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To compare swept-source (SS) versus spectral-domain (SD) optical coherence tomography angiography (OCTA) for the detection of macular neovascularization (MNV). Methods In this prospective cohort study, 72 eyes of 54 patients with subretinal hyperreflective material (SHRM) and/or pigment epithelial detachment (PED) on OCT possibly corresponding to MNV in at least one eye were included. OCTA scans were acquired using two devices, the PLEX Elite 9000 SS-OCTA and the Spectralis SD-OCTA. Fluorescein angiography (FA) was used as reference. Two graders independently evaluated en face OCTA images using a preset slab as well as a manually modified slab, followed by a combination of en face and cross-sectional OCTA. Results Sensitivity (specificity) for the automated slabs was 51.7% (93.0%) for SS-OCTA versus 58.6% (95.3%) for SD-OCTA. Manual modification of segmentation increased sensitivity to 79.3% for SS-OCTA but not for SD-OCTA (58.6%). The combination of en face OCTA with cross-sectional OCTA reached highest sensitivity values (SS-OCTA: 82.8%, SD-OCTA: 86.2%), and lowest number of cases with discrepancies between SS-OCTA and SD-OCTA (4.2%). Fleiss kappa as measure of concordance between FA, SS-OCTA, and SD-OCTA was 0.56 for the automated slabs, 0.60 for the manual slabs, and 0.73 (good agreement) for the combination of en face OCTA with cross-sectional OCTA. Concordance to FA was moderate for the automated slabs and good for manual slabs and combination with cross-sectional OCTA of both devices. Conclusion Both devices reached comparable results regarding the detection of MNV on OCTA. Sensitivity for MNV detection and agreement between devices was best when evaluating a combination of en face and cross-sectional OCTA.
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Affiliation(s)
- Anna Lentzsch
- Cologne Image Reading Center, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Laura Schöllhorn
- Cologne Image Reading Center, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christel Schnorr
- Cologne Image Reading Center, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Robert Siggel
- Cologne Image Reading Center, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Department of Ophthalmology, Helios University Hospital Wuppertal, University of Witten-Herdecke, Wuppertal, Germany
| | - Sandra Liakopoulos
- Cologne Image Reading Center, Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany. .,Department of Ophthalmology, Goethe University, Frankfurt, Germany.
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Wang Y, Hu Z, Zhu T, Su Z, Fang X, Lin J, Chen Z, Su Z, Ye P, Ma J, Zhang L, Li J, Feng L, Sun CB, Zhang Z, Shentu X. Optical Coherence Tomography Angiography-Based Quantitative Assessment of Morphologic Changes in Active Myopic Choroidal Neovascularization During Anti-vascular Endothelial Growth Factor Therapy. Front Med (Lausanne) 2021; 8:657772. [PMID: 34026789 PMCID: PMC8137977 DOI: 10.3389/fmed.2021.657772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: To establish quantitative profile of the morphologic changes among patients with active myopic choroidal neovascularization (mCNV) before and after anti-vascular endothelial growth factor (VEGF) therapy using optical coherence tomography angiography (OCTA) to assess the therapeutic response. Methods: Patients with active mCNV who received anti-VEGF injections between February 2017 to October 2020 and fit the study criteria were retrospectively reviewed. Quantitative analysis of their OCTA images were carried out to evaluate the morphologic features and vascular changes of mCNV lesions in response to anti-VEGF therapy. For further quantitative profiling, mCNV area, fractal dimension, vessel area, vessel density, vessel diameter, vessel length, vessel junction, junction density, and vessel tortuosity were obtained by means of advanced skeletonization postprocessing analyses. Results: Thirty-one eyes of 29 consecutive patients with OCTA-positive mCNV lesions (mean spherical equivalent: −12.55 ± 3.24 diopters) were included. The 31 cases were divided into two phenotypes at baseline: organized interlacing pattern (83.87%) and disorganized vascular loops pattern (16.13%). The values of mCNV area, fractal dimension, vessel area, vessel length, vessel junction, and junction density decreased remarkably 1 month after the initial anti-VEGF injection (p < 0.001). Although, vessel density, vessel diameter, and vessel tortuosity increased meanwhile, only vessel diameter displayed statistical significance (p = 0.027). Of note, relative ratio analysis showed that vessel junction was the most sensitive biomarker in response to anti-VEGF therapy, reflecting a mean decrease of 50.36%. Sensitivity lowered successively in biomarkers of vessel length, vessel area, junction density, mCNV area, and fractal dimension. In addition, percent change of mCNV area (r = 0.552, p = 0.002), fractal dimension (r = 0.446, p = 0.017), vessel area (r = 0.518, p = 0.005), and vessel length (r = 0.440, p = 0.019) were moderately associated with that of central retinal thickness. Conclusions: The study showed morphological as well as quantitative changes on OCTA responding to anti-VEGF treatment in mCNV patients, among which vessel junctions might be the most predictive biomarker. OCTA-based analysis, providing intuitive images and a large spectrum of quantitative data at the same time, could promote new insights into the therapeutic response assessment in mCNV patients.
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Affiliation(s)
- Yao Wang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhongli Hu
- Department of Ophthalmology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Tiepei Zhu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhitao Su
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyun Fang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jijian Lin
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiqing Chen
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhaoan Su
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Panpan Ye
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Ma
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Zhang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinyu Li
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lei Feng
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chuan-Bin Sun
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiyong Zhang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xingchao Shentu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Faatz H, Rothaus K, Gunnemann ML, Book M, Wilming P, Gutfleisch M, Spital G, Lommatzsch A, Pauleikhoff D. Morphologic analysis of macular neovascularizations by OCT angiography-Technical limitations in the comparison of 3×3mm and 6×6mm images. PLoS One 2020; 15:e0237785. [PMID: 32822371 PMCID: PMC7446777 DOI: 10.1371/journal.pone.0237785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to ascertain whether there are relevant differences between the vascular morphology of macular neovascularizations (MNV) in 3×3mm and 6×6mm images, produced by optical coherence tomography angiography (OCTA). Methods MNV of 49 patients were automated quantitative analysed, measuring area, flow, the fractal dimension, average vessel length, vascular density, and average vessel caliber. These parameters were compared between the 3×3mm and the 6×6mm images. Results A strong linear association was found between the 3×3mm and the 6×6mm images. While area, flow, and FD of the MNV were very similar, the 3×3mm images showed significantly lower average total vessel length, greater vascular density, and lower average vessel caliber. Conclusion In quantitative analysis of the morphologic parameters of MNV in 3×3mm and 6×6mm images, the structures are not directly equivalent in the two sizes of scan. The images must be evaluated on an individual basis.
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Affiliation(s)
- Henrik Faatz
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
- * E-mail:
| | - Kai Rothaus
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | | | - Marius Book
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | - Pia Wilming
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | | | - Georg Spital
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | - Albrecht Lommatzsch
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
- Department of Ophthalmology, University of Essen–Duisburg, Duisburg, Germany
- Achim Wessing Institute for Imaging in Ophthalmology, University Hospital Duisburg-Essen, Duisburg, Germany
| | - Daniel Pauleikhoff
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
- Department of Ophthalmology, University of Essen–Duisburg, Duisburg, Germany
- Achim Wessing Institute for Imaging in Ophthalmology, University Hospital Duisburg-Essen, Duisburg, Germany
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Levine ES, Custo Greig E, Mendonça LSM, Gulati S, Despotovic IN, Alibhai AY, Moult E, Muakkassa N, Quaranta-El Maftouhi M, El Maftouhi A, Chakravarthy U, Fujimoto JG, Baumal CR, Witkin AJ, Duker JS, Hartnett ME, Waheed NK. The long-term effects of anti-vascular endothelial growth factor therapy on the optical coherence tomography angiographic appearance of neovascularization in age-related macular degeneration. Int J Retina Vitreous 2020; 6:39. [PMID: 32844038 PMCID: PMC7441632 DOI: 10.1186/s40942-020-00242-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background The short-term effects of anti-vascular endothelial growth factor (anti-VEGF) treatment on macular neovascularization (MNV) morphology is well described, but long-term studies on morphologic changes and correlation of such changes to the type of MNV have not been conducted. This study aims to determine if different types of MNVs in neovascular AMD (nAMD) behave differently with anti-VEGF treatment as visualized on optical coherence tomography angiography (OCTA). Methods Treatment-naïve nAMD patients were retrospectively screened for baseline and follow-up OCTA imaging 10 or more months after initial treatment. Images were graded for MNV type, area, activity, mature versus immature vessels, vessel density, presence of atrophy, atrophy location and area. Growth rate was calculated as the percent change in lesion area from baseline over the years of follow-up. In addition, the occurrence of complete regression and the percent of lesions that grew, remained stable, and shrunk per type was also evaluated. Results Forty-three eyes from 43 patients with a mean follow-up of 2 years were evaluated. On structural OCT, 26 lesions were classified as pure type 1 MNVs, 12 MNVs had a type 2 component, and 5 MNVs had a type 3 component. Of these cases, 2 mixed-type MNVs were considered to have completely regressed. There was no significant differences in MNV area and growth rate between type 1 and type 2 lesions, but all cases of type 3 lesions shrunk in the follow-up period. There was no correlation between the number of injections per year and growth rate, endpoint MNV area or endpoint activity status for any MNV type. There was no significant association between the development of atrophy and the number of injections, baseline MNV area, baseline vessel density, or lesion growth rate. Conclusions In nAMD, complete regression of an MNV network exposed to anti-VEGF is rare. This work emphasizes the role of anti-VEGF as anti-leakage rather than vascular regression agents in nAMD.
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Affiliation(s)
- Emily S Levine
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,Tufts University School of Medicine, Boston, MA USA
| | - Eugenia Custo Greig
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,Yale School of Medicine, New Haven, CT USA
| | - Luísa S M Mendonça
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Shilpa Gulati
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | | | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Eric Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA USA
| | | | | | | | | | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA USA
| | | | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | | | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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6
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Camino A, Zang P, Athwal A, Ni S, Jia Y, Huang D, Jian Y. Sensorless adaptive-optics optical coherence tomographic angiography. BIOMEDICAL OPTICS EXPRESS 2020; 11:3952-3967. [PMID: 33014578 PMCID: PMC7510908 DOI: 10.1364/boe.396829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 05/18/2023]
Abstract
Optical coherence tomographic angiography (OCTA) can image the retinal blood flow but visualization of the capillary caliber is limited by the low lateral resolution. Adaptive optics (AO) can be used to compensate ocular aberrations when using high numerical aperture (NA), and thus improve image resolution. However, previously reported AO-OCTA instruments were large and complex, and have a small sub-millimeter field of view (FOV) that hinders the extraction of biomarkers with clinical relevance. In this manuscript, we developed a sensorless AO-OCTA prototype with an intermediate numerical aperture to produce depth-resolved angiograms with high resolution and signal-to-noise ratio over a 2 × 2 mm FOV, with a focal spot diameter of 6 µm, which is about 3 times finer than typical commercial OCT systems. We believe these parameters may represent a better tradeoff between resolution and FOV compared to large-NA AO systems, since the spot size matches better that of capillaries. The prototype corrects defocus, astigmatism, and coma using a figure of merit based on the mean reflectance projection of a slab defined with real-time segmentation of retinal layers. AO correction with the ability to optimize focusing in arbitrary retinal depths - particularly the plexuses in the inner retina - could be achieved in 1.35 seconds. The AO-OCTA images showed greater flow signal, signal-to-noise ratio, and finer capillary caliber compared to commercial OCTA. Projection artifacts were also reduced in the intermediate and deep capillary plexuses. The instrument reported here improves OCTA image quality without excessive sacrifice in FOV and device complexity, and thus may have potential for clinical translation.
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Affiliation(s)
- Acner Camino
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 27239, USA
| | - Pengxiao Zang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 27239, USA
| | - Arman Athwal
- Department of Engineering Science, Simon Fraser University, Burnaby, Canada
| | - Shuibin Ni
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 27239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 27239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 27239, USA
| | - Yifan Jian
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 27239, USA
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Arya M, Rebhun CB, Alibhai AY, Chen X, Moreira-Neto C, Baumal CR, Reichel E, Witkin AJ, Duker JS, Sadda SR, Waheed NK. Parafoveal Retinal Vessel Density Assessment by Optical Coherence Tomography Angiography in Healthy Eyes. Ophthalmic Surg Lasers Imaging Retina 2019; 49:S5-S17. [PMID: 30339262 DOI: 10.3928/23258160-20180814-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/01/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE To assess variability in vessel density (VD) measurements across three optical coherence tomography angiography (OCTA) devices to identify a methodology that offers the least amount of variation in VD, and to assess the effect of averaging of multiple scans on VD variability. PATIENTS AND METHODS Fifteen eyes of eight healthy individuals were imaged consecutively on three OCTA devices. Segmentations at the superficial, deep, and full retinal layers were generated. Repeat scans for each retinal layer were registered and averaged to generate one OCTA image. Two different automated thresholding techniques were used to calculate vessel area density (VAD) from binarized images and vessel skeleton density (VSD) from skeletonized images. Vessel length, a linear measure of the combined lengths of vessels, was calculated. Foveal avascular zone (FAZ) area was measured. RESULTS All three OCTA devices were significantly different (P < .0001). This finding remained after averaging images (P < .0001). VSD was more repeatable within a device but less reproducible across devices. Conversely, VAD demonstrated less repeatability but greater reproducibility. Differences in VSD between devices were systematic and attributable to differences in resolution. Vessel length, unaffected by resolution, demonstrated no significant differences between the devices (P > .107). There was no significant difference in FAZ area across devices (P = .51). After averaging images, VD was significantly different from the single images for each device and plexus (P < .05) but remained within 1% of the value of a single scan. CONCLUSIONS OCTA devices show variability in VD for healthy individuals. With greater repeatability, VSD appeared useful for following a patient on one device. VAD and vessel length seemed ideal for comparing vessel parameters between OCTA devices. After averaging multiple scans, VSD remained within 1% of a single scan, for which clinical significance remains to be determined. Caution is advised when comparing quantitative analyses across OCTA devices. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S5-S17.].
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