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Manafi N, Mahmoudi A, Emamverdi M, Corradetti G, Corona ST, Wykoff CC, Sadda SR. Topographic analysis of local OCT biomarkers which predict progression to atrophy in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024; 262:2083-2091. [PMID: 38300334 PMCID: PMC11222249 DOI: 10.1007/s00417-024-06389-x] [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: 09/01/2023] [Revised: 01/10/2024] [Accepted: 01/20/2024] [Indexed: 02/02/2024] Open
Abstract
PURPOSE To define optical coherence tomography (OCT) biomarkers that precede the development of complete retinal pigment epithelium and outer retinal atrophy (cRORA) at that location in eyes with age-related macular degeneration (AMD). METHODS In this retrospective case-control study, patients with dry AMD who had evidence of cRORA and OCT data available for 4 years (48 ± 4 months) prior to the first visit with evidence of cRORA were included. The visit 4 years prior to the development of cRORA was defined as the baseline visit, and the region on the OCT B-scans of future cRORA development was termed the case region. A region in the same eye at the same distance from the foveal center as the case region that did not progress to cRORA was selected as the control region. OCT B-scans at the baseline visit through both the case and control regions were evaluated for the presence of soft and cuticular drusen, drusen with hyporeflective cores (hcD), drusenoid pigment epithelial detachments (PED), subretinal drusenoid deposits (SDD), thick and thin double-layer signs (DLS), intraretinal hyperreflective foci (IHRF), and acquired vitelliform lesions (AVL). RESULTS A total of 57 eyes of 41 patients with dry AMD and evidence of cRORA were included. Mean time from the baseline visit to the first visit with cRORA was 44.7 ± 6.5 months. The presence of soft drusen, drusenoid PED, AVL, thin DLS, and IHRF at the baseline visit was all associated with a significantly increased risk of cRORA at that location. Multivariable logistic regression revealed that IHRF (OR, 8.559; p < 0.001), drusenoid PED (OR, 7.148; p = 0.001), and a thin DLS (OR, 3.483; p = 0.021) were independent predictors of development of cRORA at that location. CONCLUSIONS IHRF, drusenoid PED, and thin DLS are all local risk factors for the development of cRORA at that same location. These findings would support the inclusion of these features within a more granular staging system defining specific steps in the progression from early AMD to atrophy.
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Affiliation(s)
- Navid Manafi
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Alireza Mahmoudi
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Mehdi Emamverdi
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Giulia Corradetti
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | | | - Charles C Wykoff
- Retina Consultants of Texas, Retina Consultants of America, Houston, TX, USA
| | - SriniVas R Sadda
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA.
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
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Cheng Y, Hiya F, Li J, Shen M, Liu J, Herrera G, Berni A, Morin R, Joseph J, Zhang Q, Gregori G, Rosenfeld PJ, Wang RK. Calcified Drusen Prevent the Detection of Underlying Choriocapillaris Using Swept-Source Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2024; 65:26. [PMID: 38884553 PMCID: PMC11185265 DOI: 10.1167/iovs.65.6.26] [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: 01/18/2024] [Accepted: 04/28/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose In age-related macular degeneration (AMD), choriocapillaris flow deficits (CCFDs) under soft drusen can be measured using established compensation strategies. This study investigated whether CCFDs can be quantified under calcified drusen (CaD). Methods CCFDs were measured in normal eyes (n = 30) and AMD eyes with soft drusen (n = 30) or CaD (n = 30). CCFD density masks were generated to highlight regions with higher CCFDs. Masks were also generated for soft drusen and CaD based on both structural en face OCT images and corresponding B-scans. Dice similarity coefficients were calculated between the CCFD density masks and both the soft drusen and CaD masks. A phantom experiment was conducted to simulate the impact of light scattering that arises from CaD. Results Area measurements of CCFDs were highly correlated with those of CaD but not soft drusen, suggesting an association between CaD and underlying CCFDs. However, unlike soft drusen, the detected optical coherence tomography (OCT) signals underlying CaD did not arise from the defined CC layer but were artifacts caused by the multiple scattering property of CaD. Phantom experiments showed that the presence of highly scattering material similar to the contents of CaD caused an artifactual scattering tail that falsely generated a signal in the CC structural layer but the underlying flow could not be detected. Similarly, CaD also caused an artifactual scattering tail and prevented the penetration of light into the choroid, resulting in en face hypotransmission defects and an inability to detect blood flow within the choriocapillaris. Upon resolution of the CaD, the CC perfusion became detectable. Conclusions The high scattering property of CaD leads to a scattering tail under these drusen that gives the illusion of a quantifiable optical coherence tomography angiography signal, but this signal does not contain the angiographic information required to assess CCFDs. For this reason, CCFDs cannot be reliably measured under CaD, and CaD must be identified and excluded from macular CCFD measurements.
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Affiliation(s)
- Yuxuan Cheng
- Department of Bioengineering, University of Washington, Seattle, Washington, United States
| | - Farhan Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jianqing Li
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, 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
| | - Alessandro Berni
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalyn Morin
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Joan Joseph
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Qinqin Zhang
- Research and Development, Carl Zeiss Meditec, Inc., Dublin, California, United States
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Philip J. Rosenfeld
- 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
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Velaga SB, Alagorie AR, Emamverdi M, Ashrafkhorasani M, Habibi A, Nittala MG, Sing G, Haines J, Pericak-Vance MA, Stambolian D, Sadda SR. Alterations of the Ganglion Cell Complex in Age-Related Macular Degeneration: An Amish Eye Study Analysis. Am J Ophthalmol 2024; 265:80-87. [PMID: 38677638 DOI: 10.1016/j.ajo.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 04/02/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE To compare the ganglion cell complex (GCC) thickness in eyes with age-related macular degeneration (AMD) vs healthy controls in an elderly Amish population. DESIGN Prospective cross-sectional study. METHODS This is a post hoc analysis of the family-based prospective study of Amish subjects. Study subjects underwent imaging with the Cirrus HD-OCT (Carl Zeiss Meditec Inc) using a macular cube protocol of 512 × 128 scans (128 horizontal B-scans, each comprising 512 A-scans) over a 6 mm × 6 mm region centered on the fovea. The ganglion cell analysis algorithm calculated the GCC thickness by segmenting the outer boundaries of the retinal nerve fiber layer (RNFL) and inner plexiform layer (IPL) in all B-scans of the volume, with the region between these boundaries representing the combined thickness of the ganglion cell layer (GCL) and the IPL. A number of parameters were used to evaluate the GCC thickness: the average GCC thickness, minimum (lowest GCC thickness at a single meridian crossing the elliptical annulus), and sectoral (within each of 6 sectoral areas: superior, superotemporal, superonasal, inferior, inferonasal, and inferotemporal). The stage of AMD was graded on color fundus photographs in accordance with the Beckman Initiative for Macular Research classification system. RESULTS Of 1339 subjects enrolled in the Amish eye study, a total of 1294 eyes of 1294 subjects had all required imaging studies of sufficient quality and were included in the final analysis. Of these, 798 (62%) were female. Following age adjustment, the average GCC thickness was significantly (P < .001) thinner in AMD subjects (73.71 ± SD; 13.77 µm) compared to normals (77.97 ± 10.42 µm). An independent t test showed that the early AMD (75.03 ± 12.45 µm) and late AMD (61.64 ± 21.18 µm) groups (among which eyes with geographic atrophy [GA] had the lowest thickness, of 58.10 ± 20.27 µm) had a statistically significant lower GCC thickness compared to eyes without AMD. There was no significant differences in average GCC thickness between early AMD and intermediate AMD (76.36 ± 9.25 µm) eyes. CONCLUSIONS The GCC thickness in AMD eyes is reduced compared to normal eyes; however, the relationship is complex, with the greatest reduction in late AMD eyes (particularly eyes with GA) but no difference between early and intermediate AMD eyes.
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Affiliation(s)
- Swetha Bindu Velaga
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ahmed Roshdy Alagorie
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Ophthalmology (A.R.A.), Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mehdi Emamverdi
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Maryam Ashrafkhorasani
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Abbas Habibi
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Muneeswar Gupta Nittala
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gagan Sing
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA; Department of Ophthalmology (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., S.R.S.), David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Haines
- Department of Population & Quantitative Health Sciences (J.H.), Case Western Reserve University, Cleveland, Ohio, USA; Institute for Computational Biology (J.H.), Case Western Reserve University, Cleveland, Ohio, USA
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics (M.A.P.-V), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dwight Stambolian
- Department of Ophthalmology (D.S.), University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Srinivas R Sadda
- From the Doheny Eye Institute (S.B.V., A.R.A., M.E., M.A., A.H., M.G.N., G.S., S.R.S.), University of California-Los Angeles, Los Angeles, California, USA.
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Vidal-Oliver L, Montolío-Marzo E, Gallego-Pinazo R, Dolz-Marco R. Optical coherence tomography biomarkers in early and intermediate age-related macular degeneration: A clinical guide. Clin Exp Ophthalmol 2024; 52:207-219. [PMID: 38214056 DOI: 10.1111/ceo.14337] [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: 08/30/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
Advanced forms of age-related macular degeneration (AMD), characterised by atrophic and neovascular changes, are a leading cause of vision loss in the elderly population worldwide. Prior to the development of advanced AMD, a myriad of risk factors from the early and intermediate stages of AMD have been published in the scientific literature over the last years. The ability to precisely recognise structural and anatomical changes in the ageing macula, altogether with the understanding of the individual risk implications of each one of them is key for an accurate and personalised diagnostic assessment. The present review aims to summarise updated evidence of the relative risk conferred by diverse macular signs, commonly seen on optical coherence tomography, in terms of progression to geographic atrophy or macular neovascularization. This information may also serve as a basis for tailored follow-up monitoring visits.
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Affiliation(s)
- Lourdes Vidal-Oliver
- Department of Ophthalmology, Fundación Oftalmología Médica de la Comunidad Valenciana, Valencia, Spain
- Department of Ophthalmology, Clínico San Carlos Hospital, Madrid, Spain
- Macula Unit, Oftalvist Clinic, Valencia, Spain
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Kim YH, Yun C, Oh J. Integrity of the Hyperreflective Layer in the Inner Choroid in Eyes with Drusen. Ophthalmol Ther 2024; 13:529-540. [PMID: 38113024 PMCID: PMC10787704 DOI: 10.1007/s40123-023-00865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION This study aimed to compare the integrity of the hyperreflective layer of the inner choroid in eyes with and without drusen. METHODS Swept-source optical coherence tomography images of patients with drusen and normal controls were reviewed. Using a line plot of ImageJ, choroidal reflectivity was measured at the subfovea, and the integrity of the hyperreflective layer of the inner choroid was determined. RESULTS In total, 63 eyes with drusen and 30 control eyes without drusen were included. The integrity of the hyperreflective layer of the inner choroid was preserved in 81.0% of eyes with drusen and 93.3% of normal controls. The proportion of eyes with the hyperreflective layer did not differ between eyes with and without drusen. Of the 63 subjects with drusen, this hyperreflective layer was observed in all 28 eyes (100%) with pachydrusen but only in 68.6% of the 35 eyes with soft drusen, and its prevalence was significantly different (P = 0.001). CONCLUSION The prevalence of the hyperreflective layer between the choriocapillaris and medium or large choroidal vessels in eyes with soft drusen differed from that in eyes with pachydrusen. These findings support the suggestion that changes within the choroidal stroma may be involved in the pathogenesis of age-related macular degeneration.
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Affiliation(s)
- Young Ho Kim
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, 73 Goryeodae-ro Sungbuk-ku, Seoul, 02841, Korea.
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Schmetterer L, Scholl H, Garhöfer G, Janeschitz-Kriegl L, Corvi F, Sadda SR, Medeiros FA. Endpoints for clinical trials in ophthalmology. Prog Retin Eye Res 2023; 97:101160. [PMID: 36599784 DOI: 10.1016/j.preteyeres.2022.101160] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
With the identification of novel targets, the number of interventional clinical trials in ophthalmology has increased. Visual acuity has for a long time been considered the gold standard endpoint for clinical trials, but in the recent years it became evident that other endpoints are required for many indications including geographic atrophy and inherited retinal disease. In glaucoma the currently available drugs were approved based on their IOP lowering capacity. Some recent findings do, however, indicate that at the same level of IOP reduction, not all drugs have the same effect on visual field progression. For neuroprotection trials in glaucoma, novel surrogate endpoints are required, which may either include functional or structural parameters or a combination of both. A number of potential surrogate endpoints for ophthalmology clinical trials have been identified, but their validation is complicated and requires solid scientific evidence. In this article we summarize candidates for clinical endpoints in ophthalmology with a focus on retinal disease and glaucoma. Functional and structural biomarkers, as well as quality of life measures are discussed, and their potential to serve as endpoints in pivotal trials is critically evaluated.
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Affiliation(s)
- Leopold Schmetterer
- Singapore Eye Research Institute, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore; Academic Clinical Program, Duke-NUS Medical School, Singapore; School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore; Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
| | - Hendrik Scholl
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Lucas Janeschitz-Kriegl
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Department of Ophthalmology, Duke Eye Center, Duke University, Durham, NC, USA
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Viggiano P, Miere A, Borrelli E, Boscia G, Grassi MO, Souied EH, Alessio G, Boscia F. The Impact of Diabetic Retinopathy on the Choriocapillaris in Neovascular AMD. Invest Ophthalmol Vis Sci 2023; 64:32. [PMID: 37988106 PMCID: PMC10668630 DOI: 10.1167/iovs.64.14.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023] Open
Abstract
Purpose To investigate the impact of diabetic retinopathy (DR) on morphological choriocapillaris (CC) modifications in eyes with type 1 macular neovascularization (MNV) secondary to AMD using optical coherence tomography angiography (OCTA). Methods Eyes with AMD-related type 1 MNV with and without DR were prospectively included. We performed 3 × 3 mm OCTA scans at two visits: before the loading phase of intravitreal injections of aflibercept (T1) and 1 month after the last injection (T2). OCTA En face flow images of the CC were analyzed for flow deficit percentage (FD%), FD average area and FD number in a 500-µm-wide ring surrounding the dark halo (DH) around type 1 MNV. Results A total of 65 eyes, out of which 30 eyes had mild DR, were included. In the group without diabetes, there was a gradual reduction in FD% in the CC ring around the DH after antiangiogenic therapy, indicating reperfusion of the CC (P = 0.003). However, in the DR group, there were no significant changes in CC parameters between the two study visits. Specifically, the FD% in the CC ring around the DH did not show a significant reduction at T2 compared with T1 values (P > 0.05). Furthermore, the comparison of the variation in FD% between the two groups was statistically significant. The nondiabetic group exhibited a gradual CC reperfusion after the loading phase of aflibercept, whereas the diabetic eyes did not show significant changes (P = 0.029). Conclusions The CC surrounding the DH associated to type 1 MNV exhibited greater hypoperfusion in diabetic eyes compared with eyes without diabetes, both before starting therapy and after the loading phase. Hence, DR may be a potential risk factor in the development and progression of late-stage AMD and may also influence the response to antiangiogenic therapy.
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Affiliation(s)
- Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
| | - Maria Oliva Grassi
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
| | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | - Giovanni Alessio
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro,” Bari, Italy
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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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Corvi F, Bacci T, Corradetti G, Staurenghi G, Sarraf D, Freund KB, Sadda S. Characterisation of the vascular anterior surface of type 1 macular neovascularisation after anti-VEGF therapy. Br J Ophthalmol 2023; 107:1336-1343. [PMID: 35537801 DOI: 10.1136/bjophthalmol-2021-320047] [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: 07/13/2021] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To evaluate whether the status of vasculature at the top of type 1 macular neovascularisation (MNV) could function as mediator of the observed protective effect against the development of complete retinal pigment epithelial and outer retinal atrophy (cRORA). METHODS In consecutive treatment-naïve patients, the vasculature at the anterior surface of the MNV was isolated using a slab designed to extract the most superficial vascular portion of the MNV lesion showing a choriocapillaris (CC)-like structure which we termed the 'neo-CC'. The ratio between the neo-CC area (isolated using this custom slab) and the MNV area (isolated using the standard outer retina-CC slab) at baseline and at last follow-up was evaluated. RESULTS Forty-four eyes from 44 patients were included. 20 showed cRORA by the final follow-up (median 23 months), whereas 24 did not progress to atrophy (median 23.5 months). The proportion of MNV with neo-CC at the anterior surface was significantly lower in eyes which progressed to cRORA compared with those which did not. The multivariate regression showed that a lower proportion of neo-CC coverage over the MNV was associated with an increased odds for cRORA development. CONCLUSIONS More extensive coverage of neo-CC is associated with a lower likelihood of development of macular atrophy in eyes receiving antivascular endothelial growth factor therapy, suggesting the protective effect of a type 1 MNV may be mediated by the development of a neo-CC and may provide insights into the biological significance of MNV as a response mechanism in eyes with age-related macular degeneration.
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Affiliation(s)
- Federico Corvi
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Tommaso Bacci
- Dipartimento di Scienze Mediche Chirurgiche e Neuroscienze, Universita degli Studi di Siena, Siena, Italy
| | - Giulia Corradetti
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - David Sarraf
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, USA
- Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - SriniVas Sadda
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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10
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Lu J, Cheng Y, Li J, Liu Z, Shen M, Zhang Q, Liu J, Herrera G, Hiya FE, Morin R, Joseph J, Gregori G, Rosenfeld PJ, Wang RK. Automated segmentation and quantification of calcified drusen in 3D swept source OCT imaging. BIOMEDICAL OPTICS EXPRESS 2023; 14:1292-1306. [PMID: 36950236 PMCID: PMC10026581 DOI: 10.1364/boe.485999] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Qualitative and quantitative assessments of calcified drusen are clinically important for determining the risk of disease progression in age-related macular degeneration (AMD). This paper reports the development of an automated algorithm to segment and quantify calcified drusen on swept-source optical coherence tomography (SS-OCT) images. The algorithm leverages the higher scattering property of calcified drusen compared with soft drusen. Calcified drusen have a higher optical attenuation coefficient (OAC), which results in a choroidal hypotransmission defect (hypoTD) below the calcified drusen. We show that it is possible to automatically segment calcified drusen from 3D SS-OCT scans by combining the OAC within drusen and the hypoTDs under drusen. We also propose a correction method for the segmentation of the retina pigment epithelium (RPE) overlying calcified drusen by automatically correcting the RPE by an amount of the OAC peak width along each A-line, leading to more accurate segmentation and quantification of drusen in general, and the calcified drusen in particular. A total of 29 eyes with nonexudative AMD and calcified drusen imaged with SS-OCT using the 6 × 6 mm2 scanning pattern were used in this study to test the performance of the proposed automated method. We demonstrated that the method achieved good agreement with the human expert graders in identifying the area of calcified drusen (Dice similarity coefficient: 68.27 ± 11.09%, correlation coefficient of the area measurements: r = 0.9422, the mean bias of the area measurements = 0.04781 mm2).
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Affiliation(s)
- Jie Lu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Yuxuan Cheng
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Jianqing Li
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ziyu Liu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Research and Development, Carl Zeiss Meditec, Inc., Dublin, CA, USA
| | - Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gissel Herrera
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Farhan E. Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rosalyn Morin
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joan Joseph
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
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11
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Diagnostic and Therapeutic Challenges. Retina 2022; 42:1623-1627. [PMID: 34510131 DOI: 10.1097/iae.0000000000003302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Toulouie S, Chang S, Pan J, Snyder K, Yiu G. Relationship of Retinal Vessel Caliber with Age-Related Macular Degeneration. J Ophthalmol 2022; 2022:8210599. [PMID: 35957743 PMCID: PMC9357695 DOI: 10.1155/2022/8210599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Evaluate the relationship between retinal vascular caliber and age-related macular degeneration (AMD) severity or progression. Methods A retrospective secondary analysis of 1172 fundus photographs and clinical data from the prospective Age-Related Eye Disease Study (AREDS). Central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole-to-venule ratio (AVR) were measured using the Parr-Hubbard-Knudtson formula. Univariate and multivariate regressions were used to determine the association of CRAE, CRVE, and AVR with age, sex, smoking status, presence of cilioretinal artery, and AMD severity at baseline and 5 years using the 9-step AMD severity score. Results Only CRAE and CRVE were higher in men (P < 0.001), current smokers (P < 0.001), and the eyes with a cilioretinal artery (P=0.009 - 0.043). AMD severity was greater in older patients (P=0.001), current smokers (P=0.012), the eyes without a cilioretinal artery (P=0.001), and lower AVR (P=0.034) on multivariate regression but was not influenced by CRAE or CRVE (P=0.240 - 0.500). Choroidal neovascularization (CNV) presence was associated with older age (P=0.003) and absence of a cilioretinal artery (P=0.009), while central geographic atrophy (CGA) was associated with narrower CRAE (P=0.002) and possibly AVR (P=0.046). None of the retinal vessel parameters were predictive of AMD severity score or new onset of CNV or CGA at 5 years. Conclusion A lower arteriole-to-venule ratio may be associated with AMD severity, with narrower arterioles seen in the eyes with geographic atrophy, suggesting a role of the retinal vasculature in AMD pathophysiology. This trial is registered with ClinicalTrials.gov Identifier: NCT00000145.
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Affiliation(s)
- Sara Toulouie
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
- California Northstate University, College of Medicine, Elk Grove, CA, USA
| | - Sean Chang
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Julia Pan
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Kiersten Snyder
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
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13
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Liu J, Laiginhas R, Shen M, Shi Y, Li J, Trivizki O, Waheed NK, Gregori G, Rosenfeld PJ. Multimodal Imaging and En Face OCT Detection of Calcified Drusen in Eyes with Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2022; 2:100162. [PMID: 35935092 PMCID: PMC9354070 DOI: 10.1016/j.xops.2022.100162] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/13/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE En face OCT imaging was investigated as a method for the detection and monitoring of calcified drusen in eyes with nonexudative age-related macular degeneration (AMD). DESIGN Retrospective case series of a prospective study. PARTICIPANTS Patients with nonexudative AMD. METHODS A retrospective review was performed of same-day color fundus (CF), fundus autofluorescence (FAF), near-infrared (NIR), and en face swept-source (SS) OCT images to identify eyes with nonexudative AMD and calcified drusen. The appearance and progression of these lesions were compared using the different imaging methods. MAIN OUTCOME MEASURES Comparison between the presence of calcified drusen observed on CF images with the detection of these lesions on FAF, NIR, and en face SS OCT images. RESULTS Two hundred twenty eyes from 139 patients with nonexudative AMD were studied, with 42.7% of eyes containing calcified drusen either at baseline or during follow-up visits. On the en face SS OCT images, calcified drusen appeared as dark focal lesions referred to as choroidal hypotransmission defects (hypoTDs) that were detected in the choroid using a sub-retinal pigment epithelium (RPE) slab. The corresponding B-scans showed drusen with heterogenous internal reflectivity, hyporeflective cores, and hyperreflective caps. In most calcified drusen, choroidal hypertransmission defects (hyperTDs) were observed to develop over time around the periphery of the hypoTDs, giving them the appearance of a donut lesion on the en face SS OCT images. These donut lesions were associated with significant attenuation of the overlying retina, and the corresponding FAF images showed hypoautofluorescence at the location of these lesions. The donut lesions fulfilled the requirement for a persistent hyperTD, which is synonymous with complete RPE and outer retinal atrophy (cRORA). Six eyes displayed regression of the calcified drusen without cRORA developing. B-scans at the location of these regressed calcified drusen showed deposits along the RPE, with outer retinal thinning in the regions where the calcified lesions previously existed. CONCLUSIONS En face OCT imaging is a useful method for the detection and monitoring of calcified drusen and can be used to document the evolution of these drusen as they form donut lesions or foci of cRORA.
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Affiliation(s)
- Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Rita Laiginhas
- 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
| | - Yingying Shi
- 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
| | - Omer Trivizki
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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14
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Airaldi M, Corvi F, Cozzi M, Nittala MG, Staurenghi G, Sadda SR. Differences in long-term progression of atrophy between neovascular and non-neovascular age-related macular degeneration. Ophthalmol Retina 2022; 6:914-921. [PMID: 35460930 DOI: 10.1016/j.oret.2022.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare enlargement rates over 5 years of follow-up in geographic atrophy (GA) versus macular atrophy (MA) associated with macular neovascularization (MNV). DESIGN Retrospective, longitudinal comparative case series. PARTICIPANTS Consecutive series of age-related macular degeneration (AMD) patients with GA (dry) or MA with MNV. METHODS Atrophic regions on serial registered fundus autofluorescence (FAF) images were semiautomatically delineated and area measurements were recorded every 6±3 months for the first 2 years of follow-up and at yearly intervals up to 5 years. MAIN OUTCOME MEASURES Annual raw and square root transformed atrophy growth rates. RESULTS 117 eyes of 95 patients were included (61 in the GA and 56 in the MA cohort); 100% and 38.5% of eyes completed 2 and 5 years of follow-up, respectively. Mean baseline lesion size was similar between the two groups (raw: 1.74 vs. 1.53 mmˆ2, p = 0.56; sqrt transformed: 1.17 vs. 1.02 mm, p = 0.26). Overall enlargement rates were greater for the GA cohort (raw: 1.72 vs. 1.32 mmˆ2/year, p = 0.002; sqrt transformed: 0.41 vs. 0.33 mm/year; p = 0.03), as well as the area of atrophy growth at 5 years (raw: +8.06 vs. +4.55 mmˆ2, p = 0.001; sqrt transformed: +1.93 vs. +1.38 mm, p = 0.02). Estimated sqrt transformed area was also significantly greater for the GA cohort at 2 years (1.84 vs. 1.67 mm, p = 0.01). CONCLUSIONS Presence of MNV was associated with a slower rate of expansion resulting in overall smaller areas of atrophy over time. These findings support the hypothesis that MNV may protect against the progression of atrophy.
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Affiliation(s)
- Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy; Doheny Eye Institute, University of California at Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | | | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California at Los Angeles, Los Angeles, California, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
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15
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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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16
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Kalra G, Kar SS, Sevgi DD, Madabhushi A, Srivastava SK, Ehlers JP. Quantitative Imaging Biomarkers in Age-Related Macular Degeneration and Diabetic Eye Disease: A Step Closer to Precision Medicine. J Pers Med 2021; 11:1161. [PMID: 34834513 PMCID: PMC8622761 DOI: 10.3390/jpm11111161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 01/21/2023] Open
Abstract
The management of retinal diseases relies heavily on digital imaging data, including optical coherence tomography (OCT) and fluorescein angiography (FA). Targeted feature extraction and the objective quantification of features provide important opportunities in biomarker discovery, disease burden assessment, and predicting treatment response. Additional important advantages include increased objectivity in interpretation, longitudinal tracking, and ability to incorporate computational models to create automated diagnostic and clinical decision support systems. Advances in computational technology, including deep learning and radiomics, open new doors for developing an imaging phenotype that may provide in-depth personalized disease characterization and enhance opportunities in precision medicine. In this review, we summarize current quantitative and radiomic imaging biomarkers described in the literature for age-related macular degeneration and diabetic eye disease using imaging modalities such as OCT, FA, and OCT angiography (OCTA). Various approaches used to identify and extract these biomarkers that utilize artificial intelligence and deep learning are also summarized in this review. These quantifiable biomarkers and automated approaches have unleashed new frontiers of personalized medicine where treatments are tailored, based on patient-specific longitudinally trackable biomarkers, and response monitoring can be achieved with a high degree of accuracy.
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Affiliation(s)
- Gagan Kalra
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.K.); (D.D.S.); (S.K.S.)
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Sudeshna Sil Kar
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Duriye Damla Sevgi
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.K.); (D.D.S.); (S.K.S.)
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH 44106, USA
| | - Sunil K. Srivastava
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.K.); (D.D.S.); (S.K.S.)
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Justis P. Ehlers
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.K.); (D.D.S.); (S.K.S.)
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
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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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18
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Corvi F, Sadda SR. Progression of geographic atrophy. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1951231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Federico Corvi
- Doheny Eye Institute, United States, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - SriniVas R. Sadda
- Doheny Eye Institute, United States, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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