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Mannil SS, Agarwal A, Conner IP, Kumar RS. A comprehensive update on the use of optical coherence tomography angiography in glaucoma. Int Ophthalmol 2022; 43:1785-1802. [PMID: 36472722 DOI: 10.1007/s10792-022-02574-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The primary purpose of this review is to provide a comprehensive summary on the technical principles of OCTA and to enumerate vascular parameters being explicated for glaucoma diagnosis and progression with emphasis on recent studies. In addition, the authors also summarize the future clinical potentials of OCTA in glaucoma and enumerate the limitations of this imaging modality in the present-day scenario. METHODS The index study is a narrative review on OCTA in glaucoma. The authors searched the PubMed database using the key phrases ''optical coherence tomography angiography" AND "glaucoma,'' AND/OR "vascular parameters" AND/OR "ocular perfusion." Being a relatively recent development in ocular imaging, studies in which OCTA imaging had been used for glaucoma evaluation since 2012 were included until March 2022. The literature search included original studies and previous review articles, while case reports were excluded. Preliminary search was based on relevant articles with search keywords in the title and abstract. The second screening was performed by reading the full text of the literature. RESULTS Recent studies indicate reduction in microcirculation in glaucomatous eyes compared to the normal subjects. The area of interest for glaucoma evaluation using OCTA varies among the different studies. Based on the literature reviewed here, (1) OCTA parameters measured in the peripapillary; ONH and macular area have been shown to differentiate between glaucoma and normal eyes with a discriminatory power comparable to OCT parameters used routinely in clinics, (2) monitoring of peripapillary and macular vessel density may provide important information to the evaluation of glaucoma progression and prediction of rates of disease worsening, (3) studies suggest strong correlation between the OCTA parameters, the OCT parameters and visual function, measured by visual field testing, in glaucomatous eyes, (4) future prospects of OCTA in glaucoma evaluations using AI predicting structural and functional features and prognosis based on early vascular findings would open up scope for early detection of high-risk suspects and fast progressors in glaucoma. CONCLUSION OCTA can be useful in quantifying vascular parameters in the optic disc, peripapillary and the macular regions for glaucoma evaluation. OCTA shows potential to become a part of everyday glaucoma management.
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Affiliation(s)
- Suria S Mannil
- Byers Eye Institute, Stanford University, Palo Alto, USA
| | - Aniruddha Agarwal
- Cleveland Clinic Abu Dhabi, The Eye Institute, Al Maryah Island, 112412, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western, Reserve University, Cleveland, OH, USA
| | - Ian P Conner
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Rajesh S Kumar
- Cleveland Clinic Abu Dhabi, The Eye Institute, Al Maryah Island, 112412, Abu Dhabi, United Arab Emirates.
- Cleveland Clinic Lerner College of Medicine, Case Western, Reserve University, Cleveland, OH, USA.
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Optical Microangiography and Progressive Retinal Nerve Fiber Layer Loss in Primary Open Angle Glaucoma. Am J Ophthalmol 2022; 233:171-179. [PMID: 34320375 PMCID: PMC8678163 DOI: 10.1016/j.ajo.2021.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the association between optical microangiography (OMAG) measurements and progressive retinal nerve fiber layer (RNFL) loss in primary open angle glaucoma (POAG). DESIGN Prospective case series. METHODS Sixty-four eyes of 40 patients with POAG (108 quadrants) with mild to moderate functional damage were longitudinally studied for at least 2 years and with a minimum of 3 optical coherence tomography examinations. OMAG imaging was performed at the baseline visit. Effect of clinical parameters (age, sex, presence of systemic diseases, central corneal thickness, presence of disc hemorrhage, and mean and fluctuation of intraocular pressure during follow-up), baseline hemifield mean deviation, baseline quadrant optical coherence tomography RNFL and ganglion cell inner plexiform layer thickness), and OMAG (peripapillary and macular perfusion density [PD] and vessel density [VD]) on the rate of RNFL change was evaluated using linear mixed models. RESULTS Average (±SD) mean deviation, RNFL, and ganglion cell inner plexiform layer thickness of the analyzed quadrants at baseline were -5.5 ± 2.9 dB, 96.5 ± 17.9 µm, and 73.8 ± 8.6 µm, respectively. Peripapillary PD and VD in the quadrant were 44.6% ± 5.9% and 17.5 ± 2.2 mm/mm2, respectively. Rate of quadrant RNFL change was -1.8 ± 0.6 µm/y. Multivariate mixed models showed that lower peripapillary PD (coefficient = 0.08, P = .01) and lower VD (coefficient = 0.21, P = .02) were significantly associated with a faster rate of RNFL loss. CONCLUSIONS Lower baseline peripapillary PD and VD measured using OMAG were significantly associated with a faster rate of RNFL loss in POAG. OMAG imaging provides useful information about the risk of glaucoma progression and the rate of disease worsening.
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Abstract
Early detection and monitoring are critical to the diagnosis and management of glaucoma, a progressive optic neuropathy that causes irreversible blindness. Optical coherence tomography (OCT) has become a commonly utilized imaging modality that aids in the detection and monitoring of structural glaucomatous damage. Since its inception in 1991, OCT has progressed through multiple iterations, from time-domain OCT, to spectral-domain OCT, to swept-source OCT, all of which have progressively improved the resolution and speed of scans. Even newer technological advancements and OCT applications, such as adaptive optics, visible-light OCT, and OCT-angiography, have enriched the use of OCT in the evaluation of glaucoma. This article reviews current commercial and state-of-the-art OCT technologies and analytic techniques in the context of their utility for glaucoma diagnosis and management, as well as promising future directions.
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Affiliation(s)
- Alexi Geevarghese
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA;
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA;
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA
- Center for Neural Science, NYU College of Arts and Sciences, New York, NY 10003, USA
| | - Hiroshi Ishikawa
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA;
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA
| | - Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA;
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, New York 11201, USA
- Center for Neural Science, NYU College of Arts and Sciences, New York, NY 10003, USA
- Department of Physiology and Neuroscience, NYU Langone Health, NYU Grossman School of Medicine, New York, NY 10016, USA
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Cano J, Rahimi M, Xu BY, Richter GM, Tan O, Huang D, Shahidi M. Relationship Between Macular Vessel Density and Total Retinal Blood Flow in Primary Open-angle Glaucoma. J Glaucoma 2021; 30:666-671. [PMID: 33979111 PMCID: PMC8373641 DOI: 10.1097/ijg.0000000000001880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/21/2021] [Indexed: 01/12/2023]
Abstract
PRECIS An association between macular vessel density (VD) and total retinal blood flow (TRBF) was demonstrated in subjects with primary open-angle glaucoma (POAG) and visual field (VF) loss. PURPOSE The purpose of this study was to report relationships of macular VD metrics and TRBF in POAG. MATERIALS AND METHODS A total of 24 POAG and 19 healthy control subjects participated in the study. Subjects underwent optical coherence tomography and angiography for measurements of inner retinal thickness (IRT), VD, and spacing between large vessels (SLV) and small vessels (SSV). Doppler optical coherence tomography imaging was performed for TRBF measurement. In POAG subjects, automated perimetry was performed and VF loss expressed as mean deviation was measured. RESULTS Compared with the control group, POAG group had decreased VD, TRBF, IRT, and increased SLV (P<0.0001). Decreased VD (Pearson correlation, r=0.51; P<0.0001; N=43) and increased SLV (Spearman correlation, rs=-0.47; P=0.001) were correlated with decreased TRBF. Decreased VD and SSV (r≥0.39; P≤0.001; N=43) and increased SLV (rs=-0.71; P<0.0001) were associated with decreased IRT. Decreased VF mean deviation was correlated with decreased VD, SSV, IRT (r≥0.53; P≤0.001; N=24), and with increased SLV (rs=-0.84; P<0.0001). CONCLUSIONS The finding of an association between macular VD and TRBF supports the role of vascular factors in the pathophysiology of POAG and potential conduct of future studies aimed at identifying multiple image-based vascular metrics for disease diagnosis.
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Affiliation(s)
- Jennifer Cano
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Mansour Rahimi
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Benjamin Y. Xu
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Grace M. Richter
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Ou Tan
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Mahnaz Shahidi
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
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Hansen C, Bojikian KD, Chu Z, Zhou X, Zhang Q, Mudumbai RC, Johnstone MA, Wang RK, Chen PP. Macular microvascular parameters in the ganglion cell-inner plexiform layer derived by optical coherence tomography angiography: Vascular structure-central visual function analysis. PLoS One 2020; 15:e0240111. [PMID: 33002090 PMCID: PMC7529279 DOI: 10.1371/journal.pone.0240111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the relationships between global and sectoral macular vascular microcirculation parameters in the ganglion cell-inner plexiform layer (GCIPL) assessed by optical coherence tomography angiography (OCTA), and global and sectoral visual field (VF) central mean sensitivity (CMS) assessed by standard automated perimetry. METHODS Fifty-four eyes with open angle glaucoma were scanned using a swept-source OCTA (Plex Elite 9000, Zeiss, Dublin, CA) and macular vascular microcirculation was measured by calculating the overall flux and vessel area density (VAD) over the entire 6mm x 6mm area, excluding large retinal vessels. Central 10-degree VF CMS was calculated based on 24-2 VF. Pearson correlation was used to investigate the correlation between global and sectoral OCTA parameters and global and sectoral VF CMS. RESULTS Both global GCIPL flux and VAD were significantly correlated with VF CMS (p<0.001). For the sectoral analysis, sectoral VAD was significantly correlated with sectoral VF CMS in all comparisons except for the inferonasal VF CMS with supero-temporal (ST) GCIPL VAD (p = 0.097). Although highest correlation was observed for both ST VF CMS with inferior GCIPL VAD and infero-temporal VF CMS with superior GCIPL VAD (r = 0.683, p<0.001), there was no significant difference in correlation when compared to the global VAD and other sectors' correlation coefficients (p≥ 0.091), except for the ST GCIPL VAD (p = 0.001). CONCLUSIONS Global and sectoral macular vascular microcirculation in the GCIPL, as determined by OCTA, was significantly correlated with global and sectoral VF CMS in glaucomatous patients. OCTA can aid in the understanding of the structure-function relationships of the macular region.
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Affiliation(s)
- Cody Hansen
- University of Washington School of Medicine, Seattle, WA, United States of America
| | - Karine D Bojikian
- Department of Ophthalmology, University of Washington, Seattle, WA, United States of America
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Xiao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Raghu C Mudumbai
- Department of Ophthalmology, University of Washington, Seattle, WA, United States of America
| | - Murray A Johnstone
- Department of Ophthalmology, University of Washington, Seattle, WA, United States of America
| | - Ruikang K Wang
- Department of Ophthalmology, University of Washington, Seattle, WA, United States of America.,Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Philip P Chen
- Department of Ophthalmology, University of Washington, Seattle, WA, United States of America
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Abstract
Optical coherence tomography angiography (OCTA) is a relatively new, noninvasive, dye-free imaging modality that provides a qualitative and quantitative assessment of the vasculature in the retina and optic nerve head. OCTA also enables visualization of the choriocapillaris, but only in areas of parapapillary atrophy. With OCTA, the movement of red blood cells is used as a contrast to delineate blood vessels from static tissues. The features seen with OCTA in eyes with glaucoma are reduction in the superficial vessel density in the peripapillary and macular areas, and complete loss of choriocapillaris in localized regions of parapapillary atrophy (called deep-layer microvascular dropout). These OCTA changes correlate well topographically with the functional changes seen on visual field examination and structural changes seen on optical coherence tomography (OCT) (ie, parapapillary retinal nerve fiber layer changes and inner retinal layer thickness changes at macula). The OCTA measurements also have acceptable test-retest variability and well differentiate glaucomatous from normal eyes. OCTA measurements can be affected by various subject-related, eye-related, and disease-related factors. Vessel density reduction on OCTA reaches a base level (floor) at a more advanced disease stage than the structural changes on OCT and therefore has the potential to monitor progression in eyes with advanced glaucomatous damage. OCTA also adds information about glaucoma patients at risk of faster progression. OCTA, therefore, complements visual field and OCT examinations to diagnose glaucoma, detect progression, and assess risk of progression.
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Holló G. Optical coherence tomography angiography in glaucoma: analysis of the vessel density-visual field sensitivity relationship. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1203. [PMID: 33241052 PMCID: PMC7576041 DOI: 10.21037/atm.2020.03.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glaucoma, a well-defined group of progressive optic neuropathies is one of the leading causes of irreversible blindness worldwide. In order to stop or slow down the progression of glaucomatous vision deterioration, intraocular pressure reduction by medical, laser or surgical treatment is needed. To ensure that treatment is efficient and tailored to the actual needs both cross sectional evaluation of disease severity and measurement of rate of progression are essential. Currently staging and progression are investigated with visual field and retinal thickness measurements. Perimetry, however, is influenced by several biological factors which are not related to glaucoma, and the use of retinal thinning is limited by floor effect. Therefore, clinical application of optical retinal coherence tomography angiography, a new and rapidly developing non-invasive measurement of the capillary perfusion in the various retinal layers, respectively, is now in the focus of clinical glaucoma research. This comprehensive review summarizes the current knowledge on one of the most important research areas in optical coherence tomography angiography in glaucoma, the relationship between retinal capillary perfusion and the spatially corresponding visual field threshold sensitivity.
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Affiliation(s)
- Gábor Holló
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Bojikian KD, Nobrega P, Wen JC, Zhang Q, Mudumbai RC, Johnstone MA, Wang RK, Chen PP. Macular Vascular Microcirculation in Eyes With Open-angle Glaucoma Using Different Visual Field Severity Classification Systems. J Glaucoma 2019; 28:790-796. [PMID: 31233458 PMCID: PMC11436114 DOI: 10.1097/ijg.0000000000001308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PRECIS We found significant differences in macular vascular microcirculation between normal and glaucomatous eyes using optical coherence tomography angiography (OCTA). Macular vascular microcirculation changes also showed significant correlations with visual field (VF) severity classification systems. PURPOSE To correlate VF severity defined by different classification systems and macular vascular microcirculation in eyes with glaucoma using OCTA. PATIENTS AND METHODS Twenty normal and 58 open-angle glaucoma (OAG) eyes were scanned using a swept-source OCTA (Plex Elite 9000) and macular vascular microcirculation was measured by calculating the overall blood flux index (BFI) and vessel area density (VAD) over the entire 6×6 mm area excluding the big retinal vessels. Glaucomatous eyes were staged into severity groups based on 4 VF severity classifications: Hodapp-Parrish-Anderson scale, Glaucoma Severity Staging system, ICD-10 glaucoma staging definitions, and VF mean deviation. Central 10-degree VF mean sensitivity (CMS) was calculated based on 24-2 VF. One-way analysis of variance was used to analyze the differences and correlation between macular vascular microcirculation and other clinical parameters. RESULTS Glaucomatous eyes had significantly lower ganglion cell and inner plexiform layer BFI and VAD (P<0.0001) compared with normal eyes. In OAG patients, BFI and VAD were significantly higher in mild OAG compared with severe OAG with all VF disease severity classification systems (P<0.001). Glaucoma Severity Staging had the highest correlation with changes in macular vascular microcirculation metrics (r=0.734 for BFI; r=0.647 for VAD) and VF CMS had highest correlation with macular vascular microcirculation metrics (r=0.887 for BFI; r=0.903 for VAD). CONCLUSION Macular vascular microcirculation metrics detected by OCTA correlate with disease severity in glaucomatous eyes. VF CMS, calculated from only 12 tested central 10-degree points, correlated best with macular OCTA.
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Affiliation(s)
| | | | - Joanne C. Wen
- Department of Ophthalmology, University of Washington, Seattle, WA
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, WA
| | | | | | - Ruikang K. Wang
- Department of Ophthalmology, University of Washington, Seattle, WA
- Department of Bioengineering, University of Washington, Seattle, WA
| | - Philip P. Chen
- Department of Ophthalmology, University of Washington, Seattle, WA
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Honda H, Anraku A, Ishida K, Enomoto N, Tomita G. Relationship between Macular Vessel Density and Focal Electroretinograms in Early Normal Tension Glaucoma. Curr Eye Res 2019; 44:753-759. [DOI: 10.1080/02713683.2019.1593464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hakuei Honda
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ayako Anraku
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kyoko Ishida
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobuko Enomoto
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Goji Tomita
- Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
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