1
|
Ninomiya T, Kiyota N, Sharma P, Omodaka K, Himori N, Yasuda M, Kunikata H, Nakazawa T. The Relationship Between Artificial Intelligence-Assisted OCT Angiography-Derived Foveal Avascular Zone Parameters and Visual-Field Defect Progression in Eyes with Open-Angle Glaucoma. OPHTHALMOLOGY SCIENCE 2024; 4:100387. [PMID: 38524379 PMCID: PMC10960060 DOI: 10.1016/j.xops.2023.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 03/26/2024]
Abstract
Purpose To investigate clinical factors associated with foveal avascular zone (FAZ) parameters obtained using OCT angiography (OCTA) with assistance from a previously developed artificial intelligence (AI) platform in eyes with open-angle glaucoma (OAG). Design Retrospective longitudinal. Participants This study followed up 885 eyes of 558 patients with OAG for ≥ 2 years; all eyes underwent ≥ 5 Humphrey visual-field (VF) tests and had 3.0 × 3.0 mm macular OCTA scans available. Methods Average total deviation (TD) in the superior, superocentral, inferocentral, and inferior sectors of the Humphrey 24-2 program was calculated. We collected 3.0 × 3.0 mm macular OCTA images from each patient and used a previously developed AI platform with these images to obtain FAZ parameters, including FAZ area, FAZ circularity index (CI), and FAZ perimeter. Multivariable linear mixed-effects models were used to analyze the relationship between FAZ parameters, TD or TD slope in each quadrant, and systemic factors, adjusting for potential confounding factors, including axial length. Main Outcome Measures Ophthalmic and systemic variables, FAZ parameters, and TD or TD slope in each quadrant. Results The multivariable model showed that FAZ parameters were correlated with both TD and TD slope in the inferocentral quadrant (β = -0.244 - 0.168, P < 0.001). Both upper-half and lower-half FAZ parameters were better associated with TD-inferocentral and TD-inferocentral slope than TD-superocentral or TD-superocentral slope in terms of β size and statistical significance, indicating that there was no evident vertical anatomical correspondence between TD in the central quadrant and FAZ parameters. Foveal avascular zone area enlargement was associated with female gender (β = 0.242, P = 0.003). Loss of FAZ circularity was associated with both aging and comorbid sleep apnea syndrome (SAS) (yes: 1, no: 0) (β = -0.188, P < 0.001; β = -0.261, P = 0.031, respectively). Foveal avascular zone perimeter elongation was associated with aging and female gender (β = 0.084, P = 0.040; β = 0.168, P = 0.042, respectively). Conclusions Artificial intelligence-assisted OCTA-measured FAZ enlargement and irregular shape might be good markers of ocular hypoperfusion and associated inferocentral VF defect progression in eyes with OAG. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Takahiro Ninomiya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Parmanand Sharma
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Aging Vision Healthcare, Tohoku University Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| |
Collapse
|
2
|
Nishida T, Moghimi S, Walker E, Gunasegaran G, Wu JH, Kamalipour A, Mahmoudinezhad G, Zangwill LM, Weinreb RN. Association of foveal avascular zone change and glaucoma progression. Br J Ophthalmol 2023:bjo-2023-323970. [PMID: 38164585 PMCID: PMC11192860 DOI: 10.1136/bjo-2023-323970] [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: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/AIMS To investigate the association between longitudinal changes of foveal avascular zone (FAZ) area and the rate of structural and functional progression in glaucoma. METHODS A longitudinal cohort included 115 eyes (46 glaucoma suspect and 66 primary open-angle glaucoma) of 81 patients having ≥2 year follow-up, and ≥4 visits with optical coherence tomography angiography and visual field (VF). Eyes in the longitudinal cohort with a slope greater than that found in 95 percentile of separate healthy test-retest series for FAZ area were categorised into FAZ progressors; all other eyes were defined as FAZ non-progressors. A generalised linear mixed-effect model was used to investigate the association of FAZ progressors with demographic and clinical characteristics. RESULTS Faster ganglion cell complex (GCC) thinning and faster VF mean deviation (MD) loss were found in eyes with FAZ progressors compared with FAZ non-progressors (mean difference: -0.7 (95% CI, -1.4 to -0.1) µm/y; p=0.026, -0.3 (-0.5 to -0.1) dB/y; p=0.017, respectively), while whole image vessel density was not associated with FAZ progressors (p=0.929). SD of intraocular pressure (IOP) and IOP range were also associated with FAZ progressors in separate multivariable models (OR: 1.54 (1.02 to 2.32) per 1 mm Hg higher, p=0.041; OR: 1.20 (1.01 to 1.41) per 1 mm Hg higher; p=0.035, respectively). CONCLUSIONS Significant FAZ increase was weakly associated with moderately faster rates of both GCC thinning and VF MD loss, but not macular vessel density change in glaucoma eyes. Additional studies are needed to elucidate the pathophysiological associations between macula GCC thinning and FAZ area increases in glaucoma.
Collapse
Affiliation(s)
- Takashi Nishida
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Sasan Moghimi
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Evan Walker
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Gopikasree Gunasegaran
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Jo-Hsuan Wu
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Alireza Kamalipour
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Golnoush Mahmoudinezhad
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Linda M Zangwill
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Robert N Weinreb
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| |
Collapse
|
3
|
Igarashi R, Ochiai S, Akagi T, Miyamoto D, Sakaue Y, Iikawa R, Fukuchi T. Parapapillary choroidal microvasculature dropout in eyes with primary open-angle glaucoma. Sci Rep 2023; 13:20601. [PMID: 37996611 PMCID: PMC10667346 DOI: 10.1038/s41598-023-48102-8] [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: 08/01/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023] Open
Abstract
The purpose of this study was to evaluate how various parameters are related to microvasculature dropout (MvD) area measured using optical coherence tomography angiography (OCTA). We measured the area of MvD in 55 patients with primary open-angle glaucoma (POAG). Using OCTA, MvD area and peripapillary choroidal atrophy (PPA) area were assessed in a 4.5 mm × 4.5 mm region. The following were examined: circumpapillary nerve fiber layer (cpRNFL) thickness, optic disc area, optic disc cupping area, optic disc rim area, Humphrey Field Analyzer (HFA) 24/10-2 mean deviation (MD), and pattern standard deviation (PSD). The relationship between MvD area and each parameter was evaluated using Spearman's rank correlation coefficient analysis. Mean MvD area and PPA area were 0.18 ± 0.17 mm2 and 1.13 ± 0.72 mm2, respectively. MvD area was significantly correlated with optic disc rim area (p = 0.0017), cpRNFL (p = 0.0027), HFA 24/10-2 MD, and PSD (p < 0.001). In eyes with POAG, MvD area indicates the severity of glaucoma, which might be associated with structural changes in the peripapillary vasculature around the optic disc.
Collapse
Affiliation(s)
- Ryoko Igarashi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan.
| | - Shun Ochiai
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan
| | - Tadamichi Akagi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan
| | - Daiki Miyamoto
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan
| | - Yuta Sakaue
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan
| | - Ryu Iikawa
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan
| | - Takeo Fukuchi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan
| |
Collapse
|
4
|
Nishida T, Oh WH, Moghimi S, Yarmohammadi A, Hou H, David RCC, Kamalipour A, Shoji T, El-Nimri N, Rezapour J, Zangwill LM, Weinreb RN. Central macular OCTA parameters in glaucoma. Br J Ophthalmol 2023; 107:207-214. [PMID: 34426401 PMCID: PMC9368252 DOI: 10.1136/bjophthalmol-2021-319574] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND/AIMS To investigate the relationship between the foveal avascular zone (FAZ) parameters assessed by optical coherence tomography angiography (OCTA) and central visual field parameters in glaucoma and healthy subjects. METHODS One hundred and eighty-eight subjects (248 eyes), including 24 healthy (38 eyes), 37 glaucoma suspect (42 eyes, and 127 primary open angle glaucoma (POAG) patients (168 eyes), underwent imaging using OCTA and standard automated perimetry using the 24-2 and 10-2 Swedish Interactive Thresholding Algorithm. OCTA-based and OCT-based FAZ parameters (superficial FAZ area, FAZ circumference), foveal vessel density (FD300) and foveal thickness were measured. The correlation between FAZ parameters and visual field parameters was assessed using linear mixed model. RESULTS Axial length adjusted-FAZ area was not different among the three groups (mean (95% CI)): in healthy 0.31 (0.27 to 0.36) mm2, glaucoma suspect 0.29 (0.26 to 0.31) mm2 and POAG eyes 0.28 (0.27 to 0.30) mm2 (p=0.578). FD300 was lower in glaucoma suspect 49.1% (47.9% to 50.4%) and POAG eyes 48.7% (48.1% to 49.4%) than healthy eyes 50.5% (49.3% to 51.7%) though the difference was not statistically significant (p=0.071). Lower FD300 was associated with worse 24-2 and 10-2 visual field mean deviation and foveal threshold in multivariable linear mixed models (all p<0.05). In addition, a smaller FAZ area was associated with lower intraocular pressure (IOP) (p=0.026). CONCLUSIONS The FD300, but not the FAZ area was correlated with 10° central visual field mean deviation and foveal threshold in healthy, glaucoma suspect and POAG eyes. In contrast, a smaller FAZ area was associated with lower IOP.
Collapse
Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Won Hyuk Oh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States.,Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul, Korea
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Adeleh Yarmohammadi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Huiyuan Hou
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Ryan Caezar C. David
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Takuhei Shoji
- Department of Ophthalmology, Saitama Medical University, Japan
| | - Nevin El-Nimri
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Jasmin Rezapour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| |
Collapse
|
5
|
A Deep Learning System Using Optical Coherence Tomography Angiography to Detect Glaucoma and Anterior Ischemic Optic Neuropathy. J Clin Med 2023; 12:jcm12020507. [PMID: 36675435 PMCID: PMC9865592 DOI: 10.3390/jcm12020507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Glaucoma and non-arteritic anterior ischemic optic neuropathy (NAION) are optic neuropathies that can both lead to irreversible blindness. Several studies have compared optical coherence tomography angiography (OCTA) findings in glaucoma and NAION in the presence of similar functional and structural damages with contradictory results. The goal of this study was to use a deep learning system to differentiate OCTA in glaucoma and NAION. MATERIAL AND METHODS Sixty eyes with glaucoma (including primary open angle glaucoma, angle-closure glaucoma, normal tension glaucoma, pigmentary glaucoma, pseudoexfoliative glaucoma and juvenile glaucoma), thirty eyes with atrophic NAION and forty control eyes (NC) were included. All patients underwent OCTA imaging and automatic segmentation was used to analyze the macular superficial capillary plexus (SCP) and the radial peripapillary capillary (RPC) plexus. We used the classic convolutional neural network (CNN) architecture of ResNet50. Attribution maps were obtained using the "Integrated Gradients" method. RESULTS The best performances were obtained with the SCP + RPC model achieving a mean area under the receiver operating characteristics curve (ROC AUC) of 0.94 (95% CI 0.92-0.96) for glaucoma, 0.90 (95% CI 0.86-0.94) for NAION and 0.96 (95% CI 0.96-0.97) for NC. CONCLUSION This study shows that deep learning architecture can classify NAION, glaucoma and normal OCTA images with a good diagnostic performance and may outperform the specialist assessment.
Collapse
|
6
|
Kurysheva NI, Nikitina AD. [Optical coherence tomography and optical coherence tomography angiography for detecting glaucoma progression. Part 2. Clinical and functional correlations, monitoring of advanced glaucoma and limitations of the method]. Vestn Oftalmol 2023; 139:76-83. [PMID: 37067935 DOI: 10.17116/oftalma202313902176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
The purpose of this study is to analyze the literature on the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in the diagnosis of glaucoma. This review considers the structural and functional correlations observed during the progression of glaucomatous optic neuropathy, as well as the capabilities of the method in late glaucoma, describes the strengths and weaknesses of OCT and OCTA, and pays particular attention to the role of OCT in assessing the effectiveness of treatment. Optical coherence tomography is the main method for determining the progression of glaucoma, which plays a key role in the choice of treatment algorithm. However, the use of OCT in far advanced glaucoma has certain particularities and limitations. OCTA can be helpful in overcoming this problem.
Collapse
Affiliation(s)
- N I Kurysheva
- Medical Biological University of Innovations and Continuing Education of the Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia
- Ophthalmological Center of the Federal Medical-Biological Agency of the Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia
| | - A D Nikitina
- Medical Biological University of Innovations and Continuing Education of the Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia
- Ophthalmological Center of the Federal Medical-Biological Agency of the Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia
| |
Collapse
|
7
|
Dong YM, Zhu HY, Liu ZH, Fu SY, Wang K, Du LP, Jin XM. Various configuration types of the foveal avascular zone with related factors in normal Chinese adults with or without myopia assessed by swept-source OCT angiography. Int J Ophthalmol 2022; 15:1502-1510. [PMID: 36124188 DOI: 10.18240/ijo.2022.09.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To describe the morphological characteristics of foveal avascular zone (FAZ) in normal Chinese adults with or without myopia by swept-source optical coherence tomography angiography (SS-OCTA) and analyze the possible associated factors. METHODS Normal Chinese adults with or without myopia aged between 18 and 60y were recruited into the study. One eye in each individual was randomly selected for scanning using SS-OCTA. FAZ parameters, central retinal thickness (CRT) and central choroidal thickness (CCT) were then analyzed. Correlations between systemic and ocular variables and FAZ parameters were subsequently evaluated. The subgroup analysis based on refractive error was also carried out. RESULTS In total, 127 eyes out of 127 normal subjects were finally included in the study (mean age 29.5±8.22y, 61 males and 66 females). The pattern of FAZ was variable: round configuration in 28 eyes (22%), quadrilateral configuration in 23 eyes (18%), pentagonal configuration in 20 eyes (16%), oval configuration in 15 eyes (12%), triangular configuration in 6 eyes (5%) and irregular configuration in 35 eyes (28%). The mean area of FAZ was 0.37±0.12 mm2. Females had a larger FAZ (0.41±0.11 mm2 vs 0.32±0.11 mm2) compared with that of males (P<0.01). All myopic individuals showed smaller FAZ area and perimeter compared with that of normal individuals (P<0.01). There was no obvious correlation between age and FAZ. In the univariate regression analysis, both axial length (AL) and refractive error were significantly related to FAZ parameters. However, only CRT showed negative correlation with FAZ in the multivariate regression analysis. CONCLUSION The pattern of FAZ configuration in normal Chinese adults with or without myopia is highly variable. Establishing quantitative parameters of FAZ would not only provide details of macular pathophysiology but could possibly contribute as a biomarker in disease staging.
Collapse
Affiliation(s)
- Yan-Min Dong
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Hai-Yan Zhu
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Zhen-Hui Liu
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Shu-Ying Fu
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Ke Wang
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Li-Ping Du
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Xue-Min Jin
- Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| |
Collapse
|
8
|
Effect of Mydriatic Administration On Retinal Hemodynamics in Glaucoma: An Optical Coherence Tomography Angiography Study. J Glaucoma 2022; 31:659-665. [PMID: 35439783 DOI: 10.1097/ijg.0000000000002039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 04/02/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Pupillary dilation with 0.5% tropicamide and 2.5% phenylephrine resulted in a statistically significant decrease in foveal avascular zone (FAZ) metrics in glaucoma eyes. This observation emphasizes the critical role of pupillary status in interpreting glaucomatous vascular alterations detected by OCTA. PURPOSE To evaluate the influence of mydriatic eye drops on optical coherence tomography angiography (OCTA) parameters in patients with primary open-angle glaucoma (POAG). METHODS A total of 20 POAG eyes and 20 control eyes were recruited in the study. The imaging area on the fundus was visualized by AngioPlex (Cirrus 5000 HD-OCT; Carl Zeiss Meditec) using en face view of 3×3▒mm and 6×6▒mm preview scans. Images were generated before and after the instillation of topical 0.5% tropicamide and 2.5% phenylephrine. Optic nerve head (ONH) perfusion, ONH flux index, macular perfusion density, macular vessel density, and foveal avascular zone (FAZ) measurements were consecutively obtained for each session. Differences between the pre-and post-dilation measurements were evaluated in POAG patients and controls. RESULTS POAG eyes showed a statistically significant decrease in the FAZ area from a mean of 0.29▒mm2to 0.25▒mm2(P=0.037) and FAZ perimeter from a mean of 2.27▒mm to 2.09▒mm (P=0.045) in the OCTA 6×6▒mm scan area after tropicamide/phenylephrine instillation. Pre-and post-dilation measurements of ONH perfusion and ONH flux index were significantly lower in the glaucoma group compared to controls (P<0.05, for all). CONCLUSION Topical pupillary dilation with 0.5% tropicamide and 2.5% phenylephrine results in a statistically significant reduction in the FAZ area and FAZ perimeter in POAG eyes. Further OCTA studies are needed for the diagnostic value of vascular changes due to pupil dilation in glaucoma.
Collapse
|
9
|
Relationship Between Macular Microvasculature and Visual Acuity in Advanced and Severe Glaucoma. Am J Ophthalmol 2022; 236:154-163. [PMID: 34653358 DOI: 10.1016/j.ajo.2021.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the correlation between structural parameters and visual acuity (VA) in advanced glaucoma. DESIGN Prospective, cross-sectional study. METHODS A total of 238 eyes from 238 patients (82 were men and mean ± SD age was 59.9 ± 13.8 years) from a tertiary center were divided into an advanced (mean deviation of 24-2 visual field tests from -12.01 to -20.0 dB) and severe (< -20 dB) glaucoma group. Structural parameters were obtained by RTVue (Optovue Inc) optical coherence tomography and angiography. Pearson correlation, partial correlation adjusted for age and axial length, and receiver operating characteristic curves to detect decreased VA (<20/25) were performed. RESULTS In the advanced glaucoma group (133 eyes), superficial (Pearson correlation coefficient, r = -0.46, P < .001; partial correlation coefficient, r' = -0.30, P < .001) and deep macular vessel densities (VDs) (r = -0.47, P < .001; r' = -0.30, P < .001) showed highest correlation with VA. The area under the receiver operating characteristic curves of the superficial parafoveal/macular VDs were 0.816 (95% CI, 0.735-0.897) and 0.808 (95% CI, 0.725-0.891), respectively. In the severe glaucoma group (105 eyes), deep nasal grid VD (r = -0.31, P = 0.002; r' = -0.35, P < .001) showed highest correlation with VA. Deep macular VD showed better correlation with VA than other structural parameters. The area under the receiver operating characteristic curves of deep macular VD and deep nasal grid VD were 0.740 (95% CI, 0.632-0.849) and 0.748 (95% CI, 0.640-0.857), respectively. CONCLUSIONS Macular VD showed better correlation with VA in advanced glaucoma. Deep macular VD, especially nasal grid, may be a promising structural parameter in severe glaucoma.
Collapse
|
10
|
Optic Nerve Head Hemoglobin Levels in Glaucoma: A Structural and Functional Correlation Study. J Ophthalmol 2021; 2021:9916102. [PMID: 34659827 PMCID: PMC8516580 DOI: 10.1155/2021/9916102] [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: 04/03/2021] [Revised: 06/25/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate structural and functional correlations in glaucoma patients using optic nerve head hemoglobin (ONH Hb) measurements as determined by automated colorimetric analysis of conventional retinography. Methods We prospectively enrolled healthy participants and glaucomatous patients with a wide range of disease stages. All participants underwent visual field (VF) testing (standard automated perimetry, SAP), color fundus imaging (mydriatic retinography), and peripapillary retinal nerve fiber layer (pRNFL) assessment through spectral-domain optical coherence tomography (SD-OCT). Software Laguna ONhE was used to estimate the amount of ONH Hb and to determine the glaucoma discriminant function (GDF) index. Scatter plots were constructed, and regression analysis was used to investigate the correlations between GDF, average pRNFL thickness, and VF mean deviation (VFMD) index values. A secondary analysis was performed to compare each parameter between three different glaucoma groups divided according to VFMD values (mild, >−6 dB; moderate, −6 to −12 dB; and advanced, <−12 dB). Results One hundred ninety-six eyes from 123 participants (69 with glaucoma and 54 controls) were enrolled. Overall, all parameters evaluated differed significantly between glaucomatous and control eyes (p ≤ 0.001). The comparison of each parameter according to groups of disease stages revealed significant differences between controls and each of the glaucomatous groups (p < 0.001). More pronounced changes in GDF values were observed in early disease stages. We found significant nonlinear correlations between GDF and VFMD values (R2 = 0.295, p < 0.001) and between pRNFL thickness and VFMD (R2 = 0.598, p < 0.001). A linear correlation was found between GDF and pRNFL thickness values (R2 = 0.195, p < 0.001). Conclusion Our results showed significant associations between ONH Hb values and both structural and functional damage in glaucoma obtained by SD-OCT and SAP, respectively. The nonlinear correlation we found and the GDF behavior along different disease stages suggest that ONH Hb levels' reduction may precede visual function changes in early glaucoma stages.
Collapse
|
11
|
Mendez-Hernandez C, Wang S, Arribas-Pardo P, Salazar-Quiñones L, Güemes-Villahoz N, Fernandez-Perez C, Garcia-Feijoo J. Diagnostic validity of optic nerve head colorimetric assessment and optical coherence tomography angiography in patients with glaucoma. Br J Ophthalmol 2020; 105:957-963. [PMID: 32703781 PMCID: PMC8237198 DOI: 10.1136/bjophthalmol-2020-316455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/07/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
Background/Aims The aim of this study was to assess the optic nerve head (ONH) and macular vessel density with optical coherence tomography angiography (OCT-A) and the ONH haemoglobin (ONH Hb) amount with Laguna ONhE program in open-angle glaucoma (OAG) patients. Methods In this prospective observational cross-sectional study, 67 OAG patients and 41 healthy age-sex frequency matched subjects were examined with OCT-A and retinal photos. The circumpapillary (wcpVD), optic nerve head (iVD) and macular (wmVD) capillary vessel density of OCT-A and ONH colorimetric assessment to determine the ONH Hb amount using the Laguna ONhE program were evaluated. Results Significant differences between normal subjects and glaucoma patients in the wcpVD (22.18±3.42 vs 16.03±2.89%; p<0.001), iVD (18.31±5.56 vs 12.52±4.67%; p<0.001), wmVD (15.60±2.34 vs 13.34±2.32%; p<0.001) and amount of ONH Hb (71.10±1.67 vs 68.86±2.46%; p<0.001) and in the papillary cup (68.14±5.25 vs 64.77±5.08%; p=0.001) were found. The Laguna ONhE glaucoma discriminant function (GDF) index had a negative value in the OAG patients and normal values in healthy subjects (−18.76±13.31 vs 7.98±14.09; p<0.001). The area under the receiver operating characteristic (ROC) curve (AUROC) for discriminating between healthy and glaucomatous eyes was highest for wcpVD (0.93; 95% CI 0.86 to 0.97, p<0.0001), followed by GDF (0.92; 95% CI 0.86 to 0.97, p<0.0001), iVD (0.79; 95% CI 0.70 to 0.86; p<0.0001) and ONH Hb (0.78; 95% CI 0.69 to 0.85, p<0.0001). Pair wise comparisons showed that the AUROC of wcpVD (0.93) was not significantly different than GDF (0.92) (p=0.855). Conclusion Laguna ONhE program and OCT-A have similar diagnostic validity in open-angle glaucoma patients.
Collapse
Affiliation(s)
- Carmen Mendez-Hernandez
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain .,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain.,OFTARED, Madrid, Spain
| | - Surina Wang
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | | | - Liseth Salazar-Quiñones
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | - Noemi Güemes-Villahoz
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | - Cristina Fernandez-Perez
- Medicina Preventiva, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Julian Garcia-Feijoo
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain.,OFTARED, Madrid, Spain
| |
Collapse
|