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Jalili J, Nadimi M, Jafari B, Esfandiari A, Mojarad M, Subramanian PS, Aghsaei Fard M. Vessel Density Features of Optical Coherence Tomography Angiography for Classification of Optic Neuropathies Using Machine Learning. J Neuroophthalmol 2024; 44:41-46. [PMID: 37440373 DOI: 10.1097/wno.0000000000001925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND To evaluate the classification performance of machine learning based on the 4 vessel density features of peripapillary optical coherence tomography angiography (OCT-A) for classifying healthy, nonarteritic anterior ischemic optic neuropathy (NAION), and optic neuritis (ON) eyes. METHODS Forty-five eyes of 45 NAION patients, 32 eyes of 32 ON patients, and 76 eyes of 76 healthy individuals with optic nerve head OCT-A were included. Four vessel density features of OCT-A images were developed using a threshold-based segmentation method and were integrated in 3 models of machine learning classifiers. Classification performances of support vector machine (SVM), random forest, and Gaussian Naive Bayes (GNB) models were evaluated with the area under the receiver-operating-characteristic curve (AUC) and accuracy. RESULTS We divided 121 images into a 70% training set and 30% test set. For ON-NAION classification, best results were achieved with 50% threshold, in which 3 classifiers (SVM, RF, and GNB) discriminated ON from NAION with an AUC of 1 and accuracy of 1. For ON-Normal classification, with 100% threshold, SVM and RF classifiers were able to discriminate normal from ON with AUCs of 1 and accuracies of 1. For NAION-normal classification, with 50% threshold, the SVM and RF classified the NAION from normal with AUC and accuracy of 1. CONCLUSIONS ML based on the combined peripapillary vessel density features of total vessels and capillaries in the whole image and ring image could provide excellent performance for NAION and ON distinction.
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Affiliation(s)
- Jalil Jalili
- Biomedical Engineering Unit (JJ, MN), Cardiovascular Disease Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran; Farabi Eye Hospital (BJ, AE, MAF), Tehran University of Medical Sciences, Tehran, Iran; School of Medicine (MM), Guilan University of Medical Sciences, Rasht, Iran; and Department of Ophthalmology (PSS), University of Colorado, School of Medicine, Aurora, Colorado
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Nowomiejska K, Lesiuk P, Brzozowska A, Tońska K, Rejdak R. Vascular Changes in the Macula of Patients after Previous Episodes of Vision Loss Due to Leber Hereditary Optic Neuropathy and Non-Arteritic Ischemic Optic Neuropathy. Diagnostics (Basel) 2023; 13:diagnostics13101726. [PMID: 37238209 DOI: 10.3390/diagnostics13101726] [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: 02/01/2023] [Revised: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE to assess the vasculature and thickness of the macula using OCT-A in patients who had experienced a previous episode of Leber hereditary optic neuropathy (LHON) or non-arteritic anterior ischemic optic neuropathy (NA-AION). METHODS twelve eyes with chronic LHON and ten eyes with chronic NA-AION and eight NA-AION fellow eyes were examined using OCT-A. The vessel density was measured in the superficial and deep plexus of the retina. Moreover, the full and inner thicknesses of the retina were assessed. RESULTS There were significant differences in all sectors between the groups in regard to the superficial vessel density and the inner and full thicknesses of the retina. The nasal sector of the macular superficial vessel density was affected more in LHON than in NA-AION; the same with the temporal sector of the retinal thickness. There were no significant differences between the groups in the deep vessel plexus. There were no significant differences between the vasculature of the inferior and superior hemifields of the macula in all groups and no correlation with the visual function. CONCLUSIONS The superficial perfusion and structure of the macula assessed with OCT-A are affected both in chronic LHON and NA-AION, but more in LHON eyes, especially in the nasal and temporal sectors.
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Affiliation(s)
- Katarzyna Nowomiejska
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Patrycja Lesiuk
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Agnieszka Brzozowska
- Department of Informatics and Medical Biostatistics, Medical University of Lublin, 20-059 Lublin, Poland
| | - Katarzyna Tońska
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 02-096 Warsaw, Poland
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland
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Pugazhendhi S, Yu M, Zhou G, Chen Y, Wang R, Liao YJ. Peripapillary and macular microvasculature features of non-arteritic anterior ischemic optic neuropathy. Front Med (Lausanne) 2023; 9:1033838. [PMID: 36714135 PMCID: PMC9877420 DOI: 10.3389/fmed.2022.1033838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose The hallmark of non-arteritic anterior ischemic optic neuropathy (NAION) is vascular compromise to the anterior optic nerve and thinning of the retinal nerve fiber layer (RNFL) and secondary degeneration of the retinal ganglion cell body or thinning of the ganglion cell complex (GCC). This study investigates optical coherence tomography (OCT) and OCT Angiography (OCTA) changes in chronic NAION and identifies imaging biomarkers that best predict disease. Methods We performed a retrospective case-control study of 24 chronic NAION eyes (18 patients) and 70 control eyes (45 patients) to compare both whole-eye and regional OCT, OCTA, static perimetry measurements. OCT measurements were quantified automatically using commercial software, and OCTA was analyzed using custom MATLAB script with large vessel removal to measure 154 total parameters per eye. Results We confirmed that static perimetry mean deviation (MD) was significantly worse in chronic NAION (-13.53 ± 2.36) than control (-0.47 ± 0.72; P < 0.001) eyes, and NAION eyes had 31 μm thinner RNFL (control: 95.9 ± 25.8 μm; NAION: 64.5 ± 18.0, P < 0.001), and 21.8 μm thinner GCC compared with controls (control: 81.5 ± 4.4 μm; NAION: 59.7 ± 10.5, P < 0.001). Spearman correlation analysis of OCTA parameters reveal that vessel area density (VAD) and flux are highly correlated with visual field MD and OCT measurements. Hierarchical clustering two distinct groups (NAION and control), where standardized measurements of NAION eyes were generally lower than controls. Two-way mixed ANOVAs showed significant interaction between patient status (control and chronic NAION) and structure (optic disk and macula) for annulus VAD and flux values and mean RNFL and GCC thickness. Post-hoc tests showed this effect stems from lower peripapillary values in NAION compared to controls. Separate logistic regression models with LASSO regularization identified VAD and flux are one of the best OCTA parameters for predicting NAION. Conclusion Ischemic insult to the optic disk is more severe likely from primary degeneration of the affected peripapillary region while macula is affected by secondary retrograde degeneration and loss of retinal ganglion cells. In addition to OCT measurements, peripapillary and macular vascular parameters such as VAD and flux are good predictors of optic nerve and retinal changes in NAION.
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Affiliation(s)
| | - Miaomiao Yu
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Gabriella Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Yuxuan Chen
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Ruikang Wang
- Department of Bioengineering, University of Washington, Seattle, WA, United States,Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Yaping Joyce Liao
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, United States,Department of Neurology, School of Medicine, Stanford University, Stanford, CA, United States,*Correspondence: Yaping Joyce Liao,
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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.
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Khalili MR, Bremner F, Tabrizi R, Bashi A. Optical coherence tomography angiography (OCT angiography) in anterior ischemic optic neuropathy (AION): A systematic review and meta-analysis. Eur J Ophthalmol 2023; 33:530-545. [PMID: 35844139 DOI: 10.1177/11206721221113681] [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: 01/11/2023]
Abstract
PURPOSE To summarize the evidence available on optical coherence tomography angiography (OCTA) in patients with anterior ischemic optic neuropathy (AION). METHODS Systematic searches were conducted on PubMed, Embase, Web of Science, Scopus, Cochrane, and Google Scholar Databases. The quality assessment of the included studies was performed using Newcastle -Ottawa Scale. The data were extracted to an Excel sheet. Vessel density (VD) data were pooled by random effects model, presented as pooled percentage change (PPC), and weighted mean differences (WMD). Additional subgroup analysis was also conducted. RESULTS In initial searches in online databases, we found 3535 citations, and after screening and checking the titles and abstracts, 26 articles were ultimately eligible for our meta-analysis. The overall PPC of Intra-optic-disc (IOD) VD (-10.73%; p = 0.017, I2 = 0.0%; p = 0.898) was lower than that of radial peripapillary (RP) VD (-17.57%; p < 0.001, I2 = 44.3%; p = 0.002). The overall PPC of peripapillary choroid VD (-6.99%; p < 0.001, I2 = 0.0%; p = 0.766) was significant, but noticeably lower than the pooled percentage change of RPVD and IOD VD. The WMD of RPVD was significant when non-affected fellow eyes were compared to the healthy subjects' eyes (-36.26; p < 0.001, I2 = 0.0%; p = 0.706). CONCLUSIONS The central retinal artery and its branches might be the main vessels which are affected in AION. The superficial retina was more affected than choroid layer in AION. Also, radial peripapillary retinal nerve fibre layer was more affected than the IOD area. OCTA might be a suitable tool for prediction of AION in susceptible eyes.
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Affiliation(s)
- Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, 48435Shiraz University of Medical Science, Medical school, Shiraz, Iran
| | - Fion Bremner
- Department of Neuro-ophthalmology, 98546National Hospital for Neurology & Neurosurgery, London, UK
| | - Reza Tabrizi
- Non-Communicable Diseases Research Center, 158767Fasa University of Medical Sciences, Fasa, Fars, Iran
| | - Ali Bashi
- Poostchi Ophthalmology Research Center, 48435Shiraz University of Medical Science, Medical school, Shiraz, Iran
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The Role of Optical Coherence Tomography Angiography in Optic Nerve Head Edema: A Narrative Review. J Ophthalmol 2022; 2022:5823345. [PMID: 36505507 PMCID: PMC9729054 DOI: 10.1155/2022/5823345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/21/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Optic nerve head (ONH) edema is a clinical manifestation of many ocular and systemic disorders. Ocular and central nervous system imaging has been used to differentiate the underlying cause of ONH edema and monitor the disease course. ONH vessel abnormalities are among the earliest signs of impaired axonal transportation. Optical coherence tomography angiography (OCTA) is a noninvasive method for imaging ONH and peripapillary vessels and has been used extensively for studying vascular changes in ONH disorders, including ONH edema. In this narrative review, we describe OCTA findings of the most common causes of ONH edema and its differential diagnoses including ONH drusen.
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Measurement of retinal nerve fiber layer thickness with a deep learning algorithm in ischemic optic neuropathy and optic neuritis. Sci Rep 2022; 12:17109. [PMID: 36224300 PMCID: PMC9556618 DOI: 10.1038/s41598-022-22135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/10/2022] [Indexed: 01/04/2023] Open
Abstract
This work aims at determining the ability of a deep learning (DL) algorithm to measure retinal nerve fiber layer (RNFL) thickness from optical coherence tomography (OCT) scans in anterior ischemic optic neuropathy (NAION) and demyelinating optic neuritis (ON). The training/validation dataset included 750 RNFL OCT B-scans. Performance of our algorithm was evaluated on 194 OCT B-scans from 70 healthy eyes, 82 scans from 28 NAION eyes, and 84 scans of 29 ON eyes. Results were compared to manual segmentation as a ground-truth and to RNFL calculations from the built-in instrument software. The Dice coefficient for the test images was 0.87. The mean average RNFL thickness using our U-Net was not different from the manually segmented best estimate and OCT machine data in control and ON eyes. In NAION eyes, while the mean average RNFL thickness using our U-Net algorithm was not different from the manual segmented value, the OCT machine data were different from the manual segmented values. In NAION eyes, the MAE of the average RNFL thickness was 1.18 ± 0.69 μm and 6.65 ± 5.37 μm in the U-Net algorithm segmentation and the conventional OCT machine data, respectively (P = 0.0001).
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Wu Y, Yang Q, Ding L, Tu Y, Deng X, Yang Y, Shen M, Lu Q, Lu F, Chen Q. Peripapillary structural and microvascular alterations in early dysthyroid optic neuropathy. EYE AND VISION (LONDON, ENGLAND) 2022; 9:30. [PMID: 35941698 PMCID: PMC9361673 DOI: 10.1186/s40662-022-00301-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/20/2022] [Indexed: 01/04/2023]
Abstract
Background To explore the changes in blood supply and structure around the optic nerve head (ONH) in thyroid-associated ophthalmopathy (TAO) patients with suspected dysthyroid optic neuropathy (DON). Methods TAO patients [19 with DON; 24 non-DON (NDON); 20 with equivocal DON (EDON)], and 34 control subjects were examined. Optical coherence tomography angiography (OCTA) was used to obtain peripapillary retinal nerve fiber layer (p-RNFL) and vessel density parameters, including the ONH whole image vessel density (ONH-wiVD) and the radial peripapillary capillary vessel density (RPC-VD) in early DON. Results Although there were no differences in p-RNFL thickness among the groups, there were differences in the ONH-wiVD of each grid section and the RPC-VD in all areas (P < 0.01). Compared with healthy controls, the EDON eyes had significantly lower RPC-VDs in all aeras (P < 0.05).The peripapillary region was further divided into eight sectors, and the RPC-VD in the temporal upper, superior temporal, and temporal lower sectors in the EDON group were significantly lower than in the controls. The visual impairment was closely related to the loss of peripapillary capillary vessel density. Univariate correlation analysis showed that the ONH-wiVD and RPC-VD of the TAO groups were negatively correlated with the intraocular pressure (r = − 0.296, P = 0.006; r = − 0.258, P = 0.016 respectively). Conclusions EDON patients had significantly lower ONH-wiVD and RPC-VD than control subjects, and the temporal and upper VDs were more likely to be affected in the early stage of TAO. The combined use of spectral domain optical coherence tomography and OCTA technologies offer a new method for early diagnosis of suspected DON patients.
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Affiliation(s)
- Yufei Wu
- The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.,School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Qiaoli Yang
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Liujun Ding
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Yunhai Tu
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Xiaoyu Deng
- The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yan Yang
- The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Qinkang Lu
- The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
| | - Qi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
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Prognostic value of radial peripapillary capillary density for visual field outcomes in pituitary adenoma: A case-control study. J Clin Neurosci 2022; 100:113-119. [DOI: 10.1016/j.jocn.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
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Abdolalizadeh P, Kashkouli MB, Moradpasandi F, Falavarjani KG, Mirshahi R, Akbarian S. Optic Nerve Head Vessel Density Changes from Graves' Disease without TED to TED Dysthyroid Optic Neuropathy: Does Optic Nerve Head Ischemia Play a Role? Ophthalmic Plast Reconstr Surg 2022; 38:250-257. [PMID: 34593713 DOI: 10.1097/iop.0000000000002046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the retinal peripapillary capillary (RPC) vessel density (VD) between 5 groups of patients on the spectrum of thyroid eye disease (TED). METHOD This is a prospective comparative study looking at 5 groups of patients who were consecutively included from January 2018 to March 2021. They were composed of: Healthy volunteers (39 eyes and 20 subjects), patients with Graves' disease without TED (26 eyes and 13 patients), mild TED (28 eyes and 14 patients), moderate-severe TED (30 eyes and 17 patients), and TED with dysthyroid optic neuropathy (DON) (21 eyes and 12 patients). Ocular and periocular examination, visual field indices, RPC-VD (with optical coherence tomography angiography), and retinal nerve fiber layer, and macular ganglion cell complex thickness were recorded. RESULT An initial insignificant (0.5 < p < 0.9) rise in the peripapillary-VD (pp-VD) and whole image-VD (wi-VD) from the healthy subject to the Graves' disease without TED was followed by a significant (p = 0.001) fall in RPC-VD in different severity grades of the TED. Paired comparison between the 5 groups showed that the statistically significant fall from the Graves' disease group occurred in the moderate-severe and DON groups (0.001 ≤ p ≤ 0.04). No variable significantly affected the VD (0.08 ≤ p ≤ 0.9). A lower wi-VD and pp-VD were significantly (0.001 ≤ p ≤ 0.009) correlated with the impaired optic nerve functional and structural tests. The sensitivity and specificity of wi-VD (81% and 76%) and pp-VD (69% and 71%) for detecting the DON were statistically significant (p < 0.001). CONCLUSION Despite an insignificant rise in the wi- and pp-VD from the healthy volunteers to the patients with Graves' disease without TED, VD showed a declining trend in the course of patients with TED, which was statistically significant in the moderate-severe TED and DON groups.
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Affiliation(s)
- Parya Abdolalizadeh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Mohsen Bahmani Kashkouli
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Farideh Moradpasandi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
| | - Shadi Akbarian
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences
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Lee GI, Kim Y, Park KA, Oh SY, Kong DS, Hong SD. Parafoveal and peripapillary vessel density in pediatric and juvenile craniopharyngioma patients. Sci Rep 2022; 12:5355. [PMID: 35354881 PMCID: PMC8969166 DOI: 10.1038/s41598-022-09391-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractWe assessed the retinal microvascular alterations detected by optical coherence tomography angiography (OCT-A) in pediatric and juvenile craniopharyngioma (CP) patients with chiasmal compression. We included 15 eyes of 15 pediatric or juvenile CP patients and 18 eyes of 18 healthy subjects. The evaluation of vessel density from the superficial retinal capillary plexus (SRCP), the deep retinal capillary plexus, and the radial peripapillary capillary (RPC) segments was obtained by OCT-A. The association between vessel density measures and functional and structural measurements was also analyzed. There were significant reductions in the nasal sector of the SRCP (p < 0.0001) and all sectors of the RPC segment vessel density (nasal, temporal, and superior; p < 0.0001, inferior; p = 0.0015) in CP patients postoperatively compared to the healthy subjects. The peripapillary retinal nerve fiber layer (r = 0.6602, p = 0.0074) and ganglion cell-inner plexiform layer thicknesses (r = 0.7532, p = 0.0030) were associated with RPC segment vessel density. Visual acuity (r = − 0.5517, p = 0.0330) and temporal visual field sensitivity loss (r = 0.5394, p = 0.0465) showed an association with SRCP vessel density. In pediatric and juvenile patients with CP, parafoveal and peripapillary vascular changes following chiasmal compression were observed. The changes in vascular structures were closely related to structural and functional outcomes.
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Chou Y, Zhang B, Ma J, Zhong Y. Microvascular alterations detected by optical coherence tomography angiography in non-arteritic anterior ischaemic optic neuropathy: a meta-analysis. Acta Ophthalmol 2022; 100:e386-e395. [PMID: 34155823 DOI: 10.1111/aos.14930] [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: 11/15/2020] [Revised: 04/05/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate microvascular alterations with optical coherence tomography angiography (OCTA) in eyes with non-arteritic anterior ischaemic optic neuropathy (NAION) and the unaffected fellow eyes. DESIGN Systematic review and meta-analysis. METHODS A comprehensive literature search was conducted in the PubMed and Embase databases through 6 September 2020, to identify the studies on NAION and the unaffected fellow eyes using OCTA. Eligible studies and data of interest were extracted and analysed by RevMan Software v. 5.4 and Stata Software v.14.0. The weighted mean differences and 95% confidence intervals were used to assess the strength of the association. RESULTS Seventeen observational comparative studies, including 379 eyes with NAION, 175 unaffected contralateral eyes and 470 eyes of healthy controls, were identified. Compared to those of the healthy controls, the perfusion density (PD) of radial peripapillary capillary (RPC) and peripapillary superficial capillary plexus (ppSCP) of NAION were significantly lower. Moreover, the PD of the macular SCP (mSCP) in NAION was significantly reduced in the whole image, superior quadrant and temporal quadrant, while the macular deep capillary plexus (mDCP) showed a decreasing PD only within the whole image. Between unaffected fellow eyes and healthy eyes, significant differences of PD were demonstrated in the whole image and some peripapillary regions of the RPC and ppSCP. CONCLUSION Our results suggested that compared to those of healthy controls, the eyes affected by NAION and unaffected fellow eyes demonstrated significant microvascular impairments in different regions. Between acute and non-acute NAION, macular OCTA parameters showed different characteristic patterns.
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Affiliation(s)
- Yuyu Chou
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences Beijing China
| | - Bilei Zhang
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences Beijing China
| | - Jin Ma
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences Beijing China
| | - Yong Zhong
- Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China
- Key Laboratory of Ocular Fundus Diseases Chinese Academy of Medical Sciences Beijing China
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Evaluation of retinal microvascular structures by optical coherence tomography angiography in primary Sjögren's syndrome. Int Ophthalmol 2021; 42:1147-1159. [PMID: 34746971 DOI: 10.1007/s10792-021-02100-9] [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: 07/23/2020] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES There are insufficient data in the literature on how retinal capillaries are affected in primary Sjögren's syndrome (PSS). The aim of this study was to evaluate the retinal capillary density (CD) in PSS using optical coherence tomography angiography (OCTA). METHODS In this case-control study, 26 eyes from 13 PSS patients and 39 eyes from 20 healthy controls (HCs) were included. The CD in the regions of the superior capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillaries (RPC) as well as assessment parameters of the foveal avascular zone (FAZ) were examined by OCTA. RESULTS The mean CD (%) was 50.2 ± 4.2 and 50.5 ± 3.4 in the SCP (p = 0.904), 49.2 ± 7.5 and 53.9 ± 5.7 in the DCP (p = 0.006) and 50.8 ± 2.1 and 49.8 ± 2.2 in the RPC (p = 0.088) regions in patients with PSS and HCs, respectively. In patients with PSS and HCs, the mean sizes of the FAZ were 0.243 ± 0.07 mm2 and 0.283 ± 0.13 mm2 (p = 0.142), and the mean sizes of the non-flow area were 0.480 ± 0.11 mm2 and 0.509 ± 0.13 mm2, respectively (p = 0.359). The correlation coefficients (Rho) of retinal CD in the SCP, DCP and RPC regions with disease duration were - 0.545 (p = 0.004), - 0.389 (p = 0.050) and - 0.795 (p < 0.001), respectively. CONCLUSION The retinal CD in PSS is lower than that in the healthy population in deep retinal capillaries, and retinal CD shows a negative correlation with disease duration in PSS. CLINICAL TRIALS REGISTRATION This study was not registered to clinicaltrials.gov.
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Ye X, Zhang H, Xiao P, Wang G, Hu X, Yan C, Li F, Hu Y, Su L, Luo J, Yuan J, Wen F, Chi W. Microvasculature Features of Vogt-Koyanagi-Harada Disease Revealed by Widefield Swept-Source Optical Coherence Tomography Angiography. Front Med (Lausanne) 2021; 8:719593. [PMID: 34722564 PMCID: PMC8551582 DOI: 10.3389/fmed.2021.719593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Vogt-Koyanagi-Harada (VKH) disease is a multisystem autoimmune disorder which could induce bilateral panuveitis involving the posterior pole and peripheral fundus. Optical coherence tomography angiography (OCTA) provides several advantages over traditional fluorescence angiography for revealing pathological abnormalities of the retinal vasculature. Until recently, however, the OCTA field of view (FOV) was limited to 6 × 6 mm2 scans. Purpose: This study examined retinal vasculature and choriocapillaris abnormalities across multiple regions of the retina (15 × 9 mm2 wide field, macular, peripapillary regions) among acute and convalescent VKH patients using a novel widefield swept-source OCTA (WSS-OCTA) device and assessed correlations between imaging features and best-corrected visual acuity (BCVA). Methods: Twenty eyes of 13 VHK disease patients in the acute phase, 30 eyes of 17 patients in the convalescent phase, and 30 eyes of 15 healthy controls (HCs) were included in this study. Vascular length density (VLD) in superficial and deep vascular plexuses (SVP, DVP), vascular perfusion density (VPD) in SVP, DVP, and choriocapillaris (CC), and flow voids (FV) in CC were measured across multiple retinal regions via WSS-OCTA (PLEX Elite 9000, Carl Zeiss Meditec Inc., USA) using the 15 × 9 mm2 scan pattern centered on the fovea and quantified by ImageJ. Results: Compared to HCs, acute phase VKH patients exhibited significantly reduced SVP-VLD, SVP-VPD, and CC-VPD across multiple retinal regions (all p < 0.01). Notably, the FV area was more extensive in VKH patients, especially those in the acute phase (p < 0.01). These changes were reversed in the convalescent phase. Stepwise multiple linear regression analysis demonstrated that macular DVP-VLD and macular CC-VPD were the best predictive factors for BCVA in the acute and convalescent VKH groups. Conclusion: The wider field of SS-OCAT provides more comprehensive and detailed images of the microvasculature abnormalities characterizing VKH disease. The quantifiable and layer-specific information from OCTA allows for the identification of sensitive and specific imaging markers for prognosis and treatment guidance, highlighting WSS-OCTA as a promising modality for the clinical management of VKH disease.
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Affiliation(s)
- Xiaoyuan Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haiping Zhang
- Tianjin Aier Eye Hospital, Tianjin, China.,Aier Eye Institute, Changsha, China
| | - Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Gengyuan Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoqing Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chun Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yixin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lishi Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jiawen Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Chi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Liu B, Yu Y, Liu W, Deng T, Xiang D. Risk Factors for Non-arteritic Anterior Ischemic Optic Neuropathy: A Large Scale Meta-Analysis. Front Med (Lausanne) 2021; 8:618353. [PMID: 34671609 PMCID: PMC8520961 DOI: 10.3389/fmed.2021.618353] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 09/02/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: We conducted a meta-analysis to explore all the potential risk factors for non-arteritic anterior ischemic optic neuropathy (NAION) based on the published literature. Methods: A comprehensive literature search through the online databases was performed to obtain studies concerning the risk factors of NAION up to June 2020. Pooled unadjusted odds ratios (ORs) or rate ratios (RRs) were calculated to evaluate the weight of risk factors. This study was registered in PROSPERO under the number CRD42018084960. Results: Our meta-analysis included 49 original studies comprising of more than 10 million patients. The following risk factors were proved to be significantly associated with NAION: male gender (OR = 1.67, 95% CI: 1.50-1.85, P < 0.00001), hypertension (RR = 1.28, 95% CI: 1.20-1.37, P < 0.00001), hyperlipidemia (RR = 1.43, 95% CI: 1.26-1.62, P < 0.00001), diabetes mellitus (DM) (RR = 1.53, 95% CI: 1.36-1.73, P < 0.00001), coronary heart disease (CHD) (RR = 1.68, 95% CI: 1.24-2.27, P = 0.0008), sleep apnea (RR = 3.28, 95% CI: 2.08-5.17, P < 0.00001), factor V Leiden heterozygous (RR = 2.21, 95% CI: 1.19-4.09, P = 0.01), and medication history of cardiovascular drugs. Conclusion: We concluded that the above risk factors were significantly related to NAION. Better understanding of these risk factors in NAION can help the direct therapeutic approaches.
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Affiliation(s)
- Bing Liu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ying Yu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen Liu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tuo Deng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Daoman Xiang
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Lee EJ, Kee HJ, Park KA, Han JC, Kee C. Comparative Topographical Analysis of Choroidal Microvascular Dropout Between Glaucoma and Nonarteritic Anterior Ischemic Optic Neuropathy. Invest Ophthalmol Vis Sci 2021; 62:27. [PMID: 34705024 PMCID: PMC8556563 DOI: 10.1167/iovs.62.13.27] [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] [Indexed: 01/27/2023] Open
Abstract
Purpose To identify the presence of choroidal microvascular dropout (MvD) in nonarteritic anterior ischemic optic neuropathy (NAION) eyes and to characterize the topographical distribution for the mechanistic interpretation of MvD development. Methods We performed optical coherence tomography angiography on 47 open-angle glaucoma (OAG) and 19 NAION eyes with β-zone peripapillary atrophy (βPPA). We recorded the presence of MvD and compared between the peripapillary topographical measures of MvD, retinal nerve fiber layer (RNFL) defect, and βPPA in angular width and location. Results MvD was present in both diseases, marginally more frequently in NAION eyes (19/19, 100.0%) than in OAG eyes (38/47, 80.6%, P = 0.050), without a discernable difference in appearance. NAION eyes also showed wider MvD and RNFL defects compared to OAG eyes (both P < 0.001). In topographical measurements, the distribution of MvD showed a strong correspondence to superimposition areas of βPPA and RNFL defects, more distinctly than to RNFL defects (all P < 0.001). The outline of superimposition area also remarkably resembled the MvD area. Conclusions MvD was present in both the OAG and NAION groups. The βPPA-RNFL defect superimposition area topographically and morphologically matched MvD. Further investigations are needed to elucidate the role of RNFL defects in the pathogenesis of MvD and the clinical significance.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Joo Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Coffey AM, Hutton EK, Combe L, Bhindi P, Gertig D, Constable PA. Optical coherence tomography angiography in primary eye care. Clin Exp Optom 2021; 104:3-13. [PMID: 32285493 DOI: 10.1111/cxo.13068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Optical coherence tomography angiography (OCT-A) is a non-invasive imaging modality for assessing the vasculature within ocular structures including the retina, macula, choroid and optic nerve. OCT-A has a wide range of clinical applications in various optometric conditions which have been independently reported in the literature. This paper aims to present a review of the current literature on the clinical application of OCT-A in optometric practice as well as to analyse and evaluate the quality of the available evidence. This review included 78 articles from a literature search conducted on 26 May 2019 across the following databases: Cochrane Library of Systematic Reviews, Medline, Scopus and Web of Science. Primary ocular pathologies discussed in this review include glaucoma, diabetic retinopathy, age-related macular degeneration, myopia, acquired and congenital macular dystrophies, epiretinal membrane, retinal vein occlusion, retinitis pigmentosa, choroidal melanoma, uveitis, central serous chorioretinopathy, amblyopia and optic neuropathies. Primary outcome variables included vessel density, foveal avascular zone area and diameter, flow velocity and flow index. This review aims to evaluate the evidence available for OCT-A applications in diagnosis and prognosis of ocular conditions in an optometric setting.
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Affiliation(s)
- Alexandra M Coffey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University , Adelaide, Australia
| | - Emily K Hutton
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University , Adelaide, Australia
| | - Louise Combe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University , Adelaide, Australia
| | - Pooja Bhindi
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University , Adelaide, Australia
| | - Demi Gertig
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University , Adelaide, Australia
| | - Paul A Constable
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University , Adelaide, Australia
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Abri Aghdam K, Aghajani A, Razi-Khosroshahi M, Soltan Sanjari M, Chaibakhsh S, Falavarjani KG. Optical Coherence Tomography Angiography and Structural Analyses of the Pale Optic Discs: Is It Possible to Differentiate the Cause? Curr Eye Res 2021; 46:1876-1885. [PMID: 33980086 DOI: 10.1080/02713683.2021.1929331] [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: 10/21/2022]
Abstract
Introduction: To compare the optic nerve head (ONH) structure and microvasculature in patients with optic atrophy due to non-arteritic anterior ischemic optic neuropathy (NAION), compressive optic neuropathy (CON), methanol-induced optic neuropathy (MION), and traumatic optic neuropathy (TON) using optical coherence tomography angiography.Methods: In this comparative, cross-sectional study, 32 eyes with NAION, 18 eyes with CON, 32 eyes with MION, 23 eyes with TON, and 55 normal eyes were enrolled. Radial peripapillary capillary (RPC) vessel density, peripapillary retinal nerve fiber layer (RNFL) thickness, disc area, cup volume, and cup/disc area ratio were obtained using the RTVue XR Avanti system (Optovue Inc., Fremont, CA, USA).Results: RPC vessel density and peripapillary RNFL thickness in all patients were significantly lower than normal subjects. A positive correlation was found between the RPC vessel density and peripapillary RNFL thickness in normal subjects and all study groups. The positive correlation between the inside and outside disc RPC vessel density was only found in the NAION (r = 0.36, P = .042) and MION (r = 0.42, P = .018) groups. No significant difference was found among the groups in terms of peripapillary and inside disc vascular densities (all P > .05). Disc area and cup volume in patients with MION was larger than the values in patients with NAION (P = .018) and TON (P = .044) and normal subjects (P = .015). The discriminating features among the study groups were the larger cup volume and cup/disc area ratio in patients with MION, and lower RNFL thickness in patients with TON.Conclusions: There was a positive correlation between the RNFL thickness and peripapillary RPC vessel density regardless of the cause of optic disc pallor. Structural evaluation of the ONH seems to be a better way to differentiate the cause of optic nerve head atrophy than the microangiographic changes.
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Affiliation(s)
- Kaveh Abri Aghdam
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aghajani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Razi-Khosroshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Soltan Sanjari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
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Lee G, Park K, Oh SY, Min J, Kim BJ. Peripapillary and parafoveal microvascular changes in eyes with optic neuritis and their fellow eyes measured by optical coherence tomography angiography: an Exploratory Study. Acta Ophthalmol 2021; 99:288-298. [PMID: 32833336 DOI: 10.1111/aos.14577] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE This study aimed to evaluate parafoveal and peripapillary microvascular alterations in eyes with optic neuritis (ON) along with their fellow eyes compared to healthy control eyes using optical coherence tomography angiography (OCT-A). METHODS We included 31 ON-affected eyes and 31 fellow eyes of 31 patients who had experienced unilateral ON and 33 eyes of 33 healthy controls in this exploratory retrospective cross-sectional study. Optical coherence tomography angiography (OCT-A) was used to generate microvascular structural images and quantify the vessel density of the superficial retinal capillary plexus (SRCP), the deep retinal capillary plexus (DRCP) and radial peripapillary capillary (RPC) segments. We used the Kruskal-Wallis test for the comparison of OCT-A results between the three groups and generalized estimating equation models for the pairwise comparisons. RESULTS There were significant differences of SRCP (p = 0.0003) and RPC segment (p < 0.0001) vessel densities between the three groups. Specifically, there was a reduction in parafoveal and peripapillary vessel density in the ON-affected eyes compared to fellow eyes (SRCP, estimates, -1.97, 95% confidence interval [CI], -3.07, -0.87; RPC, -6.95, 95% CI, -8.70, -5.19) and controls (SRCP, -3.15, 95% CI, -4.61, -1.69; RPC, -8.66, 95% CI, -10.55, -6.76). The superior sector of the RPC segments vessel density in the fellow eyes was decreased compared to the controls (-4.93, 95% CI, -8.07, -1.80). CONCLUSIONS The results of this study suggest that microvascular changes occur in both the affected eye and unaffected fellow eye after a unilateral ON episode. Future studies are needed to clarify the clinical implications of these findings.
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Affiliation(s)
- Ga‐In Lee
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Kyung‐Ah Park
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Sei Yeul Oh
- Department of Ophthalmology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Ju‐Hong Min
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Byoung Joon Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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Aghsaei Fard M, Safizadeh M, Shaabani A, Kafieh R, Hojati S, Afzali M, Suwan Y, Ritch R, Moghimi S. Automated Evaluation of Parapapillary Choroidal Microvasculature in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma. Am J Ophthalmol 2021; 224:178-184. [PMID: 33309810 DOI: 10.1016/j.ajo.2020.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether parapapillary choroidal microvasculature (PPCMv) density as measured by optical coherence tomography angiography differs between pseudoexfoliation syndrome (PXS) and pseudoexfoliation glaucoma (PXG). DESIGN Cross-sectional study. METHODS One hundred ninety-two eyes of 120 subjects from 2 academic referral institutions were enrolled. Automated PPCMv density was calculated using custom Matlab software in inner and outer annuli around the optic nerve region in addition to peripapillary superficial vasculature. Linear modeling was used to compare vessel densities among groups. RESULTS Data from 64 eyes with PXS, 84 eyes with PXG, and 44 eyes healthy control subjects were analyzed. The differences of visual field mean deviation and peripapillary retinal nerve fiber layer thickness among study groups were statistically significant with lower values in PXG eyes compared with the PXS and control groups. Peripapillary superficial retinal vessel densities were significantly reduced in patients with PXG compared with patients with PXS and normal control subjects (all P < .001) without a difference between PXS and control eyes. Customized outer annular PPCMv density in the PXG group with a value of 11.1% (SD 5.1%) was lower than that in PXS with a value of 13.2% (SD 5.3%; P = .001). Similarly, PXS values were lower than those of control eyes with a value of 18.6% (SD 5.1%; P < .001). CONCLUSION A progressive decrease in outer PPCMv from the control group to those with PXS without glaucoma to those with PXS and glaucoma (PXG) showed deep peripapillary vasculopathy in pseudoexfoliation syndrome. Choroidal vessel density may be affected early in the course of pseudoexfoliation before glaucoma develops.
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Costello F, Chen JJ. The role of optical coherence tomography in the diagnosis of afferent visual pathway problems: A neuroophthalmic perspective. HANDBOOK OF CLINICAL NEUROLOGY 2021; 178:97-113. [PMID: 33832689 DOI: 10.1016/b978-0-12-821377-3.00007-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Optical coherence tomography (OCT) is a noninvasive ocular imaging technique that has become a standard tool in neuroophthalmic practice. Specifically, OCT captures retinal manifestations of neuroaxonal injury caused by lesions along anterior and posterior regions of the afferent visual pathway, in patients presenting with vision loss. More recently, the advent of OCT angiography (OCTA) has enabled evaluation of the choroidal and retinal microvasculature, thus informing our understanding regarding vascular mechanisms associated with optic nerve and retinal injuries. Much of our longitudinal experience with OCT in the field of neuroophthalmology has been acquired from the study of optic neuritis (ON) caused by inflammatory disorders of the central nervous system (CNS). Over the past two decades, OCT has emerged as a surrogate endpoint for CNS neuroaxonal injury in multiple sclerosis (MS) research trials. On a more pragmatic level, OCT is used in the clinical arena to diagnose ON associated with: MS, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody associated disease (MOGAD). Subsequent advancements in swept-source (SS) and enhanced depth imaging (EDI) have established OCT as the new "gold standard" in the diagnosis of optic disc drusen. Recent studies have highlighted pathognomonic OCT features that distinguish cases of true papilledema from pseudopapilledema, in patients presenting with undifferentiated optic disc elevation. Preoperative OCT measures of neuroaxonal integrity have shown prognostic value in predicting postoperative visual outcomes for patients with compressive anterior visual pathway lesions. Finally, OCT is indispensable in differentiating optic neuropathies from retinal diseases in patients with visual loss and a nondiagnostic fundus examination. An in-depth discussion regarding the technical aspects of OCT is beyond the scope of this chapter. Instead, we wish to highlight the value OCT brings to the diagnosis and management of common neuroophthalmic conditions, with emphasis on optic neuropathies and retinal disorders.
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Affiliation(s)
- Fiona Costello
- Departments of Clinical Neurosciences and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, United States
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22
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Lo C, Vuong LN, Micieli JA. Recent advances and future directions on the use of optical coherence tomography in neuro-ophthalmology. Taiwan J Ophthalmol 2021; 11:3-15. [PMID: 33767951 PMCID: PMC7971436 DOI: 10.4103/tjo.tjo_76_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022] Open
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging technique used to qualitatively and quantitatively analyze various layers of the retina. OCT of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) is particularly useful in neuro-ophthalmology for the evaluation of patients with optic neuropathies and retrochiasmal visual pathway disorders. OCT allows for an objective quantification of edema and atrophy of the RNFL and GCIPL, which may be evident before obvious clinical signs and visual dysfunction develop. Enhanced depth imaging OCT allows for visualization of deep structures of the optic nerve and has emerged as the gold standard for the detection of optic disc drusen. In the evaluation of compressive optic neuropathies, OCT RNFL and GCIPL thicknesses have been established as the most important visual prognostic factor. There is increasing evidence that inclusion of OCT as part of the diagnostic criteria for multiple sclerosis (MS) increases its sensitivity. Moreover, OCT of the RNFL and GCIPL may be helpful in the early detection and monitoring the treatment of conditions such as MS and Alzheimer's disease. OCT is an important aspect of the neuro-ophthalmologic assessment and its use is likely to increase moving forward.
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Affiliation(s)
- Cody Lo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laurel N. Vuong
- The New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Jonathan A. Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Murphy OC, Kalaitzidis G, Vasileiou E, Filippatou AG, Lambe J, Ehrhardt H, Pellegrini N, Sotirchos ES, Luciano NJ, Liu Y, Fitzgerald KC, Prince JL, Calabresi PA, Saidha S. Optical Coherence Tomography and Optical Coherence Tomography Angiography Findings After Optic Neuritis in Multiple Sclerosis. Front Neurol 2020; 11:618879. [PMID: 33384660 PMCID: PMC7769949 DOI: 10.3389/fneur.2020.618879] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Background: In people with multiple sclerosis (MS), optic neuritis (ON) results in inner retinal layer thinning, and reduced density of the retinal microvasculature. Objective: To compare inter-eye differences (IEDs) in macular optical coherence tomography (OCT) and OCT angiography (OCTA) measures in MS patients with a history of unilateral ON (MS ON) vs. MS patients with no history of ON (MS non-ON), and to assess how these measures correlate with visual function outcomes after ON. Methods: In this cross-sectional study, people with MS underwent OCT and OCTA. Superficial vascular plexus (SVP) density of each eye was quantified using a deep neural network. IEDs were calculated with respect to the ON eye in MS ON patients, and with respect to the right eye in MS non-ON patients. Statistical analyses used mixed-effect regression models accounting for intra-subject correlations. Results: We included 43 MS ON patients (with 92 discrete OCT/OCTA visits) and 14 MS non-ON patients (with 24 OCT/OCTA visits). Across the cohorts, mean IED in SVP density was −2.69% (SD 3.23) in MS ON patients, as compared to 0.17% (SD 2.39) in MS non-ON patients (p = 0.002). When the MS ON patients were further stratified according to time from ON and compared to MS non-ON patients with multiple cross-sectional analyses, we identified that IED in SVP density was significantly increased in MS ON patients at 1–3 years (p = < 0.001) and >3 years post-ON (p < 0.001), but not at <3 months (p = 0.21) or 3–12 months post-ON (p = 0.07), while IED in ganglion cell + inner plexiform layer (GCIPL) thickness was significantly increased in MS ON patients at all time points post-ON (p ≦ 0.01 for all). IED in SVP density and IED in GCIPL thickness demonstrated significant relationships with IEDs in 100% contrast, 2.5% contrast, and 1.25% contrast letter acuity in MS ON patients (p < 0.001 for all). Conclusions: Our findings suggest that increased IED in SVP density can be detected after ON in MS using OCTA, and detectable changes in SVP density after ON may occur after changes in GCIPL thickness. IED in SVP density and IED in GCIPL thickness correlate well with visual function outcomes in MS ON patients.
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Affiliation(s)
- Olwen C Murphy
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Grigorios Kalaitzidis
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Eleni Vasileiou
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Angeliki G Filippatou
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Jeffrey Lambe
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Henrik Ehrhardt
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicole Pellegrini
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Elias S Sotirchos
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicholas J Luciano
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Yihao Liu
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Kathryn C Fitzgerald
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Peter A Calabresi
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
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Optical Coherence Tomography Angiography Assessment of the Peripapillary Vessel Density and Structure in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1359120. [PMID: 33178816 PMCID: PMC7647740 DOI: 10.1155/2020/1359120] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/22/2023]
Abstract
Background This meta-analysis is aimed at assessing the peripapillary vessel density (VD) and structural outcomes using optical coherence tomography angiography (OCTA) in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases for literature comparing VD and structural outcomes in patients with NAION and controls was performed. Mean differences (MDs) and its 95% confidence interval (CI) were calculated for continuous estimates. Review Manager (V5.30) was used for analysis. Results Fourteen published studies met the requirement. The radial peripapillary capillary (RPC) whole enface VD measured by OCTA was significantly lower in patients with NAION compared to that of the controls (MD = −10.51, P < 0.00001). The RPC inside disc VD was significantly decreased in the NAION group than that in the control group (MD = −8.47, P < 0.00001). For RPC peripapillary VD, there was a statistically significant difference between patients with NAION and the controls (MD = −12.48, P < 0.00001). The peripapillary retinal nerve fibre layer (p-RNFL) thickness was significantly lower in patients with NAION in comparison to the controls (MD = −22.18, P = 0.004). The ganglion cell complex (GCC) thickness in the macular zone of NAION patients was remarkably reduced compared to that in the controls (MD = −17.18, P = 0.0002). Conclusions The findings suggested that the peripapillary VD and RNFL thickness were attenuated, and the macular GCC thickness was reduced in patients with NAION. OCTA, in the future, may facilitate the diagnosis and monitoring of patients with NAION.
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Zheng X, Wang Y, Chen G, Ma C, Yan W, Chen M. Diagnosis of ischemic optic neuropathy caused by dissection of the internal carotid artery: A case report. Medicine (Baltimore) 2020; 99:e20034. [PMID: 32871969 PMCID: PMC7437740 DOI: 10.1097/md.0000000000020034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ischemic optic neuropathy (ION), due to diseases of the arteries supplying the optic nerve, is an ischemic damage of the optic nerve. This report highlights a case with monocular decreasing visual acuity caused by dissection of the internal carotid artery (ICA), which is a relatively rare cause for ION. PATIENT CONCERNS A 44-year-old woman presented with a decreasing visual acuity and defected visual field in the right eye for 1 week. The best corrected visual acuity (BCVA) was 20/400 in the right eye, and 20/20 in the left eye. In the right eye, the pupil showed little reaction to light with a relative afferent pupillary defect. The visual field test disclosed a defect in the inferior field connecting to the blind spot. Electroretinogram recording showed no obviously declined retinal function. No recognizable waveforms were presented in pattern visual-evoked potential (PVEP) examination, whereas the flash visual-evoked potential result revealed a delayed peak time and a reduced amplitude of P2-wave. DIAGNOSIS The patient was diagnosed as ION with the aid of computed tomographic angiography of the brain and neck, which revealed a stenosis in the right ICA and an occlusion in the right cerebral middle artery. The stenosis was verified as dissection of the ICA by digital subtraction angiography. INTERVENTIONS Based on the clinical findings, stent implantation inside the right ICA was performed. OUTCOMES The ICA was recanalized soon and the BCVA of the right eye was improved to be 20/25 five months later. A second PVEP examination revealed a recognizable waveform in the right eye, although the peak time and amplitude of the P100-wave was a bit abnormal compared to that of the left eye. LESSONS ION with the sign of decreasing monocular visual acuity could occur due to dissection of the ICA, with no obvious neurologic symptom at the beginning. The present case emphasizes the importance of suspicion of ICA problems as the underlying cause for ION, which could help to take in-time measure to save the vision and avoid further complications.
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MESH Headings
- Adult
- Carotid Artery, Internal, Dissection/complications
- Carotid Artery, Internal, Dissection/diagnosis
- Carotid Artery, Internal, Dissection/therapy
- Diagnosis, Differential
- Female
- Humans
- Optic Neuropathy, Ischemic/diagnosis
- Optic Neuropathy, Ischemic/etiology
- Optic Neuropathy, Ischemic/therapy
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Aghsaei Fard M, Salabati M, Mahmoudzadeh R, Kafieh R, Hojati S, Safizadeh M, Moghimi S, Ritch R, Subramanian PS. Automated Evaluation of Parapapillary Choroidal Microvasculature in Ischemic Optic Neuropathy and Open Angle Glaucoma. Invest Ophthalmol Vis Sci 2020; 61:35. [PMID: 32191289 PMCID: PMC7401492 DOI: 10.1167/iovs.61.3.35] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine whether parapapillary choroidal microvasculature (PPCMv) density as measured by optical coherence tomography angiography differs between nonarteritic anterior ischemic optic neuropathy (NAION) and primary open angle glaucoma (POAG). Methods Thirty-seven eyes with chronic NAION, 34 unaffected fellow eyes with NAION, 47 moderate and severe POAG eyes, and 54 healthy control subjects were evaluated. Automated PPCMv density was calculated using custom Matlab software in inner and outer annuli around the optic nerve region in addition to peripapillary superficial retinal vessels. Results Linear models showed no difference in peripapillary retinal nerve fiber layer between NAION and POAG eyes. Mean peripapillary superficial small vessels in the NAION and POAG groups were 36.62 ± 7.1% and 39.72 ± 8.18% without a statistically difference between them (P = 0.16). Mean inner and outer annular region PPCMv densities in the NAION group were 26.55 ± 9.2% and 17.81 ± 6.9%, which were not different from unaffected fellow eyes and the control group. However, the POAG group had significantly reduced PPCMv density in both inner and outer annuli with values of 15.84 ± 6.5% and 12.80 ± 5.0%, respectively, compared with normal subjects (both P < 0.001). Inner and outer circle PPCMv densities were also significantly reduced in the POAG group compared with the NAION group. Conclusions Reduced PPCMv density in POAG eyes shows that deep optic nerve head ocular blood flow may contribute to axonal damage in patients with glaucoma.
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Leal‐González M, Pessanha F, Azevedo González‐Oliva M, Pérez‐Fernández E, Gili P. Study of peripapillary vascular flow using optical coherence tomography angiography in optic nerve head drusen. Clin Exp Ophthalmol 2020; 48:775-782. [DOI: 10.1111/ceo.13783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Filipa Pessanha
- Ophthalmology Unit, Hospital Universitario Fundación Alcorcón Madrid Spain
| | | | | | - Pablo Gili
- Ophthalmology Unit, Hospital Universitario Fundación Alcorcón Madrid Spain
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