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Tan B, Chua J, Wong D, Liu X, Ismail M, Schmetterer L. Techniques for imaging the choroid and choroidal blood flow in vivo. Exp Eye Res 2024; 247:110045. [PMID: 39154819 DOI: 10.1016/j.exer.2024.110045] [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: 05/26/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
The choroid, which is a highly vascularized layer between the retina and sclera, is essential for supplying oxygen and nutrients to the outer retina. Choroidal vascular dysfunction has been implicated in numerous ocular diseases, including age-related macular degeneration, central serous chorioretinopathy, polypoidal choroidal vasculopathy, and myopia. Traditionally, the in vivo assessment of choroidal blood flow relies on techniques such as laser Doppler flowmetry, laser speckle flowgraphy, pneumotonometry, laser interferometry, and ultrasonic color Doppler imaging. While the aforementioned methods have provided valuable insights into choroidal blood flow regulation, their clinical applications have been limited. Recent advancements in optical coherence tomography and optical coherence tomography angiography have expanded our understanding of the choroid, allowing detailed visualization of the larger choroidal vessels and choriocapillaris, respectively. This review provides an overview of the available techniques that can investigate the choroid and its blood flow in vivo. Future research should combine these techniques to comprehensively image the entire choroidal microcirculation and develop robust methods to quantify choroidal blood flow. The potential findings will provide a better picture of choroidal hemodynamics and its effect on ocular health and disease.
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Affiliation(s)
- Bingyao Tan
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Xinyu Liu
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Munirah Ismail
- Singapore Eye Research Institute, National Eye Centre, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, National Eye Centre, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland; School of Chemical and Biomedical Engineering, Nanyang Technological University (NTU), Singapore; Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Rothschild Foundation Hospital, Paris, France.
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Fragiotta S, Parravano M, Sacconi R, Polito MS, Capuano V, Costanzo E, Tombolini B, Souied EH, Bandello F, Querques G. LeptoVitelliform Maculopathy: delineating a distinct clinical entity from acquired vitelliform lesions. Eye (Lond) 2024:10.1038/s41433-024-03240-9. [PMID: 39020047 DOI: 10.1038/s41433-024-03240-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To characterize acquired vitelliform lesions associated with leptochoroid (i.e., diffuse choroidal thinning) and reticular pseudodrusen (RPD) and compare this phenotype to the acquired vitelliform lesion (AVL) in the dystrophic spectrum. METHODS This retrospective, observational case-control study enrolled 56 patients (56 eyes) affected by vitelliform lesions (AVL), including 27 patients with AVL associated with RPD and leptochoroid (i.e., choroidal thinning) referred to as LeptoVitelliform Maculopathy (LVM), and 29 AVL patients without other funduscopic abnormalities. The main structural features analysed were the integrity of the external limiting membrane (ELM), ellipsoid zone (EZ), and retinal pigment epithelium (RPE), the presence of hyporeflective spaces, and hypertransmission. Choroidal vascular index (CVI) was calculated using ImageJ software. RESULTS Patients with LVM were 6.69 years older and presented smaller vitelliform lesions considering both vertical (P < 0.001) and horizontal diameters (P < 0.001) with a similar visual impairment compared to the AVL group (P = 0.27). The LVM subgroup showed a greater alteration of the ELM (p < 0.001) and choroidal hypertransmission (i = 0.007), accompanied by less frequent RPE bumps (P = 0.001) and hyporeflective spaces within the vitelliform material (P = 0.002). Furthermore, the LVM group presented a lower CVI with a significant attenuation on both the luminal and stromal compartments compared to AVL (P < 0.001, both). CONCLUSIONS The phenotypic combination of subretinal vitelliform lesion and RPD may delineate a distinct phenotype that shares with AVL only the presence of vitelliform material and a similar visual deterioration. The presented findings of LVM highlight significant structural and microvascular alterations that may hold prognostic relevance, warranting future longitudinal studies.
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Affiliation(s)
- Serena Fragiotta
- Ophthalmology Unit, "Sapienza" University of Rome, NESMOS Department, St. Andrea Hospital, Rome, Italy
| | | | - Riccardo Sacconi
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | | | - Vittorio Capuano
- Ophthalmology, Centre Hospitalier Intercommunal De Creteil, Creteil, France
| | | | - Beatrice Tombolini
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Eric H Souied
- Ophthalmology, Centre Hospitalier Intercommunal De Creteil, Creteil, France
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy.
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Sacconi R, Fazzari G, Capuano V, Menean M, Beretta F, El Matri K, Bandello F, Souied E, Querques G. Pachy-Reticular Pseudodrusen. Ophthalmol Retina 2024:S2468-6530(24)00269-0. [PMID: 38844200 DOI: 10.1016/j.oret.2024.05.020] [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: 04/10/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE To characterize the features of a peculiar association between reticular pseudodrusen (RPD) and pachychoroid (pachy-RPD) and to compare them with eyes affected by RPD and normal/leptochoroid. DESIGN Observational, retrospective, case-control study. PARTICIPANTS Among a cohort of patients with intermediate age-related macular degeneration (AMD), we selected eyes with RPD and pachychoroid (i.e., choroidal thickness of >50 μm). A control group of RPD eyes but without pachychoroid (i.e., a choroidal thickness of <250 μm) was included. METHODS Number and stages of RPD were evaluated in each ETDRS subfield. Furthermore, choroidal perfusion was investigated using the choroidal vascularity index (CVI), and choriocapillaris perfusion density (PD) on structural OCT and OCT angiography. MAIN OUTCOME MEASURES Description of the multimodal imaging features of pachy-RPD and differences with RPD associated with normal/leptochoroid. RESULTS Among 111 RPD eyes, 37 were included in the pachy-RPD group and 74 in the control group. Patients with pachy-RPD were significantly younger than patients with RPD and normal/leptochoroid (mean age, 75 ± 16 and 82 ± 7 years, respectively; P = 0.002). Total RPD number was comparable between the 2 groups (P = 0.220). However, pachy-RPD eyes showed a significantly higher number of stage 1 RPD in comparison to the controls (P < 0.001), and a lower number of stage 3 (P < 0.001) and stage 4 RPD (P = 0.052). The CVI and choriocapillaris PD were greater in pachy-RPD than in the control group (P < 0.001 and P= 0.010, respectively). CONCLUSIONS Pachy-RPD are characterized by a different distribution of RPD stages (i.e., more early stages and fewer advanced stages) in comparison to RPD with normal/leptochoroid. Furthermore, pachy-RPD eyes showed greater perfusion indices of the choroid. These features suggest that the presence of pachychoroid could be a protective factor in the RPD evolution to the advanced AMD forms. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giusi Fazzari
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Vittorio Capuano
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Matteo Menean
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Beretta
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Khaled El Matri
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France; Faculté de Médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eric Souied
- Department of Ophthalmology, Hospital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Wang Y, Chen J, Zhang M, Yu S, Gong Y, Lin F, Wu Y, Liu W, Sun J, Li T, Sun X. GENETIC FACTORS AND CHARACTERISTICS ON SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY ARE ASSOCIATED WITH CHOROIDAL THICKNESS IN ABCA4 -RELATED RETINOPATHY. Retina 2024; 44:166-174. [PMID: 37695977 DOI: 10.1097/iae.0000000000003931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
PURPOSE To investigate the possible correlation factors of choroidal thickness in ABCA4 -related retinopathy. METHODS A total of 66 patients were included in the cohort. It is a retrospective, cross-sectional laboratory investigation. The patients were tested using whole-exon sequencing and ophthalmic examinations, including slit-lamp examinations, best-corrected visual acuity, spectral-domain optical coherence tomography, fundus photograph, and fundus autofluorescence. RESULTS Besides demographic characteristics (age, onset age, duration), we selected genetic factors and ocular characteristics on spectral-domain optical coherence tomography as the candidates related to choroidal thickness. Mutation type (inframe mutation or premature termination codon), epiretinal membrane, retinal pigment epithelium- Bruch membrane integrity, and macular curvature changes were identified as related factors to choroidal thickness in ABCA4 -related retinopathy after the adjustment of Logistic LASSO regression. CONCLUSION Mutation type, epiretinal membrane, retinal pigment epithelium-Bruch membrane integrity, and macular curvature changes are related factors to choroidal thinning. These findings could provide us a further understanding for the pathological process and clinical features of ABCA4 mutation.
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Affiliation(s)
- Yimin Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China, Shanghai, China; and
| | - Jieqiong Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
| | - Min Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
| | - Suqin Yu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
| | - Yuanyuan Gong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
| | - Feng Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yidong Wu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
| | - Wenjia Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
| | - Junran Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
| | - Tong Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine
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Rosenfeld PJ, Cheng Y, Shen M, Gregori G, Wang RK. Unleashing the power of optical attenuation coefficients to facilitate segmentation strategies in OCT imaging of age-related macular degeneration: perspective. BIOMEDICAL OPTICS EXPRESS 2023; 14:4947-4963. [PMID: 37791280 PMCID: PMC10545179 DOI: 10.1364/boe.496080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 10/05/2023]
Abstract
The use of optical attenuation coefficients (OAC) in optical coherence tomography (OCT) imaging of the retina has improved the segmentation of anatomic layers compared with traditional intensity-based algorithms. Optical attenuation correction has improved our ability to measure the choroidal thickness and choroidal vascularity index using dense volume scans. Algorithms that combine conventional intensity-based segmentation with depth-resolved OAC OCT imaging have been used to detect elevations of the retinal pigment epithelium (RPE) due to drusen and basal laminar deposits, the location of hyperpigmentation within the retina and along the RPE, the identification of macular atrophy, the thickness of the outer retinal (photoreceptor) layer, and the presence of calcified drusen. OAC OCT algorithms can identify the risk-factors that predict disease progression in age-related macular degeneration.
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Affiliation(s)
- Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer
Eye Institute, University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Yuxuan Cheng
- Department of Bioengineering,
University of Washington, Seattle,
Washington, USA
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer
Eye Institute, University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer
Eye Institute, University of Miami Miller School of
Medicine, Miami, Florida, USA
| | - Ruikang K. Wang
- Department of Bioengineering,
University of Washington, Seattle,
Washington, USA
- Department of Ophthalmology,
University of Washington, Seattle,
Washington, USA
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Abdolrahimzadeh S, Di Pippo M, Sordi E, Cusato M, Lotery AJ. Subretinal drusenoid deposits as a biomarker of age-related macular degeneration progression via reduction of the choroidal vascularity index. Eye (Lond) 2023; 37:1365-1370. [PMID: 35739243 PMCID: PMC10169760 DOI: 10.1038/s41433-022-02134-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/09/2022] [Accepted: 06/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to analyse the role of the choroid in early age-related macular degeneration (AMD) by analysing choroidal vascularity index (CVI) in pure cohorts of patients with subretinal drusenoid deposits (SDD) or conventional drusen (CD). SUBJECTS/METHODS This was an observational cross-sectional study. Comprehensive ophthalmologic examination and multimodal imaging including fundus photography, autofluorescence, near infrared reflectance, and spectral domain optical coherence tomography (SDOCT) was performed. CVI processing was performed on a foveal horizontal SDOCT scan with binarization using Image J Image software and calculated as the ratio between luminal area (LA) and total area (TA). RESULTS Sixty-nine eyes of 69 participants were included; 23 eyes with SDD alone, 22 eyes with CD alone, and 24 control eyes of healthy age-matched subjects. CVI was significantly reduced in the SDD and CD group compared to controls (p = 0.0001). Post-hoc analysis revealed a significant reduction of CVI in the SDD versus the control group (p = 0.0002), in the CD versus the control group (p = 0.001), and in the SDD versus the CD group (p = 0.006). Covariance analysis showed a significant difference of LA (p = 0.033) but no significant difference of TA (p = 0.106) between the three groups. Direct comparison between CD and SDD showed a significant reduction of LA and TA in the SDD group. CONCLUSIONS CVI may have prognostic implications in early AMD. SDD is a biomarker of AMD progression and the mechanism for this could be via reduction of the CVI.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy.
- St. Andrea Hospita, Via di Grottarossa 1035/1039, Rome, 00189, Italy.
| | - Mariachiara Di Pippo
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Edoardo Sordi
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Mattia Cusato
- Ophthalmology Unit, Neurosciences, Mental Health, and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Andrew John Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
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CHOROIDAL VASCULAR DENSITY IN DIABETIC RETINOPATHY ASSESSED WITH SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY. Retina 2023; 43:34-41. [PMID: 36223764 DOI: 10.1097/iae.0000000000003644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to assess choroidal vascularity by diabetic retinopathy (DR) stage using the choroidal vascular density (CVD) obtained from swept-source optical coherence tomography en-face images. METHODS This prospective, cross-sectional, multicenter study included patients from Niigata City General Hospital and Saiseikai Niigata Hospital between October 2016 and October 2017. Choroidal vascular density was obtained by binarizing swept-source optical coherence tomography en-face images of patients with diabetes and those with DR, patients without DR, and healthy age-matched volunteers. RESULTS Patients were allocated to the healthy control (n = 28), no DR (n = 23), nonproliferative DR (NPDR) without diabetic macular edema (DME) (n = 50), NPDR + DME (n = 38), and proliferative DR (PDR) or any previous treatment with panretinal photocoagulation (n = 26) groups. Investigation of the choriocapillaris slab level indicated that the no DR group had significantly high CVD values ( P < 0.05), and the PDR groups had significantly low CVD values ( P < 0.01). Investigation of the large choroidal vessel level indicated that the NPDR + DME and PDR groups had significantly lower CVD values than the control group ( P < 0.05 and P < 0.01, respectively). CONCLUSION We found that at the choriocapillaris slab level, the no DR group had a higher CVD and the NPDR with DME and PDR groups had a lower CVD than the control group. At the level of the large choroidal vessels, the NPDR with DME and PDR groups had a lower CVD than the control group. There were significant differences in choroidal vasculature found using CVD obtained from swept-source optical coherence tomography en-face images of patients with diabetes and DR.
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Sacconi R, Borrelli E, Balasubramanian S, Vella G, Battista M, Vupparaboina KK, Chhablani J, Bandello F, Querques G. Choroidal vascularity index in leptochoroid: A comparative analysis between reticular pseudodrusen and high myopia. Eye (Lond) 2023; 37:75-81. [PMID: 35001089 PMCID: PMC9829680 DOI: 10.1038/s41433-021-01889-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate the choroidal vascularity index (CVI) in patients affected by leptochoroid. METHODS Three distinct age-matched cohorts were collected: patients with reticular pseudodrusen (RPD) secondary to age-related macular degeneration, patients with high-myopia, and healthy controls. CVI was calculated in the subfoveal 6000 μm diameter area. RESULTS 54 eyes (54 patients) were included (18 eyes in each cohort). No statistical differences were disclosed in terms of age between controls, RPD patients (p = 0.062), and myopic patients (p = 0.070). Total choroidal area showed a different distribution among the 3 cohorts (p < 0.001), due to the reduction of luminal and stromal choroidal area in both RPD and myopic groups in comparison to controls (p < 0.001). Interestingly, CVI showed a different distribution between the 3 cohorts (p < 0.001). In detail, RPD group showed no changes in CVI in comparison to controls (p = 1.000), whereas the myopic group showed a higher CVI in comparison to both RPD group and controls (p < 0.001 in both analyses). CONCLUSIONS Different changes of the choroidal vascular and stromal components characterize the leptochoroid secondary to RPD eyes and high-myopic eyes. The relative greater impairment of the vascular area in RPD eyes in comparison to myopic eyes could be at the basis of the lower development of RPD in patients with high myopia.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Siva Balasubramanian
- Advanced Clinical, San Francisco, CA, USA
- Genentech, Inc., South San Francisco, San Francisco, CA, USA
| | - Giovanna Vella
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Jay Chhablani
- Department of Ophthalmology, The University of Pittsburg, Pittsburg, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Chantarasorn Y, Smitthimathin W, Vorasayan P. The role of dual antiplatelets in geographic atrophy secondary to non-neovascular aged-related macular degeneration. FRONTIERS IN OPHTHALMOLOGY 2022; 2:984903. [PMID: 38983510 PMCID: PMC11182290 DOI: 10.3389/fopht.2022.984903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/18/2022] [Indexed: 07/11/2024]
Abstract
Background To evaluate the effects of dual antiplatelets on progression of geographic atrophy (GA) secondary to age-related macular degeneration (AMD), and to determine additional factors predicting rapid GA growth. Material and Methods In this retrospective cohort study, patients with unifocal GA were consecutively enrolled (one eye per patient) from 2018 to 2021. The patients were categorized as 1. those receiving dual antiplatelet therapy containing a daily dose of 75 mg clopidogrel plus 81 mg aspirin (DAPT group), and 2. those not receiving DAPT (control group). Areas of GA, based on red-filtered fundus autofluorescence, were measured at baseline, and at 3, 6, and 12 months. The primary outcome was absolute 12-month changes in the square root (SQRT) area. Results One eye in each group developed neovascular AMD and was excluded from the analysis. The DAPT (24 eyes) and control (22 eyes) groups had comparable age and baseline SQRT area (1.2 ± 0.27 and 1.8 ± 0.41 mm, respectively; p adjusted for age = 0.23). At 12 months, after controlling for age and the presence of soft drusen or reticular pseudodrusen, patients receiving DAPT had fewer changes in the SQRT area than that of the control group (0.097 vs. 0.17 mm; p = 0.02). The presence of drusen significantly predicted increased GA growth and choroidal thickness reduction. Conclusions Routine uses of dual antiplatelets were associated with decelerating GA growth. Drusen-associated GA may represent a generalized form of choroidal vascular alterations.
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Affiliation(s)
- Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Warin Smitthimathin
- Department of Ophthalmology, Metta Pracharak Hospital, Ministry of Public Health, Nakhon Pathom, Thailand
| | - Pongpat Vorasayan
- Neurology Unit, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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10
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Bartol-Puyal FDA, Pablo Júlvez L. Deep-learning algorithms for choroidal thickness measurements in high myopia. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:654. [PMID: 35845543 PMCID: PMC9279797 DOI: 10.21037/atm-22-2551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Francisco de Asís Bartol-Puyal
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Luis Pablo Júlvez
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain.,Universidad de Zaragoza, Zaragoza, Spain
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11
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Lu Y, Zhou H, Zhou X, Chen Y, Wang RK. Correlation Between Laser Speckle Flowgraphy and OCT-Derived Retinal and Choroidal Metrics in Healthy Human Eye. Transl Vis Sci Technol 2022; 11:15. [PMID: 35704328 PMCID: PMC9206497 DOI: 10.1167/tvst.11.6.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate the correlation between laser speckle flowgraphy (LSFG) signals and the quantitative metrics derived from optical coherence tomography (OCT) in normal eyes. Methods LSFG, OCT, and OCT angiography (OCTA) imaging were performed on normal participants using a custom-designed LSFG system and a commercial swept-source OCT system. Mean (PWM) and amplitude (PWA) of the LSFG pulse waveform were selected to quantify the LSFG signals. Retinal and choroidal maps were obtained using the standard 6 × 6 mm OCT and OCTA scans. Structural and vascular metrics maps, including thickness, vessel area density, vessel skeleton density, and vessel diameter index of the retina, and choroidal thickness (CT), choroidal vessel volume (CVV) and choroidal vessel index (CVI), were employed to quantify the retinal and choroidal properties. Correlation analysis was then performed between the LSFG, retinal, and choroidal metrics maps. Results Twelve healthy participants aged 23 to 36 years were enrolled in this study. The spatial distribution of the PWM and PWA values was highly correlated with that of the CT and CVV metrics. On average, Spearman correlation coefficients (ρ) were 0.80 and 0.78 (all P < 0.001) for the correlations between PWM and CT and CVV, respectively, and were 0.61 and 0.63 (all P < 0.05) for the correlations between PWA and CT and CVV, respectively. In comparison, both PWM and PWA were generally weak or not correlated with all the retinal metrics and CVI. Conclusions LSFG signals were positively correlated with the choroidal thickness and vessel volume, suggesting choroidal blood flows dominate the LSFG signals at the area absent of large retinal vessels. Translational Relevance This study illustrates the dominant source of the LSFG signals in the eye.
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Affiliation(s)
- Yiming Lu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Xiao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Yuxuan Chen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Karalis Johnson Retina Center, Department of Ophthalmology, University of Washington, Seattle, WA, USA
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12
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Wang W, Li L, Wang J, Chen Y, Kun X, Gong X, Wei D, Wang D, Liang X, Liu H, Huang W. Macular Choroidal Thickness and the Risk of Referable Diabetic Retinopathy in Type 2 Diabetes: A 2-Year Longitudinal Study. Invest Ophthalmol Vis Sci 2022; 63:9. [PMID: 35420642 PMCID: PMC9034727 DOI: 10.1167/iovs.63.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/19/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the associations between choroidal thickness (CT) and the 2-year incidence of referable diabetic retinopathy (RDR). Methods This was a prospective cohort study. Patients with type 2 diabetes in Guangzhou, China, aged 30 to 80 years underwent comprehensive examinations, including standard 7-field fundus photography. Macular CT was measured using a commercial swept-source optical coherence tomography (SS-OCT) device (DRI OCT Triton; Topcon, Tokyo, Japan). The relative risk (RR) with 95% confidence intervals (CIs) was used to quantify the association between CT and new-onset RDR. The prognostic value of CT was assessed using the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results A total of 1345 patients with diabetes were included in the study, and 120 (8.92%) of them had newly developed RDR at the 2-year follow-up. After adjusting for other factors, the increased RDR risk was associated with greater HbA1c (RR = 1.35, 95% CI = 1.17-1.55, P < 0.001), higher systolic blood pressure (SBP; RR = 1.02, 95% CI = 1.01-1.03, P = 0.005), lower triglyceride (TG) level (RR = 0.81, 95% CI = 0.69-0.96, P = 0.015), presence of diabetic retinopathy (DR; RR = 8.16, 95% CI = 4.47-14.89, P < 0.001), and thinner average CT (RR = 0.903, 95% CI = 0.871-0.935, P < 0.001). The addition of average CT improved NRI (0.464 ± 0.096, P < 0.001) and IDI (0.0321 ± 0.0068, P < 0.001) for risk of RDR, and it also improved the AUC from 0.708 (95% CI = 0.659-0.757) to 0.761 (95% CI = 0.719-0.804). Conclusions CT thinning measured by SS-OCT is an early imaging biomarker for the development of RDR, suggesting that alterations in CT play an essential role in DR occurrence.
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Affiliation(s)
- Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Longyue Li
- School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jun Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Xiong Kun
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xia Gong
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Daheng Wei
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Dongning Wang
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Xiaolin Liang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hua Liu
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Wenyong Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
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13
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Sacconi R, Battista M, Borrelli E, Senni C, Tombolini B, Grosso D, Querques L, Bandello F, Querques G. CHOROIDAL VASCULARITY INDEX IS ASSOCIATED WITH GEOGRAPHIC ATROPHY PROGRESSION. Retina 2022; 42:381-387. [PMID: 34561405 DOI: 10.1097/iae.0000000000003305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the correlation between choroidal vascularity index and the enlargement of geographic atrophy (GA) lesion secondary to age-related macular degeneration during the 2-year follow-up. METHODS In this longitudinal observational study, 26 eyes (26 patients, mean age 75.7 ± 8.8 years) affected by GA were included. Choroidal vascularity index was calculated in the subfoveal 3000-µm area. The main outcome measure included correlation analysis between baseline choroidal vascularity index and the rate of GA enlargement. RESULTS During the 2-year follow-up, the mean GA area increased from 6.99 ± 5.28 mm2 to 10.69 ± 6.61 mm2(P < 0.001), accounting for a growth rate of 0.35 ± 0.20 and 0.31 ± 0.17 mm/year after the square root transformation in the first and second year of follow-up, respectively. Stromal choroidal area significantly decreased during the 2-year follow-up (P = 0.002). Interestingly, there was a significant correlation between the baseline choroidal vascularity index and the rate of GA enlargement (r=-0.432, P = 0.027) and between stromal choroidal area and the rate of GA enlargement (r = 0.422, P = 0.032). No other significant relationship was disclosed among choroidal parameters with the rate of GA enlargement. CONCLUSION Choroidal vascularity index impairment is strictly related to the rate of GA enlargement during the 1-year and 2-year follow-up in patients affected by GA. For this reason, choroidal vascularity index could be considered a predictor of GA progression in the clinical setting, and it could be considered as a new potential biomarker in the efficacy evaluation of new GA interventions.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Carlotta Senni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Domenico Grosso
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Lea Querques
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
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14
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Ghassemi F, Berijani S, Babeli A, Faghihi H, Gholizadeh A, Sabour S. The quantitative measurements of choroidal thickness and volume in diabetic retinopathy using optical coherence tomography and optical coherence tomography angiography; correlation with vision and foveal avascular zone. BMC Ophthalmol 2022; 22:3. [PMID: 34980024 PMCID: PMC8722222 DOI: 10.1186/s12886-021-02178-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To represent choroidal thickness (CT) and choroidal volume (CV) databases in diabetic retinopathy (DR) patients and healthy control participants using optical coherence tomography (OCT) and enhanced depth imaging OCT (EDI-OCT). No study had evaluated CT at all main stages of diabetic retinopathy in a single study. METHODS The study included 176 eyes from 93 patients (39-80 years old; 42% females) who were divided into three groups based on DR severity and normal control group: 39 eyes no DR, 64 eyes NPDR, 33 eyes PDR, and 40 eyes normal control. The CT and CV were measured and statistically analyzed. Intra-observer and inter-observer coefficients of repeatability were calculated. RESULTS Subfoveal CT showed persistent thinning from normal group (322.50 ± 69.24) to no-diabetic retinopathy (NDR, 308.33 ± 74.45) to nonproliferative diabetic retinopathy (NPDR, 283.45 ± 56.50) group and then thickening as the patient progressed to proliferative diabetic retinopathy (PDR, 295.17 ± 95.69) (P = 0.087). A significant difference was found between the control group and the NDR, NPDR, and PDR groups in nearly all CT and CV of Early Treatment Diabetic Retinopathy Study macular subfields. Fasting blood sugar (FBS = 189.08 ± 51.3 mg/dl) and diabetes mellitus (DM) duration (13.6 ± 6.5 years) had no noticeable effect on CT. In patients with diabetes, the best-corrected visual acuity (BCVA), diabetic macular edema (DME), and foveal avascular zone (FAZ) were not affected by CT and CV. CONCLUSIONS The choroidal thickness decreases from the early stages of diabetic retinopathy up to the NPDR stage, with a subsequent modest rise in CT during the PDR stage. There was no correlation between FBS, diabetes duration, BCVA, DME, and FAZ, and CT.
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Affiliation(s)
- Fariba Ghassemi
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, IR, 1336616351, Iran. .,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR, Iran.
| | - Sahar Berijani
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, IR, 1336616351, Iran
| | - Ameneh Babeli
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, IR, 1336616351, Iran
| | - Houshang Faghihi
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, IR, 1336616351, Iran.,Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Alireza Gholizadeh
- Eye research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, IR, 1336616351, Iran
| | - Siamak Sabour
- Department of Clinical Epidemiology, School of Public health and Safety, Safety Promotion and Injury Prevention Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
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15
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Lu J, Zhou H, Shi Y, Choe J, Shen M, Wang L, Chen K, Zhang Q, Feuer WJ, Gregori G, Rosenfeld PJ, Wang RK. Interocular asymmetry of choroidal thickness and vascularity index measurements in normal eyes assessed by swept-source optical coherence tomography. Quant Imaging Med Surg 2022; 12:781-795. [PMID: 34993118 DOI: 10.21037/qims-21-813] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND To investigate the symmetry of interocular choroidal thickness and vascularity index measurements in normal eyes using swept-source optical coherence tomography (SS-OCT). Cross-sectional and observational study. This study included 244 eyes of 122 normal adults with ages uniformly distributed from 19 to 89 years. METHODS SS-OCT imaging was performed using a scanning pattern of 12×12 mm. Mean choroidal thickness (MCT) and choroidal vascularity index (CVI) measurements in the entire scanning region were obtained using a validated and published automatic method. The correlation and differences (including signed and absolute differences) between bilateral MCT and CVI measurements were analyzed at the following 6 regions: 3 concentric circles centered on the fovea with diameters of 2.5, 5, and 11 mm; the inner rim from 2.5 to 5 mm circle; the outer rim from 5 to 11 mm circle; and the entire 12×12-mm scan region, respectively. Comparison of interocular MCT and CVI measurements. RESULTS MCT measurements in right and left eyes were strongly correlated in all regions [all intraclass correlation (ICC) >0.73], but MCT measurements in right eyes were significantly thicker than in left eyes. CVI measurements in right and left eyes were moderately correlated in all regions (all ICC >0.46), but CVI measurements in right eyes were significantly smaller than that in left eyes in the macular subregions (2.5 mm circle, 5 mm circle, and the inner rim). Neither signed nor absolute interocular differences in MCT were correlated with corresponding CVI interocular differences. CONCLUSIONS Choroidal differences exist between normal fellow eyes in adults in the absence of obvious pathology. This study is useful in assisting clinicians and researchers in distinguishing asymmetric changes that are to be expected in normal eyes versus changes that could be associated with diseases.
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Affiliation(s)
- Jie Lu
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James Choe
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kelly Chen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - William J Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
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16
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Sato-Akushichi M, Ono S, Klose G, Song Y. Choroidal Volume Evaluation after Photodynamic Therapy Using New Optical Coherence Tomography Imaging Algorithm. Pharmaceuticals (Basel) 2021; 14:ph14111140. [PMID: 34832922 PMCID: PMC8621234 DOI: 10.3390/ph14111140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
To evaluate choroidal volume and thickness changes after photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Chronic CSC eyes with a history of PDT were selected. Average choroidal volume, average choroidal thickness, the maximum and minimum choroidal thickness of the macula irradiated area and peripheral non-irradiated areas before and after one and three months of treatment were examined. A total of 14 patients with chronic CSC and 9 controls without any eye pathology were enrolled. The mean choroidal volume in CSC before and, and after one and three months of treatment were 2.36 (standard deviation: 0.70), 1.90 (0.69), 1.86 (0.66) mm3 for the central area, 1.25 (0.38), 1.14 (0.35), 1.13 (0.34) mm3 for superior nasal area, 1.47 (0.41), 1.28 (0.43), 1.26 (0.43) mm3 for superior temporal area, 1.07 (0.49), 0.95 (0.38), 0.93 (0.35) mm3 for inferior nasal area, 1.17 (0.38), 1.04 (0.32), 1.03 (0.33) mm3 for inferior temporal area. This study revealed the choroidal volume changes in a short period after PDT and a decrease in unirradiated choroidal volume was also shown after the treatment. The algorithm provided on the ARI Network enables to evaluate the choroidal changes quantitatively and qualitatively.
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Affiliation(s)
- Miki Sato-Akushichi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa 078-8510, Japan; (S.O.); (Y.S.)
- Correspondence: ; Tel.: +81-166-68-2543
| | - Shinji Ono
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa 078-8510, Japan; (S.O.); (Y.S.)
| | - Gerd Klose
- Carl Zeiss Meditec, Inc., Dublin, CA 94568, USA;
| | - Youngseok Song
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa 078-8510, Japan; (S.O.); (Y.S.)
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17
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Wu Z, Fletcher EL, Kumar H, Greferath U, Guymer RH. Reticular pseudodrusen: A critical phenotype in age-related macular degeneration. Prog Retin Eye Res 2021; 88:101017. [PMID: 34752916 DOI: 10.1016/j.preteyeres.2021.101017] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/07/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022]
Abstract
Reticular pseudodrusen (RPD), or subretinal drusenoid deposits (SDD), refer to distinct lesions that occur in the subretinal space. Over the past three decades, their presence in association with age-related macular degeneration (AMD) has become increasingly recognized, especially as RPD have become more easily distinguished with newer clinical imaging modalities. There is also an increasing appreciation that RPD appear to be a critical AMD phenotype, where understanding their pathogenesis will provide further insights into the processes driving vision loss in AMD. However, key barriers to understanding the current evidence related to the independent impact of RPD include the heterogeneity in defining their presence, and failure to account for the confounding impact of the concurrent presence and severity of AMD pathology. This review thus critically discusses the current evidence on the prevalence and clinical significance of RPD and proposes a clinical imaging definition of RPD that will help move the field forward in gathering further key knowledge about this critical phenotype. It also proposes a putative mechanism for RPD formation and how they may drive progression to vision loss in AMD, through examining current evidence and presenting novel findings from preclinical and clinical studies.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Erica L Fletcher
- Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Himeesh Kumar
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Ursula Greferath
- Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
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18
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Kobayashi Y, Watanabe S, Ong ALC, Shirai M, Yamashiro C, Ogata T, Higashijima F, Yoshimoto T, Hayano T, Asai Y, Sasai N, Kimura K. Early manifestations and differential gene expression associated with photoreceptor degeneration in Prom1-deficient retina. Dis Model Mech 2021; 14:272527. [PMID: 34664634 PMCID: PMC8628633 DOI: 10.1242/dmm.048962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022] Open
Abstract
Retinitis pigmentosa (RP) and macular dystrophy (MD) are characterized by gradual photoreceptor death in the retina and are often associated with genetic mutations, including those in the prominin-1 (Prom1) gene. Prom1-knockout (KO) mice recapitulate key features of these diseases including light-dependent retinal degeneration and constriction of retinal blood vessels. The mechanisms underlying such degeneration have remained unclear, however. We here analysed early events associated with retinal degeneration in Prom1-KO mice. We found that photoreceptor cell death and glial cell activation occur between 2 and 3 weeks after birth. Whereas gene expression was not affected at 2 weeks, the expression of several genes was altered at 3 weeks in the Prom1-KO retina, with the expression of that for endothelin-2 (Edn2) being markedly upregulated. Expression of Edn2 was also induced by light stimulation in Prom1-KO mice reared in the dark. Treatment with endothelin receptor antagonists attenuated photoreceptor cell death, gliosis and retinal vessel stenosis in Prom1-KO mice. Our findings thus reveal early manifestations of retinal degeneration in a model of RP/MD and suggest potential therapeutic agents for these diseases. This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Yuka Kobayashi
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-0046, Japan
| | - Shizuka Watanabe
- Developmental Biomedical Science, Division of Biological Sciences, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma 630-0192, Japan
| | - Agnes Lee Chen Ong
- Developmental Biomedical Science, Division of Biological Sciences, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma 630-0192, Japan
| | - Manabu Shirai
- Omics Research Center (ORC), National Cerebral and Cardiovascular Center, 6-1 Kishibe Shinmachi, Suita, Osaka 564-8565, Japan
| | - Chiemi Yamashiro
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-0046, Japan
| | - Tadahiko Ogata
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-0046, Japan
| | - Fumiaki Higashijima
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-0046, Japan
| | - Takuya Yoshimoto
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-0046, Japan
| | - Takahide Hayano
- Department of Systems Bioinformatics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-0046, Japan
| | - Yoshiyuki Asai
- Department of Systems Bioinformatics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-0046, Japan
| | - Noriaki Sasai
- Developmental Biomedical Science, Division of Biological Sciences, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma 630-0192, Japan
| | - Kazuhiro Kimura
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube 755-0046, Japan
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19
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Guler Alis M, Alis A. Choroidal vascularity index in adults with different refractive status. Photodiagnosis Photodyn Ther 2021; 36:102533. [PMID: 34520880 DOI: 10.1016/j.pdpdt.2021.102533] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022]
Abstract
AIM We aimed to perform structural analysis of the choroid in adults with different refractive status. MATERIALS AND METHODS A prospective, comparative study of 100 right eyes of 100 patients ages 18-40 years was conducted. The patients were divided into four groups according to spherical equivalent (SE): Group 1: -0.5 and above, low-to-moderate myopia; Group 2: -6 and above, high myopia; Group 3: +0.5 and above, hyperopia; Group 4: +/- 0.5, emmetropia. With the images obtained using enhanced depth imaging optical coherence tomography (EDI-OCT), the total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascular index (CVI) were calculated using the binarization method. The anterior chamber depth (ACD), axial length (AL), and central corneal thickness (CCT) values were measured by optical biometry. All parameters were compared between groups. The correlation of biometric parameters with CVI was examined. RESULTS Parameters were found to be statistically different between the four groups. TCA, LA, and SA values were the highest in Group 3 and lowest in Group 2. L/S ratio and CVI values in Group 3 were significantly lower than in the other groups. There was a negative correlation between AL with SE and CT, and no correlation between the CVI and other parameters. CONCLUSION CVI decreases when emmetropization is disrupted and changes to hypermetropia or myopia. The reason for the decrease in myopia is the reduction of the luminal area, while in hyperopia it is due to an increase in the stromal area. When there is a shift toward myopia, there is a decrease in the TCA, but the CVI does not change significantly. Unlike CT, the CVI is not affected by factors such as SE and AL; therefore, the CVI can be a useful parameter for examining choroidal changes in refractive errors.
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Affiliation(s)
- Meryem Guler Alis
- Fatih Sultan Mehmet Training and Research Hospital, Atasehir, Istanbul, Turkey.
| | - Abdulkadir Alis
- Fatih Sultan Mehmet Training and Research Hospital, Atasehir, Istanbul, Turkey
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Saxena A, Yao X, Wong D, Chua J, Ang M, Hoang QV, Agrawal R, Girard M, Cheung G, Schmetterer L, Tan B. Framework for quantitative three-dimensional choroidal vasculature analysis using optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2021; 12:4982-4996. [PMID: 34513237 PMCID: PMC8407849 DOI: 10.1364/boe.426093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 05/25/2023]
Abstract
Choroidal vasculature plays an important role in the pathogenesis of retinal diseases, such as myopic maculopathy, age-related macular degeneration, diabetic retinopathy, central serous chorioretinopathy, and ocular inflammatory diseases. Current optical coherence tomography (OCT) technology provides three-dimensional visualization of the choroidal angioarchitecture; however, quantitative measures remain challenging. Here, we propose and validate a framework to segment and quantify the choroidal vasculature from a prototype swept-source OCT (PLEX Elite 9000, Carl Zeiss Meditec, USA) using a 3×3 mm scan protocol centered on the macula. Enface images referenced from the retinal pigment epithelium were reconstructed from the volumetric data. The boundaries of the choroidal volume were automatically identified by tracking the choroidal vessel feature structure over the depth, and a selective sliding window was applied for segmenting the vessels adaptively from attenuation-corrected enface images. We achieved a segmentation accuracy of 96% ± 1% as compared with manual annotation, and a dice coefficient of 0.83 ± 0.04 for repeatability. Using this framework on both control (0.00 D to -2.00 D) and highly myopic (-8.00 D to -11.00 D) eyes, we report a decrease in choroidal vessel volume (p<0.001) in eyes with high myopia.
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Affiliation(s)
- Ashish Saxena
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
| | - Quan V. Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Rupesh Agrawal
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Michael Girard
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Institute of Molecular and Clinical Ophthalmology, 4031 Basel, Switzerland
| | - Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- NTU Institute for Health Technologies, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4031 Basel, Switzerland
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
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Kovacs KD, Young B, Adelman RA. Quantitative Modeling of Ultra-Widefield Choroidal Indocyanine Green Angiography in Systemic Vascular Diseases. Ophthalmic Surg Lasers Imaging Retina 2021; 52:281-287. [PMID: 34044717 DOI: 10.3928/23258160-20210429-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate quantitative measurements of choroidal vasculature as obtained via ultra-widefield indocyanine green angiography (ICGA) in patients with systemic vascular diseases. PATIENTS AND METHODS Retrospective chart review and image analysis of 38 eyes from 21 patients with ICGA as part of routine retinal care. Images were binarized with lines drawn at specific antero-posterior landmarks. The vessel density and mean vessel caliber were measured along these lines and correlated with systemic vascular disease status. RESULTS Unlike those with other systemic vascular diseases, patients with obstructive sleep apnea (OSA) were found to have increased choroidal vascular density and vessel caliber in all measurements of the peripheral choroid compared with those patients without (P < .05 for all measurements). CONCLUSIONS Patients with OSA may have increased vascular density secondary to increased choroidal vessel caliber. Further work is needed to validate the modeling and confirm the association. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:281-287.].
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CHOROIDAL THICKNESS AND VASCULARITY VARY WITH DISEASE SEVERITY AND SUBRETINAL DRUSENOID DEPOSIT PRESENCE IN NONADVANCED AGE-RELATED MACULAR DEGENERATION. Retina 2021; 40:632-642. [PMID: 30664125 DOI: 10.1097/iae.0000000000002434] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate how choroidal features vary with age-related macular degeneration (AMD) severity in early-intermediate disease. METHODS One hundred fifty-one eyes of 151 participants >50 years with no to intermediate AMD were analyzed with enhanced depth imaging optical coherence tomography. Mean macular choroidal thickness (CT), choroidal vascular thickness (CV), and choroidal vascularity index (CVI) were determined, and statistical associations were calculated. RESULTS Decreased CT and CV were associated with increased axial length (+30 and +14 µm/mm, respectively; P < 0.0001 each), whereas decreased CVI was associated with increased age (+0.1%/year; P = 0.004). Compared with eyes with no/early AMD (Group 0), eyes with large drusen without late AMD in the fellow eye (Group 1) showed increased CV and CVI (+22 µm, P = 0.03 and +2.2%, P = 0.02, respectively). However, eyes with large drusen and late AMD in the fellow eye (Group 2) resembled Group 0. Eyes with subretinal drusenoid deposits demonstrated lower mean CT/CV/CVI than Group 0 (-57 µm, P = 0.02; -31 µm, P = 0.02; -3.6%, P = 0.007). CONCLUSION Early AMD progression seems associated with biphasic alterations in choroidal dimensions, increasing during early drusen formation but decreasing thereafter. Subretinal drusenoid deposits are independently associated with marked reductions in all choroidal parameters. Changes in choroidal vascular anatomy may drive or reflect the pathobiology of AMD progression.
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Kim MS, Lim HB, Lee WH, Kim KM, Nam KY, Kim JY. Wide-Field Swept-Source Optical Coherence Tomography Analysis of Interocular Symmetry of Choroidal Thickness in Healthy Young Individuals. Invest Ophthalmol Vis Sci 2021; 62:5. [PMID: 33656554 PMCID: PMC7938000 DOI: 10.1167/iovs.62.3.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose The purpose of this paper was to study the bilateral choroidal thickness (CT) symmetry and differences in healthy individuals using wide-field swept-source optical coherence tomography (SS-OCT). Methods All participants underwent a wide-field 16-mm 1-line scan using SS-OCT. CTs were measured at the following 12 points: 3 points at 900 µm, 1800 µm, and 2700 µm away from the nasal optic disc margin (nasal peripapillary area), 1 point at the subfovea, 6 points at 900 µm, 1800 µm, and 2700 µm away from the subfovea to the nasal and temporal areas (macular area), and 2 peripheral points at 2700 and 5400 µm from temporal point 3 (peripheral area). Bilateral CTs were measured; their correlations and differences in the corresponding regions were analyzed. Results There were no statistically significant differences in CTs between the right and left eyes in all corresponding areas (all P > 0.05); they all showed significant positive correlation coefficients (r) (all P < 0.001). However, the nasal peripapillary and peripheral areas had relatively low correlation coefficients, compared to the macular areas. In addition, the bilateral CT differences were 32.60 ± 25.80 µm in the macular area, 40.67 ± 30.58 µm in the nasal peripapillary area, and 56.03 ± 45.73 µm in the peripheral area (all P < 0.001). Conclusions Overall, the CTs of each region were bilaterally symmetrical. However, the differences in CTs increased from the center to the periphery, which indicated that the anatomic variation of the nasal peripapillary and peripheral choroid was greater than that of the macula.
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Affiliation(s)
- Min-Su Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hyung-Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Woo-Hyuk Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.,Department of Ophthalmology, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Kyeung-Min Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ki Yup Nam
- Department of Ophthalmology, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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Kal M, Winiarczyk M, Głuszek S, Mackiewicz J. Choroidal thickness in lamellar macular holes. Graefes Arch Clin Exp Ophthalmol 2021; 259:653-659. [PMID: 32944817 PMCID: PMC7904735 DOI: 10.1007/s00417-020-04922-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/24/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE (1) To assess the thickness of the central choroid (BM-CSI) in swept-source optical coherence tomography (SS-OCT) examination of lamellar macular holes (LMHs). (2) To establish correlations between the thickness of the central choroid (BM-CSI) in the LHM and the parameters of best-corrected visual acuity and reading vision in patients with LMH. METHODS This prospective case-control study assessed a group of 30 patients (30 eyes) with LMHs and a control group of 45 patients (90 eyes). The thickness of the central choroid (BM-CSI) was measured with an SS-OCT device. The average choroidal thickness in the fovea was defined as average thickness in the central area of 1000 μm in diameter, according to the Early Treatment Diabetic Retinopathy Study (ETDRS). The results were correlated with best-corrected visual acuity (BCVA), and reading vision. RESULTS The average choroidal thickness in the study group (SG) with LMH was 160.34 μm (SD = 77.1), whereas in the control group (CG), it was 225.11 μm (SD = 93.8). The difference of 64.77 μm was statistically significant (p < 0.05). The BCVA was within the range between 0.7 (logMAR) and 0.1 (logMAR), with an average of 0.36 (logMAR) (SD = 0.23). Reading vision was within the range between - 0.2 (logMAR) and 0.3 (logMAR), with an average of 0.27 (logMAR) (SD = 0.12). A significant correlation between BCVA and the choroid (BM-CSI) was found. The correlation coefficient is average (r = 0.44) and positive. With better BCVA, a significantly thicker choroid (BM-CSI) can be observed. No significant correlation between BM-CSI and reading vision was found. The correlation coefficient value is minor (r = - 0.289), whereas lower values of BM-CSI can be observed with worse reading vision. CONCLUSION We suggest that the choroid may take part in the pathogenesis of LMH development. Its significant thinning may be responsible for the ischemic degenerative mechanism degenerating outer layers of retina, apart from tractional mechanism.
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Affiliation(s)
- Magdalena Kal
- Institute of Medical Sciences of Jan Kochanowski University in Kielce, Kielce, Poland
- Ophthalmic Clinic of the Provincial Hospital in Kielce, Kielce, Poland
| | - Mateusz Winiarczyk
- Department of Vitreoretinal Surgery, Medical University of Lublin, Lublin, Poland
| | - Stanisław Głuszek
- Collegium Medicum of Jan Kochanowski University in Kielce, Kielce, Poland
- Oncological, Endocrinological and General Surgery Clinic of the Provincial Hospital in Kielce, Kielce, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, Lublin, Poland.
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Huang LC, Zhou H, Legocki AT, Scoville NM, Zhong J, Ding L, Wang RK, Cabrera MT. Choroidal Thickness by Handheld Swept-Source Optical Coherence Tomography in Term Newborns. Transl Vis Sci Technol 2021; 10:27. [PMID: 34003912 PMCID: PMC7900868 DOI: 10.1167/tvst.10.2.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To describe normative values for choroidal thickness in newborns and characterize their relationship to vitreoretinal features. Methods Term newborns underwent awake, handheld swept-source optical coherence tomography (SS-OCT) in this prospective cohort study. An automated segmentation algorithm followed by manual adjustments measured choroidal thickness at the fovea and five perifoveal locations. Two masked, trained graders, with a third mediating disagreements, analyzed scans for vitreoretinal findings. OCT vitreoretinal findings, including dome-shaped macula, subretinal fluid, punctate hyperreflective vitreous opacities, persistent inner retinal layers, foveal ellipsoid zone, tractional and non-tractional vitreous bands, epiretinal membrane, cystoid macular edema, vessel elevation, scalloped retinal layers, hyporeflective vessels, and retinal spaces, were assessed and correlated with foveal choroidal thickness using a generalized linear mixed model. Results Fifty-nine eyes of 39 infants (mean gestational age, 39.5 weeks; 18 male, 46%) were included. Mean foveal choroidal thickness was 455.5 ± 93.9 µm. Choroid was thinner inferonasally (343.6 ± 106.2 µm) compared to superonasally (368.4 ± 92.9 µm; P = 0.03) and superotemporally (369.6 ± 100.6 µm; P = 0.02). Thinner foveal choroidal thickness was associated with absence of a foveal ellipsoid zone (437.1 ± 78.5 µm vs. 553.7 ± 93.9 µm; P = 0.02). Choroidal thickness was not significantly associated with other OCT findings. Conclusions We identified an association between thinner choroid and foveal immaturity. Additional study is needed to determine whether choroidal development impacts visual outcomes. Translational Relevance Handheld SS-OCT achieved normative measurements for choroidal thickness across the macula in term newborns, providing a foundation for future investigations into the role of choroidal development in infancy.
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Affiliation(s)
- Laura C Huang
- Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Alex T Legocki
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - N Max Scoville
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Junping Zhong
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Ruikang K Wang
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.,Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Michelle T Cabrera
- Division of Pediatric Ophthalmology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
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Viggiano P, Toto L, Ferro G, Evangelista F, Porreca A, Mastropasqua R. Choroidal structural changes in different intermediate AMD patterns. Eur J Ophthalmol 2021; 32:460-467. [PMID: 33506710 DOI: 10.1177/1120672121992009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To report variation of choroidal thickness (CT) and choroidal vascularity index (CVI) in subjects with drusen and subjects with reticular pseudodrusen (RPD) compared with healthy individuals using the Spectral-domain (SD)-Optical Coherence Tomography with enhanced depth imaging (EDI) system. DESIGN A prospective, observational, cross-sectional study. SUBJECTS Eighty-four participants. METHODS The patients were imaged using the Heidelberg Spectralis device (Heidelberg Engineering, Heidelberg, Germany) with EDI mode. EDI-OCT images were exported and then imported into image analysis ImageJ software (National Institutes of Health, Bethesda) and a semiautomated algorithm was used for subsequent quantitative analysis. MAIN OUTCOME MEASURES This study evaluated two choroidal parameters: (i) choroidal thickness (CT); (ii) choroidal vascularity index (CVI). RESULTS CT analysis was performed in three different regions: (i) foveal region, (ii) parafoveal region; (iii) perifoveal region. All the analyzed regions were significantly decreased in RPD pattern, as compared with both the drusen group (p < .005) and healthy eyes (p < .005). CVI was significantly decreased in the RPD pattern, as compared with healthy eyes (p < 0.001). However, the drusenoid pattern did not have statistical significance in comparison with the control group suggesting the lower incidence of this pattern on choroidal vasculopathy. CONCLUSIONS We report CT and CVI difference in RPD and drusen eyes. The RPD pattern seems to be a consequence of an alteration in the choroidal vascularity resulting in severe ischemia and excessive hypoxia inducing an increased risk of late AMD compared to the drusenoid pattern.
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Affiliation(s)
- Pasquale Viggiano
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Giada Ferro
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Federica Evangelista
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
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Zhang H, Yang J, Zhou K, Li F, Hu Y, Zhao Y, Zheng C, Zhang X, Liu J. Automatic Segmentation and Visualization of Choroid in OCT with Knowledge Infused Deep Learning. IEEE J Biomed Health Inform 2020; 24:3408-3420. [PMID: 32931435 DOI: 10.1109/jbhi.2020.3023144] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The choroid provides oxygen and nourishment to the outer retina thus is related to the pathology of various ocular diseases. Optical coherence tomography (OCT) is advantageous in visualizing and quantifying the choroid in vivo. However, its application in the study of the choroid is still limited for two reasons. (1) The lower boundary of the choroid (choroid-sclera interface) in OCT is fuzzy, which makes the automatic segmentation difficult and inaccurate. (2) The visualization of the choroid is hindered by the vessel shadows from the superficial layers of the inner retina. In this paper, we propose to incorporate medical and imaging prior knowledge with deep learning to address these two problems. We propose a biomarker-infused global-to-local network (Bio-Net) for the choroid segmentation, which not only regularizes the segmentation via predicted choroid thickness, but also leverages a global-to-local segmentation strategy to provide global structure information and suppress overfitting. For eliminating the retinal vessel shadows, we propose a deep-learning pipeline, which firstly locate the shadows using their projection on the retinal pigment epithelium layer, then the contents of the choroidal vasculature at the shadow locations are predicted with an edge-to-texture generative adversarial inpainting network. The results show our method outperforms the existing methods on both tasks. We further apply the proposed method in a clinical prospective study for understanding the pathology of glaucoma, which demonstrates its capacity in detecting the structure and vascular changes of the choroid related to the elevation of intra-ocular pressure.
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Mano F, Sprehe N, Olsen TW. Association of Drusen Phenotype in Age-Related Macular Degeneration from Human Eye-Bank Eyes to Disease Stage and Cause of Death. Ophthalmol Retina 2020; 5:743-749. [PMID: 33227563 DOI: 10.1016/j.oret.2020.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To stage maculopathy, assess and quantify drusen, determine drusen subtype frequency, and compare subtypes with age-related macular degeneration (AMD) stage and cause of death using an eye-bank model of AMD. DESIGN Cross-sectional study. PARTICIPANTS Two thousand ninety-two human eyes from 1067 eye-bank donors, selected from a population at risk for AMD. METHODS We analyzed donor eye tissue images (2005-2020) using both the 4- and 9-step Minnesota Grading System (MGS), an AMD grading system for eye-bank eyes corresponding to the Age-Related Eye Disease Study classification. The 9-step MGS quantifies total drusen area, hyperpigmentation, and depigmentation. We analyzed reticular pseudodrusen (RPD), basal laminar drusen (BLD), and calcified drusen (CaD) frequency within this population and explored associations with AMD stage, donor age, gender, and cause of death. Statistical analyses were performed using Wilcoxon rank-sum and chi-square tests. Testing encompassed staging eye-bank eyes using MGS analysis. MAIN OUTCOME MEASURES Drusen subtype frequency associations with AMD stage and cause of death. RESULTS We detected RPD in 228 (13%), BLD in 131 (7%), and CaD in 84 (5%) of the examined eyes (n = 1777). All subtypes were associated with advanced AMD (RPD: odds ratio [OR], 3.4 [95% confidence interval (CI), 2.5-4.5; P < 0.0001]; BLD: OR, 2.2 [95% CI, 1.5-3.2; P < 0.0001]; and CaD: OR, 39.1 [95% CI, 16.8-91.0; P < 0.0001]). Only the RPD subtype was associated statistically with cardiovascular death when compared with those without cardiovascular death (48% vs. 32%; OR, 2.0 [95% CI, 1.4-2.9]; P = 0.0002). CONCLUSIONS In a large group of eye-bank eyes selected from a population at risk for AMD and graded using the 4-step and 9-step MGS, RPD, BLD, and especially CaD were associated strongly with advanced AMD. The RPD subtype was associated with a cardiovascular cause of death and may represent an ophthalmologic biomarker for cardiovascular disease.
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Affiliation(s)
- Fukutaro Mano
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology, Kindai University, Osakasayama, Osaka, Japan
| | - Nicholas Sprehe
- Lions Eye Institute for Transplant and Research, Tampa Bay, Florida
| | - Timothy W Olsen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
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Haller's vessels patterns in non-neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020; 258:2163-2171. [PMID: 32535671 DOI: 10.1007/s00417-020-04769-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/11/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To investigate the optical coherence tomography (OCT) en face reconstruction of the choroid in different phenotypes of non-neovascular age-related macular degeneration (AMD), to identify the relative distribution of the vascular patterns of the Haller's layer in each AMD category. METHODS Retrospective study enrolling consecutive patients with non-neovascular AMD. Patients were divided into the following: (1) those with reticular pseudodrusen (RPD); (2) those with small (< 63 μm) or medium-large drusen (63-124 μm); (3) those with geographic atrophy (GA). Qualitative analysis of the en face images provided by CIRRUS HD-OCT 5000 (Carl Zeiss Meditech, Inc., Dublin, USA) was performed, identifying five arrangements of Haller's vessels: temporal herringbone, branched from below, laterally diagonal, double arcuate, and reticular. Choroidal thickness (CT) was measured from structural OCT. Healthy age-matched subjects were included as a control group. RESULTS Fifty-eight eyes of 58 patients (20 eyes with RPD; 22 eyes with drusen; 16 eyes with GA) and 18 control eyes were enrolled. The laterally diagonal configuration was the most prevalent (40.0%) in the RPD group; the reticular pattern was the most frequent in the drusen group (50.0%); the double arcuate (62.5%) was the most recurrent pattern in patients with GA. In the control group, the temporal herringbone (38.9%) arrangement was the most represented. The CT associated with the temporal herringbone and reticular arrangement was significantly higher compared to the branched from below (p < 0.001), the laterally diagonal (p = 0.014), and the double arcuate pattern (p = 0.009). CONCLUSION Different phenotypes of non-neovascular AMD present a specific distribution of vascular arrangement on en face OCT. The temporal herringbone and the reticular pattern (the ones more associated in a physiological setting) disclosed a thicker choroid compared to the arrangements more represented in non-neovascular AMD-correlated phenotypes.
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Choroidal vascular densities of macular disease on ultra-widefield indocyanine green angiography. Graefes Arch Clin Exp Ophthalmol 2020; 258:1921-1929. [PMID: 32494872 DOI: 10.1007/s00417-020-04772-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE We sought to compare choroidal vascular characteristics of central serous chorioretinopathy (CSC), polypoidal choroidal vasculopathy (PCV), and age-related macular degeneration (AMD) using quantitative analyses of ultra-widefield indocyanine green (UWF ICGA) images. METHODS Eyes with CSC (n = 57), thick-choroid PCV (n = 29), thin-choroid PCV (n = 25), neovascular AMD (n = 45), and pachychoroid neovasculopathy (PNV) (n = 28) were enrolled. On UWF ICGA images, choroidal vascular density (CVD) was assessed using binarization in the total area, posterior pole, each quadrant, and vortex ampullae. Subfoveal choroidal thickness (SFCT) was measured using optical coherence tomography. RESULTS The CVDs of thin-choroid PCV and typical AMD were lower than those of CSC (P = 0.002 and P < 0.001, respectively; P = 0.010 and P = 0.016 when adjusted for age.), whereas the CVDs of CSC, thick-choroid PCV, and PNV did not differ from each other (all P ≥ 0.161; all P ≥ 0.424 when adjusted for age). The CVD of the total area showed a positive correlation with SFCT in each also a whole group (all P ≤ 0.001). Meanwhile, the CVD of each ampullae positively correlated with that of the corresponding quadrant in total eyes and in each group (all P ≤ 0.001). CONCLUSIONS The mean CVD on UWF ICGA was increased in CSC, thick-choroid PCV, and PNV, whereas it was relatively low in thin-choroid PCV and typical AMD. Congestion at the vortex ampulla might be a cause of increased CVD, therefore increasing the SFCT in pachychoroid eyes.
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Rosa R, Corazza P, Musolino M, Mochi C, Maiello G, Traverso CE, Nicolò M. Choroidal changes in intermediate age-related macular degeneration patients with drusen or pseudodrusen. Eur J Ophthalmol 2020; 31:505-513. [PMID: 32338527 DOI: 10.1177/1120672120914530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reticular pseudodrusen are associated with a thinner choroid. The aim of our study was to determine the differences in central choroidal thickness and choriocapillaris vascular flow area between eyes with and without reticular pseudodrusen using swept-source optical coherence tomography and swept-source optical coherence tomography angiography. We conducted a retrospective case control study which included 27 eyes from 27 consecutive patients with intermediate age-related macular degeneration and 17 eyes from 17 healthy participants. Complete ophthalmic examinations were carried out including axial length measurements; fundus color retinography; fundus autofluorescence; swept-source optical coherence tomography and swept-source optical coherence tomography angiography; central choroidal thickness and choriocapillaris vascular flow area. Patients were classified as no reticular pseudodrusen, mild reticular pseudodrusen, and severe reticular pseudodrusen. Mean central choroidal thickness in patients exhibiting severe reticular pseudodrusen (110 ± 56 μm) was significantly smaller than in patients with no reticular pseudodrusen (201 ± 76 μm, p < 0.01). Mean choriocapillaris vascular flow area in severe reticular pseudodrusen patients (45.2% ± 3.0%) was also significantly less than in patients with no (47.9% ± 1.6%, p < 0.001) and mild reticular pseudodrusen (47.7% ± 1.0%, p < 0.05). Stepwise multiple regression models confirmed the association of reticular pseudodrusen with central choroidal thickness (p < 0.001) and choriocapillaris vascular flow area (p < 0.01) even after accounting for age, axial length, and refractive error. Soft drusen were not associated with changes in either central choroidal thickness (p = 0.13) nor choriocapillaris vascular flow area (p = 0.29). A significant, positive relationship was found between central choroidal thickness and choriocapillaris vascular flow area (r = 0.44, p = 0.01). Therefore, both central choroidal thickness and choriocapillaris vascular flow area are decreased in eyes with reticular pseudodrusen, as compared to healthy eyes and intermediate age-related macular degeneration eyes not exhibiting reticular pseudodrusen. In addition, central choroidal thickness and choriocapillaris vascular flow area are related, and the reduction of either is directly associated to the severity of reticular pseudodrusen. Further studies are needed to assess the clinical significance of these findings.
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Affiliation(s)
- Raffaella Rosa
- Clinica Oculistica, DINOGMI, Università di Genova, Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Corazza
- Clinica Oculistica, DINOGMI, Università di Genova, Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Musolino
- Clinica Oculistica, DINOGMI, Università di Genova, Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Mochi
- Clinica Oculistica, DINOGMI, Università di Genova, Ospedale Policlinico San Martino, Genova, Italy
| | - Guido Maiello
- Department of Experimental Psychology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Carlo Enrico Traverso
- Clinica Oculistica, DINOGMI, Università di Genova, Ospedale Policlinico San Martino, Genova, Italy
| | - Massimo Nicolò
- Clinica Oculistica, DINOGMI, Università di Genova, Ospedale Policlinico San Martino, Genova, Italy.,Fondazione per la Macula onlus, Genova, Italy
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Abstract
PURPOSE To study the associations of subfoveal choroidal thickness with vascular risk factors and age-related macular degeneration. METHODS Two hundred sixty-one participants of the Alienor study had gradable enhanced-depth imaging optical coherence tomography scans of the macula and available data on vascular and genetic risk factors (assessed through face-to-face interview and fasting blood samples) and age-related macular degeneration status (assessed from retinal photographs and optical coherence tomography). Subfoveal choroidal thickness was measured manually on one horizontal scan passing through the fovea. RESULTS In a multivariate mixed linear model, subfoveal choroidal thickness was independently associated with age greater than 80 years (-21.77 μm, P = 0.02), axial length (-21.77 μm, P < 0.0001), heavy smoking (≥20 pack-years: -24.89 μm, P = 0.05), fasting blood glucose higher than 7 mmol/L (-53.17 μm, P = 0.02), and lipid-lowering treatment (+18.23, P = 0.047). After multivariate adjustment for age, sex, axial length, and vascular and genetic risk factors, subfoveal choroidal thickness was thinner in eyes with central hyperpigmentation (-45.39 μm, P = 0.006), central hypopigmentation (-44.99 μm, P = 0.001), and central pigmentary abnormalities (-44.50 μm, P = 0.001), but not in eyes with late age-related macular degeneration (-18.05 μm, P = 0.33) or soft drusen. CONCLUSION These findings indicate a relationship between vascular risk factors and choroidal thinning and suggest an early involvement of the choroid in the pathogenesis of age-related macular degeneration.
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Tsuji S, Sekiryu T, Sugano Y, Ojima A, Kasai A, Okamoto M, Eifuku S. Semantic Segmentation of the Choroid in Swept Source Optical Coherence Tomography Images for Volumetrics. Sci Rep 2020; 10:1088. [PMID: 31974487 PMCID: PMC6978344 DOI: 10.1038/s41598-020-57788-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/07/2020] [Indexed: 01/21/2023] Open
Abstract
The choroid is a complex vascular tissue that is covered with the retinal pigment epithelium. Ultra high speed swept source optical coherence tomography (SS-OCT) provides us with high-resolution cube scan images of the choroid. Robust segmentation techniques are required to reconstruct choroidal volume using SS-OCT images. For automated segmentation, the delineation of the choroidal-scleral (C-S) boundary is key to accurate segmentation. Low contrast of the boundary, scleral canals formed by the vessel and the nerve, and the posterior stromal layer, may cause segmentation errors. Semantic segmentation is one of the applications of deep learning used to classify the parts of images related to the meanings of the subjects. We applied semantic segmentation to choroidal segmentation and measured the volume of the choroid. The measurement results were validated through comparison with those of other segmentation methods. As a result, semantic segmentation was able to segment the C-S boundary and choroidal volume adequately.
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Affiliation(s)
- Shingo Tsuji
- The Department of Cellular and Integrative Physiology, Fukushima Medical University, Fukushima, Japan
| | - Tetsuju Sekiryu
- The Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan.
| | - Yukinori Sugano
- The Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Akira Ojima
- The Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Akihito Kasai
- The Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | - Masahiro Okamoto
- The Department of Systems Neuroscience, Fukushima Medical University, Fukushima, Japan
| | - Satoshi Eifuku
- The Department of Systems Neuroscience, Fukushima Medical University, Fukushima, Japan
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Breher K, Ohlendorf A, Wahl S. A metrological approach to the analysis of choroidal thickness by optical coherence tomography 3D scans in myopia research. Sci Rep 2019; 9:20322. [PMID: 31889147 PMCID: PMC6937308 DOI: 10.1038/s41598-019-56915-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/19/2019] [Indexed: 11/09/2022] Open
Abstract
In myopia research, changes of choroidal thickness in response to optically induced signals serve as predictor for changes in axial length that might be correlated with myopia progression. Optical coherence tomography (OCT) provides a tool for imaging the choroid, however, with certain difficulties because of a limited visibility of the scleral-choroidal interface. Considering the previously reported effect sizes of thickness change in human myopia research, this study investigated the repeatability of automated 3D choroidal segmentation across the macular area of 6 × 6 mm2. Fifteen subjects underwent nine volume scans in two OCT devices with analysis of the 95% interval of repeatability, intersubject and intrasubject variations, as well as interdevice agreement. Repeatability generally improved with increasing eccentricity from the fovea. The nasal perifoveal region exhibited the best repeatability with ±19 and ±21 μm in both OCT devices, whereas the subfovea showed a repeatability of ±57 and ±44 μm, respectively. High inter- and intrasubject variations were observed, together with a negative bias in the device agreement. Although there is still limited data on thickness changes of the nasal choroid, future studies could focus more on measuring the effect size in the nasal perifoveal area to account for metrological issues in choroidal segmentation.
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Affiliation(s)
- Katharina Breher
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Tuebingen, 72076, Germany.
| | - Arne Ohlendorf
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Tuebingen, 72076, Germany.,Carl Zeiss Vision International GmbH, Aalen, 73430, Germany
| | - Siegfried Wahl
- Institute for Ophthalmic Research, Eberhard Karls University Tuebingen, Tuebingen, 72076, Germany.,Carl Zeiss Vision International GmbH, Aalen, 73430, Germany
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Age-Related Changes in Choroidal Thickness and the Volume of Vessels and Stroma Using Swept-Source OCT and Fully Automated Algorithms. Ophthalmol Retina 2019; 4:204-215. [PMID: 32033714 DOI: 10.1016/j.oret.2019.09.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine age-related changes in choroidal thickness and the volume of choroidal vessels and stroma using automated algorithms based on structural swept-source OCT (SS-OCT) scans. DESIGN Prospective and observational study. PARTICIPANTS The study included 144 normal participants with ages ranging from 20 to 88 years. METHODS A previously reported strategy was used to automatically segment the choroid using SS-OCT structural images. Attenuation correction was applied on B-scans to enhance the choroidal contrast and facilitate more accurate automatic segmentation of the 3-dimensional choroidal vessel and stroma. The parameters that we investigated included mean choroidal thickness (MCT), choroidal vessel volume (CVV), choroidal stroma volume (CSV), choroid vascularity index (CVI), and the choroidal stroma-to-vessel volume ratio (CSVR). Correlations between MCT and choroidal vessel metrics of CVV, CSV, CVI, and CSVR were studied. Regional distributions of MCT and CVI were analyzed using a grid centered on the fovea. Age-related changes in MCT, CVV, CSV, and CVI were studied in the entire scanning region, as well as in the subregions of the grids. MAIN OUTCOME MEASURES Age-related changes in MCT, CVV, CSV, and CVI using 6×6-mm and 12×12-mm SS-OCT scans. RESULTS The automated choroid segmentations were validated against manual segmentations, and MCT measurements were shown to be in good agreement (P < 0.0001). Choroidal vessel volume and CSV showed significant correlations with MCT (all P < 0.0001). Interestingly, CVI and CSVR were constant, with little variation among all participants regardless of age and MCT (61.1±1.8% and 0.64±0.05, respectively). Measurements on 12×12-mm and 6×6-mm scans showed excellent agreement in all scan regions (all P < 0.0001). While choroidal thickness and choroidal volume, which includes both choroidal vessels and stroma, decrease with age (all P < 0.0001), the CVI and CSVR vary little among all ages in all regions. CONCLUSIONS Whereas MCT, CVV, and CSV decrease with age, the CVI and CSVR remain constant in all regions with age. Ongoing studies are using these automated algorithms on SS-OCT structural datasets to investigate the diagnostic usefulness of these choroidal parameters in a myriad of ocular and systemic diseases.
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Thulliez M, Zhang Q, Shi Y, Zhou H, Chu Z, de Sisternes L, Durbin MK, Feuer W, Gregori G, Wang RK, Rosenfeld PJ. Correlations between Choriocapillaris Flow Deficits around Geographic Atrophy and Enlargement Rates Based on Swept-Source OCT Imaging. Ophthalmol Retina 2019; 3:478-488. [PMID: 31174669 DOI: 10.1016/j.oret.2019.01.024] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/08/2018] [Accepted: 01/30/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine the possible correlation between the annual enlargement rates (ERs) of geographic atrophy (GA) with the percentage and size of the choriocapillaris (CC) flow deficits (FDs) surrounding GA, measured with swept-source OCT angiography (SS-OCTA) images. DESIGN Prospective, observational case series. PARTICIPANTS Patients with GA secondary to nonexudative AMD. METHODS Patients were imaged with a 100-kHz SS-OCTA instrument (PLEX Elite 9000, Carl Zeiss Meditec, Dublin, CA) using a 6×6-mm field of view scan pattern. The GA area measurements were obtained from en face SS-OCT sub-retinal pigment epithelium (RPE) slab images. Visualization of the CC and quantification of FDs were performed using a previously published validated algorithm based on a 20-μm thickness slab with the inner boundary located beneath Bruch's membrane. The percentage of CC FDs (FD%) and the average FD area measurements were calculated in different regions around the GA. MAIN OUTCOME MEASURES The correlation between the CC FDs and the ERs of GA. RESULTS Twenty-two eyes from 15 patients were eligible for the analysis. The annual square root ERs for GA ranged from 0.07 to 0.75 mm/year. The CC FD% and average FD area measurements were highly correlated with each other (P < 0.001), with the highest FD values found in the region closest to the margin of GA. The ERs correlated best with the average CC FD area measurements in the total scan area minus the area of GA (Pearson r = 0.747; P < 0.001) than those in the regions immediately surrounding the GA (r = 0.544; P = 0.009). CONCLUSIONS Contrary to expectations, the global CC FD measurements had a better correlation with the ERs of GA than those in the regions immediately around the GA. The most likely explanation for this outcome is that normal age-related increases in FDs within the central macula confound the correlations between the ERs of GA and FDs, whereas the regions furthest away from the margins of GA are less affected by normal age-related changes and reflect FD alterations related to AMD severity.
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Affiliation(s)
- Marie Thulliez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Luis de Sisternes
- Research and Development, Carl Zeiss Meditec, Inc, Dublin, California
| | - Mary K Durbin
- Research and Development, Carl Zeiss Meditec, Inc, Dublin, California
| | - William Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Choroidal binarization analysis: clinical application. Int Ophthalmol 2019; 39:2947-2973. [PMID: 31140022 DOI: 10.1007/s10792-019-01122-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Image processing of optical coherence tomography scans through binarization techniques represent a non-invasive way to separately asses and measure choroidal components, in vivo. In this review, we systematically search the scientific literature regarding binarization studies published so far. METHODS A systematic research was conducted at PubMed database, including English literature articles for all of the following terms in various combinations: binarization, choroid/al, enhanced depth spectral domain/swept source optic coherence tomography, and latest publications up to November 2018 were reviewed. RESULTS Thirty-seven articles were included and analyzed regarding studied disease, binarization method, studied variables, and outcomes. Most of the studies have focused on the more common retinal pathologies, such as age-related macular degeneration, central serous chorioretinopathy and diabetic retinopathy but binarization techniques have also been applied to the study of choroidal characteristics in ocular inflammatory diseases, corneal dystrophies and in postsurgical follow-up. Advantages and disadvantages of binarization techniques are also discussed. CONCLUSION Binarization of choroidal images seems to represent a promising approach to study choroid subcomponents in an increasingly detailed manner.
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Lai FHP, Iao TWU, Ng DSC, Young AL, Leung J, Au A, Ko STC, Chong KKL. Choroidal thickness in thyroid-associated orbitopathy. Clin Exp Ophthalmol 2019; 47:918-924. [PMID: 31034694 DOI: 10.1111/ceo.13525] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 12/14/2022]
Abstract
IMPORTANCE To investigate the choroidal thickness (CT) in patients with thyroid-associated orbitopathy (TAO). BACKGROUND To compare CT of TAO patients and healthy subjects. DESIGN Prospective cross-sectional study in a public hospital. PARTICIPANTS One hundred and four eyes of 52 TAO patients and 52 eyes of 26 healthy subjects. METHODS CT was measured with enhanced-depth imaging optical coherence tomography (EDI-OCT) at the subfoveal, macular and peripapillary regions. Multivariate linear regression was used to evaluate the associations of subfoveal CT with systemic and ocular variables among TAO eyes. MAIN OUTCOME MEASURES CT of both groups. RESULTS CT of eyes with TAO was significantly increased at the subfoveal region, 1 and 2 mm from the fovea nasally, temporally and superiorly, and 1 mm inferior to the fovea (all P < .05). No significant difference was found in CT at 2 mm inferior to the fovea (P = .094) and all four quadrants of the peripapillary region (superior, P = .096; nasal, P = .732; inferior, P = .179; temporal, P = .052). Among TAO eyes, thinner subfoveal choroid was associated with worsening exophthalmos (P = .043), poorer visual acuity (P = .017), increasing age (P = .040) and axial length (P < .001). There was no association between CT and clinical activity score (P = .239). CONCLUSIONS AND RELEVANCE TAO patients showed thicker choroid than controls over the macula, but not the peripapillary regions. Thinner subfoveal choroid was associated with worsening exophthalmos and poorer vision. EDI-OCT can monitor choroidal vascular changes associated with TAO and its complications.
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Affiliation(s)
- Frank H P Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Tiara W U Iao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Danny S C Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
| | - Joy Leung
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Alvin Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Simon T C Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Kelvin K L Chong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong
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Grebe R, Mughal I, Bryden W, McLeod S, Edwards M, Hageman GS, Lutty G. Ultrastructural analysis of submacular choriocapillaris and its transport systems in AMD and aged control eyes. Exp Eye Res 2019; 181:252-262. [PMID: 30807744 DOI: 10.1016/j.exer.2019.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/31/2019] [Accepted: 02/21/2019] [Indexed: 01/11/2023]
Abstract
The choriocapillaris is the source of nutrients and oxygen for photoreceptors, which consume more oxygen per gram of tissue than any other cell in the body. The purpose of this study was to evaluate and compare the ultrastructure of the choriocapillaris and its transport systems in patients with and without age-related macular degeneration (AMD). Ultrastructural changes were also evaluated in subjects that were homozygous for polymorphisms in high risk CFH alleles (Pure 1) only or homozygous only for high risk ARMS2/HTRA1 (Pure 10) alleles. Tissue samples were obtained from the macular region of forty male (n = 24) and female (n = 16) donor eyes and prepared for ultrastructural studies with transmission electron microscopy (TEM). The average age of the aged donors was 74 ± 7.2 (n = 30) and the young donors 31.7 ± 11.25 (n = 10). There was no significant difference in average ages between the adult groups. TEM images of the capillaries in the choriocapillaris (CC) were taken at 4,000X and 25,000X and used to measure the area of endothelial cell somas, the number of fenestrations, and area of caveolae within the endothelial cells per length of Bruchs membrane (BrMb). The Student t-test and Wilcoxon sum rank test were used to determine significant differences. There was no significant difference between young subjects and aged controls in any of the morphological criteria assessed. There was a significant decrease in the number of fenestrations/mm of BrMb in atrophic areas of GA eyes (p = 0.007) when compared with aged control eyes. A significant increase was found in the caveolae area as a percent of the endothelial cell soma of capillaries from GA subjects as compared with the controls (p = 0.03). Loss of capillary segments in choriocapillaris was also evident, especially in areas of geographic atrophy and CNV. In eyes from patients with sequence variations, the capillary endothelial cells often appeared degenerative and exhibited atypical fenestrations and pericytes covering the blood vessels. Subjects that were homozygous for polymorphisms in high risk CFH alleles only had more fenestrations/mm of BrMb than subjects that were homozygous only for high risk ARMS2/HTRA1 alleles (p = 0.04), while the latter had greater caveolae area/endothelial cell area than the former (p = 0.007). This study demonstrated an attenuation of CC and a significant decline in the two major transport systems in CC endothelial cells in AMD. This may contribute to drusen deposition, nutrient transport, and vision loss in AMD subjects.
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Affiliation(s)
- Rhonda Grebe
- The Wilmer Ophthalmological Institute, Dept. of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, 21287-9915, USA
| | - Irum Mughal
- The Wilmer Ophthalmological Institute, Dept. of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, 21287-9915, USA
| | - William Bryden
- The Wilmer Ophthalmological Institute, Dept. of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, 21287-9915, USA
| | - Scott McLeod
- The Wilmer Ophthalmological Institute, Dept. of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, 21287-9915, USA
| | - Malia Edwards
- The Wilmer Ophthalmological Institute, Dept. of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, 21287-9915, USA
| | - Gregory S Hageman
- John A. Moran Eye Center, Steele Center for Translational Medicine, Dept. of Ophthalmology & Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Gerard Lutty
- The Wilmer Ophthalmological Institute, Dept. of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, 21287-9915, USA.
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Nittala MG, Hogg RE, Luo Y, Velaga SB, Silva R, Alves D, Staurenghi G, Chakravarthy U, Sadda SR. Changes in Retinal Layer Thickness in the Contralateral Eye of Patients with Unilateral Neovascular Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2019; 3:112-121. [DOI: 10.1016/j.oret.2018.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/24/2018] [Accepted: 09/14/2018] [Indexed: 11/27/2022]
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Farazdaghi MK, Ebrahimi KB. Role of the Choroid in Age-related Macular Degeneration: A Current Review. J Ophthalmic Vis Res 2019; 14:78-87. [PMID: 30820291 PMCID: PMC6388521 DOI: 10.4103/jovr.jovr_125_18] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Age-related macular degeneration (AMD) is a major cause of vision loss in the developed world and its pathogenesis is a topic of active research. To date, much study has been focused on the role of the retinal pigment epithelium (RPE) and Bruch's membrane (BrM) in AMD pathogenesis, but the role of the choroid has also been investigated. In this review, we focus on recent advancements in research in the role of the choroid in AMD, beginning with an exploration of the histopathologic, cellular and molecular changes that occur in the choroid in AMD and concluding by discussing new choroidal imaging techniques and patterns seen on fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography and optical coherence tomography angiography. Exploring these domains will lead to a better understanding of the factors at play beyond the outer retina in this important disease.
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Affiliation(s)
| | - Katayoon B Ebrahimi
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, USA
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Wang JC, Laíns I, Silverman RF, Sobrin L, Vavvas DG, Miller JW, Miller JB. Visualization of Choriocapillaris and Choroidal Vasculature in Healthy Eyes With En Face Swept-Source Optical Coherence Tomography Versus Angiography. Transl Vis Sci Technol 2018; 7:25. [PMID: 30598856 PMCID: PMC6306077 DOI: 10.1167/tvst.7.6.25] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/07/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare the visualization of the choriocapillaris and deeper choroidal vessels in healthy eyes in en face swept-source optical coherence tomography (SS-OCT) versus SS-OCT angiography (SS-OCTA). Methods This is a cross-sectional study of consecutive eyes without chorioretinal disease. En face SS-OCT and SS-OCTA images of the choriocapillaris and choroid were assessed for visualization of the vasculature. Choroidal vessel densities (CVD) of the choriocapillaris, inner choroid, midchoroid, and outer choroid were calculated from binarized en face SS-OCT and SS-OCTA images. Paired t-tests and linear regression were used for statistical analysis. Results Twenty-seven eyes of 27 patients were included. There was no statistically significant difference between the CVDs of the midchoroid assessed with en face SS-OCT versus SS-OCTA (P = 0.21). However, there were statistically significant differences between the CVDs for the choriocapillaris (P < 0.001), inner choroid (P < 0.001), and outer choroid (P = 0.006). Qualitative analysis revealed incomplete visualization of vessels in the inner choroid and exaggeration of vessel lumens in the outer choroid with SS-OCTA. Conclusions Visualization of the choriocapillaris is superior with SS-OCTA, but it has numerous limitations that make visualization of deeper choroidal vessels less reliable when compared with en face SS-OCT. It is important to understand such limitations when using these technologies to study the choroidal vasculature in chorioretinal disease. Translational Relevance The presented study of optimal imaging techniques for the choroidal vessels of healthy eyes provides an important foundation for future investigations into the role of the choroidal vasculature in chorioretinal diseases.
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Affiliation(s)
- Jay C Wang
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Rebecca F Silverman
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lucia Sobrin
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Demetrios G Vavvas
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Zhou H, Chu Z, Zhang Q, Dai Y, Gregori G, Rosenfeld PJ, Wang RK. Attenuation correction assisted automatic segmentation for assessing choroidal thickness and vasculature with swept-source OCT. BIOMEDICAL OPTICS EXPRESS 2018; 9:6067-6080. [PMID: 31065413 PMCID: PMC6490991 DOI: 10.1364/boe.9.006067] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 05/12/2023]
Abstract
Swept source optical coherence tomography (SS-OCT) is being used more widely in clinical studies to investigate the choroid due to its deeper penetration under the retinal pigment epithelium and improved image quality compared with spectral domain OCT. However, automatic methods to reliably assess choroidal thickness and vasculature are still limited. This paper reports an approach that applies attenuation correction on SS-OCT structural scans to facilitate accurate automatic segmentation of the choroid and provides visualization of the choroidal vasculature without the necessity of OCT angiography. After attenuation correction, enhanced interlayer contrast at the choroidal-scleral interface was observed (from 0.13 ± 0.05 to 0.29 ± 0.10; P < 0.001). An algorithm that segmented the choroid from attenuation compensated B-scans achieved significantly higher accuracy when compared with an automated segmentation performed on regular OCT scans (91.8 ± 3.7% vs.74.5 ± 8.0%; P < 0.01). After attenuation correction, en face images of choroidal vessels were achieved with fewer artifacts from retinal vessels. Measurements of mean choroidal thickness and vessel density showed high repeatability. The attenuation correction assisted segmentation of the choroid and visualization of the choroidal vasculature will be helpful in studying the quantitative changes that occur in a myriad of diseases involving the choroid such as age-related macular degeneration, polypoidal choroidal vasculopathy, pathologic myopia, central serous chorioretinopathy, and inflammatory eye conditions.
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Affiliation(s)
- Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Yining Dai
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Department of Ophthalmology, University of Washington, Seattle, WA 98105, USA
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Rasheed MA, Singh SR, Invernizzi A, Cagini C, Goud A, Sahoo NK, Cozzi M, Lupidi M, Chhablani J. Wide-field choroidal thickness profile in healthy eyes. Sci Rep 2018; 8:17166. [PMID: 30464195 PMCID: PMC6249207 DOI: 10.1038/s41598-018-35640-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 11/07/2018] [Indexed: 01/15/2023] Open
Abstract
The introduction of wide field optical coherence tomography (WF-OCT) has provided newer insights in the imaging of peripheral choroid. We evaluated choroidal thickness (CT) and large choroidal vessel thickness (LCVT) of 20 eyes in horizontal and vertical meridians using WF-OCT. A high-definition line scan through the fovea in both horizontal and vertical meridian was captured in primary and extremes of gaze to obtain scans up to mid-equator. CT and LCVT measurements were done across predefined points in macular area and all quadrants. LCVT was calculated after identifying a large choroidal vessel near choroidoscleral interface. The main outcome measures were differences in CT and LCVT in macular and four quadrants. Mean CT (331.23 ± 76.34 µ) and LCVT (201.46 ± 54.31 µ) in vertical macular segment were significantly more than CT (245.79 ± 55.38 µ; p = 0.0002) and LCVT (150.48 ± 52.58 µ; p = 0.004) in horizontal macular segment. CT at peripheral points in all quadrants was significantly reduced as compared to subfoveal CT (all p values < 0.05) with maximum reduction in inferior quadrant (64.5%). Using linear regression, only quadrant had a significant effect on CT and LCVT (both p < 0.001). CT and LCVT are highest at the macular area with reduction towards the periphery. The contribution of LCVT to CT is less at the fovea compared to other peripheral points.
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Affiliation(s)
- Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, 34, India
| | - Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, 34, India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Milan, Italy
| | - Carlo Cagini
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, 34, India
| | - Niroj Kumar Sahoo
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, 34, India
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Milan, Italy
| | - Marco Lupidi
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, 34, India.
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Inter- and intraobserver repeatability and reproducibility of choroidal thickness measurements using two different methods. Int Ophthalmol 2018; 39:1061-1069. [DOI: 10.1007/s10792-018-0909-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
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Motulsky E, Zheng F, Liu G, Gregori G, Rosenfeld PJ. Swept-Source OCT Angiographic Imaging of a Central Retinal Vein Occlusion During Pregnancy. Ophthalmic Surg Lasers Imaging Retina 2018; 49:206-208. [PMID: 29554389 DOI: 10.3928/23258160-20180221-09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/01/2017] [Indexed: 11/20/2022]
Abstract
To avoid fluorescein angiography in a pregnant woman diagnosed with a central retinal vein occlusion (CRVO), swept-source optical coherence tomography angiography (SS-OCTA) was performed and showed no evidence of decreased central retinal perfusion leading to the diagnosis of a nonischemic CRVO. Five months after an intravitreal injection of steroid, both her vision and the retinal appearance had returned to normal. This case demonstrates how a noninvasive, safe, 12 mm × 12 mm SS-OCTA image of a CRVO is useful in evaluating the retinal perfusion at presentation and follow-up during pregnancy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:206-208.].
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Sun M, Zhang F, Ouyang B, Wang M, Li Y, Jiao X, Zhang L, Wang N. Study of retina and choroid biological parameters of rhesus monkeys eyes on scleral collagen cross-linking by riboflavin and ultraviolet A. PLoS One 2018; 13:e0192718. [PMID: 29420622 PMCID: PMC5805357 DOI: 10.1371/journal.pone.0192718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/29/2018] [Indexed: 12/28/2022] Open
Abstract
To evaluate ocular fundus biological changes after scleral collagen cross-linking (CXL) with riboflavin/ ultraviolet A (UVA) on rhesus monkeys in vivo by analyzing retina and choroid biological parameters. Six 3-year-old male rhesus monkeys (12 eyes) were observed in this study, with scleral CXL procedures applied on superior temporal equatorial sclera on random eyes of all rhesus. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) examination were performed before and 1 week, 1 month, 3 months and 6 months after CXL. The thickness of retina and choroid and the flow density of retinal superficial vascular networks were analyzed respectively in different regions after CXL. As for retina thickness and flow density of retinal superficial vascular networks, no statistical difference was noted between CXL eyes and control eyes at 1 day, 1week, 1 month, 3 months and 6 months (P>0.05). Among choroid parameters, the choroidal thickness in 1500μm temporal to the fovea center of CXL eyes revealed a significant reduction in 1 week postoperatively (P<0.05), but it subsequently increased from 1 month postoperatively, and no statistical difference was found between two groups in the following periods (P>0.05). The choroidal thickness nearby crosslinked region may change temporarily following scleral CXL, and it might recover gradually after 1 month postoperatively. The vascular flow density and thickness of retina were not affected by scleral CXL. Further study should be performed to evaluate the potential adverse effects at the direct vicinity of the application site and the long-term effect of scleral CXL in clinical application.
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Affiliation(s)
- Mingshen Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, China
| | - Fengju Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, China
| | - Bowen Ouyang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, China
| | - Mengmeng Wang
- Hebei Ophthalmology Key Lab, Hebeisheng Eye Hospital, Xingtai, Hebei Province, China
| | - Yu Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, China
| | - Xuan Jiao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, China
| | - Li Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, China
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Czepita M, Czepita D. Enhancement of Choriocapillaris Visualization in En Face Swept-Source Optical Coherence Tomography Angiography Images. Med Sci Monit 2018; 24:596-601. [PMID: 29380815 PMCID: PMC5800321 DOI: 10.12659/msm.905534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Visualization of the choriocapillaris vessels using swept-source optical coherence tomography is a novel technique. However, en face images obtained with current commercial equipment using this method are still unclear. Therefore, using freely available image processing software, we have been able to enhance and clearly visualize single choriocapillaris blood vessels. Material/Methods We examined 4 swept-source optical coherence tomography en face images of the choriocapillaris in 2 male patients in both eyes and processed them using Image J software. Results In our study, all images displayed clearly individual choriocapillaris vessels. Conclusions Implementation of this technique significantly improves visualization of the choriocapillaris. Further studies need to be carried out in order to validate this method of enhancement.
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Yasin Alibhai A, Or C, Witkin AJ. Swept Source Optical Coherence Tomography: a Review. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0158-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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