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Parameswarappa DC, Langstang AJ, Kavya S, Mohamed A, Stewart MW, Rani PK. The Role of Widefield Optical Coherence Tomography Angiography in Assessing the Severity of Diabetic Retinopathy. Ophthalmol Ther 2024; 13:2369-2380. [PMID: 38995480 PMCID: PMC11341797 DOI: 10.1007/s40123-024-00995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Physicians need an accurate understanding of diabetic retinopathy (DR) severity to optimally manage patients. The aim of this prospective study is to correlate the severity of macular and peripheral retinal vascular abnormalities seen on widefield (WF) optical coherence tomography angiography (OCTA) with DR grading based on WF fundus photography. METHODS The study included 150 eyes from 82 patients with treatment-naïve DR. All patients were imaged with WF fundus photography and swept-source WF OCTA. Quantitative and qualitative analyses of the foveal avascular zone (FAZ) size and shape, and measurement of capillary nonperfusion (CNP) areas, were performed from the OCTA images. The mixed-effects model was used to compare the DR grading from WF photography with the vascular changes seen on WF-OCTA, and Bonferroni correction was applied to the gradings. RESULTS The mean [± standard deviation (SD)] age of patients was 55.5 (± 9.4) years. The WF-OCTA showed that an increasing size of the FAZ (from 0.442 (± 0.059) µm to 0.933 (± 0.086) µm) correlated with increasing severity of the DR (as determined with WF photography). The deep capillary plexus, FAZ size, and CNP areas in eyes with proliferative diabetic retinopathy (PDR) differed from those with mild nonproliferative diabetic retinopathy (NPDR) (p < 0.001). Most eyes with severe nonproliferative DR were found to have CNP in four quadrants [superficial capillary plexus (SCP) 60%, deep capillary plexus (DCP) 50%]. The WF-OCTA detected subtle neovascularization of the disc (NVD) in 7 eyes (10%) and neovascularization elsewhere (NVE) in 13 eyes (18%) that had been diagnosed with only moderate NPDR on WF photography. CONCLUSIONS FAZ and CNP areas as measured by WF-OCTA correlate with DR severity. WF-OCTA can also detect subtle NVE and NVD that cannot be seen with fundus photography.
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Affiliation(s)
- Deepika C Parameswarappa
- Srimati. Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, Telangana, India
| | - Amelia Janis Langstang
- Srimati. Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, Telangana, India
| | - Sanagavarapu Kavya
- Srimati. Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, Telangana, India
| | - Ashik Mohamed
- Ophthalmic Biophysics Lab, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Padmaja Kumari Rani
- Srimati. Kanuri Santhamma Center for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, Telangana, India.
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Lorenz AT, Pollreisz A, Schmidt-Erfurth U, Szurman P, Stanzel B. [OCT biomarkers in diabetic maculopathy and artificial intelligence]. DIE OPHTHALMOLOGIE 2024; 121:623-630. [PMID: 39012371 DOI: 10.1007/s00347-024-02065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/03/2024] [Accepted: 06/06/2024] [Indexed: 07/17/2024]
Abstract
Diabetes mellitus is a chronic disease the microvascular complications of which include diabetic retinopathy and maculopathy. Diabetic macular edema, proliferative diabetic retinopathy, and diabetic macular ischemia pose a threat to visual acuity. Artificial intelligence can play an increasingly more important role in making the diagnosis and the treatment regimen of maculopathies in everyday clinical practice in the future. It can be used to automatically detect and quantify pathological parameters of the retina. The aim is to improve patient care in the clinical routine using so-called clinical decision support systems with personalized treatment algorithms. This review article outlines the current research regarding new biomarkers in diabetic maculopathy using optical coherence tomography (OCT) and OCT angiography (OCT-A).
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Affiliation(s)
- Anna Theresa Lorenz
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Andreas Pollreisz
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Wien, Österreich
| | - Ursula Schmidt-Erfurth
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Wien, Österreich
| | - Peter Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach, Deutschland
| | - Boris Stanzel
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland.
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach, Deutschland.
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3
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Iorga RE, Costin D, Munteanu-Dănulescu RS, Rezuș E, Moraru AD. Non-Invasive Retinal Vessel Analysis as a Predictor for Cardiovascular Disease. J Pers Med 2024; 14:501. [PMID: 38793083 PMCID: PMC11122007 DOI: 10.3390/jpm14050501] [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: 04/19/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Cardiovascular disease (CVD) is the most frequent cause of death worldwide. The alterations in the microcirculation may predict the cardiovascular mortality. The retinal vasculature can be used as a model to study vascular alterations associated with cardiovascular disease. In order to quantify microvascular changes in a non-invasive way, fundus images can be taken and analysed. The central retinal arteriolar (CRAE), the venular (CRVE) diameter and the arteriolar-to-venular diameter ratio (AVR) can be used as biomarkers to predict the cardiovascular mortality. A narrower CRAE, wider CRVE and a lower AVR have been associated with increased cardiovascular events. Dynamic retinal vessel analysis (DRVA) allows the quantification of retinal changes using digital image sequences in response to visual stimulation with flicker light. This article is not just a review of the current literature, it also aims to discuss the methodological benefits and to identify research gaps. It highlights the potential use of microvascular biomarkers for screening and treatment monitoring of cardiovascular disease. Artificial intelligence (AI), such as Quantitative Analysis of Retinal vessel Topology and size (QUARTZ), and SIVA-deep learning system (SIVA-DLS), seems efficient in extracting information from fundus photographs and has the advantage of increasing diagnosis accuracy and improving patient care by complementing the role of physicians. Retinal vascular imaging using AI may help identify the cardiovascular risk, and is an important tool in primary cardiovascular disease prevention. Further research should explore the potential clinical application of retinal microvascular biomarkers, in order to assess systemic vascular health status, and to predict cardiovascular events.
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Affiliation(s)
- Raluca Eugenia Iorga
- Department of Surgery II, Discipline of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, Strada Universitatii No. 16, 700115 Iași, Romania; (R.E.I.); (A.D.M.)
| | - Damiana Costin
- Doctoral School, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | | | - Elena Rezuș
- Department of Internal Medicine II, Discipline of Reumathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Andreea Dana Moraru
- Department of Surgery II, Discipline of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, Strada Universitatii No. 16, 700115 Iași, Romania; (R.E.I.); (A.D.M.)
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Chan WCF, Zhu MM, Choy BNK, Chan JCH, Ng ALK, Shih KC, Cheung JJC, Wong JKW, Shum JWH, Ni MY, Lai JSM, Leung GM, Wong IYH. Contribution of systemic factors on macular vessel density: a sex-specific population-based study. Jpn J Ophthalmol 2024; 68:174-182. [PMID: 38658452 DOI: 10.1007/s10384-024-01053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/22/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To evaluate the influence of systemic factors on macular vessel density in quantitative Optical Coherence Tomography Angiography (OCTA) by sex. STUDY DESIGN A cross-sectional study. METHODS A total of 2018 adults were recruited in this study. Participants were excluded (n=964) due to missing data, eye-related problems, or low OCTA scan quality. Macular vessel densities were measured with OCTA using split-spectrum amplitude decorrelation angiography algorithm. Only the data from the right eyes were selected for analysis. Multivariable linear regression analysis was performed to determine the associations between macular vessel density and obesity-related systemic factors in each gender group. RESULTS The right eyes of 1054 participants (59.6% women) were enrolled. Men had significantly higher obesity parameters and associated risk factors. In multivariable linear regression analysis in men, older age and type 2 diabetes mellitus were independently associated with lower superficial retinal vessel density (β = -0.37, p = 0.002; β = -1.22, p = 0.03) and deep retinal vessel density, respectively (β = -0.66, p < 0.001; β = -1.76, p = 0.02); positive association was also observed between body mass index (BMI) and superficial retinal vessel density (β = 0.56, p = 0.02). In women, only higher systolic blood pressure was independently associated with a lower deep retinal vessel density (β = -0.50, p = 0.003). CONCLUSIONS This large cross-sectional study shows that older age and type 2 diabetes mellitus are associated with lower superficial and deep retinal capillary vessel density in men. This may help clinicians better understand how systemic factors influence retinal vessel density in different genders and future studies can ascertain more potential sex differences.
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Affiliation(s)
| | - Ming Ming Zhu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China.
| | - Jonathan Cheuk Hung Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
| | - Alex Lap Ki Ng
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
| | - Kendrick Co Shih
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
| | - Janice Jing Chee Cheung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
| | - Jasper Ka Wai Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
| | - Jennifer Wei Huen Shum
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
| | - Michael Yuxuan Ni
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Healthy High Density Cities Laboratory, HKUrbanLab, The University of Hong Kong, Hong Kong SAR, China
| | - Jimmy Shiu Ming Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
| | - Gabriel Matthew Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian Yat Hin Wong
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
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Yılmaz Tuğan B, Bünül SD, Kara B, Alikılıç D, Karabaş L, Efendi H, Yüksel N. Retinal and Choroidal Vascularity Evaluation in Pediatric Radiologically Isolated Syndrome and Multiple Sclerosis. Pediatr Neurol 2024; 153:34-43. [PMID: 38320456 DOI: 10.1016/j.pediatrneurol.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND To assess vessel density (VD) and flow of retinal plexuses and peripapillary region related with the pediatric radiologically isolated syndrome (RIS) and multiple sclerosis (MS). METHODS We analyzed 24 eyes of 12 participants with the diagnosis of RIS, 24 eyes of 12 participants with the diagnosis of MS, and 26 eyes of 13 age- and sex-matched healthy controls in this prospective, cross-sectional study. The superficial capillary plexus (SCP) and deep capillary plexus, foveal avascular zone, and the flow of choriocapillaris were investigated using optical coherence tomography angiography. RESULTS Parafoveal VD and all subregion parameters in SCP were significantly decreased in the MS group compared with the controls, whereas only nasal and inferior VD were significantly decreased in the pediatric RIS group compared with the controls. Ganglion cell layer (GCL) thickness of all subregions of the inner ring was significantly decreased in the pediatric MS group compared with the control group. No significant difference was observed between the pediatric RIS group and the control group regarding thickness. CONCLUSIONS We showed lower parafoveal VD in all subregions of SCP in pediatric MS, whereas only parafoveal nasal and inferior VD were decreased in pediatric RIS. GCL thickness of inner ring was significantly decreased in the pediatric MS, whereas GCL thickness did not change in pediatric RIS. Therefore, a decrease of parafoveal nasal and inferior VD without a decrease in thickness implies an early impairment of microvasculature in the RIS before impairment of thickness and that microvascular alterations begin from highly vascular superficial parafovea.
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Affiliation(s)
| | | | - Bülent Kara
- Division of Pediatric Neurology, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Defne Alikılıç
- Division of Pediatric Neurology, Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
| | - Levent Karabaş
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
| | - Hüsnü Efendi
- Department of Neurology, Kocaeli University, Kocaeli, Turkey
| | - Nurşen Yüksel
- Department of Ophthalmology, Kocaeli University, Kocaeli, Turkey
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Li M, Huang K, Xu Q, Yang J, Zhang Y, Ji Z, Xie K, Yuan S, Liu Q, Chen Q. OCTA-500: A retinal dataset for optical coherence tomography angiography study. Med Image Anal 2024; 93:103092. [PMID: 38325155 DOI: 10.1016/j.media.2024.103092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 11/10/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
Optical coherence tomography angiography (OCTA) is a novel imaging modality that has been widely utilized in ophthalmology and neuroscience studies to observe retinal vessels and microvascular systems. However, publicly available OCTA datasets remain scarce. In this paper, we introduce the largest and most comprehensive OCTA dataset dubbed OCTA-500, which contains OCTA imaging under two fields of view (FOVs) from 500 subjects. The dataset provides rich images and annotations including two modalities (OCT/OCTA volumes), six types of projections, four types of text labels (age/gender/eye/disease) and seven types of segmentation labels (large vessel/capillary/artery/vein/2D FAZ/3D FAZ/retinal layers). Then, we propose a multi-object segmentation task called CAVF, which integrates capillary segmentation, artery segmentation, vein segmentation, and FAZ segmentation under a unified framework. In addition, we optimize the 3D-to-2D image projection network (IPN) to IPN-V2 to serve as one of the segmentation baselines. Experimental results demonstrate that IPN-V2 achieves an about 10% mIoU improvement over IPN on CAVF task. Finally, we further study the impact of several dataset characteristics: the training set size, the model input (OCT/OCTA, 3D volume/2D projection), the baseline networks, and the diseases. The dataset and code are publicly available at: https://ieee-dataport.org/open-access/octa-500.
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Affiliation(s)
- Mingchao Li
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Kun Huang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Qiuzhuo Xu
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Jiadong Yang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Yuhan Zhang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Zexuan Ji
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Keren Xie
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, NanJing 210029, China.
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, NanJing 210029, China.
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, NanJing 210029, China.
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
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Dai L, Sheng B, Chen T, Wu Q, Liu R, Cai C, Wu L, Yang D, Hamzah H, Liu Y, Wang X, Guan Z, Yu S, Li T, Tang Z, Ran A, Che H, Chen H, Zheng Y, Shu J, Huang S, Wu C, Lin S, Liu D, Li J, Wang Z, Meng Z, Shen J, Hou X, Deng C, Ruan L, Lu F, Chee M, Quek TC, Srinivasan R, Raman R, Sun X, Wang YX, Wu J, Jin H, Dai R, Shen D, Yang X, Guo M, Zhang C, Cheung CY, Tan GSW, Tham YC, Cheng CY, Li H, Wong TY, Jia W. A deep learning system for predicting time to progression of diabetic retinopathy. Nat Med 2024; 30:584-594. [PMID: 38177850 PMCID: PMC10878973 DOI: 10.1038/s41591-023-02702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/10/2023] [Indexed: 01/06/2024]
Abstract
Diabetic retinopathy (DR) is the leading cause of preventable blindness worldwide. The risk of DR progression is highly variable among different individuals, making it difficult to predict risk and personalize screening intervals. We developed and validated a deep learning system (DeepDR Plus) to predict time to DR progression within 5 years solely from fundus images. First, we used 717,308 fundus images from 179,327 participants with diabetes to pretrain the system. Subsequently, we trained and validated the system with a multiethnic dataset comprising 118,868 images from 29,868 participants with diabetes. For predicting time to DR progression, the system achieved concordance indexes of 0.754-0.846 and integrated Brier scores of 0.153-0.241 for all times up to 5 years. Furthermore, we validated the system in real-world cohorts of participants with diabetes. The integration with clinical workflow could potentially extend the mean screening interval from 12 months to 31.97 months, and the percentage of participants recommended to be screened at 1-5 years was 30.62%, 20.00%, 19.63%, 11.85% and 17.89%, respectively, while delayed detection of progression to vision-threatening DR was 0.18%. Altogether, the DeepDR Plus system could predict individualized risk and time to DR progression over 5 years, potentially allowing personalized screening intervals.
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Grants
- the National Key Research and Development Program of China (2022YFA1004804), the Shanghai Municipal Key Clinical Specialty, Shanghai Research Center for Endocrine and Metabolic Diseases (2022ZZ01002), and the Chinese Academy of Engineering (2022-XY-08)
- the General Program of NSFC (62272298), the National Key Research and Development Program of China (2022YFC2407000), the Interdisciplinary Program of Shanghai Jiao Tong University (YG2023LC11 and YG2022ZD007), National Natural Science Foundation of China (62272298 and 62077037), the College-level Project Fund of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital (ynlc201909), and the Medical-industrial Cross-fund of Shanghai Jiao Tong University (YG2022QN089)
- the Clinical Special Program of Shanghai Municipal Health Commission (20224044) and Three-year action plan to strengthen the construction of public health system in Shanghai (GWVI-11.1-28)
- the National Natural Science Foundation of China (82100879)
- the National Key Research and Development Program of China (2022YFA1004804), Excellent Young Scientists Fund of NSFC (82022012), General Fund of NSFC (81870598), Innovative research team of high-level local universities in Shanghai (SHSMU-ZDCX20212700)
- the National Key R & D Program of China (2022YFC2502800) and National Natural Science Fund of China (8238810007)
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Affiliation(s)
- Ling Dai
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Sheng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Tingli Chen
- Department of Ophthalmology, Huadong Sanatorium, Wuxi, China
| | - Qiang Wu
- Department of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruhan Liu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chun Cai
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Liang Wu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Haslina Hamzah
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Yuexing Liu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Xiangning Wang
- Department of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhouyu Guan
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Shujie Yu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Tingyao Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Anran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Haoxuan Che
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jia Shu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shan Huang
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chan Wu
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiqun Lin
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dan Liu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Jiajia Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zheyuan Wang
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ziyao Meng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Shen
- Medical Records and Statistics Office, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuhong Hou
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Chenxin Deng
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Ruan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Lu
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Miaoli Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ten Cheer Quek
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ramyaa Srinivasan
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Jiarui Wu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- Center for Excellence in Molecular Science, Chinese Academy of Sciences, Shanghai, China
| | - Hai Jin
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Rongping Dai
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dinggang Shen
- School of Biomedical Engineering, Shanghai Tech University, Shanghai, China
- Shanghai United Imaging Intelligence, Shanghai, China
- Shanghai Clinical Research and Trial Center, Shanghai, China
| | - Xiaokang Yang
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Minyi Guo
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huating Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Tsinghua Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Weiping Jia
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
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8
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Wei-Zhang S, He K, Zhou W, Yu J, Zhao J, He T, Chen S, Kaysar P, Sun Z, Jia D, Zhu Y, Yan H. Relationship between visual acuity and OCT angiography parameters in diabetic retinopathy eyes after treatment. Eur J Ophthalmol 2024:11206721241228010. [PMID: 38291627 DOI: 10.1177/11206721241228010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE To assess the relationship between visual acuity and OCT angiography parameters in diabetic retinopathy eyes after treatment, and to analyze the relative factors in PDR eyes. METHODS A total of 89 eyes, including 42 eyes with non-PDR (NPDR), and 47 eyes after vitrectomy with PDR were included and underwent OCTA. All images were processed by Python or FIJI. Multivariable linear regression models were used to analyze the associations between postoperative BCVA and OCTA parameters in PDR patients. RESULTS Postoperative OCTA parameters including deep capillary plexus (DCP) parafoveal and perifoveal vessel density (VD), DCP parafoveal and perifoveal vessel length density (VLD), DCP fractal dimension (FD), choriocapillaris plexus (CCP) VD, CCP VLD, were significantly lower in the PDR group than in the NPDR group. In the superficial capillary plexus (SCP), we found a negative correlation between the postoperative BCVA and VD (parafovea: β coefficient = -0.351, p = 0.023; perifovea: β coefficient = -0.338, p = 0.036). Perifoveal VLD (β coefficient = -0.343, p = 0.031) and FD (β coefficient = -0.375, p = 0.016) of the SCP were also negatively correlated with postoperative BCVA. Regarding the DCP, perifoveal VD (β coefficient = -0.396, p = 0.008), perifoveal VLD (β coefficient = -0.334, p = 0.025), vessel tortuosity (VT) (β coefficient = -0.369, p = 0.015) were negatively correlated with postoperative BCVA. In CCP, VLD (β coefficient = -0.373, p = 0.023) and number of flow voids (β coefficient = -0.334, p = 0.036) exhibited a negative association with postoperative BCVA. CONCLUSIONS Postoperative BCVA of PDR patients was related to OCTA parameters of the SCP (parafoveal and perifoveal VD, perifoveal VLD and FD), DCP (perifoveal VD, VLD, and VT) and CCP (VLD and number of flow voids).
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Affiliation(s)
- Selena Wei-Zhang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China
| | - Kai He
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China
| | - Wei Zhou
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Jing Zhao
- Key Laboratory of Micro Opto-electro Mechanical System Technology, College of Precision Instrument & Opto- electronics Engineering, Tianjin University, Ministry of Education, Tianjin, 300072, China
| | - Tiangeng He
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Song Chen
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Parhat Kaysar
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China
| | - Zhiyong Sun
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Dagong Jia
- Key Laboratory of Micro Opto-electro Mechanical System Technology, College of Precision Instrument & Opto- electronics Engineering, Tianjin University, Ministry of Education, Tianjin, 300072, China
| | - Yun Zhu
- Department of Epidemiology, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
- Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, 300070, China
- School of Medicine, Nankai University, Tianjin, China
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9
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Ahmed TS, Shah J, Zhen YNB, Chua J, Wong DWK, Nusinovici S, Tan R, Tan G, Schmetterer L, Tan B. Ocular microvascular complications in diabetic retinopathy: insights from machine learning. BMJ Open Diabetes Res Care 2024; 12:e003758. [PMID: 38167606 PMCID: PMC10773391 DOI: 10.1136/bmjdrc-2023-003758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Diabetic retinopathy (DR) is a leading cause of preventable blindness among working-age adults, primarily driven by ocular microvascular complications from chronic hyperglycemia. Comprehending the complex relationship between microvascular changes in the eye and disease progression poses challenges, traditional methods assuming linear or logistical relationships may not adequately capture the intricate interactions between these changes and disease advances. Hence, the aim of this study was to evaluate the microvascular involvement of diabetes mellitus (DM) and non-proliferative DR with the implementation of non-parametric machine learning methods. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study that included optical coherence tomography angiography (OCTA) images collected from a healthy group (196 eyes), a DM no DR group (120 eyes), a mild DR group (71 eyes), and a moderate DR group (66 eyes). We implemented a non-parametric machine learning method for four classification tasks that used parameters extracted from the OCTA images as predictors: DM no DR versus healthy, mild DR versus DM no DR, moderate DR versus mild DR, and any DR versus no DR. SHapley Additive exPlanations values were used to determine the importance of these parameters in the classification. RESULTS We found large choriocapillaris flow deficits were the most important for healthy versus DM no DR, and became less important in eyes with mild or moderate DR. The superficial microvasculature was important for the healthy versus DM no DR and mild DR versus moderate DR tasks, but not for the DM no DR versus mild DR task-the stage when deep microvasculature plays an important role. Foveal avascular zone metric was in general less affected, but its involvement increased with worsening DR. CONCLUSIONS The findings from this study provide valuable insights into the microvascular involvement of DM and DR, facilitating the development of early detection methods and intervention strategies.
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Affiliation(s)
- Thiara S Ahmed
- Singapore Eye Research Institute, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore
| | | | - Yvonne N B Zhen
- Singapore Eye Research Institute, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Damon W K Wong
- Singapore Eye Research Institute, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Simon Nusinovici
- Singapore Eye Research Institute, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Rose Tan
- Singapore Eye Research Institute, Singapore
| | - Gavin Tan
- Singapore Eye Research Institute, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
- Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore
- Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
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10
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Korkmaz HA, Devebacak A, Erbaş İM, Değirmenci C, Uyar N, Afrashi F, Özkan B. Comparison of Optical Coherence Tomography Angiography Findings between Healthy Children and Children with Type 1 Diabetes Mellitus and Autoimmune Thyroiditis. J Clin Res Pediatr Endocrinol 2023; 15:390-396. [PMID: 37470245 PMCID: PMC10683539 DOI: 10.4274/jcrpe.galenos.2023.2022-12-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/22/2023] [Indexed: 07/21/2023] Open
Abstract
Objective The aim of this study was to compare the development of early diabetic retinopathy (DR) findings, a microvascular complication, between patients with isolated type 1 diabetes mellitus (T1DM) (Group 1), concurrent T1DM and autoimmune thyroiditis (AT) (Group 2), and healthy controls (Group 3), who were matched for age, sex, number, and body mass index for comparison. Methods This was a prospective observational study that included individuals aged 10-20 years, and patients in Groups 1 and 2 had been followed up for ≥5 years. None of them developed clinical DR during the follow-up period. Optical coherence tomography angiography (OCTA) was used to evaluate the foveal avascular zone (FAZ) and parafoveal vascular density (PVD) for the development of early DR. OCTA findings were compared between patients and healthy controls. Results Thirty-five individuals were included in each of the groups. The mean FAZ and PVD differed significantly between the three groups (FAZ, p=0.016; PVD, p=0.006). The mean FAZ was higher in Groups 1 and 2 than in Group 3 (p=0.013 and p=0.119, respectively). The mean PVD was lower in Groups 1 and 2 than in Group 3 (p=0.007, respectively). No significant difference was found between Groups 1 and 2 in terms of the mean FAZ and PVD (p=0.832 and p=0.653, respectively). The mean glycated hemoglobin (HbA1c) level was significantly correlated with FAZ and PVD (FAZ: r=0.496, p<0.001; PVD: r=-0.36, p=0.001). Conclusion In patients with T1DM who did not develop clinical DR, OCTA findings revealed an increase in FAZ, which was associated with higher HbA1c levels. The mean PVD was significantly lower in the group with coexisting AT and T1DM than in the control group. These results suggest that the coexistence of AT and T1DM can contribute to the development of microvascular complications. However, studies with larger patient series are required.
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Affiliation(s)
- Hüseyin Anıl Korkmaz
- University of Health Sciences Turkey, İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Ali Devebacak
- Ege University Faculty of Medicine, Department of Ophtalmology, İzmir, Turkey
| | - İbrahim Mert Erbaş
- University of Health Sciences Turkey, İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Cumali Değirmenci
- Ege University Faculty of Medicine, Department of Ophtalmology, İzmir, Turkey
| | - Nilüfer Uyar
- University of Health Sciences Turkey, İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Filiz Afrashi
- Ege University Faculty of Medicine, Department of Ophtalmology, İzmir, Turkey
| | - Behzat Özkan
- University of Health Sciences Turkey, İzmir Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Clinic of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
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11
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Waheed NK, Rosen RB, Jia Y, Munk MR, Huang D, Fawzi A, Chong V, Nguyen QD, Sepah Y, Pearce E. Optical coherence tomography angiography in diabetic retinopathy. Prog Retin Eye Res 2023; 97:101206. [PMID: 37499857 PMCID: PMC11268430 DOI: 10.1016/j.preteyeres.2023.101206] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
There remain many unanswered questions on how to assess and treat the pathology and complications that arise from diabetic retinopathy (DR). Optical coherence tomography angiography (OCTA) is a novel and non-invasive three-dimensional imaging method that can visualize capillaries in all retinal layers. Numerous studies have confirmed that OCTA can identify early evidence of microvascular changes and provide quantitative assessment of the extent of diseases such as DR and its complications. A number of informative OCTA metrics could be used to assess DR in clinical trials, including measurements of the foveal avascular zone (FAZ; area, acircularity, 3D para-FAZ vessel density), vessel density, extrafoveal avascular zones, and neovascularization. Assessing patients with DR using a full-retinal slab OCTA image can limit segmentation errors and confounding factors such as those related to center-involved diabetic macular edema. Given emerging data suggesting the importance of the peripheral retinal vasculature in assessing and predicting DR progression, wide-field OCTA imaging should also be used. Finally, the use of automated methods and algorithms for OCTA image analysis, such as those that can distinguish between areas of true and false signals, reconstruct images, and produce quantitative metrics, such as FAZ area, will greatly improve the efficiency and standardization of results between studies. Most importantly, clinical trial protocols should account for the relatively high frequency of poor-quality data related to sub-optimal imaging conditions in DR and should incorporate time for assessing OCTA image quality and re-imaging patients where necessary.
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Affiliation(s)
- Nadia K Waheed
- New England Eye Center, Tufts University School of Medicine, Boston, MA, USA.
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yali Jia
- School of Medicine, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick AG, Pfäffikon, Switzerland
| | - David Huang
- School of Medicine, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Amani Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Victor Chong
- Institute of Ophthalmology, University College London, London, UK
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasir Sepah
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
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12
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Namvar E, Ahmadieh H, Maleki A, Nowroozzadeh MH. Sensitivity and specificity of optical coherence tomography angiography for diagnosis and classification of diabetic retinopathy; a systematic review and meta-analysis. Eur J Ophthalmol 2023; 33:2068-2078. [PMID: 37013361 DOI: 10.1177/11206721231167458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Optical coherence tomography angiography (OCTA) is a noninvasive imaging method that can be used for the staging of diabetic retinopathy. In addition, alterations in OCTA parameters can precede the clinical fundus changes. In this review, we aimed to assess the accuracy of OCTA in diagnosis and staging of diabetic retinopathy. METHODS Two independent reviewers participated in the literature search using electronic databases (PubMed, Embase, Cochrane Library Central Register of Controlled Trials, ISI, and Scopus) from inception till December 2020. The heterogeneity of data was assessed by Q statistics, Chi-square test and I2 index. RESULTS Forty-four articles published from 2015 to the end of 2020 were included in this meta-analysis. Of these, 27 were case-control studies, 9 were case series, and 8 were cohort studies. In total, 4284 eyes of 3553 patients were assessed in this study. OCTA could differentiate diabetic retinopathy from diabetes without diabetic retinopathy with a sensitivity of 88% (95% CI: 85% to 92%) and specificity of 88% (95% CI: 85% to 91%). In addition, it could differentiate proliferative diabetic retinopathy from non-proliferative diabetic retinopathy with a sensitivity of 91% (95% CI: 86% to 95%) and specificity of 91% (95% CI:86% to 96%). The sensitivity of OCTA for diagnosing diabetic retinopathy was increased by the size of scan (3 × 3 mm: 85%; 6 × 6 mm: 91%, 12 × 12 mm: 96%). CONCLUSION OCTA, as a non-invasive method, has acceptable sensitivity and specificity for diagnosis and classification of diabetic retinopathy. A larger scan size is associated with more sensitivity for discriminating diabetic retinopathy.
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Affiliation(s)
- Ehsan Namvar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Maleki
- Department of Ophthalmology, Alzahra Eye Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Hossein Nowroozzadeh
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Sun KX, Xiang YG, Zhang T, Yi SL, Xia JY, Yang X, Zheng SJ, Ji Y, Wan WJ, Hu K. Evaluation of childhood developing via optical coherence tomography-angiography in Qamdo, Tibet, China: A prospective cross-sectional, school-based study. World J Clin Cases 2023; 11:5479-5493. [PMID: 37637695 PMCID: PMC10450379 DOI: 10.12998/wjcc.v11.i23.5479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/11/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Optical coherence tomography angiography (OCTA) is a new and reliable machine used to evaluate retinal structure and macular perfusion in children. The use of OCTA under bad condition such as high altitude, low atmospheric oxygen, and low humidity, in children is rarely. AIM To quantify the macular micro-vasculature in healthy children of various ages using OCTA in Qamdo. METHODS Design: Prospective cross-sectional, school-based study. Three hundred and forty-seven normal students from 9 schools in 4 different areas in Qamdo were included. OCTA was performed on a 3 mm × 3 mm area centered on the macular region and macular cube 512 × 128 showed details in macular. Early treatment of diabetic retinopathy study Vessel Flow Density (VD) of the macular central vascular plexus density (CVD), inner vascular plexus density (IVD), full vascular plexus density (FVD), and the size of the foveal avascular zone (FAZ) were measured. All these results corrected by t/s = 3.382 × 0.01306 × (axial length-1.82). The differences were compared among various ages, sexes and living environments. RESULTS The mean FAZ area in all eyes was 0.27 mm2 ± 0.12 mm2. The mean foveal thickness (MFT) in the macular cube was 227.64 μm ± 23.51 μm. Compared with girls, boys had a lager FAZ (P = 0.0029). Among the different age groups, MFT (P < 0.001) and FVD (P < 0.0001), IVD (P < 0.0001), and CVD (P = 0.0050) increased with age. FAZ areas were not correlated with age (P = 0.8853) or others (MFT, area). CONCLUSION OCTA can use to evaluate macular perfusion in children. Our data bridge the gap between structural OCT and perfusion density in children in high altitude. Even though these were not a longitudinal study, it may provide us with hints about retina development during puberty and clinical implications of OCTA in children.
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Affiliation(s)
- Ke-Xin Sun
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yong-Guo Xiang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Tong Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 400016, China
| | - Sheng-Lan Yi
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jiu-Yi Xia
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin Yang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shi-Jie Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yan Ji
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wen-Juan Wan
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ke Hu
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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14
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Shah PN, Mishra DK, Falahat P, Fischer L, Guzman G, Terheyden JH, Holz FG, Krohne TU, Finger RP, Wintergerst MWM. Inter-Rater Reliability of Proliferative Diabetic Retinopathy Assessment on Wide-Field OCT-Angiography and Fluorescein Angiography. Transl Vis Sci Technol 2023; 12:13. [PMID: 37432848 DOI: 10.1167/tvst.12.7.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Purpose To assess inter-rater reliability in the detection of proliferative diabetic retinopathy (PDR) changes using wide-field optical coherence tomography angiography (WF-OCTA) versus fluorescein angiography (FA). Methods This retrospective, cross-sectional study included patients with severe nonproliferative and PDR. Images were acquired with 12 × 12 mm WF-OCTA and FA with a 55° lens. Images were cropped to represent the exact same field of view. Qualitative (detection of neovascularization at the disc [NVD] and elsewhere [NVE], enlarged foveal avascular zone [FAZ], vitreous hemorrhage [VH]) and quantitative analyses (FAZ area, horizontal, vertical, and maximum FAZ diameter) were performed by 2 masked graders using ImageJ. Inter-rater reliability was calculated using unweighted Cohen's kappa coefficient (κ) for qualitative analyses and intraclass correlation coefficients (ICC) for quantitative analyses. Results Twenty-three eyes of 17 patients were included. Inter-rater reliability was higher for FA than for WF-OCTA in qualitative analyses: κ values were 0.65 and 0.78 for detection of extended FAZ, 0.83 and 1.0 for NVD, 0.78 and 1.0 for NVE, and 0.19 and 1 for VH for WF-OCTA and FA, respectively. In contrast, inter-rater reliability was higher for WF-OCTA than for FA in the quantitative analyses: ICC values were 0.94 and 0.76 for FAZ size, 0.92 and 0.79 for horizontal FAZ diameter, 0.82 and 0.72 for vertical FAZ diameter, and 0.88 and 0.82 for maximum FAZ diameter on WF-OCTA and FA, respectively. Conclusions Inter-rater reliability of FA is superior to WF-OCTA for qualitative analyses whereas inter-rater reliability of WF-OCTA is superior to FA for quantitative analyses. Translational Relevance The study highlights the specific merits of both imaging modalities in terms of reliability. FA should be preferred for qualitative parameters, whereas WF-OCTA should be preferred for quantitative parameters.
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Affiliation(s)
- Payal N Shah
- Department of Vitreoretinal and Ocular Oncology, Sankara Eye Hospital, Kundalahalli Gate, Bangalore, India
| | - Divyansh K Mishra
- Department of Vitreoretinal and Ocular Oncology, Sankara Eye Hospital, Kundalahalli Gate, Bangalore, India
| | - Peyman Falahat
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Lars Fischer
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Gabriela Guzman
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Tim U Krohne
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
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Zhao T, Laotaweerungsawat S, Chen Y, Liu X, Liu D, Stewart JM. Right versus left eye asymmetry of microvasculature in diabetes revealed by optical coherence tomography angiography. Sci Rep 2023; 13:9332. [PMID: 37291258 PMCID: PMC10250307 DOI: 10.1038/s41598-023-36058-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/28/2023] [Indexed: 06/10/2023] Open
Abstract
In this study, we explored inter-ocular asymmetry (between the two eyes of the same patient) using optical coherence tomography angiography (OCTA) in patients with diabetes mellitus (DM) at different retinopathy stages. A total of 258 patients were divided into four groups: no DM, DM without diabetic retinopathy (DR), non-proliferative DR (NPDR), and proliferative DR (PDR). Superficial and deep vessel density (SVD, DVD), superficial and deep perfusion density (SPD, DPD), foveal avascular zone (FAZ) area, perimeter and circularity were calculated, and asymmetry index (AI) was used to evaluate the asymmetry of two eyes of the same subject. AIs of SPD, SVD, FAZ area and FAZ perimeter in the PDR group were larger than all other 3 groups (all p < 0.05). The AIs of DPD, DVD, FAZ area and FAZ perimeter in males were larger than in females (p = 0.015, p = 0.023, p = 0.006 and p = 0.017). Hemoglobin A1c (HbA1c) was positively correlated with AI of FAZ perimeter (p = 0.02) and circularity (p = 0.022). In conclusion, PDR patients' eyes were significantly asymmetric in both vascular density and FAZ metrics. Male sex and HbA1c are risk factors that influenced symmetry. This study highlights that right-left asymmetry should be taken into account in DR-related studies, particularly those analyzing microvascular changes with OCTA.
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Affiliation(s)
- Tong Zhao
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Yi Chen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
- School of Optometry, Shenzhen University, Shenzhen, China
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Dongwei Liu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
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16
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Xiao H, Tang J, Zhang F, Liu L, Zhou J, Chen M, Li M, Wu X, Nie Y, Duan J. Global trends and performances in diabetic retinopathy studies: A bibliometric analysis. Front Public Health 2023; 11:1128008. [PMID: 37124794 PMCID: PMC10136779 DOI: 10.3389/fpubh.2023.1128008] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/09/2023] [Indexed: 05/02/2023] Open
Abstract
Objective The objective of this study is to conduct a comprehensive bibliometric analysis to identify and evaluate global trends in diabetic retinopathy (DR) research and visualize the focus and frontiers of this field. Methods Diabetic retinopathy-related publications from the establishment of the Web of Science (WOS) through 1 November 2022 were retrieved for qualitative and quantitative analyses. This study analyzed annual publication counts, prolific countries, institutions, journals, and the top 10 most cited literature. The findings were presented through descriptive statistics. VOSviewer 1.6.17 was used to exhibit keywords with high frequency and national cooperation networks, while CiteSpace 5.5.R2 displayed the timeline and burst keywords for each term. Results A total of 10,709 references were analyzed, and the number of publications continuously increased over the investigated period. America had the highest h-index and citation frequency, contributing to the most influence. China was the most prolific country, producing 3,168 articles. The University of London had the highest productivity. The top three productive journals were from America, and Investigative Ophthalmology Visual Science had the highest number of publications. The article from Gulshan et al. (2016; co-citation counts, 2,897) served as the representative and symbolic reference. The main research topics in this area were incidence, pathogenesis, treatment, and artificial intelligence (AI). Deep learning, models, biomarkers, and optical coherence tomography angiography (OCTA) of DR were frontier hotspots. Conclusion Bibliometric analysis in this study provided valuable insights into global trends in DR research frontiers. Four key study directions and three research frontiers were extracted from the extensive DR-related literature. As the incidence of DR continues to increase, DR prevention and treatment have become a pressing public health concern and a significant area of research interest. In addition, the development of AI technologies and telemedicine has emerged as promising research frontiers for balancing the number of doctors and patients.
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Affiliation(s)
- Huan Xiao
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jinfan Tang
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Feng Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Luping Liu
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Zhou
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Meiqi Chen
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mengyue Li
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoxiao Wu
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yingying Nie
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Junguo Duan
- School of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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17
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Böhm EW, Pfeiffer N, Wagner FM, Gericke A. Methods to measure blood flow and vascular reactivity in the retina. Front Med (Lausanne) 2023; 9:1069449. [PMID: 36714119 PMCID: PMC9877427 DOI: 10.3389/fmed.2022.1069449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
Disturbances of retinal perfusion are involved in the onset and maintenance of several ocular diseases, including diabetic retinopathy, glaucoma, and retinal vascular occlusion. Hence, knowledge on ocular vascular anatomy and function is highly relevant for basic research studies and for clinical judgment and treatment. The retinal vasculature is composed of the superficial, intermediate, and deep vascular layer. Detection of changes in blood flow and vascular diameter especially in smaller vessels is essential to understand and to analyze vascular diseases. Several methods to evaluate blood flow regulation in the retina have been described so far, but no gold standard has been established. For highly reliable assessment of retinal blood flow, exact determination of vessel diameter is necessary. Several measurement methods have already been reported in humans. But for further analysis of retinal vascular diseases, studies in laboratory animals, including genetically modified mice, are important. As for mice, the small vessel size is challenging requiring devices with high optic resolution. In this review, we recapitulate different methods for retinal blood flow and vessel diameter measurement. Moreover, studies in humans and in experimental animals are described.
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18
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Xiong H, You QS, Guo Y, Wang J, Wang B, Gao L, Flaxel CJ, Bailey ST, Hwang TS, Jia Y. Deep learning-based signal-independent assessment of macular avascular area on 6×6 mm optical coherence tomography angiogram in diabetic retinopathy: a comparison to instrument-embedded software. Br J Ophthalmol 2023; 107:84-89. [PMID: 34518161 PMCID: PMC8918061 DOI: 10.1136/bjophthalmol-2020-318646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/24/2021] [Indexed: 01/03/2023]
Abstract
SYNOPSIS A deep-learning-based macular extrafoveal avascular area (EAA) on a 6×6 mm optical coherence tomography (OCT) angiogram is less dependent on the signal strength and shadow artefacts, providing better diagnostic accuracy for diabetic retinopathy (DR) severity than the commercial software measured extrafoveal vessel density (EVD). AIMS To compare a deep-learning-based EAA to commercial output EVD in the diagnostic accuracy of determining DR severity levels from 6×6 mm OCT angiography (OCTA) scans. METHODS The 6×6 mm macular OCTA scans were acquired on one eye of each participant with a spectral-domain OCTA system. After excluding the central 1 mm diameter circle, the EAA on superficial vascular complex was measured with a deep-learning-based algorithm, and the EVD was obtained with commercial software. RESULTS The study included 34 healthy controls and 118 diabetic patients. EAA and EVD were highly correlated with DR severity (ρ=0.812 and -0.577, respectively, both p<0.001) and visual acuity (r=-0.357 and 0.420, respectively, both p<0.001). EAA had a significantly (p<0.001) higher correlation with DR severity than EVD. With the specificity at 95%, the sensitivities of EAA for differentiating diabetes mellitus (DM), DR and severe DR from control were 80.5%, 92.0% and 100.0%, respectively, significantly higher than those of EVD 11.9% (p=0.001), 13.6% (p<0.001) and 15.8% (p<0.001), respectively. EVD was significantly correlated with signal strength index (SSI) (r=0.607, p<0.001) and shadow area (r=-0.530, p<0.001), but EAA was not (r=-0.044, p=0.805 and r=-0.046, p=0.796, respectively). Adjustment of EVD with SSI and shadow area lowered sensitivities for detection of DM, DR and severe DR. CONCLUSION Macular EAA on 6×6 mm OCTA measured with a deep learning-based algorithm is less dependent on the signal strength and shadow artefacts, and provides better diagnostic accuracy for DR severity than EVD measured with the instrument-embedded software.
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Affiliation(s)
- Honglian Xiong
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Qi Sheng You
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yukun Guo
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Bingjie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Liqin Gao
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Christina J Flaxel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
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Kanno J, Shoji T, Ishii H, Ibuki H, Yoshikawa Y, Sasaki T, Shinoda K. Deep Learning with a Dataset Created Using Kanno Saitama Macro, a Self-Made Automatic Foveal Avascular Zone Extraction Program. J Clin Med 2022; 12:jcm12010183. [PMID: 36614984 PMCID: PMC9821090 DOI: 10.3390/jcm12010183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/08/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
The extraction of the foveal avascular zone (FAZ) from optical coherence tomography angiography (OCTA) images has been used in many studies in recent years due to its association with various ophthalmic diseases. In this study, we investigated the utility of a dataset for deep learning created using Kanno Saitama Macro (KSM), a program that automatically extracts the FAZ using swept-source OCTA. The test data included 40 eyes of 20 healthy volunteers. For training and validation, we used 257 eyes from 257 patients. The FAZ of the retinal surface image was extracted using KSM, and a dataset for FAZ extraction was created. Based on that dataset, we conducted a training test using a typical U-Net. Two examiners manually extracted the FAZ of the test data, and the results were used as gold standards to compare the Jaccard coefficients between examiners, and between each examiner and the U-Net. The Jaccard coefficient was 0.931 between examiner 1 and examiner 2, 0.951 between examiner 1 and the U-Net, and 0.933 between examiner 2 and the U-Net. The Jaccard coefficients were significantly better between examiner 1 and the U-Net than between examiner 1 and examiner 2 (p < 0.001). These data indicated that the dataset generated by KSM was as good as, if not better than, the agreement between examiners using the manual method. KSM may contribute to reducing the burden of annotation in deep learning.
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Affiliation(s)
- Junji Kanno
- Department of Ophthalmology, Saitama Medical University School of Medicine, Iruma 350-0495, Japan
| | - Takuhei Shoji
- Department of Ophthalmology, Saitama Medical University School of Medicine, Iruma 350-0495, Japan
- Koedo Eye Institute, Kawagoe 350-1123, Japan
- Correspondence: ; Tel.: +81-49-276-1250
| | - Hirokazu Ishii
- Department of Ophthalmology, Saitama Medical University School of Medicine, Iruma 350-0495, Japan
| | - Hisashi Ibuki
- Department of Ophthalmology, Saitama Medical University School of Medicine, Iruma 350-0495, Japan
| | - Yuji Yoshikawa
- Department of Ophthalmology, Saitama Medical University School of Medicine, Iruma 350-0495, Japan
| | - Takanori Sasaki
- Department of Ophthalmology, Saitama Medical University School of Medicine, Iruma 350-0495, Japan
| | - Kei Shinoda
- Department of Ophthalmology, Saitama Medical University School of Medicine, Iruma 350-0495, Japan
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Morphological Changes in the Foveal Avascular Zone after Panretinal Photocoagulation for Diabetic Retinopathy Using OCTA: A Study Focusing on Macular Ischemia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121797. [PMID: 36556999 PMCID: PMC9781560 DOI: 10.3390/medicina58121797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Background and objectives: This study aimed to analyze the morphological changes in the foveal avascular zone (FAZ) after panretinal photocoagulation (PRP) in patients with diabetic retinopathy, with a particular focus on the presence or absence of comorbid diabetic macular ischemia (DMI), using optical coherence tomography angiography (OCTA). Materials and Methods: Treatment-naïve 25 eyes of 16 patients who received PRP were examined in this retrospective case series. FAZ area, perimeter, and circularity were calculated on a 3 × 3-mm en-face OCTA image before PRP (baseline) and 1 and 3 months after PRP. The patients were divided into two groups according to coexisting DMI, and each group was statistically analyzed. Results: In patients with DMI (9 eyes), FAZ area significantly decreased from the baseline to 3 months after PRP (0.86 ± 0.56 to 0.61 ± 0.31 mm2, p = 0.018), whereas FAZ perimeter and circularity remained unchanged following treatment (p = 0.569 and 0.971, respectively). In patients without DMI (16 eyes), FAZ parameters did not show statistically significant changes across the 3-month follow-up period. Conclusion: PRP significantly reduces FAZ area in patients with DMI.
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Liu Y, Carass A, Zuo L, He Y, Han S, Gregori L, Murray S, Mishra R, Lei J, Calabresi PA, Saidha S, Prince JL. Disentangled Representation Learning for OCTA Vessel Segmentation With Limited Training Data. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:3686-3698. [PMID: 35862335 PMCID: PMC9910788 DOI: 10.1109/tmi.2022.3193029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Optical coherence tomography angiography (OCTA) is an imaging modality that can be used for analyzing retinal vasculature. Quantitative assessment of en face OCTA images requires accurate segmentation of the capillaries. Using deep learning approaches for this task faces two major challenges. First, acquiring sufficient manual delineations for training can take hundreds of hours. Second, OCTA images suffer from numerous contrast-related artifacts that are currently inherent to the modality and vary dramatically across scanners. We propose to solve both problems by learning a disentanglement of an anatomy component and a local contrast component from paired OCTA scans. With the contrast removed from the anatomy component, a deep learning model that takes the anatomy component as input can learn to segment vessels with a limited portion of the training images being manually labeled. Our method demonstrates state-of-the-art performance for OCTA vessel segmentation.
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22
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Quantitative assessment of textural features in the early detection of diabetic retinopathy with optical coherence tomography angiography. Photodiagnosis Photodyn Ther 2022; 41:103214. [PMID: 36460230 DOI: 10.1016/j.pdpdt.2022.103214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
The diagnostic power of the textural features and fractal dimension (FD) for early detection of diabetic retinopathy (DR) were quantitatively evaluated with optical coherence tomography angiography (OCTA). 41 normal healthy OD eyes (age: 46.41 ± 13.69), and 10 diabetic OD eyes (age: 60.90 ± 13.46) in the early stages of DR (mild or moderate non-proliferative diabetic retinopathy (NPDR)) were employed. Four retinal vascular plexuses including nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) were generated by using OCTA. The FD and the five textural features including contrast, correlation, entropy, energy, and homogeneity in four parafoveal sectors were extracted from OCTA images. The factor of aging on textural features and FD was evaluated based on the comparisons among five normal healthy subgroups. Our results showed that FD in superior sector of NFLVP and in nasal sector of ICP had the significant decreases when comparing the older healthy subgroup (age range: 60-69) with the younger healthy subgroup (age range: 20-29). Our results also indicated that the correlation did not show the significant differences in all sectors of the four retinal sublayers among the normal healthy subgroups except in the temporal sector in NFLVP. Furthermore, our results indicated that the correlation in nasal and inferior sectors in SVP can effectively differentiate diabetic patients in early stages of DR from normal healthy subjects with the highest AUROC values. In our study, the specific textural feature - correlation can effectively stage the early DR, which may contribute to the diagnosis of DR in clinic practice.
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23
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Balaratnasingam C, An D, Hein M, Yu P, Yu DY. Studies of the retinal microcirculation using human donor eyes and high-resolution clinical imaging: Insights gained to guide future research in diabetic retinopathy. Prog Retin Eye Res 2022; 94:101134. [PMID: 37154065 DOI: 10.1016/j.preteyeres.2022.101134] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
The microcirculation plays a key role in delivering oxygen to and removing metabolic wastes from energy-intensive retinal neurons. Microvascular changes are a hallmark feature of diabetic retinopathy (DR), a major cause of irreversible vision loss globally. Early investigators have performed landmark studies characterising the pathologic manifestations of DR. Previous works have collectively informed us of the clinical stages of DR and the retinal manifestations associated with devastating vision loss. Since these reports, major advancements in histologic techniques coupled with three-dimensional image processing has facilitated a deeper understanding of the structural characteristics in the healthy and diseased retinal circulation. Furthermore, breakthroughs in high-resolution retinal imaging have facilitated clinical translation of histologic knowledge to detect and monitor progression of microcirculatory disturbances with greater precision. Isolated perfusion techniques have been applied to human donor eyes to further our understanding of the cytoarchitectural characteristics of the normal human retinal circulation as well as provide novel insights into the pathophysiology of DR. Histology has been used to validate emerging in vivo retinal imaging techniques such as optical coherence tomography angiography. This report provides an overview of our research on the human retinal microcirculation in the context of the current ophthalmic literature. We commence by proposing a standardised histologic lexicon for characterising the human retinal microcirculation and subsequently discuss the pathophysiologic mechanisms underlying key manifestations of DR, with a focus on microaneurysms and retinal ischaemia. The advantages and limitations of current retinal imaging modalities as determined using histologic validation are also presented. We conclude with an overview of the implications of our research and provide a perspective on future directions in DR research.
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Affiliation(s)
- Chandrakumar Balaratnasingam
- Lions Eye Institute, Nedlands, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia; Department of Ophthalmology, Sir Charles Gairdner Hospital, Western Australia, Australia.
| | - Dong An
- Lions Eye Institute, Nedlands, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Martin Hein
- Lions Eye Institute, Nedlands, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Paula Yu
- Lions Eye Institute, Nedlands, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - Dao-Yi Yu
- Lions Eye Institute, Nedlands, Western Australia, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
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Freedman IG, Li E, Hui L, Adelman RA, Nwanyanwu K, Wang JC. The Impact of Image Processing Algorithms on Optical Coherence Tomography Angiography Metrics and Study Conclusions in Diabetic Retinopathy. Transl Vis Sci Technol 2022; 11:7. [PMID: 36107113 PMCID: PMC9483236 DOI: 10.1167/tvst.11.9.7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of image processing on quantitative metrics in optical coherence tomography angiography (OCTA) images and study conclusions in patients with diabetes. Methods This was a single center, retrospective cross-sectional study. OCTA imaging with the Cirrus HD-OCT 5000 AngioPlex of patients with diabetes was performed. The 8 × 8 mm superficial slab images underwent 4 different preprocessing methods (none, background subtraction [BGS], foveal avascular zone brightness adjustment, and contrast limited adaptive histogram equalization [CLAHE]) followed by 4 different binarization algorithms (global Huang, global Otsu, local Niblack, and local Phansalkar) in ImageJ. Vessel density (VD), skeletonized VD (SVD), and fractal dimension (FD) were calculated. Mixed-effect multivariate linear regressions were performed. Results Two hundred eleven scans from 104 patients were included. Of these scans, 67 (31.8%) had no diabetic retinopathy (DR), 99 (46.9%) had nonproliferative DR (NPDR), and 45 (21.3%) had proliferative DR (PDR). Forty-eight of 211 (22.7%) scans had diabetic macular edema (DME). The image processing method used significantly impacted values of VD, SVD, and FD (all P -values < 0.001). On multivariate analysis, the image processing method changed the clinical variables significantly associated with VD, SVD, and FD. However, BGS and CLAHE yielded more consistent significant covariates across multiple binarization algorithms. Conclusions The image processing method can impact the conclusions of any given study analyzing quantitative OCTA metrics. Thus, caution is urged in the interpretation of such studies. Background subtraction or CLAHE may play a role in the standardization of image processing. Translational Relevance This work proposes strategies to achieve robust and consistent analysis of OCTA imaging, which is especially important for clinical trials.
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Affiliation(s)
- Isaac G Freedman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Emily Li
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA.,Division of Oculoplastic and Reconstructive Surgery, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lucy Hui
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Jay C Wang
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA.,Northern California Retina Vitreous Associates, Mountain View, CA, USA
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Wang R, Yang J, Shi L, Qu Y, Xu D, Liu Y, Li X. Changes of macular blood flow and structure in acute primary angle closure glaucoma. Int Ophthalmol 2022; 42:3789-3801. [PMID: 35781598 DOI: 10.1007/s10792-022-02399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/13/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE We assessed the relationship between acute primary angle closure glaucoma (APACG) severity and macular microcirculation, as well as the diagnostic ability of blood flow and macular structural parameters on optical coherence tomography angiography (OCTA) for APACG. METHODS APACG patients were assigned to mild, moderate, and severe groups in this cross-sectional study. Age-matched primary angle closure suspect (PACS) and healthy control groups were also recruited. The vessel density (VD) and foveal avascular zone (FAZ) in each macular superficial area were measured using OCTA. The retinal nerve fiber layer thickness (RNFLT) and ganglion cell complex thickness (GCCT) of the corresponding regions were measured using OCT. RESULTS All parameters in the control, PACS, and mild APACG groups differed significantly from those in the moderate and severe APACG groups (all P < 0.05). VD and RNFLT showed high and moderate diagnostic ability, respectively, to distinguish moderate APACG from PACS, with significant differences (P < 0.05) in areas under the receiver operating characteristic curve (AUCs) for VD and RNFLT in six macular areas. The diagnostic abilities of VD and RNFLT for distinguishing severe APACG from PACS were increased, with significant differences in the AUCs for VD and RNFLT in five macular areas (P < 0.05). All macular VDs and GCCTs were similar among the three APACG groups (P > 0.05). CONCLUSIONS Damage to the VD and FAZ in the macula increased with APACG severity. VD in the macular superficial layer showed a higher diagnostic ability than RNFLT, which was equivalent to that of GCCT.
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Affiliation(s)
- Rui Wang
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Jin Yang
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Liukun Shi
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Yue Qu
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Dan Xu
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Yufeng Liu
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China
| | - Xuan Li
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, No.4.Gansu Road, He-ping District, Tianjin, China.
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26
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Cheung CMG, Fawzi A, Teo KY, Fukuyama H, Sen S, Tsai WS, Sivaprasad S. Diabetic macular ischaemia- a new therapeutic target? Prog Retin Eye Res 2022; 89:101033. [PMID: 34902545 PMCID: PMC11268431 DOI: 10.1016/j.preteyeres.2021.101033] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/21/2022]
Abstract
Diabetic macular ischaemia (DMI) is traditionally defined and graded based on the angiographic evidence of an enlarged and irregular foveal avascular zone. However, these anatomical changes are not surrogate markers for visual impairment. We postulate that there are vascular phenotypes of DMI based on the relative perfusion deficits of various retinal capillary plexuses and choriocapillaris. This review highlights several mechanistic pathways, including the role of hypoxia and the complex relation between neurons, glia, and microvasculature. The current animal models are reviewed, with shortcomings noted. Therefore, utilising the advancing technology of optical coherence tomography angiography (OCTA) to identify the reversible DMI phenotypes may be the key to successful therapeutic interventions for DMI. However, there is a need to standardise the nomenclature of OCTA perfusion status. Visual acuity is not an ideal endpoint for DMI clinical trials. New trial endpoints that represent disease progression need to be developed before irreversible vision loss in patients with DMI. Natural history studies are required to determine the course of each vascular and neuronal parameter to define the DMI phenotypes. These DMI phenotypes may also partly explain the development and recurrence of diabetic macular oedema. It is also currently unclear where and how DMI fits into the diabetic retinopathy severity scales, further highlighting the need to better define the progression of diabetic retinopathy and DMI based on both multimodal imaging and visual function. Finally, we discuss a complete set of proposed therapeutic pathways for DMI, including cell-based therapies that may provide restorative potential.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Kelvin Yc Teo
- Singapore Eye Research Institution, Singapore National Eye Centre, Singapore
| | | | | | - Wei-Shan Tsai
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom.
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27
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Yılmaz Tuğan B, Bünül SD. The Effect of Radiologically Isolated Syndrome on Retinal and Choroidal Hemodynamics - An Optical Coherence Tomography Angiography Study. Curr Eye Res 2022; 47:1312-1321. [DOI: 10.1080/02713683.2022.2078493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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28
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Teo KYC, Invernizzi A, Staurenghi G, Cheung CMG. COVID-19-Related Retinal Micro-vasculopathy - A Review of Current Evidence. Am J Ophthalmol 2022; 235:98-110. [PMID: 34587494 PMCID: PMC8465265 DOI: 10.1016/j.ajo.2021.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the occurrence of retinal microvasculopathy in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who developed coronavirus disease (COVID-19). DESIGN Systematic review and meta-analysis. METHODS The Pubmed and Embase databases were comprehensively searched to identify studies that reported retina vascular changes in eyes with COVID-19. Two independent reviewers selected papers and extracted data for analysis. Data of interest were extracted and analyzed in RevMan Web versions 3.3. Quality of evidence was assessed using the National Institute of Health quality assessment tool for a case-control study. RESULTS Thirty-one studies reporting on 1373 subjects (972 COVID-19 and 401 controls) were included. Only case-control studies were included in the pooled analysis. There was a significantly higher likelihood of retinal microvasculopathy in subjects with COVID-19 compared to controls (odds ratio [95% confidence interval], 8.86 [2.54-27.53], P < .01). Optical coherence tomography angiography (OCTA) revealed reduced vessel density and enlarged foveal avascular zone in subjects with COVID-19 compared to controls. CONCLUSIONS The results suggested that COVID-19-related retinal microvasculopathy is a significant ocular manifestation of COVID-19 and may herald future retinal complications. These microvascular impairments might have occurred antecedent to clinically visible changes and could be detected earlier by OCTA. These findings are significant, due to the large numbers with COVID-19, and need to be recognized by ophthalmologists as a potential long-term sequalae of the disease.
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Affiliation(s)
- Kelvin YC Teo
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore (K.Y.C.T, C.M.G.C),Duke-NUS Medical School, National University of Singapore, Singapore (K.Y.C.T, C.M.G.C),Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia (K.Y.C.T, A.I)
| | - Alessandro Invernizzi
- Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia (K.Y.C.T, A.I),Eye Clinic, Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Italy (A.I, G.S)
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Italy (A.I, G.S)
| | - Chui Ming Gemmy Cheung
- From the Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore (K.Y.C.T, C.M.G.C); Duke-NUS Medical School, National University of Singapore, Singapore (K.Y.C.T, C.M.G.C).
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29
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Attia Ali Ahmed M, Shawkat Abdelhaleem A. Evaluation of Microvascular and Visual Acuity Changes in Patients with Early Diabetic Retinopathy: Optical Coherence Tomography Angiography Study. Clin Ophthalmol 2022; 16:429-440. [PMID: 35210748 PMCID: PMC8860397 DOI: 10.2147/opth.s353426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Comparison of early microvascular changes detected by optical coherence tomography angiography (OCTA) in patients with mild non-proliferative diabetic retinopathy (NPDR) with healthy volunteers. Patients and Methods Forty-four eyes of 44 type-2 diabetic patients with mild non-proliferative diabetic retinopathy and 30 eyes of 30 age-matched healthy controls were imaged using OCTA to quantify microvascular changes and the FAZ quantitative parameters (area, perimeter, and circularity index); the values of patients and controls were then compared. Results Macular vessel density, perfusion index, and circularity index values were reduced and positively correlated with visual acuity in patients (15.4 ± 2.6, 38.0 ± 6.7, 0.6 ± 0.06 and p = 0.003, 0.001, and 0.003, respectively). However, FAZ area and perimeter were found to be larger in patients than controls (0.30 ± 0.08, 2.5 ± 0.3 and p < 0.001). Conclusion OCTA quantified vessel density and perfusion density were found to be correlated with visual acuity and FAZ parameters in patients with early NPDR; this could help in detecting early disease progression and modifying treatment decisions.
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Affiliation(s)
- Mohamed Attia Ali Ahmed
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt
- Correspondence: Mohamed Attia Ali Ahmed, Email ;
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30
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Ong JX, Fawzi AA. Perspectives on diabetic retinopathy from advanced retinal vascular imaging. Eye (Lond) 2022; 36:319-327. [PMID: 34987198 PMCID: PMC8807653 DOI: 10.1038/s41433-021-01825-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023] Open
Abstract
Diabetic retinopathy (DR) is a microvascular complication of diabetes and the most common cause of acquired vision loss in adults worldwide. DR is associated with long-term chronic hyperglycaemia and its detrimental effects on the neurovascular structure and function of the retina. Direct imaging of the retinal vasculature and staging of DR has been traditionally based on fundoscopy and fluorescein angiography, which provide only 2D views of the retina, and in the case of fluorescein angiography, requires an invasive dye injection. In contrast, advanced retinal imaging modalities like optical coherence tomography angiography (OCTA) and adaptive optics (AO) are non-invasive and provide depth-resolved, 3D visualization of retinal vessel structure as well as blood flow. Recent studies utilizing these imaging techniques have shown promise in evaluating quantitative vascular parameters that correlate tightly to clinical DR staging, elucidating functional changes in early diabetes, and monitoring DR treatment response. In this article, we discuss and synthesize the results of advanced retinal imaging studies in DR and their implications for our clinical and pathophysiologic understanding of the disease. Based on the recent literature, we also propose a model to describe the differential changes in vascular structure and flow that have been described on advanced retinal imaging as DR progresses. Future studies of these imaging modalities in larger and more diverse populations, as well as corroboration with histological and functional studies, will be important to further our understanding of DR.
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Affiliation(s)
- Janice X Ong
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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31
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Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review. Biomedicines 2021; 10:biomedicines10010088. [PMID: 35052768 PMCID: PMC8773551 DOI: 10.3390/biomedicines10010088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR. Methods: A systematic literature search was performed in PubMed and Embase, including the keywords “OCTA” OR “OCT angiography” OR “optical coherence tomography angiography” AND “diabetes” OR “diabetes mellitus” OR “diabetic retinopathy” OR “diabetic maculopathy” OR “diabetic macular oedema” OR “diabetic macular ischaemia”. Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review. Results: We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease. Conclusion: OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.
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32
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Alé-Chilet A, Bernal-Morales C, Barraso M, Hernández T, Oliva C, Vinagre I, Ortega E, Figueras-Roca M, Sala-Puigdollers A, Esquinas C, Gimenez M, Esmatjes E, Adán A, Zarranz-Ventura J. Optical Coherence Tomography Angiography in Type 1 Diabetes Mellitus-Report 2: Diabetic Kidney Disease. J Clin Med 2021; 11:197. [PMID: 35011940 PMCID: PMC8745787 DOI: 10.3390/jcm11010197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study is to investigate potential associations between optical coherence tomography angiography (OCTA) parameters and diabetic kidney disease (DKD) categories in type 1 diabetes mellitus (T1DM) patients and controls. A complete ocular and systemic examination, including OCTA imaging tests and bloods, was performed. OCTA parameters included vessel density (VD), perfusion density (PD), foveal avascular zone area (FAZa), perimeter (FAZp) and circularity (FAZc) in the superficial vascular plexus, and DKD categories were defined according to glomerular filtration rate (GFR), albumin-creatinine ratio (ACR) and KDIGO prognosis risk classifications. A total of 425 individuals (1 eye/1 patient) were included. Reduced VD and FAZc were associated with greater categories of GFR (p = 0.002, p = 0.04), ACR (p = 0.003, p = 0.005) and KDIGO risk prognosis classifications (p = 0.002, p = 0.005). FAZc was significantly reduced in greater KDIGO prognosis risk categories (low risk vs. moderate risk, 0.65 ± 0.09 vs. 0.60 ± 0.07, p < 0.05). VD and FAZc presented the best diagnostic performance in ROCs. In conclusion, OCTA parameters, such as VD and FAZc, are able to detect different GFR, ACR, and KDIGO categories in T1DM patients and controls in a non-invasive, objective quantitative way. FAZc is able to discriminate within T1DM patients those with greater DKD categories and greater risk of DKD progression.
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Affiliation(s)
- Aníbal Alé-Chilet
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| | - Marina Barraso
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
| | - Teresa Hernández
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Cristian Oliva
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Irene Vinagre
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Emilio Ortega
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 08036 Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
| | - Cristina Esquinas
- Respiratory Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Marga Gimenez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Enric Esmatjes
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, 08036 Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain; (A.A.-C.); (C.B.-M.); (M.B.); (T.H.); (C.O.); (M.F.-R.); (A.S.-P.); (A.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (I.V.); (E.O.); (M.G.); (E.E.)
- Diabetes Unit, Hospital Clínic, 08036 Barcelona, Spain
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Hormel TT, Hwang TS, Bailey ST, Wilson DJ, Huang D, Jia Y. Artificial intelligence in OCT angiography. Prog Retin Eye Res 2021; 85:100965. [PMID: 33766775 PMCID: PMC8455727 DOI: 10.1016/j.preteyeres.2021.100965] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
Optical coherence tomographic angiography (OCTA) is a non-invasive imaging modality that provides three-dimensional, information-rich vascular images. With numerous studies demonstrating unique capabilities in biomarker quantification, diagnosis, and monitoring, OCTA technology has seen rapid adoption in research and clinical settings. The value of OCTA imaging is significantly enhanced by image analysis tools that provide rapid and accurate quantification of vascular features and pathology. Today, the most powerful image analysis methods are based on artificial intelligence (AI). While AI encompasses a large variety of techniques, machine-learning-based, and especially deep-learning-based, image analysis provides accurate measurements in a variety of contexts, including different diseases and regions of the eye. Here, we discuss the principles of both OCTA and AI that make their combination capable of answering new questions. We also review contemporary applications of AI in OCTA, which include accurate detection of pathologies such as choroidal neovascularization, precise quantification of retinal perfusion, and reliable disease diagnosis.
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Affiliation(s)
- Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA.
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Shaikh NF, Vohra R, Balaji A, Azad SV, Chawla R, Kumar V, Venkatesh P, Kumar A. Role of optical coherence tomography-angiography in diabetes mellitus: Utility in diabetic retinopathy and a comparison with fluorescein angiography in vision threatening diabetic retinopathy. Indian J Ophthalmol 2021; 69:3218-3224. [PMID: 34708776 PMCID: PMC8725072 DOI: 10.4103/ijo.ijo_1267_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To determine the utility of optical coherence tomography-angiography (OCT-A) in diabetic retinopathy (DR) and comparison versus fluorescein angiography (FA) in vision-threatening diabetic retinopathy (VTDR). Methods: In this cross-sectional observational study, 60 eyes with no DR (NDR), 60 eyes with non-proliferative diabetic retinopathy (NPDR), and 60 eyes with proliferative diabetic retinopathy (PDR) underwent OCT-A. FA was done in VTDR. OCT-A of the NDR eyes was analyzed by two independent retina specialists. Vessel density (VD) (mm/mm2), perfusion density (PD) (%), and foveal avascular zone (FAZ) (mm2) area was analyzed among the groups. Montage angiography with vitreoretinal interface (VRI) segmentation was done in PDR. A qualitative comparison was done between OCT-A and FA for features of DR. Results: OCT-A detected 16.66% of the eyes with microaneurysm and 57.5% of the patients with capillary non-perfusion (CNP) areas in the NDR group. The inter-grader coefficient between the two observers was 0.820 for microaneurysm and 0.880 for CNP. The mean VD in NDR, NPDR, and PDR was 16.865, 13.983, and 11.643 mm/mm2. The mean PD in NDR, NPDR, and PDR was 30.595, 26.853, and 23.193%. The VD and PD values were statistically significant (P < 0.001). The mean FAZ area was not statistically significant (NPDR and PDR) (P > 0.05). The VRI showed elevated neovascularization in four eyes. OCT-A delineated microaneurysm and FAZ in 97/97 eyes who underwent FA. The FA failed to delineate FAZ in 2/37 NPDR eyes and 13/60 PDR eyes. The CNP areas (OCT-A) were detectable in all eyes. The FA demonstrated CNP areas in 17/37 and 36/60 eyes in NPDR and PDR, respectively. The FA could show peripheral CNP. Conclusion: The OCT-A helps in the early diagnosis of DR by providing vascular indices which are consistent with disease progression. OCT-A is non-invasive and ideal for follow-up. FA is a dynamic test with a larger field of view.
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Affiliation(s)
- Nawazish F Shaikh
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Akshaya Balaji
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shorya V Azad
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Laotaweerungsawat S, Psaras C, Haq Z, Liu X, Stewart JM. Racial and ethnic differences in foveal avascular zone in diabetic and nondiabetic eyes revealed by optical coherence tomography angiography. PLoS One 2021; 16:e0258848. [PMID: 34679118 PMCID: PMC8535464 DOI: 10.1371/journal.pone.0258848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose The purpose of this study was to examine whether racial and ethnic differences in retinal microvasculature are detectable with quantitative measures derived from optical coherence tomography angiography (OCTA). Methods OCTA scans and fundus photography were obtained in 447 eyes from 271 patients with and without diabetes between April and October 2018. Fundus photos were graded by the hospital reading center for diabetic retinopathy (DR) severity. Eight OCTA parameters relating to the foveal avascular zone (FAZ), superficial vascular perfusion, and deep vascular perfusion were analyzed for significant differences between race and ethnicity groups, self-reported by patients and organized according to National Center for Health Statistics groupings. Multiple regression was then used to adjust estimates for possible confounding by age, gender, hypertension, and last hemoglobin A1c level. Results Significant differences in FAZ area were found between white and non-white patients. After adjustment, the differences between white and all non-white groups were statistically significant (p<0.05) among patients with mild to moderate DR. In those without diabetes, the Hispanic and Asian groups had significantly larger FAZ areas (p<0.005) than NH white patients. In those with mild to moderate non-proliferative diabetic retinopathy (NPDR), NH Black, Hispanic, and Asian patients also had significantly larger FAZ areas than NH white patients (p<0.005). Conclusion Significant differences in FAZ area exist among different racial and ethnic groups. These results highlight the importance of considering and further studying race and ethnicity in OCTA analyses of the retinal microvasculature.
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Affiliation(s)
- Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, United States of America
- Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Catherine Psaras
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, United States of America
| | - Zeeshan Haq
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, United States of America
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, United States of America
- * E-mail:
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Borrelli E, Sacconi R, Parravano M, Costanzo E, Querques L, Battista M, Grosso D, Giorno P, Bandello F, Querques G. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY ASSESSMENT OF THE DIABETIC MACULA: A Comparison Study Among Different Algorithms. Retina 2021; 41:1799-1808. [PMID: 33587426 DOI: 10.1097/iae.0000000000003145] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the impact of histogram adjustments and binarization thresholding selection on quantitative measurements of diabetic macular ischemia using optical coherence tomography angiography (OCTA). METHODS Patients with diabetic retinopathy (DR) who had swept-source OCTA imaging obtained were enrolled. An additional group of 15 healthy control subjects was included for comparison. Previously used brightness/contrast changes and binarization thresholds were applied to original OCTA images to obtain and compare different binarized images. Qualitative and quantitative comparisons were performed. RESULTS Thirty patients with DR (30 eyes) were included in the analysis. Fifteen eyes displayed the presence of diabetic macular edema. Qualitative grading revealed that binarized images obtained using a global threshold had better quality compared with local or multistep thresholds. The "median" filter was most frequently graded as the histogram adjustment resulting in binarized images with best quality. In the quantitative analysis, local thresholds tended to generate higher values of measured metrics. Differences in OCTA metrics between global and local thresholds were associated with presence of diabetic macular edema and signal strength index value. In the comparison between healthy and DR eyes, differences in OCTA metrics were significantly affected by binarization threshold selection. CONCLUSION Quantitative OCTA parameters may be significantly influenced by strategies to quantify macular perfusion. Image quality and presence of macular edema can significantly impact OCTA-derived quantitative vascular measurements and differences between global and local binarization thresholds. These findings highlight the importance of consistent strategies to reliably generate quantitative OCTA metrics in patients with DR.
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Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy ; and
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy ; and
| | | | | | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy ; and
| | - Marco Battista
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy ; and
| | - Domenico Grosso
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy ; and
| | | | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy ; and
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy ; and
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Balıkçı A, Parmak Yener N, Seferoğlu M. Optical Coherence Tomography and Optical Coherence Tomography Angiography Findings in Multiple Sclerosis Patients. Neuroophthalmology 2021; 46:19-33. [DOI: 10.1080/01658107.2021.1963787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ayşe Balıkçı
- Department of Ophthalmology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Neslihan Parmak Yener
- Department of Ophthalmology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Meral Seferoğlu
- Department of Neurology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey
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Wang X, Han Y, Sun G, Yang F, Liu W, Luo J, Cao X, Yin P, Myers FL, Zhou L. Detection of the Microvascular Changes of Diabetic Retinopathy Progression Using Optical Coherence Tomography Angiography. Transl Vis Sci Technol 2021; 10:31. [PMID: 34191017 PMCID: PMC8254014 DOI: 10.1167/tvst.10.7.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate microvascular parameters that are related to the severity of diabetic retinopathy (DR) with optical coherence tomography angiography (OCTA). Methods In total, 105 eyes from 105 diabetic patients were recruited in this prospective cross-sectional study, including 37 eyes with no clinical signs of DR (NoDR), 43 eyes with nonproliferative diabetic retinopathy (NPDR), and 25 eyes with proliferative diabetic retinopathy (PDR). Angiogram images from the parafoveal superficial capillary plexus (SCP), the deep capillary plexus (DCP), and the radial peripapillary capillary plexus were analyzed, and metrics were compared among groups. Multivariate regression analysis was used to identify the best OCTA parameters that could distinguish DR severity among groups. Results Parafoveal vessel diameter index in the SCP and vessel density (VD) in the DCP showed the strongest correlation with the severity of DR (P < 0.01). Extrafoveal avascular area in the SCP was the parameter that could most distinguish NoDR from NPDR (P < 0.01) with sensitivity and specificity of 83.72% and 78.38%, respectively. VD in the DCP also was the most sensitive biomarker to distinguish NPDR from PDR (P < 0.01) with sensitivity and specificity of 84.00% and 79.07%, respectively. Conclusions The microvascular changes in the SCP and DCP in DR may have different characteristics that could be identified with specific OCTA parameters. OCTA serves as a promising technology to discriminate eyes with different severity of DR. Translational Relevance Our study investigated OCTA metrics and severity of DR. At different stages of DR, ophthalmologists may focus on specific OCTA parameters to predict the progression of retinopathy in individual patients.
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Affiliation(s)
- Xiaogang Wang
- Department of Ophthalmology, Shanxi Eye Hospital, Taiyuan, Shanxi, P.R. China
| | - Yongqing Han
- Department of Ophthalmology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, P.R. China
| | - Gang Sun
- College of electrical and information engineering, Hunan University, Changsha, Hunan, P.R. China
| | - Fang Yang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, P.R. China
| | - Wen Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, P.R. China
| | - Jing Luo
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Xing Cao
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Pengyi Yin
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Frank L Myers
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Liang Zhou
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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COMPARISON OF PROJECTION-RESOLVED OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY-BASED METRICS FOR THE EARLY DETECTION OF RETINAL MICROVASCULAR IMPAIRMENTS IN DIABETES MELLITUS. Retina 2021; 40:1783-1792. [PMID: 31584558 DOI: 10.1097/iae.0000000000002655] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To determine the ability of nonperfusion, vessel density, and morphologic measurements using projection-resolved optical coherence tomography angiography to detect early retinal microvasculature impairments in diabetes mellitus. METHODS A retrospective review was performed on Type 2 diabetes mellitus patients with no diabetic retinopathy (DR) or mild nonproliferative DR and age-matched controls imaged with optical coherence tomography angiography. Foveal avascular zone-related metrics and extrafoveal avascular area were measured in optical coherence tomography angiography images. Vessel density and fractal dimension were calculated with and without a skeletonization process. The vessel diameter index and vessel tortuosity were computed. The area under the receiver operating characteristic curve (AUC) estimated diagnostic performances. RESULTS Dilated capillary diameter was observed in the deep capillary plexus in the diabetic groups. Vessel density and fractal dimension of skeletonized deep capillary plexus significantly and progressively decreased in the no DR and mild nonproliferative DR groups compared with controls. Superficial extrafoveal avascular area, vessel density, and fractal dimension of the skeletonized deep capillary plexus had the highest diagnostic performance to differentiate mild nonproliferative DR from control eyes, with AUCs of 0.885, 0.876, and 0.876, respectively. CONCLUSION Vessel density and fractal dimension from the skeletonized deep capillary network may be the most sensitive for detecting early retinal capillary loss in diabetes mellitus.
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Llanas S, Linderman RE, Chen FK, Carroll J. Assessing the Use of Incorrectly Scaled Optical Coherence Tomography Angiography Images in Peer-Reviewed Studies: A Systematic Review. JAMA Ophthalmol 2021; 138:86-94. [PMID: 31774456 DOI: 10.1001/jamaophthalmol.2019.4821] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Individual differences in axial length affect the lateral magnification of in vivo retinal images and as a result can affect the accuracy of quantitative measurements made from these images. As measurements from optical coherence tomography angiography (OCTA) images are becoming increasingly used in the diagnosis and monitoring of a wide range of diseases, evaluating which studies use correctly scaled images is crucial to their interpretation. Objective To perform a systematic literature review to assess the percentage of articles that report correcting the scale of their OCTA images for individual differences in retinal magnification. Evidence Review A PubMed (MEDLINE) search was conducted for articles on OCTA retinal imaging published between June 1, 2015, and June 1, 2018. Initial results included 7552 articles. Initial exclusion criteria removed studies of animal models, as well as reviews, letters, replies, comments, and image-based or photographic essays. Articles not written in English and those that required purchase from non-English language websites were excluded. Articles that did not use OCTA for imaging the retina were also excluded. Remaining articles were reviewed in detail to assess whether the OCTA measurements required correct lateral scaling, and if so, whether axial length was reported or used to scale the images. We also determined the number of articles that mentioned the lack of correct lateral scaling as a limitation of the study. Findings A total of 989 articles were included in the detailed review. Of these, 509 were determined to require correct image scaling for their analyses, but only 41 (8.0%) report measuring and using axial length to correct the lateral scale of their OCTA images. Furthermore, of the 468 articles that did not correctly scale their images, only 18 (3.8%) mentioned this as a limitation to their study. Conclusions and Relevance These findings suggest that most peer-reviewed articles in PubMed that use quantitative OCTA measurements use incorrectly scaled images. This could call into question the conclusions of such studies and warrants consideration by OCTA manufacturers, physicians, authors, journal reviewers, and journal editors.
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Affiliation(s)
| | - Rachel E Linderman
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Joseph Carroll
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee.,Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee
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Hogg RE, Wright DM, Dolz-Marco R, Gray C, Waheed N, Teussink MM, Naskas T, Perais J, Das R, Quinn N, Bontzos G, Nicolaou C, Annam K, Young IS, Kee F, McGuiness B, Mc Kay G, MacGillivray T, Peto T, Chakravarthy U. Quantitative Parameters from OCT Angiography in Patients with Diabetic Retinopathy and in Those with Only Peripheral Retinopathy Compared with Control Participants. OPHTHALMOLOGY SCIENCE 2021; 1:100030. [PMID: 36249296 PMCID: PMC9559874 DOI: 10.1016/j.xops.2021.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
Purpose To describe the differences in a range of quantitative OCT angiography (OCTA) metrics across early stages of diabetic retinopathy (DR), providing robust effect estimates as well as sensitivity and specificity. Design Cross-sectional study with population-based sampling. Participants Four hundred forty-one eyes from 296 individuals: 328 control eyes (no diabetes mellitus [DM] and no DR), 55 eyes with DM and no DR, and 58 eyes with early nonproliferative DR. Methods Multimodal retinal imaging included color fundus photography, color Optomap ultra-widefield imaging, and spectral-domain OCT (Spectralis OCT2; Heidelberg Engineering GmbH) with the OCTA module. All images were graded for the presence and severity of DR features. OCTA images were assessed manually for inclusion based on quality. Binary OCTA metrics were assessed after 3-dimensional projection artifact removal including from the nerve fiber layer vascular plexus, superficial vascular plexus (SVC), and deep vascular plexus (DVC) by Early Treatment Diabetic Retinopathy Study (ETDRS) grid, foveal avascular zone (FAZ) area, FAZ minimum and maximum diameter, perimeter length, and circularity. Main Outcome Measures Diabetes mellitus and DR status and presence or absence of DR in the retinal periphery. Results The reduction in vessel densities in participants with DM and manifest DR compared with control participants tended to be twice that of those with DM, but no DR, compared with control participants. Some evidence of spatial heterogeneity in vessel reductions was found in those yet to develop DR, whereas those with manifest DR had significant reductions across the ETDRS grid. The FAZ perimeter and circularity were impacted most significantly by DM, and those with DR showed decreased multispectral fractal dimensions compared with control participants. Eyes with peripheral DR had reduced vessel density compared with those with DM and no DR only in the superior outer, temporal inner, and temporal outer regions in the DVC and SVC. The area under the receiver operating characteristic curve ranged between 0.48 and 0.73. Conclusions Significant differences in OCTA metrics can be found in those with DM before manifest DR using commercially available equipment with minimal image postprocessing. Although diagnostic performance was poor, these metrics may be useful for measuring change over time in clinical trials.
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Key Words
- AUC, area under the receiver operating characteristic curve
- DM, diabetes mellitus
- DR, diabetic retinopathy
- DVC, deep vascular plexus
- Diabetes mellitus
- Diabetic retinopathy
- ETDRS, Early Treatment Diabetic Retinopathy Study
- FAZ, foveal avascular zone
- Foveal avascular zone
- NFLVP, nerve fiber layer vascular plexus
- NICOLA, Northern Ireland Cohort Study for the Longitudinal Study of Aging
- OCT angiography
- OCTA
- OCTA, OCT angiography
- Retinal periphery
- SVC, superficial vascular plexus
- Vessel density
- Vessel segmentation
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Affiliation(s)
- Ruth E. Hogg
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Correspondence: Ruth E. Hogg, PhD, Institute of Clinical Sciences, Block A, Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom.
| | - David M. Wright
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | - Calum Gray
- Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Nadia Waheed
- School of Medicine, Tufts University, Boston, Massachusetts
| | | | - Timos Naskas
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Jennifer Perais
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Radha Das
- Moorfields Eye Hospital, London, United Kingdom
| | - Nicola Quinn
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | | | - Kaushik Annam
- School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Ian S. Young
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | - Gareth Mc Kay
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Tom MacGillivray
- Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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Liu C, Xiao H, Zhang X, Zhao Y, Li R, Zhong X, Wang Y, Shu Y, Chang Y, Wang J, Li C, Lin H, Qiu W. Optical coherence tomography angiography helps distinguish multiple sclerosis from AQP4-IgG-seropositive neuromyelitis optica spectrum disorder. Brain Behav 2021; 11:e02125. [PMID: 33784027 PMCID: PMC8119797 DOI: 10.1002/brb3.2125] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/24/2021] [Accepted: 03/14/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The aim was to characterize the optical coherence tomography (OCT) angiography measures in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) and to evaluate their disease discrimination capacity. METHODS Patients with MS (n = 83) and AQP4-IgG-seropositive NMOSD (n = 91) with or without a history of optic neuritis, together with healthy controls (n = 34), were imaged. The main outcome measures were peripapillary retinal nerve fiber layer (pRNFL) thickness, macular ganglion cell-inner plexiform layer (GC-IPL) thickness, macular vessel density (VD), and perfusion density (PD) in the superficial capillary plexus. Diagnostic accuracy was assessed using the area under the receiver operating characteristics curve. RESULTS Compared with patients with MS, those with NMOSD had a significantly smaller average thickness of the pRNFL and GC-IPL (80.0 [59.0; 95.8] μm versus 92.0 [80.2; 101] μm, p < .001; 68.0 [56.0; 81.0] μm, versus 74.5 [64.2; 81.0] μm, p < .001) and significantly smaller whole VD and PD areas (15.6 [12.6; 17.0] mm-1 versus 16.7 [14.8; 17.7] mm-1 , p < .001; 0.38 [0.31; 0.42] mm-1 versus 0.40 [0.37; 0.43] mm-1 , p < .01). The combination of structural parameters (average thickness of the pRNFL and GC-IPL) with microvascular parameters (temporal-inner quadrant of VD, temporal-inner, nasal-inferior, and nasal-outer quadrant of PD) was revealed to have a good diagnostic capability for discriminating between NMOSD and MS. CONCLUSIONS OCT angiography reveals different structural and microvascular retinal changes in MS and AQP4-IgG-seropositive NMOSD. These combined structural and microvascular parameters might be promising biomarkers for disease diagnosis.
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Affiliation(s)
- Chunxin Liu
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Xiao
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yipeng Zhao
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Li
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaonan Zhong
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuge Wang
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaqing Shu
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanyu Chang
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingqi Wang
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Caixia Li
- School of Mathematics, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Qiu
- Department of Neurology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Guo M, Zhao M, Cheong AMY, Corvi F, Chen X, Chen S, Zhou Y, Lam AKC. Can deep learning improve the automatic segmentation of deep foveal avascular zone in optical coherence tomography angiography? Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Park YS, Moon H, Woo JM, Min JK. Changes in the Foveal Avascular Zone Area and Retinal Vessel Density after Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration. Semin Ophthalmol 2021; 36:110-114. [PMID: 33617401 DOI: 10.1080/08820538.2021.1889612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate changes in the foveal avascular zone (FAZ) area and retinal vessel density (VD) in the macula of patients receiving multiple anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (N-AMD). METHODS This study included 54 eyes of 54 treatment-naïve N-AMD patients. Thirty-three eyes were treated with intravitreal aflibercept injections, and 21 eyes were treated with intravitreal ranibizumab injections. Unaffected fellow eyes (54 eyes) were used as controls. All image scans were acquired after the macular architecture had recovered with drying up of the subretinal fluid/hemorrhage after treatment. RESULTS Both the superficial and deep FAZ areas were significantly larger in the aflibercept group than in the control group. The VD was also significantly reduced in the aflibercept group. CONCLUSIONS Prolonged and repeated anti-VEGF therapy may cause an increase in the FAZ area and a decrease in the VD in patients with N-AMD, indicating ischemic damage.
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Affiliation(s)
- Yong Seok Park
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Republic of Korea
| | - Haein Moon
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Republic of Korea
| | - Je Moon Woo
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Republic of Korea
| | - Jung Kee Min
- Department of Ophthalmology, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Republic of Korea
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Endo H, Kase S, Tanaka H, Takahashi M, Katsuta S, Suzuki Y, Fujii M, Ishida S, Kase M. Factors based on optical coherence tomography correlated with vision impairment in diabetic patients. Sci Rep 2021; 11:3004. [PMID: 33542264 PMCID: PMC7862609 DOI: 10.1038/s41598-021-82334-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/15/2021] [Indexed: 12/16/2022] Open
Abstract
The aim of this study is to evaluate the relationship between retinal structures and visual acuity in diabetic patients using optical coherence tomography (OCT) and OCT angiography (OCTA). This study was a retrospective observational study conducted at a single medical center in Japan. Evaluation of retinal images was analyzed using spectral domain OCT. Twelve factors including central retinal thickness, length of disorganization of retinal inner layer (DRIL), number of inner hyperreflective foci, number of outer hyperreflective foci, height of intraretinal fluid, height of subretinal fluid, length of external limiting membrane disruption, length of external ellipsoid zone (EZ) disruption, vessel density of superficial capillary plexus (SCP), foveal avascular zone (FAZ) area, and FAZ circularity were analyzed based on OCT/OCTA findings. Multivariate analysis was used to investigate the OCT-based factors that could be correlated with poor visual acuity in treatment-naïve diabetic eyes. A total of 183 eyes of 123 diabetic patients with type 2 diabetes (mean age 61.9 ± 12.3 years, 66 men and 57 women) and 62 eyes of 55 control subjects (mean age 64.4 ± 12.5 years, 15 men and 40 women) was enrolled in this study. Multiple regression analysis showed that OCT-based factors correlated with visual acuity were length of DRIL (β = 0.24, P < 0.01), length of EZ disruption (β = 0.35, P < 0.001), and FAZ circularity (β = - 0.14, P < 0.05). The other factors showed no significant correlation. In conclusion, the length of DRIL, length of EZ disruption, and FAZ circularity measured by OCT were identified as related factors for visual impairment in treatment-naïve diabetic eyes.
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Affiliation(s)
- Hiroaki Endo
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Hikari Tanaka
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Mitsuo Takahashi
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoshi Katsuta
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yasuo Suzuki
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Minako Fujii
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Manabu Kase
- Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
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Hormel TT, Jia Y, Jian Y, Hwang TS, Bailey ST, Pennesi ME, Wilson DJ, Morrison JC, Huang D. Plexus-specific retinal vascular anatomy and pathologies as seen by projection-resolved optical coherence tomographic angiography. Prog Retin Eye Res 2021; 80:100878. [PMID: 32712135 PMCID: PMC7855241 DOI: 10.1016/j.preteyeres.2020.100878] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
Optical coherence tomographic angiography (OCTA) is a novel technology capable of imaging retinal vasculature three-dimensionally at capillary scale without the need to inject any extrinsic dye contrast. However, projection artifacts cause superficial retinal vascular patterns to be duplicated in deeper layers, thus interfering with the clean visualization of some retinal plexuses and vascular pathologies. Projection-resolved OCTA (PR-OCTA) uses post-processing algorithms to reduce projection artifacts. With PR-OCTA, it is now possible to resolve up to 4 distinct retinal vascular plexuses in the living human eye. The technology also allows us to detect and distinguish between various retinal and optic nerve diseases. For example, optic nerve diseases such as glaucoma primarily reduces the capillary density in the superficial vascular complex, which comprises the nerve fiber layer plexus and the ganglion cell layer plexus. Outer retinal diseases such as retinitis pigmentosa primarily reduce the capillary density in the deep vascular complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Retinal vascular diseases such as diabetic retinopathy and vein occlusion affect all plexuses, but with different patterns of capillary loss and vascular malformations. PR-OCTA is also useful in distinguishing various types of choroidal neovascularization and monitoring their response to anti-angiogenic medications. In retinal angiomatous proliferation and macular telangiectasia type 2, PR-OCTA can trace the pathologic vascular extension into deeper layers as the disease progress through stages. Plexus-specific visualization and measurement of retinal vascular changes are improving our ability to diagnose, stage, monitor, and assess treatment response in a wide variety of optic nerve and retinal diseases. These applications will be further enhanced with the continuing improvement of the speed and resolution of the OCT platforms, as well as the development of software algorithms to reduce artifacts, improve image quality, and make quantitative measurements.
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Affiliation(s)
- Tristan T Hormel
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Yifan Jian
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA; Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - John C Morrison
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA.
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Kleerekooper I, Houston S, Dubis AM, Trip SA, Petzold A. Optical Coherence Tomography Angiography (OCTA) in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder. Front Neurol 2020; 11:604049. [PMID: 33362705 PMCID: PMC7758345 DOI: 10.3389/fneur.2020.604049] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/17/2020] [Indexed: 12/29/2022] Open
Abstract
Vascular changes are increasingly recognized as important factors in the pathophysiology of neuroinflammatory disease, especially in multiple sclerosis (MS). The relatively novel technology of optical coherence tomography angiography (OCTA) images the retinal and choroidal vasculature non-invasively and in a depth-resolved manner. OCTA provides an alternative quantitative measure of retinal damage, by measuring vascular density instead of structural atrophy. Preliminary results suggest OCTA is sensitive to retinal damage in early disease stages, while also having less of a "floor-effect" compared with commonly used OCT metrics, meaning it can pick up further damage in a severely atrophied retina in later stages of disease. Furthermore, it may serve as a surrogate marker for vascular pathology in the central nervous system. Data to date consistently reveal lower densities of the retinal microvasculature in both MS and neuromyelitis optica spectrum disorder (NMOSD) compared with healthy controls, even in the absence of prior optic neuritis. Exploring the timing of vascular changes relative to structural atrophy may help answer important questions about the role of hypoperfusion in the pathophysiology of neuroinflammatory disease. Finally, qualitative characteristics of retinal microvasculature may help discriminate between different neuroinflammatory disorders. There are however still issues regarding image quality and development of standardized analysis methods before OCTA can be fully incorporated into clinical practice.
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Affiliation(s)
- Iris Kleerekooper
- Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom.,Queen Square MS Centre, UCL Institute of Neurology and National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - Sarah Houston
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Adam M Dubis
- National Institute for Health Research, Biomedical Resource Centre at University College London, Institute of Ophthalmology and Moorfields Eye Hospital National Health Service Trust, London, United Kingdom
| | - S Anand Trip
- Queen Square MS Centre, UCL Institute of Neurology and National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - Axel Petzold
- Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom.,Queen Square MS Centre, UCL Institute of Neurology and National Hospital for Neurology & Neurosurgery, London, United Kingdom.,Dutch Expertise Centre of Neuro-Ophthalmology, Amsterdam UMC, Amsterdam, Netherlands
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Kiziltoprak H, Tekin K, Cevik S, Kocer AM, Goker YS. Normative Data Assessment of Peripapillary and Macular Vessel Density and Foveal Avascular Zone Metrics Using Optical Coherence Tomography Angiography in Children. J Pediatr Ophthalmol Strabismus 2020; 57:388-398. [PMID: 33211897 DOI: 10.3928/01913913-20200903-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To quantify the vessel density of the macula and optic disc and foveal avascular zone (FAZ) in healthy children and to evaluate the effects of age, gender, axial length, body mass index (BMI), and refractive errors on vessel density and FAZ. METHODS This study enrolled 92 eyes of 92 participants (42 boys and 50 girls). Optical coherence tomography angiography (OCTA) was performed using AngioVue (Avanti; Optivue). FAZ area, nonflow area, superficial and deep vessel density, FAZ perimeter, acircularity index of FAZ, foveal density, and radial peripapillary capillary vessel density were analyzed by gender. Correlations between the investigated OCTA parameters and age, axial length, and BMI were evaluated. RESULTS Girls had significantly larger nonflow and FAZ area than boys (P = .01 and .02). Superficial and deep vessel density at the fovea was significantly higher in boys compared to girls (P = .01 and .03). Inferior temporal and superior temporal Radial peripapillary capillary vessel densities were significantly higher in girls than boys (P = .01 and .03). No significant difference was found in the macular and optic disc vessel density measurements within refractive groups (P > .05, for all). Regarding the correlation of age with FAZ and vessel density parameters, only nonflow area was positively correlated with age (r = 0.22, P = .03). CONCLUSIONS This study provides normative data for children. Although boys had greater foveal vessel density, girls had greater FAZ area and nonflow area. Refractive status of the eye and BMI did not influence the OCTA parameters. Although nonflow area was positively correlated with age, other parameters were steady within the ages of 7 to 18 years. [J Pediatr Ophthalmol Strabismus. 2020;57(6):388-398.].
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Li M, Chen Y, Ji Z, Xie K, Yuan S, Chen Q, Li S. Image Projection Network: 3D to 2D Image Segmentation in OCTA Images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3343-3354. [PMID: 32365023 DOI: 10.1109/tmi.2020.2992244] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We present an image projection network (IPN), which is a novel end-to-end architecture and can achieve 3D-to-2D image segmentation in optical coherence tomography angiography (OCTA) images. Our key insight is to build a projection learning module (PLM) which uses a unidirectional pooling layer to conduct effective features selection and dimension reduction concurrently. By combining multiple PLMs, the proposed network can input 3D OCTA data, and output 2D segmentation results such as retinal vessel segmentation. It provides a new idea for the quantification of retinal indicators: without retinal layer segmentation and without projection maps. We tested the performance of our network for two crucial retinal image segmentation issues: retinal vessel (RV) segmentation and foveal avascular zone (FAZ) segmentation. The experimental results on 316 OCTA volumes demonstrate that the IPN is an effective implementation of 3D-to-2D segmentation networks, and the uses of multi-modality information and volumetric information make IPN perform better than the baseline methods.
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SUSPENDED SCATTERING PARTICLES IN MOTION MAY INFLUENCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY VESSEL DENSITY METRICS IN EYES WITH DIABETIC MACULAR EDEMA. Retina 2020; 41:1259-1264. [PMID: 33165296 DOI: 10.1097/iae.0000000000003016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To study the effect of the suspended scattering particles in motion (SSPiM) on optical coherence tomography angiography (OCTA) vessel density metrics in eyes with diabetic macular edema (DME). METHODS Thirty-four eyes with DME from 27 patients (16 men and 11 women; 61.4 ± 9.6 years) with DME were included in this retrospective cohort study. Among these eyes, 19 (55.9%) showed the SSPiM artifact on OCTA. All participants received 3-mm and 6-mm optical coherence tomography angiography (OCTA) imaging. Perfusion density and skeletonized vessel density were calculated for the superficial capillary plexus (SCP) and the deep capillary plexus (DCP), and these were compared between eyes with and without SSPiM. Additionally, foveal vessel density in a 300-µm-wide region around the foveal avascular zone (FVD) was evaluated on 3-mm OCTA scans. The main outcome measures were vessel density in the SCP and the DCP. RESULTS Among the 3-mm OCTA images, there was no statistically significant difference in SCP vessel density in eyes with and without SSPiM (P = 0.98). Vessel density in the DCP (P = 0.001 and P = 0.028 for perfusion and skeletonized vessel density, respectively) and FVD (P = 0.03) on 3-mm OCTA scans were significantly higher in DME eyes with SSPiM than in those without SSPiM. There were no statistically significant differences in vessel density in SCP and DCP between eyes with and without SSPiM based on 6-mm OCTA scans. CONCLUSION The presence of SSPiM may lead to an overestimation of DCP vessel density in eyes with DME when 3-mm OCTA scans are used for analysis.
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