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Kim GH, Lee J, Park YH. Exploratory analysis of choriocapillaris vasculature as a biomarker of idiopathic epiretinal membrane. PLoS One 2024; 19:e0306735. [PMID: 38968254 PMCID: PMC11226130 DOI: 10.1371/journal.pone.0306735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/22/2024] [Indexed: 07/07/2024] Open
Abstract
PURPOSE To investigate the preoperative choriocapillaris perfusion (CCP) as a biomarker in patients with idiopathic epiretinal membrane (iERM). MATERIALS AND METHODS 28 patients (28 eyes) with unilateral iERM who received pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling were included for retrospective observational study. Optical coherence tomography (OCT) and angiography (OCTA) was performed before and after PPV. Area, perimeter, and circularity of superficial foveal avascular zone (FAZ) were analyzed preoperatively in both eyes using OCTA. Preoperative CCP was also analyzed with binarized en-face OCTA images. Measurements of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) by OCT were conducted at the baseline and 6 months following the surgery. The correlations of preoperative OCT parameters with postoperative BCVA and CFT reduction were analyzed. RESULTS CCP was significantly lower (p < 0.001) and FAZ had shrunk (p < 0.001) in eyes with iERM compared to unaffected fellow eyes before surgery. BCVA and CFT became significantly improved after surgery (p = 0.001, p < 0.001). Multiple regression analysis revealed that preoperative CCP was significantly related with BCVA improvement (β = 0.185, p = 0.005), postoperative BCVA (β = 0.108, p = 0.023) and ratio of post- to preoperative CFT (β = 0.106, p = 0.044). CONCLUSIONS Preoperative CCP is a biomarker for poor functional and anatomical prognosis after surgery in iERM.
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Affiliation(s)
- Gee-Hyun Kim
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiho Lee
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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2
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Gao S, Zhang Y, Zhang M. Efficacy and Predictive Factors of Oral Spironolactone Treatment in Chronic Central Serous Chorioretinopathy. J Ophthalmol 2024; 2024:7197249. [PMID: 38529362 PMCID: PMC10963119 DOI: 10.1155/2024/7197249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/09/2024] [Accepted: 03/05/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose To evaluate the efficacy of spironolactone in the treatment of chronic central serous chorioretinopathy (CSC) and identify imaging characteristics that can predict the benefit of spironolactone treatment. Methods Patients with chronic CSC were treated with spironolactone (20 mg/tid) and followed for 6 months. The primary outcome measure was complete resolution of the subretinal fluid (SRF), and the best-corrected visual acuity (BCVA), the SRF area, the central macular thickness (CMT), the subfoveal choroidal thickness (SFCT), and the density of the choriocapillaris vessel and adverse events were secondary outcome measures. Patients who presented complete resolution of SRF were included in the responder group and the other patients who had moderate or no resolution were included in the nonresponder group. Imaging characteristic comparisons between the responder and nonresponder groups were performed with regression analyses to identify factors that are predictive of a good response to treatment. Results Forty-two eyes of 42 patients with a mean age of 46.06 ± 6.66 years were included. A total of 57.1% of the patients achieved a complete resolution of SRF. The mean SRF area, CMT, and SFCT decreased significantly (all P < 0.05) throughout the follow-up period and BCVA improved slightly (P > 0.05). The vascular density of the choriocapillaris of the fellow eyes did not vary significantly during treatment. Logistic regression analysis revealed that SFCT (P=0.002) and the intact ellipsoid zone (P=0.001) were correlated with disease resolution. A relatively higher baseline SFCT was a predictive factor associated with a good response to treatment according to multivariate analysis. Conclusions This study suggested that oral spironolactone could be an effective and safe therapy for chronic CSC patients. Eyes with a higher baseline SFCT and intact ellipsoid zone could have a good response. These parameters are an important prognostic marker.
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Affiliation(s)
- Sheng Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
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3
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Bhutto IA, McLeod DS, Thomson BR, Lutty GA, Edwards MM. Visualization of choroidal vasculature in pigmented mouse eyes from experimental models of AMD. Exp Eye Res 2024; 238:109741. [PMID: 38056552 PMCID: PMC10872330 DOI: 10.1016/j.exer.2023.109741] [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: 10/12/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023]
Abstract
A variety of techniques exist to investigate retinal and choroidal vascular changes in experimental mouse models of human ocular diseases. While all have specific advantages, a method for evaluating the choroidal vasculature in pigmented mouse eyes has been more challenging especially for whole mount visualization and morphometric analysis. Here we report a simple, reliable technique involving bleaching pigment prior to immunostaining the vasculature in whole mounts of pigmented mouse choroids. Eyes from healthy adult pigmented C57BL/6J mice were used to establish the methodology. The retina and anterior segment were separated from the choroid. The choroid with retinal pigment epithelial cells (RPE) and sclera was soaked in 1% ethylenediaminetetraacetic acid (EDTA) to remove the RPE. Tissues were fixed in 2% paraformaldehyde (PFA) in phosphate-buffered saline (PBS). Choroids were subjected to melanin bleaching with 10% hydrogen peroxide (H2O2) at 55 °C for 90 min, washed in PBS and then immunostained with anti-podocalyxin antibody to label vascular endothelium followed by Cy3-AffiniPure donkey anti-goat IgG at 4 °C overnight. Images of immunostained bleached choroids were captured using a Zeiss 710 confocal microscope. In addition to control eyes, this method was used to analyze the choroids from subretinal sodium iodate (NaIO3) RPE atrophy and laser-induced choroidal neovascularization (CNV) mouse models. The H2O2 pretreatment effectively bleached the melanin, resulting in a transparent choroid. Immunolabeling with podocalyxin antibody following bleaching provided excellent visualization of choroidal vasculature in the flat perspective. In control choroids, the choriocapillaris (CC) displayed different anatomical patterns in peripapillary (PP), mid peripheral (MP) and far peripheral (FP) choroid. Morphometric analysis of the vascular area (VA) revealed that the CC was most dense in the PP region (87.4 ± 4.3% VA) and least dense in FP (79.9 ± 6.7% VA). CC diameters also varied depending on location from 11.4 ± 1.97 mm in PP to 15.1 ± 3.15 mm in FP. In the NaIO3-injected eyes, CC density was significantly reduced in the RPE atrophic regions (50.7 ± 5.8% VA in PP and 45.8 ± 6.17% VA in MP) compared to the far peripheral non-atrophic regions (82.8 ± 3.8% VA). CC diameters were significantly reduced in atrophic regions (6.35 ± 1.02 mm in PP and 6.5 ± 1.2 mm in MP) compared to non-atrophic regions (14.16 ± 2.12 mm). In the laser-induced CNV model, CNV area was 0.26 ± 0.09 mm2 and luminal diameters of CNV vessels were 4.7 ± 0.9 mm. Immunostaining on bleached choroids with anti-podocalyxin antibody provides a simple and reliable tool for visualizing normal and pathologic choroidal vasculature in pigmented mouse eyes for quantitative morphometric analysis. This method will be beneficial for examining and evaluating the effects of various treatment modalities on the choroidal vasculature in mouse models of ocular diseases such as age-related macular degeneration, and degenerative genetic diseases.
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Affiliation(s)
- Imran A Bhutto
- Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Scott McLeod
- Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin R Thomson
- Feinberg Cardiovascular and Renal Research Institute, Northwestern University Feinberg SOM, Chicago, IL, USA
| | - Gerard A Lutty
- Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Malia M Edwards
- Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Interlandi E, Pellegrini F, Papayannis A, Latanza L, Pece A, Pavesio C. PREDICTIVE ROLE OF SWEPT SOURCE OCT ANGIOGRAPHY IN RELAPSING VOGT-KOYANAGI-HARADA DISEASE. Retin Cases Brief Rep 2023; 17:414-418. [PMID: 35880955 DOI: 10.1097/icb.0000000000001209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to describe the optical coherence tomography (OCT) angiography findings as a predictive role in the chronic relapsing stage of Vogt-Koyanagi-Harada disease and its comparison with other imaging modalities such as fluorescein angiography, indocyanine-green angiography, and spectral domain OCT. METHODS A 37-year-old woman from Bangladesh was diagnosed with Vogt-Koyanagi-Harada disease. She was evaluated 8 months before for a routine examination when she was in clinical remission. Full ophthalmic evaluation with multimodal imaging and OCT angiography was performed. RESULTS Ophthalmic evaluation was unremarkable. Spectral domain OCT disclosed increased choroidal thickness in both eyes while swept source OCT angiography imaging showed choroidal flow voids well-matching hypofluorescent round lesions found by indocyanine-green angiography. A week later the disease reactivated. CONCLUSION Optical coherence tomography angiography may provide novel insights into inflammatory activity of the choroid and potentially have a predictive role in relapsing Vogt-Koyanagi-Harada disease.
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Affiliation(s)
| | | | | | - Loredana Latanza
- Uveitis Service, "Centro Uveiti Napoli-CUN" Private Ophthamology Center, Naples, Italy
| | - Alfredo Pece
- Eye Clinic, Melegnano Hospital, Vizzolo Predabissi, Italy; and
| | - Carlos Pavesio
- Moorfields Eye Hospital, NH Foundation Trust, London, United Kingdom
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5
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Fang T, Ni S, Wang Y, Li X, Ma L, Shelley O. Proposal of translation of commonly-used acupuncture and moxibustion terminology by Beijing University of Chinese Medicine. JOURNAL OF TRADITIONAL CHINESE MEDICAL SCIENCES 2023. [DOI: 10.1016/j.jtcms.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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6
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Qiu B, Zhang X, Li Z, Chhablani J, Fan H, Wang Y, Xie R. Characterization of Choroidal Morphology and Vasculature in the Phenotype of Pachychoroid Diseases by Swept-Source OCT and OCTA. J Clin Med 2022; 11:jcm11113243. [PMID: 35683628 PMCID: PMC9181685 DOI: 10.3390/jcm11113243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/04/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to characterize the choroidal morphology and vasculature in pachychoroid diseases (PCD). A total of 49 eyes with polypoidal choroidal vasculopathy (PCV), 43 eyes with neovascular age-related macular degeneration (nAMD), and 50 eyes with central serous chorioretinopathy (CSC), along with 80 healthy eyes, were enrolled in this nested case-control study. The swept-source optical coherent tomography (OCT), OCT angiography, and En face images were quantitatively analyzed. Multivariate logistic regression models showed that older age and increased vessel density (VD) in the choriocapillaris (CC) layer were independent risk factors for both PCV (page < 0.001, pVD = 0.004), and nAMD (page < 0.001, pVD = 0.005). Decreased VD in the Sattler’s layer was an independent risk factor for PCV (p = 0.014). Increased VD in the Haller’s layer was an independent risk factor for CSC (p = 0.001). The proportion of the diffuse type of collateral circulation in the Sattler’ layer in CSC group was significantly higher than in the other three groups (p < 0.001). We concluded that the involvement of the blood flow in the CC, Haller’s, and Sattler’s layers are differently affected in CSC, nAMD, and PCV eyes, indicating the different pathological mechanism underlying the phenotype of PCD. The age-dependent establishment of collateral circulation in the Sattler’s layer may play a compensatory role regarding ischemic injury in the development of PCD.
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Affiliation(s)
- Bingjie Qiu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (B.Q.); (R.X.)
- Beijing Retinal and Choroidal Vascular Disorders Study Group, Beijing 100730, China
| | - Xinyuan Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (B.Q.); (R.X.)
- Beijing Retinal and Choroidal Vascular Disorders Study Group, Beijing 100730, China
- Correspondence: ; Tel.: +86-10-582-69911; Fax: +86-10-651-25617
| | - Zhiqing Li
- Tianjin Medical University Eye Hospital, Tianjin Medical University, Tianjin 300392, China; (Z.L.); (H.F.)
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Hao Fan
- Tianjin Medical University Eye Hospital, Tianjin Medical University, Tianjin 300392, China; (Z.L.); (H.F.)
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing 100005, China;
| | - Rui Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China; (B.Q.); (R.X.)
- Beijing Retinal and Choroidal Vascular Disorders Study Group, Beijing 100730, China
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7
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Zouache MA. Variability in Retinal Neuron Populations and Associated Variations in Mass Transport Systems of the Retina in Health and Aging. Front Aging Neurosci 2022; 14:778404. [PMID: 35283756 PMCID: PMC8914054 DOI: 10.3389/fnagi.2022.778404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
Aging is associated with a broad range of visual impairments that can have dramatic consequences on the quality of life of those impacted. These changes are driven by a complex series of alterations affecting interactions between multiple cellular and extracellular elements. The resilience of many of these interactions may be key to minimal loss of visual function in aging; yet many of them remain poorly understood. In this review, we focus on the relation between retinal neurons and their respective mass transport systems. These metabolite delivery systems include the retinal vasculature, which lies within the inner portion of the retina, and the choroidal vasculature located externally to the retinal tissue. A framework for investigation is proposed and applied to identify the structures and processes determining retinal mass transport at the cellular and tissue levels. Spatial variability in the structure of the retina and changes observed in aging are then harnessed to explore the relation between variations in neuron populations and those seen among retinal metabolite delivery systems. Existing data demonstrate that the relation between inner retinal neurons and their mass transport systems is different in nature from that observed between the outer retina and choroid. The most prominent structural changes observed across the eye and in aging are seen in Bruch's membrane, which forms a selective barrier to mass transfers at the interface between the choroidal vasculature and the outer retina.
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Affiliation(s)
- Moussa A. Zouache
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
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8
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Bartol-Puyal FDA, Isanta C, Calvo P, Méndez-Martínez S, Ruiz-Moreno Ó, Pablo L. Mapping of choriocapillaris vascular density in young and aged healthy subjects. Eur J Ophthalmol 2021; 32:2789-2800. [PMID: 34881677 DOI: 10.1177/11206721211067019] [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: 11/15/2022]
Abstract
PURPOSE To compare macular vascular density (VD) of the choriocapillaris (CC) between young and aged healthy individuals. METHODS A cross-sectional study was performed enrolling young and senior healthy individuals of Caucasian race and an axial length (AL) lower than 26 mm, and without systemic or ophthalmological diseases. CC VD was imaged with DRI Triton OCTA using a 6 × 6 mm macular analysis. Internal software delimited CC boundaries and gave colour pictures, which were analysed and codified into numbers, and a grid of 30 × 30 VD values was obtained. Two-dimension (2D) and three-dimension (3D) representations were created. RESULTS 53 eyes of 53 young healthy individuals and 30 eyes of 30 senior healthy individuals were enrolled. Mean age was 27.17 ± 3.90 years, and 67.00 ± 7.41 years, respectively (p < 0.001). There were no differences in intraocular pressure (IOP) or AL (23.73 ± 0.79 mm, 23.18 ± 0.80 mm, respectively, p = 0.24). There were differences in foveal VD and in temporal perifoveal macula, but not in nasal perifoveal macula. Foveal VD was the highest in both groups. CONCLUSIONS Foveal CC VD has been found to be considerably high with this method, and it is the area which most decreases with age. Nasal perifoveal VD is not reduced in older individuals. These outcomes are opposite to other studies using different methods but they are in line with previous histological findings.
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Affiliation(s)
- Francisco de Asís Bartol-Puyal
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Carlos Isanta
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Pilar Calvo
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Silvia Méndez-Martínez
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Óscar Ruiz-Moreno
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain.,16765Universidad de Zaragoza, Zaragoza, Spain
| | - Luis Pablo
- Ophthalmology Department, 16488Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Research Group (GIMSO), 507423Aragón Institute for Health Research (IIS Aragón), Zaragoza, Spain.,16765Universidad de Zaragoza, Zaragoza, Spain.,Biotech Vision SLP, University of Zaragoza, Spain
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9
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Correlation of Renal Profiles with Choroidal Vascularity Index in Eyes with Diabetic Retinopathy. J Clin Med 2021; 10:jcm10215155. [PMID: 34768674 PMCID: PMC8584344 DOI: 10.3390/jcm10215155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/03/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
The vascular system is affected by systemic conditions, including diabetes, hypertension, and cardiovascular disease. The choroid is an important vascular tissue surrounding the sensory retina. However, the relationship between the choroid and systemic factors in patients with diabetes has rarely been investigated. Here, we assessed the correlation of renal profiles with choroidal vasculature in eyes with diabetic retinopathy (DR) using a retrospective study design. The study included 131 patients with diabetes who underwent swept-source optical coherence tomography and routine medical work-up within a 4-week period between 1 February 2016 and 30 October 2018. Consecutive patients with treatment-naïve DR who did not receive any subsequent treatment were included. The distribution of patients according to the DR stage was as follows: no DR, 32 patients; mild-to-moderate non-proliferative DR (NPDR), 33 patients; severe NPDR, 34 patients; and treatment-naïve proliferative DR, 32 patients. Multivariate regression analyses showed that the choroidal vascularity index (CVI) of naïve eyes with DR was negatively correlated with age (p = 0.013) and the serum levels of phosphorus (p = 0.002) and positively correlated with subfoveal choroidal thickness (p < 0.001). Taken together, our findings suggest that a lower CVI is associated with phosphorus retention in patients with chronic kidney disease.
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10
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Li J, Zhu L, Zhu R, Lu Y, Rong X, Zhang Y, Gu X, Wang Y, Zhang Z, Ren Q, Rong B, Yang L. Automated Analysis of Choroidal Sublayer Morphologic Features in Myopic Children Using EDI-OCT by Deep Learning. Transl Vis Sci Technol 2021; 10:12. [PMID: 34751742 PMCID: PMC8590176 DOI: 10.1167/tvst.10.13.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to analyze the choroidal sublayer morphologic features in emmetropic and myopic children using an automatic segmentation model, and to explore the relationship between choroidal sublayers and spherical equivalent refraction (SER). Methods We collected data on 92 healthy children (92 eyes) from the Ophthalmology Department of Peking University First Hospital. The data were allocated to three groups: emmetropia (+0.50 diopters [D] to -0.50 D), low myopia (-0.75 D to -3.00 D), and moderate myopia (-3.25 D to -5.75 D). We performed standardized optical coherence tomography (OCT) and developed a new segmentation technique to measure choroidal thickness (CT), large-vessel choroidal layer (LVCL), medium-vessel choroidal layer (MVCL), and small-vessel choroidal layer thickness (SVCL), and evaluated the choroidal vascular system (choroidal vascular volume [VV], choroidal vascular index [CVI], and choroidal vascular density [CVD]). Results All choroidal sublayers (LVCL, MVCL, and SVCL) were significantly thinner in myopic than in emmetropic eyes (P < 0.05), the thinnest choroidal region being the nasal outer subfield (P < 0.05). In all choroidal regions of SVCL, a positive correlation was found between SER and thickness ratio (P < 0.001). In most subfields of MVCL, a similar correlation was found (P < 0.050), the exceptions being the two nasal subfields (0.050 < P < 0.300). In contrast, the thickness ratio of LVCL decreased in all subfields (P < 0.050). VV correlated with SER negatively in LVCL in all subfields (all P < 0.001) and most subfields in MVCL except for two temporal subfields (0.050 < P < 0.200). However, no significant correlations were found between CVI and SER in LVCL (P > 0.050) and MVCL (with the exception being the temporal inner subfield, P = 0.011). Conclusions Thickness of choroidal sublayers was reduced with higher myopic SER, whereas changes in thickness ratio varied between sublayers. No significant correlations between CVI and SER suggested that both choroidal stromal and vascular volume decreases proportionately. Translational Relevance Automatic segmentation model will be helpful for future clinical trials to quantify choroidal sublayer morphologic features in myopia.
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Affiliation(s)
- Junmeng Li
- Department of Ophthalmology, Peking University First Hospital, Beijing, China.,Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Lei Zhu
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China.,Department of Biomedical Engineering, Peking University, Beijing, China
| | - Ruilin Zhu
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Yanye Lu
- Institute of Medical Technology, Peking University Health Science Center, Peking University, Beijing, China
| | - Xin Rong
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Yadi Zhang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Xiaopeng Gu
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Yuwei Wang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Zhiyue Zhang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Qiushi Ren
- Department of Biomedical Engineering, Peking University, Beijing, China
| | - Bei Rong
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
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11
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Ng DSC, Chan LKY, Ng CM, Lai TYY. Visualising the choriocapillaris: Histology, imaging modalities and clinical research - A review. Clin Exp Ophthalmol 2021; 50:91-103. [PMID: 34387023 DOI: 10.1111/ceo.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023]
Abstract
The choriocapillaris plays a considerable role in the normal physiology of the eye as well as in various diseases. Assessing the changes in the choriocapillaris can therefore provide important information about normal ageing and pathogenesis of visual impairment, and even some systemic diseases. In vivo imaging of the choriocapillaris has evolved from non-depth resolved, dye-based angiography to advanced, high-resolution optical coherence tomography angiography (OCTA). However, the intricate microvascular networks within the choriocapillaris are still beyond the resolving limits of most OCTA instruments. Knowledge of histology, meticulous image acquisition methods, recognition of artefact and post-acquisition processing techniques are necessary for optimising OCTA choriocapillaris images. Qualitative and quantitative analyses of the choriocapillaris provide clinical information in age-related macular degeneration (AMD), diabetic retinopathy (DR), pathologic myopia and central serous chorioretinopathy (CSC). Furthermore, studies have revealed choriocapillaris changes in posterior uveitis that are correlated with treatment outcome and have important prognostic significance. In addition to retinal diseases, choriocapillaris changes have been observed in systemic vascular diseases and complications associated with pregnancy.
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Affiliation(s)
- Danny Siu-Chun Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Mong Kok, Hong Kong
| | - Leo Ka-Yu Chan
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Eye Hospital, Mong Kok, Hong Kong
| | - Ching Man Ng
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,2010 Retina & Macula Centre, Kowloon, Hong Kong
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12
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Laíns I, Wang JC, Cui Y, Katz R, Vingopoulos F, Staurenghi G, Vavvas DG, Miller JW, Miller JB. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Prog Retin Eye Res 2021; 84:100951. [PMID: 33516833 DOI: 10.1016/j.preteyeres.2021.100951] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited. In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.
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Affiliation(s)
- Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Jay C Wang
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Ying Cui
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Demetrios G Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA.
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13
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Li S, Pan Y, Xu J, Li X, Spiegel DP, Bao J, Chen H. Effects of physical exercise on macular vessel density and choroidal thickness in children. Sci Rep 2021; 11:2015. [PMID: 33479470 PMCID: PMC7820247 DOI: 10.1038/s41598-021-81770-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/11/2021] [Indexed: 11/09/2022] Open
Abstract
We used swept-source (SS) optical coherence tomography (OCT) and OCT angiography (OCTA) to investigate the effects of moderate physical exercise on retinal and choroidal vessel densities (VDs) and thicknesses in children. One eye in each of 40 myopic children (mean age, 11.70 years) and 18 emmetropic children (mean age, 11.06 years) were included. SS-OCT 6 × 6-mm radial scans and SS-OCTA 3 × 3-mm images were centered on the macula. Heart rate (HR), systolic and diastolic blood pressure, and intraocular pressure (IOP) were recorded before and immediately after a 20-min stationary cycling exercise and after a 30-min rest. The subfoveal choroidal thickness (SFCT), choroidal thickness (CT), and VD at the superficial and deep retinal layers, choriocapillaris, and deeper choroidal vessels were determined. SFCT and CT were significantly lower at all locations immediately after exercise (p < 0.001) and did not fully recover after rest (p < 0.05). VD was lower in the deep retinal layer after exercise (p = 0.02) and higher in the superficial layer after rest (p = 0.03) in myopic eyes while it was higher in the superficial (p < 0.01) and deep layer (p < 0.01) after rest in emmetropic eyes. No significant exercise-related changes in the superficial retinal VD, choroidal VD, or IOP were observed. ΔCT% and ΔSFCT% were significantly correlated with increases in HR in myopic group (p = 0.04 and p = 0.03, respectively). Exercise increased retinal VD after rest in emmetropic eyes, and caused significant CT thinning that lasted for at least 30 min in both emmetropic and myopic eyes.
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Affiliation(s)
- Shufeng Li
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Yiguo Pan
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Jingjing Xu
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Xue Li
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
| | - Daniel P Spiegel
- R&D Vision Sciences AMERA, Essilor International, Singapore, Singapore
| | - Jinhua Bao
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
| | - Hao Chen
- Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
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14
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Athwal A, Balaratnasingam C, Yu DY, Heisler M, Sarunic MV, Ju MJ. Optimizing 3D retinal vasculature imaging in diabetic retinopathy using registration and averaging of OCT-A. BIOMEDICAL OPTICS EXPRESS 2021; 12:553-570. [PMID: 33659089 PMCID: PMC7899521 DOI: 10.1364/boe.408590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 12/07/2020] [Indexed: 05/29/2023]
Abstract
High resolution visualization of optical coherence tomography (OCT) and OCT angiography (OCT-A) data is required to fully take advantage of the imaging modality's three-dimensional nature. However, artifacts induced by patient motion often degrade OCT-A data quality. This is especially true for patients with deteriorated focal vision, such as those with diabetic retinopathy (DR). We propose a novel methodology for software-based OCT-A motion correction achieved through serial acquisition, volumetric registration, and averaging. Motion artifacts are removed via a multi-step 3D registration process, and visibility is significantly enhanced through volumetric averaging. We demonstrate that this method permits clear 3D visualization of retinal pathologies and their surrounding features, 3D visualization of inner retinal capillary connections, as well as reliable visualization of the choriocapillaris layer.
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Affiliation(s)
- Arman Athwal
- School of Engineering Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Chandrakumar Balaratnasingam
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
- Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Dao-Yi Yu
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
- Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Morgan Heisler
- School of Engineering Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Marinko V. Sarunic
- School of Engineering Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Myeong Jin Ju
- School of Engineering Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- University of British Columbia, Department of Ophthalmology and Visual Sciences, 2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada
- University of British Columbia, School of Biomedical Engineering, 251–2222 Health Sciences Mall, Vancouver, BC, V6 T 1Z3, Canada
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15
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Laiginhas R, Cabral D, Falcão M. Evaluation of the different thresholding strategies for quantifying choriocapillaris using optical coherence tomography angiography. Quant Imaging Med Surg 2020; 10:1994-2005. [PMID: 33014731 PMCID: PMC7495317 DOI: 10.21037/qims-20-340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND In this paper, we evaluate the different thresholding strategies that have been used for the quantification of the choriocapillaris (CC) and explore their repeatability and the interchangeability of the measurements resulting from its application. METHODS Observational study. Eighteen eyes from nine healthy volunteers aged >18 years were imaged four consecutive times with a SD-OCTA system (Heidelberg Engineering, Germany) using a 10°×10° high-resolution protocol centered on the fovea. Projection artifacts were removed, and the CC was bracketed between 10 and 30 µm below Bruch's membrane. For the quantification of CC, we used four flow deficits (FD) parameters: FD number, mean FD size, total FD area and FD density. We performed a systematic review of literature to collect the thresholding methods that have been used for the quantification of CC. The CC quantification parameters were then evaluated after applying each of the thresholding strategies. Intraclass correlation coefficient (ICC) and Pearson's correlation analysis were used to compare the repeatability and interchangeability among the different thresholding strategies for quantifying the CC. RESULTS A total of 72 optical coherence tomography angiography (OCTA) examinations were considered. The systematic review allowed us to conclude that three local thresholding strategies (Phansalkar, mean and Niblack) and three global thresholding strategies (mean, default, Otsu) have been used for CC quantification. These strategies were evaluated in our observational study. We found a high agreement within the same method in the quantification of FD number, mean FD size, total FD area and FD density but a poor agreement with different strategies. Local strategies achieved a significantly superior ICC than global ones in CC quantification. CONCLUSIONS In conclusion, the interchangeability of the CC quantification using different thresholding strategies is low, and direct comparisons should not be performed. Local thresholding strategies are significantly superior to global ones for quantifying CC and should be preferred. There is an unmet need for a uniform strategy to quantify CC in future studies.
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Affiliation(s)
- Rita Laiginhas
- Department of Ophthalmology, CHEDV, Portugal
- PDICSS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Diogo Cabral
- CEDOC, NOVA Medical School I Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
- Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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16
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Shen C, Li Y, Wang Q, Chen YN, Li W, Wei WB. Choroidal vascular changes in retinitis pigmentosa patients detected by optical coherence tomography angiography. BMC Ophthalmol 2020; 20:384. [PMID: 32993583 PMCID: PMC7523071 DOI: 10.1186/s12886-020-01640-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate choroidal vascular changes, including choriocapillaris (CC) and middle/large choroidal vessels, in retinitis pigmentosa (RP) patients using wide-angle optical coherence tomography angiography (OCTA) and to determine whether changes in the choroidal vascularity have a relationship with visual function and retinal structural changes. METHODS 34 patients with a confirmed diagnosis of RP and 48 controls were recruited. All patients underwent detailed ophthalmologic and imaging examinations, including two types of OCTA (Optovue, 3 × 3 mm, 6 × 6 mm; VG-200, 12 × 12 mm). CC defects were defined according to the choroidal vascular structure in five degrees. To evaluate middle and large choroidal vascular changes, the choroidal vascularity index (CVI), which was the luminance volume to the total choroidal volume, was used. RESULTS Defects of choroidal vascularity of RP eyes were detected in comparison to control eyes. The defects were observed in the CC layer with a concentric or lobular pattern at different degrees. CVI, which was used to reflect middle/large choroidal vascularity, decreased in the perifoveal, pararetinal and periretinal regions in the RP eyes. CC defects degree were correlated with the BCVA (p = 0.001, r = - 0.556), the Humphrey indexes (mean deviation, MD, p < 0.001, r = - 0.673; PVF, p = 0.003, r = - 0.639; 10° mean sensitivity, 10° MS, p = 0.002, r = - 0.651) and microperimetry index (mean sensitivity, MS, p < 0.001, r = - 0.807). The preserved CC area (mean value: 28.65 ± 12.50 mm2) was negatively correlated with MS measured by microperimetry (p = 0.005, r = - 0.449). Ordinary regression analysis revealed that the CC defect degree was associated with the CVI of perifovea (p = 0.002, 95% CI: - 102.14 to - 24.01), the EZ length (p = 0.006, 95% CI: - 0.006 to - 0.001) and the VAD (vascular area density) of the DCP (deep capillary plexus) in the fovea (p = 0.022, 95% CI: 0.038-0.478). No correlations were detected between BCVA and CVI in any retinal regions. No correlations were found between the CVI and the VAD in any retinal regions. CONCLUSION The choroidal vascularity was widely defected in RP. Choriocapillaris and middle/large choroidal vascularity defects were correlated with each other. Visual function and retinal structural changes were found to be associated with choriocapillaris defects but not with middle/large choroidal vascular defects.
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Affiliation(s)
- Chang Shen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Yang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Qian Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Yu-Ning Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China
| | - Wei Li
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Lab, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Capital Medical University, Beijing, China.
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17
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Mehta N, Braun PX, Gendelman I, Alibhai AY, Arya M, Duker JS, Waheed NK. Repeatability of binarization thresholding methods for optical coherence tomography angiography image quantification. Sci Rep 2020; 10:15368. [PMID: 32958813 PMCID: PMC7505834 DOI: 10.1038/s41598-020-72358-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Binarization is a critical step in analysis of retinal optical coherence tomography angiography (OCTA) images, but the repeatability of metrics produced from various binarization methods has not been fully assessed. This study set out to examine the repeatability of OCTA quantification metrics produced using different binarization thresholding methods, all of which have been applied in previous studies, across multiple devices and plexuses. Successive 3 × 3 mm foveal OCTA images of 13 healthy eyes were obtained on three different devices. For each image, contrast adjustments, 3 image processing techniques (linear registration, histogram normalization, and contrast-limited adaptive histogram equalization), and 11 binarization thresholding methods were independently applied. Vessel area density (VAD) and vessel length were calculated for retinal vascular images. Choriocapillaris (CC) images were quantified for VAD and flow deficit metrics. Repeatability, measured using the intra-class correlation coefficient, was inconsistent and generally not high (ICC < 0.8) across binarization thresholds, devices, and plexuses. In retinal vascular images, local thresholds tended to incorrectly binarize the foveal avascular zone as white (i.e., wrongly indicating flow). No image processing technique analyzed consistently resulted in highly repeatable metrics. Across contrast changes, retinal vascular images showed the lowest repeatability and CC images showed the highest.
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Affiliation(s)
- Nihaal Mehta
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Department of Ophthalmology, University of Colorado, Denver, CO, USA
| | - Phillip X Braun
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Isaac Gendelman
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - A Yasin Alibhai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Malvika Arya
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Jay S Duker
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Nadia K Waheed
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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18
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Wang E, Zhao X, Yang J, Chen Y. Visualization of deep choroidal vasculatures and measurement of choroidal vascular density: a swept-source optical coherence tomography angiography approach. BMC Ophthalmol 2020; 20:321. [PMID: 32758186 PMCID: PMC7409427 DOI: 10.1186/s12886-020-01591-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate swept-source optical coherence tomography angiography (SS-OCTA) for deep choroid visualization and choroidal vascular density (CVD) measurement. METHODS Healthy subjects and central serous chorioretinopathy (CSC) patients were recruited for macular SS-OCTA scans. We evaluated OCTA images at various depths to determine an optimal depth for visualizing choroidal vasculatures. We measured CVD with binarized OCTA images at the optimal depth. In healthy subjects, CVD was studied for its correlation with age, axial length (AL), and subfoveal choroidal thickness (SCT). In CSC eyes, CVD was compared with matched controls. RESULTS Ninety-one healthy eyes and 22 CSC eyes were included. SS-OCTA could display deep choroidal vasculatures as dark signals, with 100 μm beneath BM as the optimal depth. In healthy subjects, the CVD at 100 μm beneath BM (56.5 ± 10.9%) was significantly correlated with SCT (P = 0.004) but not with age (P = 0.49) or AL (P = 0.72). In CSC eyes, the CVD at 100 μm beneath BM (62.3 ± 6.6%) was larger than that in 22 matched controls (54.1 ± 8.0%) (P = 0.001). The difference remained statistically significant after adjusting for SCT (P = 0.02). CONCLUSIONS SS-OCTA can be used for visualizing deep choroidal vasculatures. CVD measured by OCTA at 100 μm beneath BM is a useful parameter for quantifying choroidal vascular status.
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Affiliation(s)
- Erqian Wang
- Key Laboratory of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Department of Ophthalmology, Peking Union Medical College Hospital, No.1 Dongshuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xinyu Zhao
- Key Laboratory of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Department of Ophthalmology, Peking Union Medical College Hospital, No.1 Dongshuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jingyuan Yang
- Key Laboratory of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Department of Ophthalmology, Peking Union Medical College Hospital, No.1 Dongshuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Youxin Chen
- Key Laboratory of Ocular Fundus Disease, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Department of Ophthalmology, Peking Union Medical College Hospital, No.1 Dongshuaifuyuan, Dongcheng District, Beijing, 100730, China.
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19
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Nattagh K, Zhou H, Rinella N, Zhang Q, Dai Y, Foote KG, Keiner C, Deiner M, Duncan JL, Porco TC, Wang RK, Schwartz DM. OCT Angiography to Predict Geographic Atrophy Progression using Choriocapillaris Flow Void as a Biomarker. Transl Vis Sci Technol 2020; 9:6. [PMID: 32832213 PMCID: PMC7414606 DOI: 10.1167/tvst.9.7.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/10/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose To investigate the relationship between choriocapillaris (CC) flow void (FV) percentage and geographic atrophy (GA) growth rate, and study how variations in FV percentage surrounding GA predict regional GA growth. Methods This prospective, longitudinal study enrolled subjects with GA secondary to nonexudative age-related macular degeneration. Optical coherence tomography angiography imaged the CC and FV percentage was evaluated using a validated algorithm. GA growth rate was measured as the difference in the square root of GA area divided by the months between baseline and follow-up imaging. Results Twelve eyes from 7 subjects with a mean age of 80 ± 5 years (range 74-86) were studied once at baseline and 7 to 16 months later. GA expansion rate was positively correlated with increased CC FV percentage (Spearman rank correlation coefficient r = 0.69 [P = 0.038] and 0.76 [P = 0.013]) within the 6 x 6 mm scanned macular region and the 2° margin surrounding each GA lesion, respectively. Regions with CC FV at baseline located within 480 µm from the GA margin showed 33% greater chance of becoming atrophic compared with regions within 480 µm from the GA margin that did not show CC FV at baseline. Conclusions GA expansion rate and CC FV density throughout the macular region and surrounding the GA margin were significantly correlated. The regional magnitude of FV immediately surrounding GA was associated with GA growth into that region. Translational Relevance CC FV analysis may facilitate prediction of GA growth over time for patients with advanced nonneovascular age-related macular degeneration.
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Affiliation(s)
- Khashayar Nattagh
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Nicholas Rinella
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Yining Dai
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katharina G. Foote
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- School of Optometry and Vision Science Graduate Group, University of California- Berkeley, Berkeley, CA, USA
| | - Cathrine Keiner
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Michael Deiner
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jacque L. Duncan
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Travis C. Porco
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Daniel M. Schwartz
- Department of Ophthalmology, University of California, San Francisco, CA, USA
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20
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Cedro L, Hasler PW, Meier C, Povazay B, Burri C, Mooser M, Kaiser P, Rothenbuehler SP, Müller PL, Zarranz-Ventura J, Egan C, Tufail A, Scholl HPN, Maloca PM. Feasibility and Safety of a Coaxial Dual-Wavelength Optical Coherence Tomography Apparatus. Ophthalmic Res 2020; 64:55-61. [PMID: 32428922 DOI: 10.1159/000508751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of a coaxial dual-wavelength optical coherence tomography (OCT) device (marked as Hydra-OCT). METHODS Healthy participants without ocular pathology underwent retinal imaging using the Hydra-OCT allowing for simultaneous measurement of retinal scanning of 840 and 1,072 nm wavelength. Before and after measurement, best-corrected visual acuity and patients' comfort were assessed. Representative OCT images from both wavelengths were compared by 5 independent graders using a subjective grading scheme. RESULTS A total of 30 eyes of 30 participants (8 females and 22 males) with a mean age of 26.5 years (range from 19 to 55 years) were included. Dual-wavelength image acquisition was made possible in each subject. The participant's effort and comfort assessment using the Hydra-OCT imaging revealed an equivalent value as compared to the commercially available OCT machine. No adverse events were reported, and visual acuity was not altered by the Hydra-OCT. Imaging between the systems was comparable. CONCLUSIONS This study provides evidence for the feasibility and safety of a coaxial dual-wavelength OCT imaging method under real-life conditions. The novel Hydra-OCT imaging device may offer additional insights into the pathology of retinal and choroidal diseases.
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Affiliation(s)
- Luca Cedro
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Pascal W Hasler
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.,OCTlab, Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Christoph Meier
- Institute for Human Centered Engineering (HuCE) optoLab, Bern University of Applied Sciences, Bern, Switzerland
| | - Boris Povazay
- Institute for Human Centered Engineering (HuCE) optoLab, Bern University of Applied Sciences, Bern, Switzerland
| | - Christian Burri
- Institute for Human Centered Engineering (HuCE) optoLab, Bern University of Applied Sciences, Bern, Switzerland
| | - Matthias Mooser
- Institute for Human Centered Engineering (HuCE) optoLab, Bern University of Applied Sciences, Bern, Switzerland
| | - Pascal Kaiser
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Simon P Rothenbuehler
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.,OCTlab, Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Philipp L Müller
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Catherine Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Hendrik P N Scholl
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.,OCTlab, Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter M Maloca
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland, .,OCTlab, Department of Ophthalmology, University Hospital Basel, Basel, Switzerland, .,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland, .,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom,
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Kim JT, Park N. Changes in choroidal vascular parameters following pan-retinal photocoagulation using swept-source optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2019; 258:39-47. [PMID: 31680197 DOI: 10.1007/s00417-019-04475-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/16/2019] [Accepted: 09/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To assess the effect of pan-retinal photocoagulation (PRP) on choroidal vascular parameters in eyes with advanced diabetic retinopathy (DR). METHODS Forty patients (65 eyes) with severe nonproliferative DR or proliferative DR who underwent PRP were included. Changes in choroidal vascular parameters were assessed at 3, 6, and 12 months after PRP by using swept-source optical coherence tomography (OCT) and OCT angiography and were compared with baseline values. RESULTS Choroidal vascularity index (CVI) significantly decreased from 66.27% ± 1.55% at baseline to 65.85% ± 1.61%, 65.77% ± 1.29%, and 65.74% ± 1.60% at 3, 6, and 12 months after PRP, respectively. The ratio of luminal area to stromal area (L/S ratio) also significantly decreased from 1.98 ± 0.15 at baseline to 1.94 ± 0.14, 1.95 ± 0.13, and 1.93 ± 0.14 at 3, 6, and 12 months after PRP, respectively. The subfoveal choroidal thickness (SFCT) similarly showed a significant decrease from 319.50 ± 56.64 μm at baseline to 299. 07 ± 51.14 μm, 294.70 ± 58.96 μm, and 280.93 ± 53.57 μm at 3, 6, and 12 months after PRP, respectively. However, the choriocapillaris vessel density in both the fovea and parafovea showed no significant differences following PRP. CONCLUSION Eyes with advanced DR showed a significant reduction in CVI, L/S ratio, and SFCT over 12 months after PRP treatment.
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Affiliation(s)
- Jee Taek Kim
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, #06974, South Korea.
| | - Nari Park
- Department of Ophthalmology, College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, #06974, South Korea
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Marsh-Armstrong B, Migacz J, Jonnal R, Werner JS. Automated quantification of choriocapillaris anatomical features in ultrahigh-speed optical coherence tomography angiograms. BIOMEDICAL OPTICS EXPRESS 2019; 10:5337-5350. [PMID: 31646049 PMCID: PMC6788607 DOI: 10.1364/boe.10.005337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
In vivo visualization and quantification of choriocapillaris vascular anatomy is a fundamental step in understanding the relation between choriocapillaris degradation and atrophic retinopathies, including geographic atrophy. We describe a process utilizing ultrahigh-speed swept-source optical coherence tomography and a custom-designed "local min-max normalized masking" algorithm to extract in vivo anatomical metrics of the choriocapillaris. We used a swept-source optical coherence tomography system with a 1.6 MHz A-scan rate to image healthy retinas. With the postprocessing algorithm, we reduced noise, optimized visibility of vasculature, and skeletonized the vasculature within the images. These skeletonizations were in 89 % agreement with those made by skilled technicians and were, on average, completed in 18.6 s as compared to the 5.6 h technicians required. Anatomy within the processed images and skeletonizations was analyzed to identify average values ( mean ± SD ) of flow void radius ( 9.8 ± 0.7 µm ), flow void area ( 749 ± 110 µm 2 ), vessel radius ( 5.0 ± 0.3 µm ), branch-point to branch-point vessel length ( 26.8 ± 1.1 µm ), and branches per branch-point ( 3.1 ± 0.1 ) . To exemplify the uses of this tool a retina with geographic atrophy was imaged and processed to reveal statistically significant ( p < 0.05 ) increases in flow void radii and decreases in vessel radii under atrophic lesions as compared to atrophy-free regions on the same retina. Our results demonstrate a new avenue for quantifying choriocapillaris anatomy and studying vasculature changes in atrophic retinopathies.
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