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Johnson DA, Doble N, Choi SS. Quantitative Analysis of the Vasculature and Cone Photoreceptors in Subjects With Diabetes Without Diabetic Retinopathy. Curr Eye Res 2024; 49:650-662. [PMID: 38407181 DOI: 10.1080/02713683.2024.2320787] [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: 10/27/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To characterize any differences in the vasculature and cone photoreceptor packing geometry (CPG) between subjects with diabetes without/no diabetic retinopathy (NDR) and healthy controls. METHODS Eight NDR and five controls were enrolled. Optical coherence tomography angiography (OCTA) taken at the macula was used to measure vessel density, vessel length density, and vessel density index (VDI) in three vascular plexuses, namely, the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus (DCP). The choriocapillaris (CC) flow deficit (FD) was also measured. OCTA images were binarized and processed to extrapolate the parafovea and parafoveal quadrants and the OCTA indices mentioned above. The CC was processed with six different radii to quantify FD. Adaptive optics - scanning laser ophthalmoscopy images were acquired and processed to extract CPG indices, i.e., cone density (CD), cone-to-cone spacing (CS), linear dispersion index, heterogeneity packing index and percent of cells with six neighbors at 3.6° in the temporal retina. RESULTS In all eyes, statistically significant differences were found (i) in parafoveal FD across the six radii (p < 0.001) and (ii) in the correlation between the parafoveal temporal quadrant (PTQ) DCP VDI and CS (r = 0.606, p = 0.048). No other significant correlations were found. For OCTA or CPG indices, no significant differences were found between the cohorts in the parafovea or parafoveal quadrants. CONCLUSIONS CS is the most sensitive CPG index for detecting alterations in the cone mosaic. The DCP and the cone photoreceptors are significantly correlated, indicating that alterations in the DCP can affect the cones. Future work elucidating the vascular alterations and neurodegeneration present in diabetic eyes should focus on the DCP and multiple CPG indices, not solely CD. Moreover, such alterations are highly localized, hence using larger regions e.g. parafovea versus smaller areas, such as the PTQ, will potentially mask significant correlations.
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Affiliation(s)
- Danae A Johnson
- College of Optometry, The Ohio State University, Columbus, OH, USA
| | - Nathan Doble
- College of Optometry, The Ohio State University, Columbus, OH, USA
- Department of Ophthalmology and Vision Science, Havener Eye Institute, The Ohio State University, Columbus, OH, USA
| | - Stacey S Choi
- College of Optometry, The Ohio State University, Columbus, OH, USA
- Department of Ophthalmology and Vision Science, Havener Eye Institute, The Ohio State University, Columbus, OH, USA
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Untaroiu A, Reis LM, Higgins BP, Walesa A, Zacharias S, Nikezic D, Costakos DM, Carroll J, Semina EV. In Vivo Assessment of Retinal Phenotypes in Axenfeld-Rieger Syndrome. Invest Ophthalmol Vis Sci 2024; 65:20. [PMID: 38587439 PMCID: PMC11005067 DOI: 10.1167/iovs.65.4.20] [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: 01/05/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Axenfeld-Rieger syndrome (ARS) is characterized by ocular anomalies including posterior embryotoxon, iridocorneal adhesions, corectopia/iris hypoplasia, and developmental glaucoma. Although anterior segment defects and glaucoma contribute to decreased visual acuity, the role of potential posterior segment abnormalities has not been explored. We used high-resolution retinal imaging to test the hypothesis that individuals with ARS have posterior segment pathology. Methods Three individuals with FOXC1-ARS and 10 with PITX2-ARS completed slit-lamp and fundus photography, optical coherence tomography (OCT), OCT angiography, and adaptive optics scanning light ophthalmoscopy (AOSLO). Quantitative metrics were compared to previously published values for individuals with normal vision. Results All individuals demonstrated typical anterior segment phenotypes. Average ganglion cell and inner plexiform layer thickness was lower in PITX2-ARS, consistent with the glaucoma history in this group. A novel phenotype of foveal hypoplasia was noted in 40% of individuals with PITX2-ARS (but none with FOXC1-ARS). Moreover, the depth and volume of the foveal pit were significantly lower in PITX2-ARS compared to normal controls, even excluding individuals with foveal hypoplasia. Analysis of known foveal hypoplasia genes failed to identify an alternative explanation. Foveal cone density was decreased in one individual with foveal hypoplasia and normal in six without foveal hypoplasia. Two individuals (one from each group) demonstrated non-foveal retinal irregularities with regions of photoreceptor anomalies on OCT and AOSLO. Conclusions These findings implicate PITX2 in the development of the posterior segment, particularly the fovea, in humans. The identified posterior segment phenotypes may contribute to visual acuity deficits in individuals with PITX2-ARS.
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Affiliation(s)
- Ana Untaroiu
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Linda M. Reis
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Brian P. Higgins
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Ashleigh Walesa
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Serena Zacharias
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Danica Nikezic
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Deborah M. Costakos
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Joseph Carroll
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Elena V. Semina
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Pediatrics and Children's Research Institute, Medical College of Wisconsin and Childrens Wisconsin, Milwaukee, Wisconsin, United States
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Zouache MA, Faust CD, Silvestri V, Akafo S, Lartey S, Mehta R, Carroll J, Silvestri G, Hageman GS, Amoaku WM. Retinal and Choroidal Thickness in an Indigenous Population from Ghana: Comparison with Individuals with European or African Ancestry. OPHTHALMOLOGY SCIENCE 2024; 4:100386. [PMID: 37868802 PMCID: PMC10585639 DOI: 10.1016/j.xops.2023.100386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 10/24/2023]
Abstract
Purpose To evaluate the thickness of the macular retina and central choroid in an indigenous population from Ghana, Africa and to compare them with those measured among individuals with European or African ancestry. Design Cross-sectional study, systematic review, and meta-analyses. Participants Forty-two healthy Ghanaians, 37 healthy individuals with European ancestry, and an additional 1427 healthy subjects with African ancestry from previously published studies. Methods Macular retinal thickness in the fovea, parafovea, and perifovea and central choroidal thickness were extracted from OCT volume scans. Associations with ethnicity, age, and sex were assessed using mixed-effect regression models. Monte Carlo simulations were performed to determine the sensitivity of significant associations to additional potential confounders. Pooled estimates of retinal thickness among other groups with African ancestry were generated through systematic review and meta-analyses. Main Outcome Measures Macular retinal thickness and central choroidal thickness and their association with ethnicity, age, and sex. Results When adjusted for age and sex, the macular retina and central choroid of Ghanaians are significantly thinner as compared with subjects with European ancestry (P < 0.001). A reduction in retinal and choroidal thickness is observed with age, although this effect is independent of ethnicity. Meta-analyses indicate that retinal thickness among Ghanaians differs markedly from that of African Americans and other previously reported indigenous African populations. Conclusions The thickness of the retina among Ghanaians differs not only from those measured among individuals with European ancestry, but also from those obtained from African Americans. Normative retinal and choroidal parameters determined among individuals with African or European ancestry may not be sufficient to describe indigenous African populations. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Moussa A. Zouache
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Caitlin D. Faust
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah
| | | | - Stephen Akafo
- Unit of Ophthalmology, Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Seth Lartey
- Eye Unit, Eye Ear Nose and Throat Department, Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rajnikant Mehta
- Research Design Service, East Midlands (RDS EM), University of Nottingham, Nottingham, UK
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin Eye Institute, Milwaukee, Wisconsin
| | - Giuliana Silvestri
- Ophthalmology Department, Belfast Health and Social Care Trust, Belfast, UK
| | - Gregory S. Hageman
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Winfried M. Amoaku
- Academic Ophthalmology and Visual Sciences, Mental Health & Clinical Neurosciences (Academic Unit 1), University Hospital, QMC, Nottingham, UK
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Ji MH, Rickels KL, Yao T, Elhusseiny AM, Georgiou M, Shakarchi AF, Uwaydat SB, Dare RK, Sallam AB. Fractal Changes of the Retinal Microvasculature in Syphilitic Uveitis. Ocul Immunol Inflamm 2024:1-6. [PMID: 38324651 DOI: 10.1080/09273948.2024.2309280] [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: 10/13/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE To quantify chorioretinal microvascular damage and recovery post-treatment in patients with acute syphilitic posterior placoid chorioretinitis (ASPPC) using fractal dimension (FD). METHODS Retrospective cohort study of patients with serologically confirmed syphilitic uveitis. We obtained optical coherence tomography angiography (OCTA) scans at baseline and follow-up after intravenous penicillin treatment and computed FD of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) using ImageJ. RESULTS We enrolled seven patients with ASPPC (11 eyes), and 17 control subjects (34 eyes). Pre-treatment averages of FD-SCP, FD-DCP, and FD-CC were: 1.672 (±0.115), 1.638 (±0.097), and 1.72 (±0.137); post-treatment: 1.760 (±0.071), 1.764 (±0.043), and 1.898 (±0.047). After treatment FD-CC increased in all 11 eyes with an average of 0.163 (p = 0.003); FD-DCP increased in 10 (91%) eyes with an average of 0.126 (p = 0.003); and FD-SCP increased in seven (64%) eyes with an average of 0.089 (p = 0.059). Compared to the post-treatment FD values in the syphilitic group, controls had similar FD-SCP (p = 0.266), FD-DCP (p = 0.078), and FD-CC (p = 0.449). CONCLUSIONS CC and DCP are mostly affected in ASPPC with minimal changes in the SCP. All vascular layers FD recovered after completing antibiotic treatment.
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Affiliation(s)
- Marco H Ji
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kaersti L Rickels
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Tianyuan Yao
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Ophthalmology, Scheie Eye Institute, Philadelphia, Pennsylvania, USA
| | | | - Michalis Georgiou
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Ahmed F Shakarchi
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sami B Uwaydat
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ryan K Dare
- Department of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Ophthalmology, Ain Shams University, Cairo, Egypt
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Wijesingha N, Tsai WS, Keskin AM, Holmes C, Kazantzis D, Chandak S, Kubravi H, Sivaprasad S. Optical Coherence Tomography Angiography as a Diagnostic Tool for Diabetic Retinopathy. Diagnostics (Basel) 2024; 14:326. [PMID: 38337841 PMCID: PMC10855126 DOI: 10.3390/diagnostics14030326] [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: 01/05/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus, leading to visual impairment if left untreated. This review discusses the use of optical coherence tomography angiography (OCTA) as a diagnostic tool for the early detection and management of DR. OCTA is a fast, non-invasive, non-contact test that enables the detailed visualisation of the macular microvasculature in different plexuses. OCTA offers several advantages over fundus fluorescein angiography (FFA), notably offering quantitative data. OCTA is not without limitations, including the requirement for careful interpretation of artefacts and the limited region of interest that can be captured currently. We explore how OCTA has been instrumental in detecting early microvascular changes that precede clinical signs of DR. We also discuss the application of OCTA in the diagnosis and management of various stages of DR, including non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), diabetic macular ischaemia (DMI), and pre-diabetes. Finally, we discuss the future role of OCTA and how it may be used to enhance the clinical outcomes of DR.
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Affiliation(s)
- Naomi Wijesingha
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Wei-Shan Tsai
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Ayse Merve Keskin
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Christopher Holmes
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Dimitrios Kazantzis
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Swati Chandak
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Heena Kubravi
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
| | - Sobha Sivaprasad
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital, London EC1V 2PD, UK; (W.-S.T.); (A.M.K.); (C.H.); (D.K.); (S.C.); (H.K.)
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Moir J, Kaufmann G, Rodriguez SH, Nourian N, Abdul Rasheed M, Vupparaboina KK, Chhablani J, Skondra D. Racial Differences in Choroidal Vascularity Index in Healthy Patients: Novel Insights. Ophthalmic Surg Lasers Imaging Retina 2024; 55:30-38. [PMID: 38189798 DOI: 10.3928/23258160-20231113-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Choroidal vascularity index (CVI) measures the ratio of blood vessels in the choroid to the total choroidal area. We aimed to compare CVI between young Black and White patients without a history of ocular or systemic disease. PATIENTS AND METHODS We used a previously validated algorithm for shadow compensation and choroidal vessel binarization to measure CVI across the Early Treatment of Diabetic Retinopathy Study grid. RESULTS Black patients had a lower CVI (ß = -0.05, P < 0.001) compared to White patients. Choroidal volume or luminal volume did not significantly differ with respect to race, whereas there was a trend for Black patients to have a greater stromal volume (ß = 3.08, P = 0.01). CONCLUSIONS Black patients have a lower CVI than do White patients, likely due to a greater proportion of stromal volume. Further study of this parameter is warranted to validate the findings of this exploratory study. [Ophthalmic Surg Lasers Imaging Retina 2024;55:30-38.].
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Szpernal J, Gaffney M, Linderman RE, Langlo CS, Hemsworth K, Walesa A, Higgins BP, Rosen RB, Chui TYP, Carroll J. Assessing the Sensitivity of OCT-A Retinal Vasculature Metrics. Transl Vis Sci Technol 2023; 12:2. [PMID: 37531114 PMCID: PMC10405864 DOI: 10.1167/tvst.12.8.2] [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: 01/11/2023] [Accepted: 06/20/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose The purpose of this study was to examine the sensitivity of quantitative metrics of the retinal vasculature derived from optical coherence tomography angiography (OCT-A) images. Methods Full retinal vascular slab OCT-A images were obtained from 94 healthy participants. Capillary loss, at 1% increments up to 50%, was simulated by randomly removing capillary segments (1000 iterations of randomized loss for each participant at each percent loss). Thirteen quantitative metrics were calculated for each image: foveal avascular zone (FAZ) area, vessel density, vessel complexity index (VCI), vessel perimeter index (VPI), fractal dimension (FD), and parafoveal intercapillary area (PICA) measurements with and without the FAZ (mean PICA, summed PICA, PICA regularity, and PICA standard deviation [PICA SD]). The sensitivity of each metric was calculated as the percent loss at which 80% of the iterations for a participant fell outside of two standard deviations from the sample's normative mean. Results The most used OCT-A metrics, FAZ area and vessel density, were not significantly different from normative values until 27.69% and 16.00% capillary loss, respectively. Across the remaining metrics, metric sensitivity ranged from 6.37% (PICA SD without FAZ) to 39.78% (Summed PICA without FAZ). Conclusions The sensitivity of vasculature metrics for detecting random capillary loss varies substantially. Further efforts simulating different patterns of capillary loss are needed for comparison. Additionally, mapping the repeatability of metrics over time in a normal population is needed to further define metric sensitivity. Translational Relevance Quantitative metrics vary in their ability to detect vascular abnormalities in OCT-A images. Metric choice in screening studies will need to balance expected capillary abnormalities and the quality of the OCT-A images being used.
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Affiliation(s)
- Jacob Szpernal
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mina Gaffney
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel E. Linderman
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher S. Langlo
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Internal Medicine, Ascension St. Joseph Hospital, Milwaukee, WI, USA
| | - Katherine Hemsworth
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ashleigh Walesa
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian P. Higgins
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard B. Rosen
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Toco Y. P. Chui
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph Carroll
- Joint Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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Çetinkaya Yaprak A, Erkan Pota Ç. Comparison of retinochoroidal microvascular circulation in menstrual and postmenopausal periods using swept-source optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2023; 261:367-373. [PMID: 35984487 DOI: 10.1007/s00417-022-05807-2] [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: 03/17/2022] [Revised: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE We aimed to examine the possible effects of the postmenopausal period on retinal and choroidal microvascular circulation using swept-source optical coherence tomography angiography (SS-OCTA). METHODS This cross-sectional study included 45 eyes of 45 subjects in menstrual group and 40 eyes of 40 subjects in postmenopausal group. SS-OCTA was used for the assessment of vessel density (VD), foveal avascular zone (FAZ), choroidal thickness (CT), choriocapillaris VD, central macular thickness (CMT), nerve fiber layer thickness (RNFL), and ganglion cell layer (GCL) measurements. RESULT The VDs of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) measurements were similar in both group. FAZ area was wider in postmenopausal group (0.305 mm2 (range, 0.212-0.498 mm2)) compared to menstrual group (0.271 mm2 (range, 0.131-0.464 mm2)) (p = 0.013). Choriocapillaris VD was significantly lower in postmenopausal group (p = 0.049). CT was thicker in the postmenopausal group, but with no statistically significant difference (p = 0.066). Central macular thickness, RNFL, and GCL were similar in both groups. CONCLUSION This is the first study in the literature to evaluate the retinochoroidal microcirculation in the menstrual and postmenopausal periods with SS-OCTA. We observed an increase in both superficial and deep FAZ area and a decrease in choroidal blood flow in the postmenopausal period. We think that this enlargement in the FAZ area may be related to the decreased amount of estrogen.
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Affiliation(s)
- Aslı Çetinkaya Yaprak
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, PınarbaşıMah. AkdenizÜniversitesi Tıp FakültesiHastanesi, 07070, Konyaaltı/Antalya, Turkey.
| | - Çisil Erkan Pota
- Department of Ophthalmology, Manavgat State Hospital, Antalya, Turkey
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A normative database of wide-field swept-source optical coherence tomography angiography quantitative metrics in a large cohort of healthy adults. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-022-05963-5. [PMID: 36680613 DOI: 10.1007/s00417-022-05963-5] [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: 08/26/2022] [Revised: 11/28/2022] [Accepted: 12/27/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Data from healthy eyes is needed to interpret optical coherence tomography angiography (OCTA) findings. However, very little normative data is available for wide-field swept-source OCTA (WF SS-OCTA), particularly 12 × 12-mm and disc-centered angiograms. Therefore, we aim to report quantitative metrics in a large sample of control eyes. METHODS In this cross-sectional observational study, 482 eyes of 375 healthy adults were imaged on the 100 kHz Zeiss PLEX® Elite 9000 using protocols centered on the fovea (3 × 3, 6 × 6, and 12 × 12-mm) and optic disc (6 × 6 and 12 × 12-mm) between December 2018 and January 2022. The ARI Network (Zeiss Portal v5.4) was used to calculate vessel density (VD) and vessel skeletonized density (VSD) in the superficial capillary plexus, deep capillary plexus, and whole retina, as well as foveal avascular zone (FAZ) parameters. Mixed-effect multiple linear regression models were used for statistical analysis. RESULTS The subjects' median age was 55 (38-63) years, and 201 (53.6%) were female. Greater age and worse best-corrected visual acuity (BCVA) were associated with significantly lower VD and VSD (p < 0.05). VD and VSD differed based on race and cataract status, but not sex, on some scan protocols (p < 0.05). FAZ circularity decreased with age, and FAZ dimensions differed based on race and ethnicity in certain scan protocols. CONCLUSIONS We report a large database of parafoveal and peripapillary vascular metrics in several angiogram sizes. In referencing these values, researchers must consider characteristics such as age, race, and BCVA, but will have a valuable point of comparison for OCTA measurements in pathologic settings.
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Moir J, Rodriguez SH, Chun LY, Massamba N, Skondra D. Racial differences in quantitative optical coherence tomography angiography findings between older non-diabetics with co-morbidities. PLoS One 2023; 18:e0285360. [PMID: 37146056 PMCID: PMC10162566 DOI: 10.1371/journal.pone.0285360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/22/2023] [Indexed: 05/07/2023] Open
Abstract
This cross-sectional study compared optical coherence tomography angiography (OCTA) parameters between older Black and White adults with systemic comorbidities in an effort to further understand racial differences in the retinal microvasculature. We analyzed vessel density at the superficial (SCP), intermediate (ICP), and deep capillary plexuses (DCP), foveal avascular zone (FAZ) parameters, and blood flow area (BFA) at the choriocapillaris. We used a mixed-effects linear regression model, controlling for hypertension and two eyes from the same subject, to compare OCTA parameters. Black subjects had lower foveal vessel density at the SCP and ICP, while no differences were observed at the parafovea or 3x3 mm macular area of any capillary layer. Black subjects had greater FAZ area, perimeter, and FD-300, a measurement of vessel density in a 300 μm wide ring around the FAZ. Black subjects also had lower BFA at the choriocapillaris. Within a cohort of subjects without hypertension, these differences remained statistically significant, with the exception of foveal vessel density at the SCP and foveal BFA of the choriocapillaris. These findings suggest that normative databases of OCTA parameters must strive to be diverse in nature to adequately capture differences across patient populations. Further study is required to understand if baseline differences in OCTA parameters contribute to epidemiological disparities in ocular diseases.
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Affiliation(s)
- John Moir
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Sarah H Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
| | - Lindsay Y Chun
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
| | - Nathalie Massamba
- Department of Ophthalmology, Handicap, and Vision, Pitie Salpetriere Hospital, Sorbonne University, Paris, France
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, United States of America
- J. Terry Ernest Ocular Imaging Center, University of Chicago, Chicago, Illinois, United States of America
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Mahalingam M, Sachidanandam R, Verma A, Alagorie AR, Sen P. Choriocapillaris flow deficits in polypoidal choroidal vasculopathy using swept source optical coherence tomography angiography. Indian J Ophthalmol 2022; 70:3002-3007. [PMID: 35918961 PMCID: PMC9672729 DOI: 10.4103/ijo.ijo_2905_21] [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] [Indexed: 12/04/2022] Open
Abstract
Purpose: To evaluate the choriocapillaris flow deficits (CCFD) on swept-source optical coherence tomography angiography (SS-OCTA) in eyes with unilateral polypoidal choroidal vasculopathy (PCV), fellow unaffected eyes, and to compare them with age-matched healthy controls. Methods: This study was a cross-sectional study which included treatment-naïve eyes with unilateral PCV (group 1), fellow unaffected eyes of patients with PCV (group 2), and normal eyes (group 3). Using the SS-OCTA, the Choriocapillaris (CC) slab was segmented from the structural optical coherence tomography (OCT) and the corresponding flow map was multiplied after signal compensation. The resultant image was evaluated for CCFD in equidistant squares measuring 1 × 1 mm, 1.5 × 1.5 mm, 2 × 2 mm, 2.5 × 2.5 mm, 3 × 3 mm, and 6 × 6 mm centered on the fovea. Results: The percentage of flow deficits were significantly increased (one-way ANOVA, P = 0.003 and P = 0.049) in the eyes with PCV as compared to the fellow eyes, and age-matched healthy controls. In the multiple pairwise comparison using post hoc Bonferroni, CCFD of 1 mm in group 1 and 2 (P = 0.019), group 1 and 3 (P = 0.003), and CCFD of 1.5 mm in group 1 and 3 (P = 0.044) were statistically significant. Correlation analysis showed no significant correlation between CCFD, age, Best corrected visual acuity (BCVA), foveal thickness (FT), and subfoveal choroidal thickness (SFCT) in our study. Linear regression analysis showed that the CCFD was negatively correlated with the distance from the foveal center in group 1 (β = −0.613, P = 0.046). Conclusion: Eyes with PCV demonstrated a significant flow impairment in the choriocapillaris layer as compared to the fellow unaffected eyes and age-matched healthy eyes.
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Affiliation(s)
- Maanasi Mahalingam
- Elite School of Optometry, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
| | - Ramya Sachidanandam
- Elite School of Optometry, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
| | - Aditya Verma
- Department of Vitreo-Retinal Services, Medical Research Foundation, Chennai, India
| | | | - Parveen Sen
- Department of Vitreo-Retinal Services, Medical Research Foundation, Chennai, India
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12
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Sharma P, Ninomiya T, Omodaka K, Takahashi N, Miya T, Himori N, Okatani T, Nakazawa T. A lightweight deep learning model for automatic segmentation and analysis of ophthalmic images. Sci Rep 2022; 12:8508. [PMID: 35595784 PMCID: PMC9122907 DOI: 10.1038/s41598-022-12486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/11/2022] [Indexed: 12/04/2022] Open
Abstract
Detection, diagnosis, and treatment of ophthalmic diseases depend on extraction of information (features and/or their dimensions) from the images. Deep learning (DL) model are crucial for the automation of it. Here, we report on the development of a lightweight DL model, which can precisely segment/detect the required features automatically. The model utilizes dimensionality reduction of image to extract important features, and channel contraction to allow only the required high-level features necessary for reconstruction of segmented feature image. Performance of present model in detection of glaucoma from optical coherence tomography angiography (OCTA) images of retina is high (area under the receiver-operator characteristic curve AUC ~ 0.81). Bland–Altman analysis gave exceptionally low bias (~ 0.00185), and high Pearson’s correlation coefficient (p = 0.9969) between the parameters determined from manual and DL based segmentation. On the same dataset, bias is an order of magnitude higher (~ 0.0694, p = 0.8534) for commercial software. Present model is 10 times lighter than Unet (popular for biomedical image segmentation) and have a better segmentation accuracy and model training reproducibility (based on the analysis of 3670 OCTA images). High dice similarity coefficient (D) for variety of ophthalmic images suggested it’s wider scope in precise segmentation of images even from other fields. Our concept of channel narrowing is not only important for the segmentation problems, but it can also reduce number of parameters significantly in object classification models. Enhanced disease diagnostic accuracy can be achieved for the resource limited devices (such as mobile phone, Nvidia’s Jetson, Raspberry pi) used in self-monitoring, and tele-screening (memory size of trained model ~ 35 MB).
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Affiliation(s)
- Parmanand Sharma
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Takahiro Ninomiya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehiro Miya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Aging Vision Healthcare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Takayuki Okatani
- Graduate School of Information Sciences, Tohoku University, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Advanced Research Center for Innovations in Next-Generation Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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13
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Zapata MÁ, Banderas García S, Sánchez-Moltalvá A, Falcó A, Otero-Romero S, Arcos G, Velazquez-Villoria D, García-Arumí J. Retinal microvascular abnormalities in patients after COVID-19 depending on disease severity. Br J Ophthalmol 2022; 106:559-563. [PMID: 33328184 PMCID: PMC7745458 DOI: 10.1136/bjophthalmol-2020-317953] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Global pandemic SARS-CoV-2 causes a prothrombotic state without fully elucidated effects. This study aims to analyse and quantify the possible retinal microvascular abnormalities. MATERIALS AND METHODS Case-control study. Patients between 18 and 55 years old with PCR-confirmed SARS-CoV-2 infection within the last 3 months were included. RISK STRATIFICATION group 1-mild disease (asymptomatic/paucisymptomatic); group 2-moderate disease (required hospital admission with no acute respiratory distress) and group 3-severe disease (subjects who developed an acute respiratory distress were admitted in the intensive care unit and presented interleukin 6 values above 40 pg/mL). Age-matched volunteers with negative serology tests were enrolled to control group. A colour photograph, an optical coherence tomography (OCT) and an angiography using OCT centred on the fovea were performed. RESULTS Control group included 27 subjects: group 1 included 24 patients, group 2 consisted of 24 patients and 21 participants were recruited for group 3. There were no funduscopic lesions, neither in the colour images nor in the structural OCT. Fovea-centred vascular density (VD) was reduced in group 2 and group 3 compared with group 1 and control group (control group vs group 2; 16.92 vs 13.37; p=0.009) (control group vs group 3; 16.92 vs .13.63; p=0.026) (group 1 vs group 2; 17.16 vs 13.37; p=0.006) (group 1 vs group 3; 17.16 vs 13.63 p=0.017). CONCLUSION Patients with moderate and severe SARS-CoV-2 pneumonia had decreased central retinal VD as compared with that of asymptomatic/paucisymptomatic cases or control subjects.
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Affiliation(s)
- Miguel Ángel Zapata
- Ophthalmology Service, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Sandra Banderas García
- Ophthalmology Service, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Catalunya, Spain
| | - Adrián Sánchez-Moltalvá
- Infectious Diseases Department, Autonomous University of Barcelona, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Anna Falcó
- Infectious Diseases Department, Autonomous University of Barcelona, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Susana Otero-Romero
- Preventive Medicine and Epidemiology Department, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | | | | | - Jose García-Arumí
- Ophthalmology Service, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
- Ocular Microsurgery Institute (IMO), Barcelona, Spain
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14
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Monteiro‐Henriques I, Rocha‐Sousa A, Barbosa‐Breda J. Optical coherence tomography angiography changes in cardiovascular systemic diseases and risk factors: A Review. Acta Ophthalmol 2022; 100:e1-e15. [PMID: 33783129 DOI: 10.1111/aos.14851] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/04/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient's CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that retinal vascular alterations may reflect several systemic processes such as CVRF, we conducted a systematic review in order to summarize which ocular microvasculature changes can be found using Optical Coherence Tomography Angiography (OCTA) in patients without ocular diseases and with systemic pathologies/conditions that affect the CV system when compared to healthy subjects. We searched on online databases, namely PubMed, Scopus, Cochrane and Web of Science, and obtained additional studies through citation tracking. Case reports and review articles were excluded. A total of 47 articles were included in our review. We describe that patients with hypertension, diabetes mellitus, kidney disease, preeclampsia, coronary artery disease, carotid artery stenosis and obstructive sleep apnoea syndrome have, in general, lower retinal and choroidal Vessel Density (VD) and Length (VL), as well as an increased foveal avascular zone area and perimeter. Additionally, several characteristics and/or conditions in healthy subjects, such as smoking status, hyper or hypoxia conditions, race, among others, are also related to ocular vascular changes and should be accounted for. We concluded that OCTA could be a useful tool to assess a patient's CV risk profile in a non-invasive way, possibly integrating the diagnostic and prognostic algorithms of the most prevalent CV diseases in the future.
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Affiliation(s)
| | - Amândio Rocha‐Sousa
- Cardiovascular R&D Center Faculty of Medicine of the University of Porto Porto Portugal
- Department of Ophthalmology Centro Hospitalar e Universitário São João Porto Portugal
| | - João Barbosa‐Breda
- Cardiovascular R&D Center Faculty of Medicine of the University of Porto Porto Portugal
- Department of Ophthalmology Centro Hospitalar e Universitário São João Porto Portugal
- Research Group Ophthalmology Department of Neurosciences KULeuven Leuven Belgium
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15
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Salazar-Quiñones L, Yu-Wai-Man C, De Antonio Ramirez A, Méndez-Hernández CD, Daas A, Garcia Feijoo J, Guzman-Almagro E, Fernández-Pérez C, Sheng Lim K. Peripapillary and optic nerve head vessel density of glaucoma and healthy subjects from Afro-Caribbean and European descent: A pilot study. J Fr Ophtalmol 2021; 45:207-215. [PMID: 34972574 DOI: 10.1016/j.jfo.2021.07.010] [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: 04/20/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 12/09/2022]
Abstract
PURPOSE To compare the peripapillary and optic nerve head vessel density (PP-ONH VD) between glaucoma patients (all, early, moderated, and advanced) and healthy subjects of Afro-Caribbean descent (AD) and European descent (ED). METHODS This was a cross-sectional study. One eye was evaluated in 90 subjects, including 66 glaucoma patients and 24 healthy subjects, who underwent PP-ONH VD imaging using SPECTRALIS® Optical Coherence Tomography Angiography (OCT-A). We analysed the superficial vascular complex using the AngioTool version 0.6a software. The correlation between the PP-ONH VD and visual field mean deviation (MD) was evaluated using a scatter plot and Spearman's rho correlation coefficient. RESULTS Among the healthy subjects, the AD group had a lower superficial PP-ONH VD [43.29±3.25% (mean±standard deviation)] than the ED group (46.06±1.75%) (P=0.016). Overall, superficial PP-ONH VD did not show any significant differences between the total AD and ED glaucoma patients or in the subgroup analyses (early/moderate/advanced) (AD: 32.73±6.70%, 37.11±5.72%, 32.48±5.73%, 27.76±4.74%, respectively; ED: 33.94±6.89%, 38.52±3.82%, 35.56±4.18%; 27.65±6.31%, respectively) (P>0.05 for all). A strong, statistically significant correlation was established between vessel density and mean deviation among AD and ED glaucoma patients (r=0.709 and r=0.704, respectively) (P<0.001 for both). CONCLUSION This pilot study shows that healthy subjects of AD had lower peripapillary and optic nerve head superficial vessel density than healthy subjects of ED, but no significant differences were found between AD and ED glaucoma groups (all, early, moderate, or advanced).
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Affiliation(s)
- L Salazar-Quiñones
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain; King's College London, SE1 7EH, London, United Kingdom
| | - C Yu-Wai-Man
- King's College London, SE1 7EH, London, United Kingdom; Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom
| | - A De Antonio Ramirez
- Department of Epidemiology and Preventive Medicine, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | - C D Méndez-Hernández
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain
| | - A Daas
- Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom
| | - J Garcia Feijoo
- Department of Ophthalmology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Departamento de Inmunología, Oftalmología y ORL. Facultad de Medicina. Universidad Complutense, OFTARED, Hospital Clínico San Carlos, Madrid, Spain
| | - E Guzman-Almagro
- Department of Ophthalmology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - C Fernández-Pérez
- Department of Epidemiology and Preventive Medicine, Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | - K Sheng Lim
- King's College London, SE1 7EH, London, United Kingdom; Department of Ophthalmology, Saint-Thomas' Hospital, SE1 7EH, London, United Kingdom.
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16
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Rabiolo A, Fantaguzzi F, Sacconi R, Gelormini F, Borrelli E, Triolo G, Bettin P, McNaught AI, Caprioli J, Querques G, Bandello F. Combining Structural and Vascular Parameters to Discriminate Among Glaucoma Patients, Glaucoma Suspects, and Healthy Subjects. Transl Vis Sci Technol 2021; 10:20. [PMID: 34928324 PMCID: PMC8709930 DOI: 10.1167/tvst.10.14.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Compare the ability of peripapillary and macular structural parameters, vascular parameters, and their integration to discriminate among glaucoma, suspected glaucoma (GS), and healthy controls (HCs). Methods In this study, 196 eyes of 119 patients with glaucoma (n = 81), patients with GS (n = 48), and HCs (n = 67) underwent optical coherence tomography (OCT) and OCT angiography to measure peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell-inner plexiform layer (mGCIPL) thicknesses, radial peripapillary capillary perfusion density (RPC-PD), and macular GCIPL perfusion density (GCIPL-PD). Parameters were integrated regionally with logistic regression and globally with machine learning algorithms. Diagnostic performances were evaluated with area under the receiver operating characteristic (AUROC) curves. Results Patients with glaucoma had mild to moderate damage (median, -3.3 dB; interquartile range, -6.5 to -1.4). In discriminating between patients with glaucoma and the HCs, pRNFL thickness had higher AUROC curve values than RPC-PD for average (0.87 vs. 0.62; P < 0.001), superior (0.86 vs. 0.54; P < 0.001), inferior (0.90 vs. 0.71; P < 0.001), and temporal (0.65 vs. 0.51; P = 0.02) quadrants. mGCIPL thickness had higher AUROC curve values than GCIPL-PD for average (0.84 vs. 0.68; P < 0.001), superotemporal (0.76 vs. 0.65; P = 0.016), superior (0.72 vs. 0.57; P = 0.004), superonasal (0.70 vs. 0.56; P = 0.01), inferotemporal (0.90 vs. 0.72; P < 0.001), inferior (0.87 vs. 0.69; P < 0.001), and inferonasal (0.78 vs. 0.65, P = 0.012) sectors. All structural multisector indices had higher diagnostic ability than vascular ones (P < 0.001). Combined structural-vascular indices did not outperform structural indices. Similar results were found to discriminate glaucoma from GS. Conclusions Combining structural and vascular parameters in a structural-vascular index does not improve diagnostic ability over structural parameters alone. Translational Relevance OCT angiography does not add additional benefit to structural OCT in early to moderate glaucoma diagnosis.
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Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Fantaguzzi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Gelormini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giacinto Triolo
- Ophthalmology Department, Fatebenefratelli and Ophthalmic Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Paolo Bettin
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrew I McNaught
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.,School of Health Professions (Faculty of Health), University of Plymouth, Plymouth, UK
| | - Joseph Caprioli
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
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17
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Rodman J, Ferraz M, Baran A, Zhang B. Optical coherence tomography angiography of retinal vasculature in recovered COVID-19 patients compared to age and ethnic matched controls. Clin Exp Optom 2021; 105:842-847. [PMID: 34751081 DOI: 10.1080/08164622.2021.1978817] [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] [Indexed: 01/02/2023] Open
Abstract
CLINICAL RELEVANCE Understanding the impact of the COVID-19 virus on the retinochoroidal vasculature can provide valuable information regarding potential multi-organ ischaemic sequelae in COVID-19 patients, and can thus be a useful tool for optometrists, ophthalmologists, pulmonologists, infectious disease specialists and others. BACKGROUND Assessment of retinochoroidal vasculature alterations in recovered mild COVID-19 patients using optical coherence tomography angiography (OCTA) when compared to age and ethnic matched controls. METHODS Multimodal imaging was performed using OCTA, spectral domain (SD)-OCT (Optovue RTVue XR Avanti; Optovue, Inc, Fremont, CA), and colour fundus photography (Compass; iCare Inc, Raleigh, NC). Vessel flow density, foveal avascular zone, foveal perimeter circumference and retinal thickness were calculated automatically by the OCTA software on 6 × 6mm angiograms. Morphologic changes in the retinochoroidal vasculature on OCTA were assessed and compared with the findings on fundoscopy, SD-OCT and fundus photography and were evaluated by two trained graders. RESULTS Mean vessel parafoveal density, superior and inferior hemispheric vessel density and perifoveal temporal vessel density on 6 × 6 angiograms of the superficial capillary plexus were lower among the COVID-19 patients when compared to their age and ethnic matched controls. Vessel flow density of the deep capillary plexus, foveal avascular zone size and circumference and retinal thickness did not illustrate statistical significance between the groups. CONCLUSION OCTA provides non-invasive high-resolution imaging of the retinochoroidal vascular network. Compared with conventional imaging, OCTA can demonstrate precise microvascular structural alterations in the retinal vessels before visible on SD-OCT or fundus examination. When matched for age and ethnicity, patients with a history of mild COVID illness manifested alterations in vessel density.
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Affiliation(s)
- Julie Rodman
- College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Mariana Ferraz
- College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Ariela Baran
- College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Bin Zhang
- College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
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18
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Massamba N, Mackin AG, Chun LY, Rodriguez S, Dimitroyannis RC, Bodaghi B, Hariprasad SM, Skondra D. Evaluation of flow of chorioretinal capillaries in healthy black and white subjects using optical coherence tomography angiography. Sci Rep 2021; 11:21886. [PMID: 34750481 PMCID: PMC8575995 DOI: 10.1038/s41598-021-01380-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/11/2021] [Indexed: 12/18/2022] Open
Abstract
This study compared macular capillary parameters between healthy black and white subjects using optical coherence tomography angiography (OCTA). We measured vessel density (VD) of superficial (SCP), intermediate (ICP), and deep (DCP) capillary plexuses and choriocapillaris blood flow area (BFA) of the fovea, parafovea and total 3 mm-diameter circular area centered on the fovea, as well as the foveal avascular zone (FAZ) parameters, controlling for axial length. Black subjects had lower foveal and parafoveal VD in the SCP (p = 0.043 and p = 0.014) and the ICP (p = 0.014 and p = 0.002). In the DCP, black subjects had a trend toward lower foveal and parafoveal VD. Black subjects had decreased choriocapillaris BFA in the total 3 mm area (p = 0.011) and the parafovea (p = 0.033), larger FAZ area (p = 0.006) and perimeter (p = 0.014), and a higher capillary density in a 300 μm wide region around the FAZ (FD-300) (p = 0.001). There was no significant difference in FAZ acircularity index. To our knowledge, this is the first report analyzing the three distinct retinal capillary plexuses and identifying differing baseline VD, choriocapillaris and FAZ parameters in healthy young black compared to white subjects. Larger studies are needed to validate these findings and better understand racial differences in vulnerability to ocular diseases.
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Affiliation(s)
- Nathalie Massamba
- Department of Ophthalmology and Visual Science, The University of Chicago, 5841 S. Maryland Avenue, S426m MC2114, Chicago, IL, 60637, USA
- Department of Ophthalmology, Handicap, and Vision, Pitie Salpetriere Hospital, Sorbonne University, Paris, France
- J. Terry Ernest Ocular Imaging Center, The University of Chicago, Chicago, IL, USA
| | - Anna G Mackin
- Department of Ophthalmology and Visual Science, The University of Chicago, 5841 S. Maryland Avenue, S426m MC2114, Chicago, IL, 60637, USA
| | - Lindsay Y Chun
- Department of Ophthalmology and Visual Science, The University of Chicago, 5841 S. Maryland Avenue, S426m MC2114, Chicago, IL, 60637, USA
| | - Sarah Rodriguez
- Department of Ophthalmology and Visual Science, The University of Chicago, 5841 S. Maryland Avenue, S426m MC2114, Chicago, IL, 60637, USA
| | - Rose C Dimitroyannis
- Department of Ophthalmology and Visual Science, The University of Chicago, 5841 S. Maryland Avenue, S426m MC2114, Chicago, IL, 60637, USA
| | - Bahram Bodaghi
- Department of Ophthalmology, Handicap, and Vision, Pitie Salpetriere Hospital, Sorbonne University, Paris, France
| | - Seenu M Hariprasad
- Department of Ophthalmology and Visual Science, The University of Chicago, 5841 S. Maryland Avenue, S426m MC2114, Chicago, IL, 60637, USA
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, The University of Chicago, 5841 S. Maryland Avenue, S426m MC2114, Chicago, IL, 60637, USA.
- J. Terry Ernest Ocular Imaging Center, The University of Chicago, Chicago, IL, USA.
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19
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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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Dastiridou A, Kassos I, Samouilidou M, Koutali D, Mataftsi A, Androudi S, Ziakas N. Age and signal strength-related changes in vessel density in the choroid and the retina: an OCT angiography study of the macula and optic disc. Acta Ophthalmol 2021; 100:e1095-e1102. [PMID: 34532980 DOI: 10.1111/aos.15028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/30/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the effects of ageing and signal strength index (SSI) on vessel density (VD) measurements of the radial peripapillary capillaries (RPC) in the optic disc, the retinal superficial (SCP) and deep (DCP) capillary plexi and the choriocapillaris (CC) of the macular area using optical coherence tomography angiography (OCT-A) imaging. METHODS This cross-sectional study included 138 eyes from 77 healthy participants. High-definition (HD) disc Angio scan (4.5X4.5 mm) and HD Angio retina scan (6X6 mm) were acquired. Whole image (WI) VDs, inside disc (ID) VD and global and hemifield peripapillary RPC VDs were evaluated from the Angio Disc scans. Global and hemifield VD for the SCP, DCP and CC slab in the macula area were also recorded across different age groups. RESULTS Mean age was 48.2 ± 15.0 years (range 25-82 years). Signal strength index (SSI) was 71.6 ± 7.6 in the macula and 74.6 ± 9.2 in the disc OCT-A image. VD for both SCP and DCP decreased by 0.084% and 0.188%/year (both p < 0.001). WI VD and ID VD also decreased by 0.037%/year (p = 0.005) and 0.092%/year (p < 0.001). Peripapillary RPC VD did not change with age or SSI. The effect of SSI was significant in SCP, DCP, WI RPC, ID RPC and CC VD. In the generalized estimating equation model testing for both SSI and age, SSI remained significant against SCP, DCP and ID RPC. CONCLUSION With ageing, a decrease in VD in the SCP, DCP, WI and ID RPC, as well as in SSI, is seen. SSI and age are associated with VD changes, but only SSI is the significant variable that explains the variation in the retina microvasculature in the macula and the optic disc in multivariate analysis. In the CC, a larger SSI was associated with a lower VD. These findings underscore the importance of controlling for SSI in future studies using OCT-A.
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Affiliation(s)
- Anna Dastiridou
- 2nd Ophthalmology Department Aristotle University of Thessaloniki Thessaloniki Greece
- Ophthalmology Department Medical School, University of Thessalia Larissa Greece
| | - Ioannis Kassos
- 2nd Ophthalmology Department Aristotle University of Thessaloniki Thessaloniki Greece
| | - Maria Samouilidou
- 2nd Ophthalmology Department Aristotle University of Thessaloniki Thessaloniki Greece
| | - Despoina Koutali
- 2nd Ophthalmology Department Aristotle University of Thessaloniki Thessaloniki Greece
| | - Asimina Mataftsi
- 2nd Ophthalmology Department Aristotle University of Thessaloniki Thessaloniki Greece
| | - Sofia Androudi
- Ophthalmology Department Medical School, University of Thessalia Larissa Greece
| | - Nikolaos Ziakas
- 2nd Ophthalmology Department Aristotle University of Thessaloniki Thessaloniki Greece
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Reduced macular thickness and macular vessel density in early-treated adult patients with PKU. Mol Genet Metab Rep 2021; 27:100767. [PMID: 34026550 PMCID: PMC8121983 DOI: 10.1016/j.ymgmr.2021.100767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Macular structure is poorly evaluated in early-treated phenylketonuria (ETPKU). To evaluate potential changes, we aimed to examine retinas of PKU patients using optical coherence tomography (OCT) with additional OCT angiography (OCTA) and compare the results to healthy controls. Methods A total of 100 adults were recruited in this monocentric, case-control study: 50 patients with ETPKU (mean age: 30.66 ± 8.00 years) and 50 healthy controls (mean age: 30.45 ± 7.18 years). Macular thickness, vessel density and flow area of the right eye was assessed with spectral domain OCT angiography SD-OCT(A). Macular microstructural data between the ETPKU and control group was compared. In the ETPKU group, the relationship between visual functional parameters (best corrected visual acuity [VA], spherical equivalent [SE], contrast sensitivity [CS] and near stereoacuity) and microstructural alterations was examined. The dependency of OCT(A) values on serum phenylalanine (Phe) level was analysed. Results There was significant average parafoveal and perifoveal total retinal layer thinning in ETPKU patients compared to healthy controls (p < 0.016 and p < 0.001, respectively), while the foveal region remained unchanged in the ETPKU group. Whole macular and parafoveal superficial capillary plexus density was significantly decreased in ETPKU compared to controls (p < 0.001). There were no significant differences in the foveal avascular zone, nonflow area, macular superficial and deep capillary plexus between the groups. The temporal parafoveal inner retinal layer thickness was found to negatively correlate with individual Phe levels (r = -0.35, p = 0.042). There was no difference in vascular density and retinal thickness in the subgroup analysis of patients with good therapy adherence compared to patients on a relaxed diet. Conclusions Durable elevation in Phe levels are only partially associated with macular retinal structural changes. However, therapy adherence might not influence these ophthalmological complications.
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Key Words
- Dopamine
- Macular retinal vessel density
- Macular thickness
- Optical Coherence Tomography Angiography, (OCTA)
- Optical Coherence Tomography, (OCT)
- Optical coherence tomography angiography
- Parkinson's disease, (PD)
- Phenylalanine level
- Phenylalanine, (Phe)
- Phenylketonuria
- Tyrosine, (Tyr)
- aminoacid supplements, (AAS)
- axial length, (AL)
- contrast sensitivity, (CS)
- deep capillary plexus, (DCP)
- diopters, (D)
- dopamine, (DA)
- early treated phenylketonuria, (ETPKU)
- external limiting membrane/inner segment of photoreceptors/outer segment of photoreceptors, (ELM/IS/OS)
- ganglion cell complex, (GCC)
- ganglion cell layer, (GCL)
- inner limiting membrane, (ILM)
- inner nuclear layer, (INL)
- inner plexiform layer, (IPL)
- inner retinal layer, (IRL)
- intraocular pressure, (IOP)
- outer nuclear layer, (ONL)
- outer plexiform layer, (OPL)
- outer retinal layer, (ORL)
- phenylalanine hydroxylase gene, (PAH)
- phenylketonuria, (PKU)
- retinal nerve fiber layer, (RNFL)
- retinal pigment epithelium, (RPE)
- signal strength index, (SSI)
- sine-wave contrast test, (SWCT)
- spectral domain, (SD)
- spherical equivalent, (SE)
- split-spectrum amplitude-decorrelation angiography, (SSADA)
- superficial capillary plexus, (SCP)
- tetrahydrobiopterin, (BH4)
- total retinal layer thickness, (TRLT)
- vessel density, (VD)
- visual acuity, (VA)
- visual evoked potential, (VEP)
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Zhou DB, Castanos MV, Pinhas A, Gillette P, Migacz JV, Rosen RB, Glassberg J, Chui TYP. Quantification of intermittent retinal capillary perfusion in sickle cell disease. BIOMEDICAL OPTICS EXPRESS 2021; 12:2825-2840. [PMID: 34123506 PMCID: PMC8176806 DOI: 10.1364/boe.418874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 05/22/2023]
Abstract
Pathophysiology of sickle cell disease (SCD) features intermittent vaso-occlusion of microcirculatory networks that facilitate ischemic damage. Past research has, however, relied on static images to characterize this active disease state. This study develops imaging metrics to more fully capture dynamic vascular changes, quantifying intermittent retinal capillary perfusion in unaffected controls and SCD patients using sequential optical coherence tomography angiography (OCT-A) scans. The results reveal significant dynamic variation of capillary perfusion in SCD patients compared to controls. This measurement of vaso-occlusive burden in patients would provide utility in monitoring of the disease state and in evaluating treatment efficacy.
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Affiliation(s)
- Davis B. Zhou
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
- Ophthalmology, Icahn School of
Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York,
NY 10029, USA
| | - Maria V. Castanos
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
| | - Alexander Pinhas
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
| | - Peter Gillette
- Internal Medicine, SUNY
Downstate Medical Center, 450 Clarkson Avenue Brooklyn,
NY 11203, USA
| | - Justin V. Migacz
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
| | - Richard B. Rosen
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
- Ophthalmology, Icahn School of
Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York,
NY 10029, USA
| | - Jeffrey Glassberg
- Emergency Medicine, Icahn
School of Medicine at Mount Sinai, 3 East 101st Street,
Box 1620, New York, NY 10029, USA
| | - Toco Y. P. Chui
- Ophthalmology, New York Eye
and Ear Infirmary of Mount Sinai, 310 East 14th St.,
Suite 500, S. Bldg., New York, NY 10003, USA
- Ophthalmology, Icahn School of
Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York,
NY 10029, USA
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23
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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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The foveal avascular zone area in healthy eyes measured by ocular coherence tomography angiography using a full spectrum probabilistic algorithm. Int Ophthalmol 2021; 41:2187-2196. [PMID: 33725269 DOI: 10.1007/s10792-021-01776-3] [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: 08/09/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Report the foveal avascular zone (FAZ) area imaged by OCT angiography (OCTA) using a full spectrum probabilistic algorithm in eyes of healthy individuals from Costa Rica without any ocular or systemic pathology. METHODS Retrospective chart review of consecutive healthy patients that were evaluated from January 2018 to October 2018 that underwent OCTA of the macular area. The OCTA consisted of a 10° × 10° cube of 512 A scans separated by 6 µm each with an automated real time mode of 5. The FAZ area of the superficial vascular complex (SVC), the deep vascular complex (DVC), superficial vascular plexus (SVP), intermediate vascular plexus (IVP) and the deep vascular plexus (DVP) were measured manually by 2 different observers at 3 different times. RESULTS A total of 234 eyes of 121 patients were included in this study. Mean age was 50 years (range, 15-89), 85 patients (70%) were female. Inter- and intra-observer agreements were excellent. The mean FAZ areas in the different layers were 0.258 ± 0.0035 mm2 for the SVC, 0.205 ± 0.01 mm2 for the DVC, 0.415 ± 0.01 mm2 for the SVP, 0.305 ± 0.01 mm2 for the ICP and 0.420 ± 0.01 mm2 for the DCP. The mean FAZ areas in most of the measured layers increased with age and decreased with CMT. Gender and spherical equivalence were not correlated with FAZ area. CONCLUSION Manual measurements of the FAZ imaged by OCT-A using a full spectrum probabilistic algorithm are widely reproducible both by the same observer and between observers. The FAZ increases with age and decreases with CMT in normal individuals.
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25
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Shaw LT, Khanna S, Chun LY, Dimitroyannis RC, Rodriguez SH, Massamba N, Hariprasad SM, Skondra D. Quantitative Optical Coherence Tomography Angiography (OCTA) Parameters in a Black Diabetic Population and Correlations with Systemic Diseases. Cells 2021; 10:cells10030551. [PMID: 33806492 PMCID: PMC7998203 DOI: 10.3390/cells10030551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 01/02/2023] Open
Abstract
This is a cross-sectional, prospective study of a population of black diabetic participants without diabetic retinopathy aimed to investigate optical coherence tomography angiography (OCTA) characteristics and correlations with systemic diseases in this population. These parameters could serve as novel biomarkers for microvascular complications; especially in black populations which are more vulnerable to diabetic microvascular complications. Linear mixed models were used to obtain OCTA mean values ± standard deviation and analyze statistical correlations to systemic diseases. Variables showing significance on univariate mixed model analysis were further analyzed with multivariate mixed models. 92 eyes of 52 black adult subjects were included. After multivariate analysis; signal strength intensity (SSI) and heart disease had statistical correlations to superficial capillary plexus vessel density in our population. SSI and smoking status had statistical correlations to deep capillary plexus vessel density in a univariate analysis that persisted in part of the imaging subset in a multivariate analysis. Hyperlipidemia; hypertension; smoking status and pack-years; diabetes duration; creatinine; glomerular filtration rate; total cholesterol; hemoglobin A1C; and albumin-to-creatinine ratio were not significantly associated with any OCTA measurement in multivariate analysis. Our findings suggest that OCTA measures may serve as valuable biomarkers to track systemic vascular functioning in diabetes mellitus in black patients.
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Affiliation(s)
- Lincoln T. Shaw
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (L.T.S.); (S.K.); (L.Y.C.); (R.C.D.); (S.H.R.); (N.M.); (S.M.H.)
| | - Saira Khanna
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (L.T.S.); (S.K.); (L.Y.C.); (R.C.D.); (S.H.R.); (N.M.); (S.M.H.)
| | - Lindsay Y. Chun
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (L.T.S.); (S.K.); (L.Y.C.); (R.C.D.); (S.H.R.); (N.M.); (S.M.H.)
| | - Rose C. Dimitroyannis
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (L.T.S.); (S.K.); (L.Y.C.); (R.C.D.); (S.H.R.); (N.M.); (S.M.H.)
- University of Chicago, Chicago, IL 60637, USA
| | - Sarah H. Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (L.T.S.); (S.K.); (L.Y.C.); (R.C.D.); (S.H.R.); (N.M.); (S.M.H.)
| | - Nathalie Massamba
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (L.T.S.); (S.K.); (L.Y.C.); (R.C.D.); (S.H.R.); (N.M.); (S.M.H.)
- J. Terry Ernest Ocular Imaging Center, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Seenu M. Hariprasad
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (L.T.S.); (S.K.); (L.Y.C.); (R.C.D.); (S.H.R.); (N.M.); (S.M.H.)
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60637, USA; (L.T.S.); (S.K.); (L.Y.C.); (R.C.D.); (S.H.R.); (N.M.); (S.M.H.)
- J. Terry Ernest Ocular Imaging Center, University of Chicago Medical Center, Chicago, IL 60637, USA
- Correspondence: ; Tel.: 1-773-702-3937
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Peripapillary and Macular Microcirculation in Glaucoma Patients of African and European Descent Using Optical Coherence Tomography Angiography. J Glaucoma 2021; 29:885-889. [PMID: 32769732 DOI: 10.1097/ijg.0000000000001629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRéCIS:: We found no significant differences in peripapillary and macula microcirculation blood flow metrics in eyes with open-angle glaucoma of African descent (AD) and European descent (ED) as detected by optical coherence tomography angiography (OCTA). PURPOSE The purpose of this study was to investigate the peripapillary retinal nerve fiber layer (RNFL) and macular vascular microcirculation in subjects of AD and ED with open-angle glaucoma using OCTA. PATIENTS AND METHODS One eye from each subject was scanned using AngioPlex OCTA system covering both a 6×6 mm scanning area centered at the optic nerve head and at the foveola. Peripapillary RNFL and macular microcirculation were measured by calculating the overall flux and vessel area density excluding the large retinal vessels. Two-sample, independent t tests were used to compare the OCTA metrics between AD and ED eyes. Linear regression models were used to investigate the correlation between OCTA metrics and structural and functional parameters. RESULTS Twenty-eight eyes of AD and 56 eyes of ED were included in the study. There was no significant difference in age, sex, hypertension, antihypertensive medications, diabetes, systolic and diastolic blood pressure, mean ocular perfusion pressure, RNFL thickness and visual field (VF) mean deviation and VF pattern standard deviation (P≥0.054) between AD and ED eyes included. Both groups had similar OCTA blood flow metrics (P≥0.161). OCTA blood flow metrics were significantly correlated with VF mean deviation (r≥0.466), VF pattern standard deviation (r≤-0.366) and RNFL thickness (r≥0.333). CONCLUSIONS No significant differences were found in peripapillary and macular microcirculation detected by OCTA between AD and ED glaucomatous eyes. Peripapillary and macular microcirculation were significantly correlated with disease severity in AD and ED glaucomatous eyes.
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Song A, Johnson N, Ayala A, Thompson AC. Optical Coherence Tomography in Patients with Alzheimer's Disease: What Can It Tell Us? Eye Brain 2021; 13:1-20. [PMID: 33447120 PMCID: PMC7802785 DOI: 10.2147/eb.s235238] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/09/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Although Alzheimer's disease (AD) is a leading cause of dementia worldwide, its clinical diagnosis remains a challenge. Optical coherence tomography (OCT) and OCT with angiography (OCTA) are non-invasive ophthalmic imaging tools with the potential to detect retinal structural and microvascular changes in patients with AD, which may serve as biomarkers for the disease. In this systematic review, we evaluate whether certain OCT and OCTA parameters are significantly associated with AD and mild cognitive impairment (MCI). METHODS PubMed database was searched using a combination of MeSH terms to identify studies for review. Studies were organized by participant diagnostic groups, type of imaging modality, and OCT/OCTA parameters of interest. Participant demographic data was also collected and baseline descriptive statistics were calculated for the included studies. RESULTS Seventy-one studies were included for review, representing a total of 6757 patients (2350 AD, 793 MCI, 2902 healthy controls (HC), and 841 others with a range of other neurodegenerative diagnoses). The mean baseline ages were 72.78±3.69, 71.52±2.88, 70.55±3.85 years for AD, MCI and HC groups, respectively. The majority of studies noted significant structural and functional decline in AD patients when compared to HC. Although analysis of MCI groups yielded more mixed results, a similar pattern of decline was often noted amongst patients with MCI relative to HC. OCT and OCTA measurements were also shown to correlate with established measures of AD such as neuropsychological testing or neuroimaging. CONCLUSION OCT and OCTA show great potential as non-invasive technologies for the diagnosis of AD. However, further research is needed to determine whether there are AD-specific patterns of structural or microvascular change in the retina and optic nerve that distinguish AD from other neurodegenerative diseases. Development of sensitive and specific OCT/OCTA parameters will be necessary before they can be used to detect AD in clinical settings.
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Affiliation(s)
- Ailin Song
- Duke University School of Medicine, Durham, NC, USA
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Mammas IN, Spandidos DA. Retinopathy of prematurity and neonatal gut microbiome: An interview with Professor Dimitra Skondra, Associate Professor of Ophthalmology and Vitreoretinal Surgeon at The University of Chicago (USA). Exp Ther Med 2020; 20:294. [PMID: 33209138 PMCID: PMC7668155 DOI: 10.3892/etm.2020.9424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a sight-threatening disorder of the retina affecting neonates of very low birth weight and gestational age, and is characterized by the development of abnormal blood vessel growth. According to Dr Dimitra Skondra, Associate Professor of Ophthalmology and Vitreoretinal Surgeon at the University of Chicago School of Medicine in Chicago, USA, the neonatal gut microbiome may be implicated in the neoangiogenesis process in the neonatal retina and this role may be one of the missing links in the pathogenesis of ROP. The human gut microbiome consists of bacteria, viruses, protozoa and fungi, which colonize the sterile fetal intestine, and differ depending on gestational age, mode of delivery, type of neonatal feeding, the usage of antibiotics and the requirement of neonatal intensive care. To date, it has been related to multiple nutritive, metabolic and immunological functions and has been implicated in the pathogenesis of several human diseases, such as the inflammatory bowel diseases, autoimmune and neurogenerative disorders, metabolic syndrome, cardiovascular diseases and various types of malignant neoplasias. Recent research has proposed that the neonatal gut microbiome profile in high-risk neonates who develop ROP is significantly enriched with Enterobacteriacaea species several weeks prior to the diagnosis of ROP. Further research using animal models is required to prove the causative or secondary role of the microbiome composition in the development and clinical course of ROP. If this role is proven, the gut microbiome could then be a target of intervention for personalized medicine in the prevention and therapeutic management of ROP in neonates.
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Affiliation(s)
- Ioannis N Mammas
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece.,First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Demetrios A Spandidos
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
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Ong JX, Kwan CC, Cicinelli MV, Fawzi AA. Superficial capillary perfusion on optical coherence tomography angiography differentiates moderate and severe nonproliferative diabetic retinopathy. PLoS One 2020; 15:e0240064. [PMID: 33091032 PMCID: PMC7580912 DOI: 10.1371/journal.pone.0240064] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To identify objective optical coherence tomography angiography (OCTA) parameters that characterize the spectrum of non-proliferative diabetic retinopathy (NPDR), especially those that distinguish moderate from severe NPDR. Methods Sixty eyes of 60 patients with treatment-naïve NPDR (mild: 21, moderate: 21, severe: 18), 23 eyes with diabetes and no retinopathy, and 24 healthy control eyes were enrolled. OCTA slabs were segmented into superficial (SCP), middle (MCP), and deep capillary plexus (DCP) and thresholded by a new method based on DCP skeletonized vessel length. The foveal avascular zone (FAZ) area, parafoveal vessel density (VD), and adjusted flow index (AFI) from all three capillary layers and the vessel length density (VLD) of the SCP were compared between each severity group, after adjusting for age and image quality. Results All vessel density markers decreased with increasing severity of NPDR. SCP VD and VLD demonstrated significant differences between eyes with diabetes with no retinopathy and mild NPDR (p = 0.001 and p < 0.001, respectively), as well as between moderate vs. severe NPDR (p = 0.004 and p = 0.009, respectively). MCP VD significantly decreased between moderate and severe NPDR (p = 0.01). AFI significantly increased in the SCP and showed a decreasing trend in the MCP and DCP with increasing NPDR severity. Conclusions Changes in the SCP VD, SCP VLD, and MCP VD can distinguish severe NPDR from lower-risk stages. SCP changes may be more reliable due to their lower susceptibility to noise and projection artifacts. Thresholding OCTA images based on DCP skeletonized vessel length showed less variability in moderate and severe NPDR. Additional studies are warranted to validate this new thresholding method.
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Affiliation(s)
- Janice X Ong
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Changyow C Kwan
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Maria V Cicinelli
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
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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 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] [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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