1
|
Bonnin S, Kubach S, Négrier P, Lewis W, de Sisternes L, Couturier A, Erginay A, Nassisi M, Magazzeni S, Lavia C, Tadayoni R. Retinal capillary and choriocapillaris assessment using a beam modifier optical coherence tomography angiography module to increase lateral optical resolution. PLoS One 2023; 18:e0287783. [PMID: 37390050 PMCID: PMC10313058 DOI: 10.1371/journal.pone.0287783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/14/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To assess a new optical coherence tomography angiography (OCTA) technology and its contribution to retinal vascularization and choriocapillaris (CC) exploration. METHODS A new module, named "Beam expander" (BE), which increases the lateral resolution of OCTA, was used in combination with a prototype software in the PLEX® Elite 9000 Swept-Source OCT instrument (ZEISS, Dublin, CA). This prospective study involved 22 healthy subjects imaged with and without BE. Qualitative analysis of superficial capillary plexus (SCP), deep capillary complex (DCC) retinal and CC angiograms were performed. Perfusion density (PD), vessel density (VD), and foveal avascular zone (FAZ) measurements were also compared. RESULTS Qualitative analysis of single SCP and DCC retinal angiograms acquired with BE showed significantly better vessel sharpness (respectively, p = 0.0002, and p<0.0001), and greater peripheral image quality (p = 0.028 and p = 0.007) compared to standard OCTA images. Mean VD of whole retina single scans was significantly higher for BE angiograms compared to classic angiograms (28.16 ±1.29 mm-1 and 23.36 ±0.92 mm-1, respectively, p<0.0001). Repeatability of VD, PD and FAZ raw size were found to be similar between the two methods (intraclass correlation coefficient: 0.671, 0.604 and 0.994 with BE versus 0.764, 0.638 and 0.990 without BE). CC image quality was found to be significantly superior with BE, and flow deficits were more visible in all BE scans compared to standard scans. CONCLUSIONS An increase in lateral resolution of the OCT beam resulted in higher quality of retinal and choriocapillaris OCTA images in healthy subjects. These results provide significant insights into the future OCTA imaging enhancements.
Collapse
Affiliation(s)
- Sophie Bonnin
- Ophthalmology Department, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
- Fondation Adolphe de Rothschild, Paris, France
| | - Sophie Kubach
- R&D, Carl Zeiss Meditec Inc., Dublin, California, United States of America
| | - Pierre Négrier
- Ophthalmology Department, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Warren Lewis
- R&D, Carl Zeiss Meditec Inc., Dublin, California, United States of America
| | - Luis de Sisternes
- R&D, Carl Zeiss Meditec Inc., Dublin, California, United States of America
| | - Aude Couturier
- Ophthalmology Department, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Ali Erginay
- Ophthalmology Department, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marco Nassisi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Carlo Lavia
- Surgical Department, Ophthalmology Service, Azienda Sanitaria Locale, Chieri, Italy
| | - Ramin Tadayoni
- Ophthalmology Department, Hôpital Lariboisière, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
- Fondation Adolphe de Rothschild, Paris, France
| |
Collapse
|
2
|
Crincoli E, Colantuono D, Miere A, Zhao Z, Ferrara S, Souied EH. Perivenular Capillary Rarefaction in Diabetic Retinopathy: Interdevice Characterization and Association to Clinical Staging. OPHTHALMOLOGY SCIENCE 2023; 3:100269. [PMID: 36875334 PMCID: PMC9978849 DOI: 10.1016/j.xops.2023.100269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
Purpose Geometric perfusion deficit (GPD) is a newly described OCT angiography (OCTA) parameter identifying the total area of presumed retinal ischemia. The aim of our study is to characterize differences in GPD and other common quantitative OCTA parameters between macular full field, perivenular zones, and periarteriolar zones for each clinical stage of nonproliferative diabetic retinopathy (DR) and to assess the influence of ultrahigh-speed acquisition and averaging on the described differences. Design Prospective observational study. Participants Forty-nine patients, including 11 (22.4%) with no sign of DR, 12 (24.5%) with mild DR, 13 (26.5%) with moderate DR, and 13 (26.5%) with severe DR. Patients with diabetic macular edema, proliferative DR, media opacity, head tremor, and overlapping retinal diseases or systemic diseases influencing OCTA were excluded. Methods OCT angiography was performed 3 times for each patient: 1 using Solix Fullrange single volume (V1) mode, 1 using Solix Fullrange 4 volumes mode with automatically averaged scan (V4), and 1 using AngioVue. Main Outcome Measures Full macular, periarteriolar, and perivenular perfusion density (PD), vessel length density (VLD), vessel density index, and GPD for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results In patients showing no sign of DR, PD and VLD were significantly lower in the perivenular area in both the DCP and SCP using V1 and V4, whereas GPD was significantly higher in the perivenular zone in the DCP and SCP with all 3 devices. In patients with mild DR, all 3 measurements (PD, VLD, and GPD) were significantly different in the perivenular zone with all 3 devices. In patients with moderate DR, PD and VLD were lower in the DCP and SCP when measured with V1 and V4. Moreover, GPD was higher in the perivenular zone in the DCP with all 3 devices, whereas only V4 detected a difference in the SCP. In severe DR, only V4 detected a lower PD and VLD and a higher GPD in the DCP of the perivenular zone. V4 also detected a higher GPD in the SCP. Conclusions Geometric perfusion deficit highlights prevalent perivenular location of macular capillary ischemia in all stages of DR. In severe DR patients, only averaging technology allows detection of the same finding. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Key Words
- Capillary ischemia
- DCP, deep capillary plexus
- DR, diabetic retinopathy
- Diabetic retinopathy
- GPD, geometric perfusion deficit
- Geometric perfusion density
- OCT angiography
- OCTA, OCT angiography
- PD, perfusion density
- ROIs, regions of interest
- SCP, superficial capillary plexus
- V1, single volume
- V4, 4 volumes mode with automatically averaged scan
- VDI, vessel density index
- VLD, vessel length density
Collapse
Affiliation(s)
- Emanuele Crincoli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
- Catholic University of “Sacro Cuore”, Rome, Italy
| | - Donato Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
- Correspondence: Alexandra Miere, MD, PhD, Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, Créteil, 94100, France.
| | - Zhanlin Zhao
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
| | | | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Créteil, France
| |
Collapse
|
3
|
Song J, Huang BB, Ong JX, Konopek N, Fawzi AA. Hemodynamic Effects of Anti-Vascular Endothelial Growth Factor Injections on Optical Coherence Tomography Angiography in Diabetic Macular Edema Eyes. Transl Vis Sci Technol 2022; 11:5. [PMID: 36180027 PMCID: PMC9547366 DOI: 10.1167/tvst.11.10.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/21/2022] [Indexed: 01/21/2023] Open
Abstract
Purpose To evaluate retinal hemodynamic responses to anti-vascular endothelial growth factor (VEGF) injection in eyes with diabetic macular edema using optical coherence tomography angiography (OCTA). We performed a comparison of two different thresholding methods to identify the most accurate for studying the vessel density (VD) in diabetic macular edema eyes. Methods The study prospectively included 26 eyes of 22 subjects (aged 60.2 ± 13.7 years) who underwent OCTA scan before and after anti-VEGF injection (mean interval between OCTA = 31.1 ± 17.3 days). We analyzed adjusted flow index, VD, and Skeletonized vessel length density in the parafoveal area (3-mm annulus with a 1-mm inner circle), along with full-thickness fovea avascular zone area and central foveal thickness (CFT). Using averaged scans VD as the ground truth, we compared two different algorithms for VD at the different plexuses. Longitudinal changes were assessed using a generalized linear model correcting for central foveal thickness and Q-score. Results We found significantly decreased adjusted flow index in the DCP layer (P = 0.010) at the follow-up. Furthermore, foveal avascular zone (P < 0.001) and central foveal thickness (P = 0.003) showed significant decrease on follow-up compared with baseline. Comparing the thresholding algorithms showed that vessel length density-based thresholding was more accurate for quantifying the DCP VD. Conclusions The adjusted flow index decreased significantly in the DCP layer on follow-up OCTA scan, suggesting vascular flow disruption and decreased deep retinal perfusion after anti-VEGF injection. Our results also highlight the fact that the choice of thresholding method is particularly critical for DCP quantification in eyes with diabetic macular edema. Translational Relevance Findings confirmed impaired deep retinal capillary flow after anti-VEGF injection.
Collapse
Affiliation(s)
- Jessica Song
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bonnie B. Huang
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Janice X. Ong
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nicholas Konopek
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amani A. Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
4
|
Crincoli E, Colantuono D, Zhao Z, Souied EH, Miere A. Optical coherence tomography angiography for quantitative microvascular assessment in diabetic retinopathy: inter-device and intra-device agreement and correlation with clinical staging. Acta Diabetol 2022; 59:1219-1227. [PMID: 35790606 DOI: 10.1007/s00592-022-01921-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/10/2022] [Indexed: 11/01/2022]
Abstract
AIM To compare acquisitions from single-volume Solix protocol (V1), multi-volume averaged Solix protocol (V4), and AngioVue in patients with diabetic retinopathy (DR) to assess differences in quantitative parameters introduced by high-speed scanning and averaging. METHODS Thirty-eight diabetic patients were divided into 4 groups showing either no sign, mild, moderate, or severe DR at fundus examination. For optical coherence tomography angiography (OCTA) acquisitions both AngioVue, Solix V1, and V4 were used on each patient. Outcome measures were macular perfusion density (PD), vessel length density (VLD), and vessel density index (VDI) for both superficial capillary plexus (SCP) and deep capillary plexus (DCP) and flow deficits (FD) in the choriocapillaris (CC). RESULTS Our study revealed a good agreement in SCP parameters measured with all 3 devices. DCP measurements with Solix V1 showed moderate agreement with V4 and poor agreement with AngioVue measurements. Inter-device agreement in CC-FD assessment was relatively poor considering all 3 devices. The averaging process led to an underestimation of DCP and SCP parameters in all stages of DR (more evident in mild DR). AngioVue measurements compared to Solix V1 led to overestimation of SCP-PD (more pronounced in severe DR patients) and of DCP parameters (more evidently in moderate DR). The regression model derived from Solix V1 parameters was the best for categorization into the different stages. CONCLUSIONS Averaging and high-speed scanning introduce changes in OCTA quantitative parameters in DR. Solix V1 is the most suitable for early diagnosis of DR, while averaged protocol could be the preferred choice in advanced stages of the disease.
Collapse
Affiliation(s)
- Emanuele Crincoli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94100, Créteil, France
- Catholic University of "Sacro Cuore", Largo Francesco Vito 1, 00168, Rome, Italy
| | - Donato Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94100, Créteil, France
| | - Zhanlin Zhao
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94100, Créteil, France
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94100, Créteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94100, Créteil, France.
| |
Collapse
|
5
|
Sampson DM, Dubis AM, Chen FK, Zawadzki RJ, Sampson DD. Towards standardizing retinal optical coherence tomography angiography: a review. LIGHT, SCIENCE & APPLICATIONS 2022; 11:63. [PMID: 35304441 PMCID: PMC8933532 DOI: 10.1038/s41377-022-00740-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 05/11/2023]
Abstract
The visualization and assessment of retinal microvasculature are important in the study, diagnosis, monitoring, and guidance of treatment of ocular and systemic diseases. With the introduction of optical coherence tomography angiography (OCTA), it has become possible to visualize the retinal microvasculature volumetrically and without a contrast agent. Many lab-based and commercial clinical instruments, imaging protocols and data analysis methods and metrics, have been applied, often inconsistently, resulting in a confusing picture that represents a major barrier to progress in applying OCTA to reduce the burden of disease. Open data and software sharing, and cross-comparison and pooling of data from different studies are rare. These inabilities have impeded building the large databases of annotated OCTA images of healthy and diseased retinas that are necessary to study and define characteristics of specific conditions. This paper addresses the steps needed to standardize OCTA imaging of the human retina to address these limitations. Through review of the OCTA literature, we identify issues and inconsistencies and propose minimum standards for imaging protocols, data analysis methods, metrics, reporting of findings, and clinical practice and, where this is not possible, we identify areas that require further investigation. We hope that this paper will encourage the unification of imaging protocols in OCTA, promote transparency in the process of data collection, analysis, and reporting, and facilitate increasing the impact of OCTA on retinal healthcare delivery and life science investigations.
Collapse
Affiliation(s)
- Danuta M Sampson
- Surrey Biophotonics, Centre for Vision, Speech and Signal Processing and School of Biosciences and Medicine, The University of Surrey, Guildford, GU2 7XH, UK.
| | - Adam M Dubis
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Trust and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, 6009, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, 6000, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, 3002, Australia
| | - Robert J Zawadzki
- Department of Ophthalmology & Vision Science, University of California Davis, Sacramento, CA, 95817, USA
| | - David D Sampson
- Surrey Biophotonics, Advanced Technology Institute, School of Physics and School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| |
Collapse
|