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Lal B, Alonso-Caneiro D, Read SA, Carkeet A. Changes in retinal and choroidal optical coherence tomography angiography indices among young adults and children over 1 year. Clin Exp Optom 2024; 107:627-634. [PMID: 37848182 DOI: 10.1080/08164622.2023.2259907] [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: 05/15/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
CLINICAL RELEVANCE Optical coherence tomography angiography (OCT-A) indices are likely to change across time and optometrists should be aware of the variability expected during childhood development and in healthy adults. BACKGROUND Cross-sectional studies have shown that OCT-A indices are associated with age in adults and children. The aim of this study is to investigate longitudinal changes in retinal and choroidal OCT-A indices over 1 year among healthy children and young adults. METHODS This prospective longitudinal study captured macular OCT-A and OCT scans, and biometry measures at baseline and 1-year follow-up for 22 adults (18-30 years; -6.87 to +0.37 D) and 21 children (6-15 years; -5.75 to +0.25 D). Superficial and deep retinal layer, choriocapillaris and deep choroidal en face OCT-A images were analysed to extract magnification-corrected vascular indices in foveal, parafoveal and perifoveal regions. The retinal indices included foveal avascular zone metrics, perfusion, and vessel density. Flow deficit number, size, and density were extracted from choriocapillaris and perfusion density from deep choroid. Associations between annual changes in the OCT-A indices and axial length and baseline refraction were also studied. RESULTS Among children, significant reductions were noted only in parafoveal superficial retinal and foveal and perifoveal deep retinal layer indices over 1 year (p < 0.05). Choroidal OCT-A indices in children and both retinal and choroidal OCT-A indices in adults did not show significant changes. Myopia was associated with a larger reduction in the perifoveal retinal OCT-A indices in children, and with increases in sub-foveal and sub-parafoveal choroidal indices in adults. There were associations between OCT-A indices and axial length changes but differently in adults and children. CONCLUSIONS Significant changes were noted in retinal OCT-A indices over 1 year among children but not adults. In comparison, choroidal OCT-A indices in adults and children showed a stable morphology over this period of time.
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Affiliation(s)
- Barsha Lal
- Centre for Vision and Eye Research, Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - David Alonso-Caneiro
- School of Science, Technology and Engineering, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Scott A Read
- Centre for Vision and Eye Research, Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Andrew Carkeet
- Centre for Vision and Eye Research, Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
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Liu M, Wang Y, Li H, Zhao Y, Ma M, Xu S, Wei X, Xu R, Tian R, Zhou X, Wu H. Differences in choroidal responses to near work between myopic children and young adults. EYE AND VISION (LONDON, ENGLAND) 2024; 11:12. [PMID: 38561862 PMCID: PMC10986059 DOI: 10.1186/s40662-024-00382-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Near work is generally considered as a risk factor for myopia onset and progression. This study aimed to investigate the choroidal responses to a brief-period of near work in children and young adults. METHODS Thirty myopic medical students (aged 18-28 years) and 30 myopic children (aged 8-12 years) participated in this study. The submacular total choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI) and choriocapillaris flow deficit (CcFD), as well as subfoveal choroidal thickness (SFCT) were measured with swept-source optical coherence tomography/optical coherence tomography angiography (SS-OCT/OCTA) before and immediately after 20 min, 40 min, 60 min of near work at a distance of 33 cm. RESULTS In adults, 20 min of near work induced a significant reduction in SFCT (- 5.1 ± 6.5 μm), LA [(- 19.2 ± 18.6) × 103 μm2], SA [(- 8.2 ± 12.6) × 103 μm2] and TCA [(- 27.4 ± 24.9) × 103 μm2] (all P < 0.01). After 40 min of near work, LA was still reduced [(- 9.4 ± 18.3) × 103 μm2], accompanied with a decreased CVI (- 0.39% ± 0.70%) and an increased CcFD (0.30% ± 0.78%) (all P < 0.05). After 60 min of near work, CVI was still reduced (- 0.28% ± 0.59%), and CcFD was still increased (0.37% ± 0.75%) (all P < 0.05). In children, 20 min of near work induced a significant increase in CcFD (0.55% ± 0.64%), while 60 min of near work induced increases in SA [(7.2 ± 13.0) × 103 μm2] and TCA [(9.7 ± 25.3) × 103 μm2] and a reduction in CVI (- 0.28% ± 0.72%) (all P < 0.05). Children exhibited lower near work-induced LA and TCA reduction than adults, with a mean difference of - 0.86% and - 0.82%, respectively (all P < 0.05). CONCLUSIONS The temporal characteristics and magnitude of changes of choroidal vascularity and choriocapillaris perfusion during near work was not identical between children and adults. The initial response to near work was observed in choriocapillaris in children, whereas it was observed in the medium- and large-sized vessels in adults. TRIAL REGISTRATION Clinical Trial Registry (ChiCTR), ChiCTR2000040205. Registered on 25 November 2020, https://www.chictr.org.cn/bin/project/edit?pid=64501 .
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Affiliation(s)
- Mengqi Liu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yuanyuan Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Haoer Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yunpeng Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Min Ma
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Shihan Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiaohuan Wei
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ruiyan Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ruikang Tian
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiangtian Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China.
| | - Hao Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Zhang Y, Wang D, Lin F, Song Y, Chen Y, Peng Y, Chen M, Liu Y, Jiang J, Yang Z, Li F, Zhang X. Diagnostic performance of wide-field optical coherence tomography angiography in detecting open-angle glaucoma in high myopia. Acta Ophthalmol 2024; 102:e168-e177. [PMID: 38129974 DOI: 10.1111/aos.16603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/28/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To compare the diagnostic performance of the capillary density (CD) of the central 1-6 mm and peripheral 6-12 mm annular regions in detecting open-angle glaucoma in high myopia (HM) using 15 × 12 mm wide-field swept-source optical coherence tomography angiography (WF SS-OCTA). METHODS The study enrolled 206 and 103 eyes with HM and highly myopic open-angle glaucoma (HM-OAG), respectively. WF SS-OCTA images centred on the fovea were obtained to analyse the changes in the CD in the 1-3 mm, 3-6 mm, 6-9 mm, and 9-12 mm annular regions. CD of the superficial capillary plexus (SCP) was measured with the built-in software. The area under the receiver operating characteristic curve (AUROC) of each region was compared. RESULTS The diagnostic performance of the SCP CD in the central 1-6 mm annular region (AUROC = 0.849) was better than that in the peripheral 6-12 mm annular region (AUROC = 0.756, p = 0.001). The annular AUROCs of SCP CD peaked in the 3-6 mm annular region (AUROC = 0.858) and gradually decreased with increasing diameter and were lower than the corresponding AUROCs of the ganglion cell-inner plexiform layer thickness (p < 0.05 for all comparisons). SCP CD of the inferior quadrant in the 3-6 mm annular region had the best diagnostic performance (AUROC = 0.859). CONCLUSION The SCP CD in the central 1-6 mm annular region exhibited better diagnostic performance for the detection of HM-OAG in HM. The assessment of more peripheral regions has no added value in detecting glaucoma in HM.
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Affiliation(s)
- Yinhang Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Deming Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yu Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yuying Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Meiling Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yuhong Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jiaxuan Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zefeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Liu J, Tao W, Li D, Kwapong WR, Cao L, Zhang X, Ye C, Chen S, Liu M. Characterization of retinal microvasculature and structure in atrial fibrillation. Front Cardiovasc Med 2023; 10:1229881. [PMID: 38152608 PMCID: PMC10751341 DOI: 10.3389/fcvm.2023.1229881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/17/2023] [Indexed: 12/29/2023] Open
Abstract
Background and objective Quantitative changes in retinal microvasculature are associated with subclinical cardiac alterations and clinical cardiovascular diseases (i.e., heart failure and coronary artery disease). Nonetheless, very little is known about the retinal vascular and structural changes in patients with atrial fibrillation (AF). Our study aims to characterize the microvasculature and structure of the retina in AF patients and explore their differences in different types of AF (paroxysmal and sustained AF). Methods This cross-sectional study was conducted at the Departments of Neurology and Cardiology in West China Hospital, Chengdu, China. Individuals aged 40 years or older with a diagnosis of AF were eligible for inclusion and underwent an evaluation and diagnosis confirmation before enrollment. Control individuals aged 40 years or older and without a history of AF, ocular abnormalities/disease, or any significant systemic illness were recruited. The retinal vascular and structural parameters were assessed using swept-source optical coherence tomography (SS-OCT)/SS-OCT angiography. Echocardiographic data of left atrium (LA) diameter were collected in patients with AF at the time of inclusion. Results A total of 242 eyes of 125 participants [71 men (56.8%); mean (SD) age, 61.98 (8.73) years] with AF and 219 eyes of 111 control participants [53 men (47.7%); mean (SD) age, 62.31 (6.47) years] were analyzed. In our AF cohort, 71 patients with paroxysmal AF and 54 patients with sustained AF (i.e., persistent/permanent AF) were included. Decreased retinal microvascular perfusion (β coefficient = -0.08; 95% CI, -0.14 to -0.03) and densities (β coefficient = -1.86; 95% CI, -3.11 to -0.60) in superficial vascular plexus (SVC) were found in the eyes of the participants with AF. In regard to retinal structures, thinner ganglion cell-inner plexiform layer (GCIPL; β coefficient = -2.34; 95% CI, -4.32 to -0.36) and retinal nerve fiber layer (RNFL) thicknesses (β coefficient = -0.63; 95% CI, -2.09 to -0.18) were observed in the eyes of the participants with AF. The retinal parameters did not significantly differ between paroxysmal and sustained AF (all P > 0.05). However, significant interactions were observed between LA diameter and AF subtypes with the perfusion and densities in SVC (P < 0.05). Conclusion This study found that individuals with AF had decreased retinal vascular densities and perfusion in SVC, as well as thinner GCIPL and RNFL thickness compared with age- and sex-matched control participants. The differences of the retinal microvasculature in SVC between paroxysmal and sustained AF depend on the LA diameter. Given our findings, further longitudinal studies with our participants are of interest to investigate the natural history of retinal microvascular and structural changes in individuals across the clinical process of AF and AF subtypes.
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Affiliation(s)
- Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dayan Li
- Cardiac Ultrasound Office, Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Le Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoling Zhang
- Cardiac Ultrasound Office, Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Heitmar R, Link D, Kotliar K, Schmidl D, Klee S. Editorial: Functional assessments of the ocular circulation. Front Med (Lausanne) 2023; 10:1222022. [PMID: 37359007 PMCID: PMC10285660 DOI: 10.3389/fmed.2023.1222022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Rebekka Heitmar
- Centre for Vision Across the Lifespan, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Dietmar Link
- Division Optoelectrophysiological Engineering, Department of Computer Science and Automation, Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Konstantin Kotliar
- Medical Engineering and Technomathematics, Aachen University of Applied Sciences, Aachen, Germany
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Sascha Klee
- Division Optoelectrophysiological Engineering, Department of Computer Science and Automation, Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
- Division Biostatistics and Data Science, Department General Health Studies, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
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Wu H, Peng T, Zhou W, Huang Z, Li H, Wang T, Zhang J, Zhang K, Li H, Zhao Y, Qu J, Lu F, Zhou X, Jiang J. Choroidal vasculature act as predictive biomarkers of long-term ocular elongation in myopic children treated with orthokeratology: a prospective cohort study. EYE AND VISION (LONDON, ENGLAND) 2023; 10:27. [PMID: 37280689 DOI: 10.1186/s40662-023-00345-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Despite receiving orthokeratology (ortho-k), the efficacy of retarding ocular elongation during myopia varies among myopic children. The current study aimed to investigate the early changes of choroidal vasculature at one month after ortho-k treatment and its association with one-year ocular elongation, as well as the role of such choroidal responses in predicting the one-year control efficacy of ortho-k treatment. METHODS A prospective cohort study was conducted in myopic children treated with ortho-k. Myopic children aged between 8 and 12 years who were willing to wear ortho-k lenses were recruited consecutively from the Eye Hospital of Wenzhou Medical University. Subfoveal choroidal thickness (SFCT), submacular total choroidal luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow deficit (CcFD) were evaluated by optical coherence tomography (OCT) and OCT angiography over a one-year period. RESULTS Fifty eyes from 50 participants (24 males) who finished one-year follow-ups as scheduled were included, with a mean age of 10.31 ± 1.45 years. The one-year ocular elongation was 0.19 ± 0.17 mm. The LA (0.03 ± 0.07 mm2), SA (0.02 ± 0.05 mm2) increased proportionally after one-month of ortho-k wear (both P < 0.01), as did the SFCT (10.62 ± 19.98 μm, P < 0.001). Multivariable linear regression analyses showed that baseline CVI (β = - 0.023 mm/1%, 95% CI: - 0.036 to - 0.010), one-month LA change (β = - 0.009 mm/0.01 mm2, 95% CI: - 0.014 to - 0.003), one-month SFCT change (β = - 0.035 mm/10 µm, 95% CI: - 0.053 to - 0.017) were independently associated with one-year ocular elongation during ortho-k treatment after adjusting with age and sex (all P < 0.01). The area under the receiver operating characteristic curve of prediction model including baseline CVI, one-month SFCT change, age, and sex achieved 0.872 (95% CI: 0.771 to 0.973) for discriminating children with slow or fast ocular elongation. CONCLUSIONS Choroidal vasculature is associated with ocular elongation during ortho-k treatment. Ortho-k treatment induces increases in choroidal vascularity and choroidal thickness as early as one month. Such early changes can act as predictive biomarkers of myopia control efficacy over a long term. The utilization of these biomarkers may help clinicians identify children who can benefit from ortho-k treatment, and thus has critical implications for the management strategies towards myopia control.
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Affiliation(s)
- Hao Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Tianli Peng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Weihe Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Zihan Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Hongyu Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Tengfei Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jingwei Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Kou Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Haoer Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yunpeng Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jia Qu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China
| | - Fan Lu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China
| | - Xiangtian Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China.
| | - Jun Jiang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Zheng F, Deng X, Zhang Q, He J, Ye P, Liu S, Li P, Zhou J, Fang X. Advances in swept-source optical coherence tomography and optical coherence tomography angiography. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2023; 3:67-79. [PMID: 37846376 PMCID: PMC10577875 DOI: 10.1016/j.aopr.2022.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 10/18/2023]
Abstract
Background The fast development of swept-source optical coherence tomography (SS-OCT) and swept-source optical coherence tomography angiography (SS-OCTA) enables both anterior and posterior imaging of the eye. These techniques have evolved from a research tool to an essential clinical imaging modality. Main text The longer wavelength and faster speed of SS-OCT and SS-OCTA facilitate better visualization of structure and vasculature below pigmented tissue with a larger field of view of the posterior segment and 360-degree visualization of the anterior segment. In the past 10 years, algorithms dealing with OCT and OCTA data also vastly improved the image quality and enabled the automated quantification of OCT- and OCTA-derived metrics. This technology has enriched our current understanding of healthy and diseased eyes. Even though the high cost of the systems currently limited the widespread use of SS-OCT and SS-OCTA at the first beginning, the gap between research and clinic practice got obviously shortened in the past few years. Conclusions SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift toward more widespread adoption of new imaging technology in clinical practice.
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Affiliation(s)
- Fang Zheng
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofeng Deng
- State Key Lab of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, China
| | - Qi Zhang
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jingliang He
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Panpan Ye
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Shan Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Li
- State Key Lab of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, China
| | - Jian Zhou
- TowardPi (Beijing) Medical Technology Ltd, Shanghai, China
| | - Xiaoyun Fang
- Eye Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
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Richter GM, Lee JC, Khan N, Vorperian A, Hand B, Burkemper B, Zhou X, Chu Z, Wang R, Varma R, Kashani AH. Ocular and systemic determinants of perifoveal and macular vessel parameters in healthy African Americans. Br J Ophthalmol 2023; 107:540-546. [PMID: 34740885 DOI: 10.1136/bjophthalmol-2021-319675] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/18/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To determine the relationship of various systemic and ocular characteristics with perifoveal and macular vessel density in healthy African American eyes. DESIGN A population-based cross-sectional study of prospectively recruited African Americans ≥40 years of age. Participants underwent 3×3 mm and 6×6 mm macula scans using spectral-domain optical coherence tomography angiography (OCTA), clinical examinations and clinical questionnaires. Participants with glaucoma, severe non-proliferative diabetic retinopathy, proliferative diabetic retinopathy and macular oedema were excluded. Custom MATLAB based software quantified vessel area density (VAD) and vessel skeleton density (VSD) in the superficial retinal layer of the macula. Multivariable regression analysis, controlling for inter-eye correlation, was performed to determine systemic and ocular determinants of macular vessel metrics using stepwise selection. Candidate variables included: age, gender, body mass index, history of smoking, history of diabetes, diabetes duration, history of stroke or brain haemorrhage, systolic blood pressure, diastolic blood pressure (DBP), pulse pressure, mean arterial pressure, central subfield thickness (CSFT), visual field mean deviation, intraocular pressure, axial length (AL), mean ocular perfusion pressure and signal strength (SS). RESULTS A total of 2221 OCTA imaged eyes from 1472 participants were included in this study. Reduced perifoveal and macular VAD and VSD were independently associated with longer AL, reduced SS, reduced CSFT and older age. Male gender and lower DBP were also associated with reduced perifoveal and macular VSD. CONCLUSIONS When interpreting OCTA images in a clinical setting, it is important to consider the effects ocular and systemic characteristics may have on the macular microcirculation.
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Affiliation(s)
- Grace M Richter
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jae Chang Lee
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nasir Khan
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Alexander Vorperian
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Brennan Hand
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Bruce Burkemper
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Xiao Zhou
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Zhongdi Chu
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Ruikang Wang
- Bioengineering, University of Washington, Seattle, Washington, USA
| | - Rohit Varma
- Southern California Eye Institute, Los Angeles, California, USA
| | - Amir H Kashani
- Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland, USA
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9
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Moon JY, Garg I, Cui Y, Katz R, Zhu Y, Le R, Lu Y, Lu ES, Ludwig CA, Elze T, Wu DM, Eliott D, Miller JW, Kim LA, Husain D, Vavvas DG, Miller JB. Wide-field swept-source optical coherence tomography angiography in the assessment of retinal microvasculature and choroidal thickness in patients with myopia. Br J Ophthalmol 2023; 107:102-108. [PMID: 34385166 DOI: 10.1136/bjophthalmol-2021-319540] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIMS Pathological myopia (PM) is a leading cause of blindness worldwide. We aimed to evaluate microvascular and chorioretinal changes in different stages of myopia with wide-field (WF) swept-source (SS) optical coherence tomography angiography (OCTA). METHODS This prospective cross-sectional observational study included 186 eyes of 122 patients who had undergone imaging between November 2018 and October 2020. Vessel density (VD) and vessel skeletonised density (VSD) of superficial capillary plexus, deep capillary plexus and whole retina, as well as foveal avascular zone parameters, retinal thickness (RT) and choroidal thickness (CT), were calculated. RESULTS This study evaluated 75 eyes of 48 patients with high myopia (HM), 43 eyes of 31 patients with mild to moderate myopia and 68 eyes of 53 age-matched controls. Controlling for age and the presence of systemic hypertension, we found that HM was associated with decrease in VD and VSD in all layers on 12×12 mm² scans. Furthermore, HM was associated with a VD and VSD decrease in every Early Treatment Diabetic Retinopathy Study grid, with a larger decrease temporally (βVD=-0.39, βVSD=-10.25, p<0.01). HM was associated with decreased RT and CT. Reduction in RT was outside the macular region, while reduction in CT was in the macular region. CONCLUSION Using WF SS-OCTA, we identified reduction in microvasculature and structural changes associated with myopia. Decrease in VD and VSD was greater in the temporal quadrant, and reductions in RT and CT were uneven across the retina. Further work may help identify risk factors for the progression of PM and associated vision-threatening complications.
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Affiliation(s)
- Jade Y Moon
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Itika Garg
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Ying Cui
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Raviv Katz
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Ying Zhu
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Rongrong Le
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
- Wenzhou Medical University affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yifan Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Edward S Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Cassie A Ludwig
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
| | - David M Wu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Dean Eliott
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Joan W Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
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10
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Cheng W, Song Y, Gao X, Lin F, Li F, Wang P, Hu K, Li H, Li Y, Chen L, Jonas JB, Wang W, Zhang X. Axial Length and Choriocapillaris Flow Deficits in Non-pathological High Myopia. Am J Ophthalmol 2022; 244:68-78. [PMID: 35970207 DOI: 10.1016/j.ajo.2022.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To examine the relationship between axial length (AL) and choriocapillaris (CC) flow deficits percentage (FD%) in non-pathological highly myopic eyes. DESIGN Prospective cross-sectional study. METHODS This study included Chinese patients with non-pathological high myopia, which was defined by an AL of > 26 mm and a META-PM classification grade of <2. Swept-source optical coherence tomography angiography was used to obtain 6 × 6 mm images of the macular CC. The CC FD% was measured in the fovea, parafovea, and perifovea subfields. RESULTS A total of 1017 individuals (1017 eyes) with a mean age of 35.95 ± 14.11 years were included. After adjusting for age, sex, intraocular pressure, body mass index, systolic blood pressure, and image quality score, the overall CC FD% increased by 0.27% (95% CI 0.02, 0.52; P = .034) for each mm increase in AL. Among subfields, longer AL was associated with a higher CC FD% in the perifovea (β = 0.53, 95% CI 0.30, 0.77; P < .001), and was not associated with a higher CC FD% in the parafovea (β = 0.08, 95% CI -0.26, 0.42; P = .652) and fovea (β = 0.001, 95% CI -0.50, 0.50; P = .999). CONCLUSIONS The CC FD% increased with a longer AL in high myopia in the perifovea region but not in the fovea and parafovea fields. These findings may be of interest in elucidating the etiology of myopic axial elongation.
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Affiliation(s)
- Weijing Cheng
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Yunhe Song
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Xinbo Gao
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Fengbin Lin
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Fei Li
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Peiyuan Wang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Kun Hu
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z)
| | - Hao Li
- Ophthalmology Department, Guizhou Provincial People's Hospital, Guiyang, China (H.L)
| | - Yingjie Li
- Department of Ophthalmology, The First Hospital of Nanchang City, Nanchang, China (Y.L)
| | - Lina Chen
- Department of Ophthalmology, The People's Third Hospital of Dalian, Dalian Medical University, Dalian, China (L.C)
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany (J.B.J); Institute of Molecular and Clinical Ophthalmology Basel, Switzerland (J.B.J)
| | - Wei Wang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z).
| | - Xiulan Zhang
- From State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (W.C, Y.S, X.G, F.L, F.L, P.W, K.H, W.W, X.Z).
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11
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Analysis of White and Dark without Pressure in a Young Myopic Group Based on Ultra-Wide Swept-Source Optical Coherence Tomography Angiography. J Clin Med 2022; 11:jcm11164830. [PMID: 36013068 PMCID: PMC9410463 DOI: 10.3390/jcm11164830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose: This study aimed to investigate the incidence of white without pressure (WWOP) and dark without pressure (DWOP) in a young myopic group based on multimode imaging and to explore the quantitative changes in DWOP based on ultra-wide swept-source optical coherence tomography angiography (SS-OCTA). Methods: A total of 138 patients with high myopia (SE < −6.00 D) were recruited. Examinations, including indirect ophthalmoscope, ultra-wide color fundus photograph, and ultra-wide SS-OCTA, were conducted for each eye. A total of 50 of the 138 patients were selected for further analysis since their DWOP lesions in SS-OCTA could be well quantified. Results: The incidence rates of WWOP and DWOP in the young myopic group were 35.24% and 29.96%, respectively. The patients with a lower spherical equivalent (SE) showed a tendency to have a higher axial length (AL) and higher prevalence of WWOP. Multivariate regression analysis illustrated that a more serious SE and a longer AL were risk factors for both WWOP and DWOP. Eyes with DWOP lesions had lower vessel density (VD) in the whole retina (p < 0.001) and a deep vascular complex (DVC) (p < 0.001), and lower thickness of the outer retina (p < 0.001) compared with healthy counterparts. Conclusion: Ultra-wide SS-OCTA provided new insights into myopic-related peripheral retinal degenerations. DWOP was characterized by thinning of the outer retina and lower perfusion in DVC.
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12
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Li Y, Zheng F, Foo LL, Wong QY, Ting D, Hoang QV, Chong R, Ang M, Wong CW. Advances in OCT Imaging in Myopia and Pathologic Myopia. Diagnostics (Basel) 2022; 12:diagnostics12061418. [PMID: 35741230 PMCID: PMC9221645 DOI: 10.3390/diagnostics12061418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Advances in imaging with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) technology, including the development of swept source OCT/OCTA, widefield or ultra-widefield systems, have greatly improved the understanding, diagnosis, and treatment of myopia and myopia-related complications. Anterior segment OCT is useful for imaging the anterior segment of myopes, providing the basis for implantable collamer lens optimization, or detecting intraocular lens decentration in high myopic patients. OCT has enhanced imaging of vitreous properties, and measurement of choroidal thickness in myopic eyes. Widefield OCT systems have greatly improved the visualization of peripheral retinal lesions and have enabled the evaluation of wide staphyloma and ocular curvature. Based on OCT imaging, a new classification system and guidelines for the management of myopic traction maculopathy have been proposed; different dome-shaped macula morphologies have been described; and myopia-related abnormalities in the optic nerve and peripapillary region have been demonstrated. OCTA can quantitatively evaluate the retinal microvasculature and choriocapillaris, which is useful for the early detection of myopic choroidal neovascularization and the evaluation of anti-vascular endothelial growth factor therapy in these patients. In addition, the application of artificial intelligence in OCT/OCTA imaging in myopia has achieved promising results.
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Affiliation(s)
- Yong Li
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Feihui Zheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
| | - Li Lian Foo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Qiu Ying Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
| | - Daniel Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Quan V. Hoang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Ophthalmology, Columbia University, New York, NY 10027, USA
| | - Rachel Chong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Correspondence:
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13
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Tan Q, Zhu M, Du F, Jiang X, Huang X, Chen J, Peng H, Wang D. Changes in Retinal Vessel Flow after Small Incision Lenticule Extraction. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8437066. [PMID: 35309847 PMCID: PMC8926514 DOI: 10.1155/2022/8437066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 11/18/2022]
Abstract
Objective In order to analyze changes in retinal vessel flow after small incision lenticule extraction (SMILE). Methods A total of 32 patients (62 eyes) who underwent SMILE were enrolled in this prospective study. Optical parameters, including vessel density (VD), and perfusion density (PD) of foveal, parafoveal, and perifoveal regions, respectively, were measured before surgery and at 1 day, 1 week, 1 month, and 3 months postoperation. Preoperative parameters and surgical parameters were recorded. Results Significant decreases in VD and PD on postoperative day 1 were detected in all quadrants, both in 3 mm and in 6 mm regions (P < 0.001). One month after surgery, VD returned to preoperative levels. None of the preoperative and surgical parameters were significantly correlated with the VD and PD fluctuations (all P > 0.05). Conclusion. VD may decrease significantly with regional disparity 1 day after SMILE while recovering at 1 month. Elevation of intraocular pressure due to suction may account for such changes.
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Affiliation(s)
- Qian Tan
- Department of Ophthalmology, Shenzhen People's Hospital, Shenzhen 518000, China
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Minyi Zhu
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Fangfang Du
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Xianming Jiang
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Xiaoshan Huang
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Jingfang Chen
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Hongjun Peng
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
| | - Danyang Wang
- Department of Ophthalmology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, China
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14
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Cheng W, Song Y, Lin F, Jin L, Wang Z, Jonas JB, Wang W, Zhang X. Choriocapillaris Flow Deficits in Normal Chinese Imaged by Swept-Source Optical Coherence Tomographic Angiography. Am J Ophthalmol 2022; 235:143-153. [PMID: 34582767 DOI: 10.1016/j.ajo.2021.09.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the ocular and systemic determinants of the choriocapillaris flow deficits percentage (CC FD%) in normal eyes. DESIGN Observational cross-sectional study. METHODS Healthy Chinese participants without ocular or systemic diseases underwent detailed ophthalmic evaluations, including swept-source optical coherence tomography angiography (SS-OCTA) with 6- × 6-mm macular choriocapillaris images. The CC FD% was assessed in circular regions with diameters of 1.0 and 5.0 mm, rings with 1.0- to 2.5-mm diameters, and rings with 2.5- to 5.0-mm diameters. RESULTS The study included 830 individuals (mean ± SD age 58.66 ± 8.75 years). CC FD% (mean ± SD 22.05% ± 1.13%) was the lowest in the 2.5- to 5.0-mm ring, followed by the 1.0- to 2.5-mm ring, and highest in the 1.0-mm circle. In multivariable analysis, a higher CC FD% was associated with older age (β = 0.16 [95% confidence interval {CI}] 0.08-0.24, P < .001), higher intraocular pressure (β = 0.34 [95% CI 0.25-0.42], P < .001), higher serum concentrations of high-density lipoprotein cholesterol (β = 0.24 [95% CI 0.17-0.32], P < .001), and lower image quality score (β = -0.22 [95% CI -0.30 to -0.14], P < .001). CC FD% was also independent of axial length. CONCLUSIONS In healthy adult Chinese individuals, a higher CC FD% was associated with older age, higher intraocular pressure, and higher high-density lipoprotein cholesterol serum concentration. These factors may influence clinical assessments of the choriocapillaris. The lack of an association between CC FD% and axial length is consistent with similar findings for Bruch membrane thickness, macular retinal thickness, and macular retinal pigment epithelium cell density.
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Affiliation(s)
- Weijing Cheng
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunhe Song
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fengbin Lin
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ling Jin
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhenyu Wang
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jost B Jonas
- and the Department of Ophthalmology (J.B.J.), Medical Faculty Mannheim, Heidelberg University, Germany
| | - Wei Wang
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Xiulan Zhang
- From the State Key Laboratory of Ophthalmology (W.C., Y.S., F.L., L.J., Z.W., W.W., X.Z.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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15
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Li J, Zhou H, Feinstein M, Wong J, Wang RK, Chan L, Dai Y, Porco T, Duncan JL, Schwartz DM. Choriocapillaris Changes in Myopic Macular Degeneration. Transl Vis Sci Technol 2022; 11:37. [PMID: 35201337 PMCID: PMC8883151 DOI: 10.1167/tvst.11.2.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Myopic macular degeneration (MMD) can cause irreversible vision loss. Thinner choroid is associated with increased MMD severity. This cross-sectional study analyzed choriocapillaris (CC) alterations in MMD. Methods Axial length (AL), best-corrected visual acuity (BCVA), fundus photography, and swept-source optical coherence tomography angiography (SS-OCTA) were assessed in controls and high myopes (spherical equivalent ≤ −6 diopters). Myopic patients with grade 2 MMD (macular diffuse chorioretinal atrophy [MDCA]), high axial myopia (AL ≥ 26.5 mm), and BCVA ≥ 20/40 were compared with controls without MMD. CC mean thickness was measured from 3 × 3-mm SS-OCTA scans by identifying CC peaks in A-scan intensity profiles. CC flow deficit percent (CC FD%) was quantified using a fuzzy C-mean local thresholding method on en face OCTA images. Multivariate regressions compared CC thickness and CC FD% between myopic patients and controls, correcting for age and other confounders. Results Sixteen eyes with MDCA (AL, 26.96–33.93 mm; ages, 40–78 years) were compared with 51 control eyes (AL, 21.65–25.84 mm; ages, 19–88 years). CC thickness in patients with MDCA was 66% lower than that in controls (5.23 ± 0.68 µm [mean ± SD] vs. 15.46 ± 1.82 µm; P < 0.001). CC FD% in patients with MDCA was 237% greater than in controls (26.5 ± 4.3 vs. 11.2 ± 4.6; P < 0.001). Conclusions Patients with MDCA with good visual acuity had thinner CC and increased CC FD%, or reduced CC flow, compared with controls. Patients with grade 2 MMD and good visual acuity demonstrated significant choriocapillaris alterations, suggesting that choriocapillaris perfusion defects contribute to the pathogenesis of MMD. Translational Relevance Given the potential vascular etiology for MMD, current research about revascularization of ischemic retina likely has implications for the treatment of MMD.
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Affiliation(s)
- Jonathan Li
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Singapore National Eye Centre, Singapore
| | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Max Feinstein
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jessica Wong
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Lawrence Chan
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Yining Dai
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Travis Porco
- Department of Ophthalmology, University of California, San Francisco, CA, USA.,Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Jacque L Duncan
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Daniel M Schwartz
- Department of Ophthalmology, University of California, San Francisco, CA, USA
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16
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Lal B, Alonso-Caneiro D, Read SA, Carkeet A. Induced Refractive Error Changes the Optical Coherence Tomography Angiography Transverse Magnification and Vascular Indices. Am J Ophthalmol 2021; 229:230-241. [PMID: 33905748 DOI: 10.1016/j.ajo.2021.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the effect of changing anterior eye refractive power with contact lenses on the transverse magnification of en face images and associated vascular indices from optical coherence tomographic angiography (OCT-A). DESIGN Prospective crossover study. METHODS Spherical soft contact lenses (-6 diopter [D] to +6 D in 2 D steps) were used to induce anterior eye refractive power changes in 11 healthy young adults and 3 × 3-mm macular scans were captured using OCT-A (Zeiss AngioPlex, software version 11.0; Cirrus HD-OCT 5000, Carl Zeiss Meditec Inc). Image transverse magnification was predicted based on refraction and biometry measurements and compared with empirical changes in the en face images measured with image analysis. Linear regression analysis was performed to assess the relationship between induced refractive ametropia and foveal avascular zone (FAZ) area, perimeter, circularity, and vessel density and perfusion density. RESULTS The predicted transverse magnification was linearly related to induced refractive ametropia and to the empirical transverse magnification changes (average slope: 1.02, 95% CI: 0.90-1.34). All the OCT-A indices showed linear relationships with induced refractive ametropia (P < .05) with the 12 D tested range altering the indices by 7% to 12%. After correcting for transverse magnification, all OCT-A indices except FAZ area were linearly related to induced refractive ametropia (P < .05) and were reduced to 1% to 9%. CONCLUSIONS This study is the first to show that induced refractive ametropia can affect OCT-A image magnification and indices. These changes are clinically important and need to be considered along with biometry effects when interpreting OCT-A indices. Transverse magnification changes can affect the ability of OCT-A to precisely measure linear dimensions of blood vessels.
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Affiliation(s)
- Barsha Lal
- From the School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia.
| | - David Alonso-Caneiro
- From the School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
| | - Scott A Read
- From the School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
| | - Andrew Carkeet
- From the School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland, Australia
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17
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Saxena A, Yao X, Wong D, Chua J, Ang M, Hoang QV, Agrawal R, Girard M, Cheung G, Schmetterer L, Tan B. Framework for quantitative three-dimensional choroidal vasculature analysis using optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2021; 12:4982-4996. [PMID: 34513237 PMCID: PMC8407849 DOI: 10.1364/boe.426093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 05/25/2023]
Abstract
Choroidal vasculature plays an important role in the pathogenesis of retinal diseases, such as myopic maculopathy, age-related macular degeneration, diabetic retinopathy, central serous chorioretinopathy, and ocular inflammatory diseases. Current optical coherence tomography (OCT) technology provides three-dimensional visualization of the choroidal angioarchitecture; however, quantitative measures remain challenging. Here, we propose and validate a framework to segment and quantify the choroidal vasculature from a prototype swept-source OCT (PLEX Elite 9000, Carl Zeiss Meditec, USA) using a 3×3 mm scan protocol centered on the macula. Enface images referenced from the retinal pigment epithelium were reconstructed from the volumetric data. The boundaries of the choroidal volume were automatically identified by tracking the choroidal vessel feature structure over the depth, and a selective sliding window was applied for segmenting the vessels adaptively from attenuation-corrected enface images. We achieved a segmentation accuracy of 96% ± 1% as compared with manual annotation, and a dice coefficient of 0.83 ± 0.04 for repeatability. Using this framework on both control (0.00 D to -2.00 D) and highly myopic (-8.00 D to -11.00 D) eyes, we report a decrease in choroidal vessel volume (p<0.001) in eyes with high myopia.
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Affiliation(s)
- Ashish Saxena
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
| | - Quan V. Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Rupesh Agrawal
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Michael Girard
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Institute of Molecular and Clinical Ophthalmology, 4031 Basel, Switzerland
| | - Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- NTU Institute for Health Technologies, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4031 Basel, Switzerland
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
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18
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Wu H, Xie Z, Wang P, Liu M, Wang Y, Zhu J, Chen X, Xu Z, Mao X, Zhou X. Differences in Retinal and Choroidal Vasculature and Perfusion Related to Axial Length in Pediatric Anisomyopes. Invest Ophthalmol Vis Sci 2021; 62:40. [PMID: 34319397 PMCID: PMC8322721 DOI: 10.1167/iovs.62.9.40] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the interocular differences in choroidal vasculature, choriocapillaris perfusion, and retinal microvascular network, and to explore their associations with interocular asymmetry in axial lengths (ALs) in children with anisomyopia. Methods Refractive error, AL, and other biometric parameters were measured in 70 children with anisomyopia. Using optical coherence tomography (OCT) and OCT-angiography, we measured the submacular choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), stromal area (SA), choroidal vascularity index (CVI), choriocapillaris flow deficit (CcFD), retinal vessel density (VD), and foveal avascular zone (FAZ) area. Results The mean interocular differences in spherical equivalent refraction and AL were −2.26 ± 0.94 diopters and 0.95 ± 0.46 mm, respectively. Submacular ChT, TCA, LA, SA, and CVI were all significantly lower in the more myopic (longer AL) eyes than in the less myopic (shorter AL) fellow eyes. In eyes with longer ALs, both the CcFD and FAZ areas were significantly greater, whereas the superficial and deep retinal VDs were significantly less. After adjusting for corneal power and intraocular pressure, interocular differences in LA (β = −0.774), SA (β = −0.991), and CcFD (β = 0.040) were significantly associated with interocular asymmetry in AL (all P < 0.05). Conclusions In pediatric anisomyopes, eyes with longer ALs tended to have lower choroidal vascularity and choriocapillaris perfusion than the contralateral eyes with shorter ALs. Longitudinal investigations would be useful follow-ups to test for a causal role of choroidal circulation in human myopia.
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Affiliation(s)
- Hao Wu
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Zhu Xie
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Pengqi Wang
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Mengqi Liu
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yuanyuan Wang
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jiadi Zhu
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Xiangqin Chen
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Zhiqiang Xu
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Xinjie Mao
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Xiangtian Zhou
- Eye Hospital and School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China.,State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.,Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang, China
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