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DuPont M, Arthur E, Shihab Y, Kenny M, Ravichandran S, Parsons-Wingerter P, Vyas R, Murray MC, Predovic M, Lim S, Jacobs N, Ramesh S, Vu A, Sekaran S, Chalam KV, Moorthy RS, Crosson J, Mason J, Grant MB. Use of VESsel GENeration with Optical Coherence Tomography Angiography and Fluorescein Angiography for Detection and Quantification of Vascular Changes in Mild and Moderate Diabetic Retinopathy. Life (Basel) 2024; 14:893. [PMID: 39063646 PMCID: PMC11277959 DOI: 10.3390/life14070893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Previously, VESsel GENeration (VESGEN) software was used to map and quantify vascular changes observed on fluorescein angiography (FA) in subjects (n = 15 eyes) with retinal pathology ranging from mild non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR). In the current study, we used VESGEN for the assessment of individuals with early-stage NPDR imaged by FA (Cohort 1) and by optical coherence tomography angiography (OCTA; Cohort 2). (2) Methods: Cohort 1 included type 2 diabetics (T2D), represented 21 eyes (ranging from no DR to moderate DR), and also included nondiabetic controls (NDC; n = 15 eyes). Cohort 2 consisted of 23 eyes from T2D subjects (including no DR subjects and moderate DR subjects) and NDC (n = 18 eyes). (3) Results: In the FA-VESGEN study, total tortuosity (Tv) of microvessels (G ≥ 6) increased in T2D with mild DR compared to the controls. In contrast, the VESGEN analysis of OCTA images showed that vessel length (characterized as density) was lower in T2D subjects before the diagnosis of DR and following the diagnosis of DR when compared to the controls. Additionally, T2D showed a significant decrease in vessel area (density). (4) Conclusions: FA elucidated the vessel morphology of small-generation microvessels to a greater degree than OCTA; however, OCTA identified changes in vessel density better than FA. VESGEN analysis can be used with both standard FA and OCTA to facilitate our understanding of early events in DR, including before the clinical diagnosis of DR.
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Affiliation(s)
- Mariana DuPont
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Department of Hematology-Oncology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Edmund Arthur
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.A.); (M.K.); (S.R.)
| | - Yazen Shihab
- Birmingham School of Medicine, University of Alabama, Birmingham, AL 35233, USA;
| | - Madelyn Kenny
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.A.); (M.K.); (S.R.)
| | - Swetha Ravichandran
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.A.); (M.K.); (S.R.)
| | | | - Ruchi Vyas
- Mori Associates, Ames Research Center, National Aeronautics and Space Administration (NASA), Moffett Field, CA 94035, USA;
| | - Matthew C. Murray
- Blue Marble Space Institute of Science, Ames Research Center, NASA, Moffett Field, CA 94035, USA; (M.C.M.); (M.P.); (S.L.); (N.J.); (S.R.); (A.V.); (S.S.)
| | - Marina Predovic
- Blue Marble Space Institute of Science, Ames Research Center, NASA, Moffett Field, CA 94035, USA; (M.C.M.); (M.P.); (S.L.); (N.J.); (S.R.); (A.V.); (S.S.)
| | - Shiyin Lim
- Blue Marble Space Institute of Science, Ames Research Center, NASA, Moffett Field, CA 94035, USA; (M.C.M.); (M.P.); (S.L.); (N.J.); (S.R.); (A.V.); (S.S.)
| | - Nicole Jacobs
- Blue Marble Space Institute of Science, Ames Research Center, NASA, Moffett Field, CA 94035, USA; (M.C.M.); (M.P.); (S.L.); (N.J.); (S.R.); (A.V.); (S.S.)
| | - Sneha Ramesh
- Blue Marble Space Institute of Science, Ames Research Center, NASA, Moffett Field, CA 94035, USA; (M.C.M.); (M.P.); (S.L.); (N.J.); (S.R.); (A.V.); (S.S.)
| | - Amanda Vu
- Blue Marble Space Institute of Science, Ames Research Center, NASA, Moffett Field, CA 94035, USA; (M.C.M.); (M.P.); (S.L.); (N.J.); (S.R.); (A.V.); (S.S.)
| | - Srinivaas Sekaran
- Blue Marble Space Institute of Science, Ames Research Center, NASA, Moffett Field, CA 94035, USA; (M.C.M.); (M.P.); (S.L.); (N.J.); (S.R.); (A.V.); (S.S.)
| | - Kakarla V. Chalam
- Department of Ophthalmology, Loma Linda University Health Care, Loma Linda, CA 92354, USA;
| | - Ramana S. Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Indianapolis, IN 46290, USA;
| | - Jason Crosson
- Retina Consultants of Alabama Birmingham, Birmingham, AL 35233, USA; (J.C.); (J.M.)
| | - John Mason
- Retina Consultants of Alabama Birmingham, Birmingham, AL 35233, USA; (J.C.); (J.M.)
| | - Maria B. Grant
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
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2
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Yuan M, Long Q, Sun X. OCTA-based research on changes of retinal microcirculation in digestive tract malignancy. Photodiagnosis Photodyn Ther 2024; 49:104270. [PMID: 39002834 DOI: 10.1016/j.pdpdt.2024.104270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE This cross-sectional study measured retinal vessel density (VD) in patients with digestive tract malignancy by optical coherence tomography angiography (OCTA), and compared them with healthy controls to explore the retinal microcirculation changes in patients with digestive tract malignancy. METHODS 106 eligible participants were divided into three groups: gastric cancer (GC) group (36 individuals), colorectal cancer (CRC) group (34 individuals), and healthy control group (36 individuals). Angio 6 × 6 512 × 512 R4 and ONH Angio 6 × 6 512 × 512 R4 modes were performed to collect retinal vessel density data centered on fovea and papillary, respectively. The retina was automatically segmented into different layers (superficial vascular plexus (SVP), the inner retinal layer, radial peripapillary capillary plexus (RPCP), deep vascular plexus (DVP)) and areas to analyze. RESULTS At the optic nerve head (ONH) region, the VD of the inner retinal layer increased in both GC and CRC groups in all quadrants and areas. In the papillary area, VD in the inner retinal layer, SVP, and RPCP increased in the GC and CRC groups. In the parapapillary area, VD in the inner retinal layer increased in the GC and the CRC groups. Significant increase in the global VD were found in the GC group of the RPCP and SVP. Regarding the macular region, no statistical differences were observed in each layer. CONCLUSIONS The study suggested that retinal vessel density changed in patients with digestive tract malignancy, especially in the inner retinal layer of the ONH region, revealing the potential relevance of the relation between gastrointestinal cancer and retinal microcirculation.
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Affiliation(s)
- Mingzhu Yuan
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Qi Long
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Xufang Sun
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China.
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Sagar P, Divya P, Biswal S, Kakunje C, Pradeep BC, Ravishankar HN. Evaluation of agreement in macular vascular density measured by different protocols: 4.5 mm × 4.5 mm and 6 mm × 6 mm. Indian J Ophthalmol 2024; 72:864-868. [PMID: 38454875 PMCID: PMC11232854 DOI: 10.4103/ijo.ijo_2187_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/23/2023] [Accepted: 11/05/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To evaluate the agreement in the macular vascular density (MVD) measured by two protocols: 4.5 mm × 4.5 mm and 6 mm × 6 mm. DESIGN Cross-sectional observational study. METHODS Healthy volunteers between the age group of 19 and 39 years were recruited. Topcon DRI OCT Triton plus (Topcon Corporation, Tokyo, Japan) was used to acquire the fovea-centered optical coherence tomography angiography (OCTA) image using two protocols: 4.5 mm × 4.5 mm and 6 mm × 6 mm. MVD was measured by the manufacturer software in the superficial capillary plexus slab in five regions: central, superior, nasal, inferior, and temporal subfields of early treatment diabetic retinopathy study grid in each protocol. RESULTS The study included 79 eyes of 40 healthy volunteers. The difference in the mean MVD between two protocols was 3.84% in right eye and 4.2% in left eye in central subfield, 0.93% in right eye and 1.13% in left eye in superior subfield, 0.06% in right eye and 1.45% in left eye in nasal subfield, 1.65% in right eye and 0.7% in left eye in inferior subfield, 0.4% in right eye and 0.54% in left eye in temporal subfield. The measurements were significantly higher in 6 mm × 6 mm in central subfield in both the eyes and in nasal field in the left eye. Whereas, the measurements were significantly higher in 4.5 mm × 4.5 mm in superior and inferior subfield in both the eyes and in temporal subfield in the left eye. CONCLUSION The protocols should not be used interchangeably and it is necessary to include recommendation of the field of view to measure MVD while standardizing OCTA reporting.
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Affiliation(s)
- Pradeep Sagar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Pagidimarri Divya
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Suchitra Biswal
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Chaithra Kakunje
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - BC Pradeep
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - HN Ravishankar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
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4
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El Sawy S, Bekhit M, Abdelhamid A, Esmat S, Ashraf H, Naguib M. Assessment of early macular microangiopathy in subjects with prediabetes using optical coherence tomography angiography and fundus photography. Acta Diabetol 2024; 61:69-77. [PMID: 37689606 PMCID: PMC10806077 DOI: 10.1007/s00592-023-02167-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
AIMS Early detection of retinal microangiopathy in patients with prediabetes may reduce diabetic retinopathy complications. The aim of this study was to assess early macular vascular changes in prediabetics before development of over diabetes using OCTA and fundus photography. METHODS In this cross-sectional study, 66 prediabetic individuals and 66 normal controls underwent clinical, laboratory, and fundus photography evaluation followed by OCTA macular imaging to examine for the foveal avascular zone, and area of capillary non-perfusion, thickness, disorganization of vessels, and vessel density perfusion percentage of superficial capillary plexus and deep capillary plexus. RESULTS Retinal microangiopathy was detected in 36.4% of prediabetics by OCTA and only in 10.6% by fundus photography. None of clinical or laboratory parameters had significant association with DR. Area of capillary non-perfusion and disorganization of SCP were detected in 53.8% and 56.8%, respectively, in prediabetics. VDP of SCP and DCP of whole image, parafoveal, and perifoveal areas was significantly lower in prediabetes group compared to normal control. VDP of DCP of perifoveal area (β coefficient: - 0.10, OR: 0.91, 95% CI: 0.86-0.96, P < 0.001) and disorganization of DCP (β coefficient: 1.93, OR: 6.89, 95% CI: 2.5-18.8, P < 0.001) were significant predictors of DR in prediabetics. There was no difference in FAZ in prediabetics with and without retinopathy. CONCLUSIONS OCTA could detect early retinal vascular changes during the prediabetic state before developing diabetes. VDP was significantly reduced in prediabetic patients. Furthermore, VDP of DCP of perifoveal area and disorganization of DCP were the most important predictors of retinopathy in prediabetic patients.
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Affiliation(s)
- Shereen El Sawy
- Internal Medicine Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, 41 Manial Street, Cairo, 11451, Egypt
| | - Mirrette Bekhit
- Internal Medicine Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, 41 Manial Street, Cairo, 11451, Egypt
| | - Alaa Abdelhamid
- Kasr Al-Ainy Vascular Laboratory, Cairo University, Cairo, Egypt
| | - Sohair Esmat
- Ophthalmology Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Hala Ashraf
- Clinical and Chemical Pathology Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mervat Naguib
- Internal Medicine Department, Faculty of Medicine, Kasr Al-Ainy Hospital, Cairo University, 41 Manial Street, Cairo, 11451, Egypt.
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Stulova AN, Semenova NS, Akopyan VS. [Terminology of quantitative optical coherence tomography angiography metrics]. Vestn Oftalmol 2024; 140:117-124. [PMID: 38962987 DOI: 10.17116/oftalma2024140031117] [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] [Indexed: 07/05/2024]
Abstract
This review is devoted to the English- and Russian-language terminology of quantitative metrics that are used in the evaluation of images obtained by optical coherence tomography angiography (OCT-A). The paper presents an analysis of the use of terms characterizing intraretinal blood flow (vascular density, perfusion density, skeletonized density, etc.), area and shape of the foveal avascular zone, and choriocapillaris blood flow. The factors causing the heterogeneity of OCT-A terminology are described, including the lack of a unified international nomenclature for OCT-A, features of their Russian translation, inconsistency of the parameters in optical coherence tomography systems of different manufacturers. The article also considers ways to standardize the terminology.
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Affiliation(s)
- A N Stulova
- Lomonosov Moscow State University, Moscow, Russia
| | - N S Semenova
- Lomonosov Moscow State University, Moscow, Russia
| | - V S Akopyan
- Lomonosov Moscow State University, Moscow, Russia
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6
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Rahimi M, Khameneh EA, Riazi-Esfahani H, Mahmoudi T, Khalili Pour E, Kafieh R. Application of ImageJ in Optical Coherence Tomography Angiography (OCT-A): A Literature Review. J Ophthalmol 2023; 2023:9479183. [PMID: 38033422 PMCID: PMC10686712 DOI: 10.1155/2023/9479183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/23/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
Background This study aimed to review the literature on the application of ImageJ in optical coherence tomography angiography (OCT-A) images. Methods A general search was performed in PubMed, Google Scholar, and Scopus databases. The authors evaluated each of the selected articles in order to assess the implementation of ImageJ in OCT-A images. Results ImageJ can aid in reducing artifacts, enhancing image quality to increase the accuracy of the process and analysis, processing and analyzing images, generating comparable parameters such as the parameters that assess perfusion of the layers (vessel density (VD), skeletonized density (SD), and vessel length density (VLD)) and the parameters that evaluate the structure of the layers (fractal dimension (FD), vessel density index (VDI), and lacunarity (LAC)), and the foveal avascular zone (FAZ) that are used widely in the retinal and choroidal studies), and establishing diagnostic criteria. It can help to save time when the dataset is huge with numerous plugins and options for image processing and analysis with reliable results. Diverse studies implemented distinct binarization and thresholding techniques, resulting in disparate outcomes and incomparable parameters. Uniformity in methodology is required to acquire comparable data from studies employing diverse processing and analysis techniques that yield varied outcomes. Conclusion Researchers and professionals might benefit from using ImageJ because of how quickly and correctly it processes and analyzes images. It is highly adaptable and potent software, allowing users to evaluate images in a variety of ways. There exists a diverse range of methodologies for analyzing OCTA images through the utilization of ImageJ. However, it is imperative to establish a standardized strategy to ensure the reliability and consistency of the method for research purposes.
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Affiliation(s)
- Masoud Rahimi
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamid Riazi-Esfahani
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Mahmoudi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elias Khalili Pour
- Retina Ward, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahele Kafieh
- Department of Engineering, Durham University, South Road, Durham DH1 3LE, UK
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Al-Hinnawi AR, Al-Latayfeh M, Tavakoli M. Innovative Macula Capillaries Plexuses Visualization with OCTA B-Scan Graph Representation: Transforming OCTA B-Scan into OCTA Graph Representation. J Multidiscip Healthc 2023; 16:3477-3491. [PMID: 38024137 PMCID: PMC10662934 DOI: 10.2147/jmdh.s433405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim of this study is to transform optical coherence tomography angiography (OCTA) scans into innovative OCTA graphs, serving as novel biomarkers representing the macular vasculature. Patients and Methods The study included 90 healthy subjects and 39 subjects with various abnormalities (29 with diabetic retinopathy, 5 with age-related macular degeneration, and 5 with choroid neovascularization). OCTA 5µm macular coronal views (MCVs) were generated for each subject, followed by blood vessel segmentation and skeleton processing. Subsequently, the blood vessel density index, blood vessel skeleton index, and blood vessel tortuosity index were computed. The graphs of each metric were plotted against the axial axes of the OCTA B-scan, representing the integrity of vasculature at successive 5µm macular depths. Results The results revealed two significant findings. First, the B-scans from OCTA can be transformed into OCTA graphs, yielding three specific OCTA graphs in this study. These graphs provide new biomarkers for assessing the integrity of deep vascular complex (DVC) and superficial vascular complex (SVC) within the macula. Second, a statistically significant difference was observed between normal (n=90) and abnormal (n=39) subjects, with a t-test p-value significantly lower than 0.001. The Mann-Whitney u-test also yielded significant difference but only between the 90 normal and 29 DR subjects. Conclusion The novel OCTA graphs offer a unique representation of the macula's SVC and DVC, suggesting their potential in aiding physicians in the diagnosis of eye health within OCTA clinics. Further research is warranted to finalize the shape of these newly derived OCTA graphs and establish their clinical relevance and utility.
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Affiliation(s)
- Abdel-Razzak Al-Hinnawi
- Department of Medical Imaging, Faculty of Allied Medical Sciences, Isra University, Amman, Jordan
| | - Motasem Al-Latayfeh
- Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Mitra Tavakoli
- Exeter Centre of Excellence for Diabetes Research, National Institute for Health and Care Research (NIHR) Exeter Clinical Research Facility, and Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, UK
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8
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Waheed NK, Rosen RB, Jia Y, Munk MR, Huang D, Fawzi A, Chong V, Nguyen QD, Sepah Y, Pearce E. Optical coherence tomography angiography in diabetic retinopathy. Prog Retin Eye Res 2023; 97:101206. [PMID: 37499857 PMCID: PMC11268430 DOI: 10.1016/j.preteyeres.2023.101206] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
There remain many unanswered questions on how to assess and treat the pathology and complications that arise from diabetic retinopathy (DR). Optical coherence tomography angiography (OCTA) is a novel and non-invasive three-dimensional imaging method that can visualize capillaries in all retinal layers. Numerous studies have confirmed that OCTA can identify early evidence of microvascular changes and provide quantitative assessment of the extent of diseases such as DR and its complications. A number of informative OCTA metrics could be used to assess DR in clinical trials, including measurements of the foveal avascular zone (FAZ; area, acircularity, 3D para-FAZ vessel density), vessel density, extrafoveal avascular zones, and neovascularization. Assessing patients with DR using a full-retinal slab OCTA image can limit segmentation errors and confounding factors such as those related to center-involved diabetic macular edema. Given emerging data suggesting the importance of the peripheral retinal vasculature in assessing and predicting DR progression, wide-field OCTA imaging should also be used. Finally, the use of automated methods and algorithms for OCTA image analysis, such as those that can distinguish between areas of true and false signals, reconstruct images, and produce quantitative metrics, such as FAZ area, will greatly improve the efficiency and standardization of results between studies. Most importantly, clinical trial protocols should account for the relatively high frequency of poor-quality data related to sub-optimal imaging conditions in DR and should incorporate time for assessing OCTA image quality and re-imaging patients where necessary.
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Affiliation(s)
- Nadia K Waheed
- New England Eye Center, Tufts University School of Medicine, Boston, MA, USA.
| | - Richard B Rosen
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yali Jia
- School of Medicine, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick AG, Pfäffikon, Switzerland
| | - David Huang
- School of Medicine, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Amani Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Victor Chong
- Institute of Ophthalmology, University College London, London, UK
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasir Sepah
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA, USA
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Keshet A, Shilo S, Godneva A, Talmor-Barkan Y, Aviv Y, Segal E, Rossman H. CGMap: Characterizing continuous glucose monitor data in thousands of non-diabetic individuals. Cell Metab 2023; 35:758-769.e3. [PMID: 37080199 DOI: 10.1016/j.cmet.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/27/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
Despite its rising prevalence, diabetes diagnosis still relies on measures from blood tests. Technological advances in continuous glucose monitoring (CGM) devices introduce a potential tool to expand our understanding of glucose control and variability in people with and without diabetes. Yet CGM data have not been characterized in large-scale healthy cohorts, creating a lack of reference for CGM data research. Here we present CGMap, a characterization of CGM data collected from over 7,000 non-diabetic individuals, aged 40-70 years, between 2019 and 2022. We provide reference values of key CGM-derived clinical measures that can serve as a tool for future CGM research. We further explored the relationship between CGM-derived measures and diabetes-related clinical parameters, uncovering several significant relationships, including associations of mean blood glucose with measures from fundus imaging and sleep monitoring. These findings offer novel research directions for understanding the influence of glucose levels on various aspects of human health.
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Affiliation(s)
- Ayya Keshet
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Smadar Shilo
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel; The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Anastasia Godneva
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Yeela Talmor-Barkan
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel
| | - Yaron Aviv
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
| | - Hagai Rossman
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel; Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel; Pheno.AI, Tel-Aviv, Israel.
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Freedman IG, Li E, Hui L, Adelman RA, Nwanyanwu K, Wang JC. The Impact of Image Processing Algorithms on Optical Coherence Tomography Angiography Metrics and Study Conclusions in Diabetic Retinopathy. Transl Vis Sci Technol 2022; 11:7. [PMID: 36107113 PMCID: PMC9483236 DOI: 10.1167/tvst.11.9.7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the impact of image processing on quantitative metrics in optical coherence tomography angiography (OCTA) images and study conclusions in patients with diabetes. Methods This was a single center, retrospective cross-sectional study. OCTA imaging with the Cirrus HD-OCT 5000 AngioPlex of patients with diabetes was performed. The 8 × 8 mm superficial slab images underwent 4 different preprocessing methods (none, background subtraction [BGS], foveal avascular zone brightness adjustment, and contrast limited adaptive histogram equalization [CLAHE]) followed by 4 different binarization algorithms (global Huang, global Otsu, local Niblack, and local Phansalkar) in ImageJ. Vessel density (VD), skeletonized VD (SVD), and fractal dimension (FD) were calculated. Mixed-effect multivariate linear regressions were performed. Results Two hundred eleven scans from 104 patients were included. Of these scans, 67 (31.8%) had no diabetic retinopathy (DR), 99 (46.9%) had nonproliferative DR (NPDR), and 45 (21.3%) had proliferative DR (PDR). Forty-eight of 211 (22.7%) scans had diabetic macular edema (DME). The image processing method used significantly impacted values of VD, SVD, and FD (all P -values < 0.001). On multivariate analysis, the image processing method changed the clinical variables significantly associated with VD, SVD, and FD. However, BGS and CLAHE yielded more consistent significant covariates across multiple binarization algorithms. Conclusions The image processing method can impact the conclusions of any given study analyzing quantitative OCTA metrics. Thus, caution is urged in the interpretation of such studies. Background subtraction or CLAHE may play a role in the standardization of image processing. Translational Relevance This work proposes strategies to achieve robust and consistent analysis of OCTA imaging, which is especially important for clinical trials.
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Affiliation(s)
- Isaac G Freedman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Emily Li
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA.,Division of Oculoplastic and Reconstructive Surgery, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lucy Hui
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Jay C Wang
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA.,Northern California Retina Vitreous Associates, Mountain View, CA, USA
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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.
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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.
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12
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Levine ES, Moult EM, Greig EC, Zhao Y, Pramil V, Gendelman I, Alibhai AY, Baumal CR, Witkin AJ, Duker JS, Fujimoto JG, Waheed NK. MULTISCALE CORRELATION OF MICROVASCULAR CHANGES ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WITH RETINAL SENSITIVITY IN DIABETIC RETINOPATHY. Retina 2022; 42:357-368. [PMID: 34510129 PMCID: PMC8892687 DOI: 10.1097/iae.0000000000003299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess global, zonal, and local correlations between vessel density changes measured by optical coherence tomography angiography and retinal sensitivity measured by microperimetry across diabetic retinopathy severity. METHODS Diabetic patients and nondiabetic controls underwent optical coherence tomography angiography imaging and microperimetry testing. Pearson's correlation was used to assess associations between average sensitivity and skeletonized vessel density (SVD) or foveal avascular zone area centrally. Linear mixed effects modeling was used to assess relationships between local SVD measurements and their spatially corresponding retinal sensitivity measurements. RESULTS Thirty-nine eyes from 39 participants were imaged. In all slabs, there was a statistically significant positive correlation between retinal sensitivities and SVDs on both global and zonal scales. No statistically significant correlation was found between central retinal sensitivities and the foveal avascular zone areas. Assessment of 1,136 spatially paired retinal sensitivity and SVD measurements revealed a statistically significant local relationship; this seemed to be driven by eyes with proliferative diabetic retinopathy that had reduced retinal sensitivities. CONCLUSION This study supports positive correlations between SVD and retinal sensitivity at global and zonal spatial scales in diabetic eyes. However, our analysis did not find evidence of statistically significant correlations between retinal sensitivity and SVD on a local scale until advanced diabetic retinopathy.
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Affiliation(s)
- Emily S. Levine
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Eric M. Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Eugenia Custo Greig
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Yi Zhao
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Varsha Pramil
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Isaac Gendelman
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - A. Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Caroline R. Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Andre J. Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
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13
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Differentiating features of OCT angiography in diabetic macular edema. Sci Rep 2021; 11:23398. [PMID: 34862410 PMCID: PMC8642537 DOI: 10.1038/s41598-021-02859-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
The purpose of current study was to evaluate different optical coherence tomography angiography (OCTA) metrics in eyes with diabetic retinopathy with and without diabetic macular edema (DME). In this retrospective study, macular OCTA images of eyes with non-proliferative or proliferative diabetic retinopathy were evaluated. Vascular density, vascular complexity and non-perfusion densities were compared between eyes with and without DME. One-hundred-thirty-eight eyes of 92 diabetic patients including 49 eyes with DME were included. In multivariate analysis, the presence of DME was positively associated with geometric perfusion deficit (GPD) in superficial capillary plexus (SCP), capillary non-perfusion (CNP) of SCP, and GPD in deep capillary plexus (DCP) (all P < 0.05). In eyes with DME, central foveal thickness was associated with VD ratio (SCP/DCP) (P = 0.001) and FAZ area (P = 0.001). In conclusion, in eyes with diabetic retinopathy, the presence of DME was associated with more extensive capillary non-perfusion compared to those with no macular edema.
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