The vascular densities of the macula and optic disc in normal eyes from children by optical coherence tomography angiography

Papillary and peripapillary vascular densities and corresponding correlation with peripapillary retinal thicknesses using optical coherence tomography angiography in healthy children and adolescents

To evaluate the peripapillary retinal thickness (PPRT), vascular density (PPVD), and disc vascular density (PVD) and their correlations in normal healthy children using optical coherence tomography angiography (OCTA). This was a cross-sectional study of 70 eyes from 36 normal healthy children aged 6-18 years who performed optic nerve head scans using OCTA. The PPRT included the peripapillary nerve fiber layer (PP-RNFLT), inner retina (PP-IRT), middle retinal thickness, and outer retinal thicknesses. The PP-RNFLT and PP-IRT were not significantly different between males and females. Superior nasal peripapillary RNFLT and IRT were significantly affected by age (ANOVA, P > 0.05). The PP-IRT and PP-RNFLT were lower in the 7-11 years old group in comparison with the other 3 groups (Post hoc Tukey test, P value < 0.05). Age and sex-matched PVD were not correlated with PPVD (partial correlation, P > 0.05). PPRT was not correlated with PVD, PPVD, superficial and deep retinal vascular densities, and choroidal vascular density. This study demonstrated that PPRT appears to change during growth in childhood. Superior nasal PPRT was affected more in the groups, decreasing from less than 7 years old to 7-11 years old and then back to pre-reduction values after 11 years old.

Correlation of the macular microvasculature to the axial length in pediatric patients with high axial refractive errors

AIMS

To compare the vascular density (VD) of the macular superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC), and the foveal avascular zone (FAZ) among high hyperopic, high myopic, and emmetropic children using optical coherence tomography angiography (OCTA).

METHODS

This was a cross sectional comparative study of otherwise healthy children with different refractive errors. Patients were recruited from Cairo University Children's Hospital. OCTA imaging was performed using the RTVue XR Avanti device with AngioVue software. Both the 3 × 3 and 6 × 6 mm macular scans were utilized. Automated measurements were obtained from the built-in machine software. Axial length (AL) measurements were done using Lenstar LS 900 optical biometer.

RESULTS

Ninety eyes from 51 healthy children were included. Among high myopes, there was significant thinning of the parafovea (p < 0.001). SCP-VD was also lower in high myopes in all areas except the fovea (all p < 0.001). The DCP-VD was significantly lower in high myopes in the parafovea and perifovea. High hyperopes had lower subfoveal CC-VD. Despite high myopes showing a significantly lower OCTA signal strength, linear regression analysis revealed that AL was an independent and significant predictor for the FAZ-area, as well as parafoveal and perifoveal SCP and DCP-VD.

CONCLUSION

High myopia results in a reduction of VD in both the SCP and DCP, which can be non-invasively detected and monitored using OCTA. While lower VD may, in part, be attributed to lower OCTA image quality, our findings demonstrate that AL independently and significantly predicts macular vascular parameters on OCTA in children.

Effects of repeated low-level red-light therapy on macular retinal thickness and microvascular system in children with myopia

OBJECTIVE

The objective of the study was to use optical coherence tomography angiography (OCTA) to analyze the effects of repeated low-level red-light (LLLT) therapy on macular retinal thickness and the microvascular system in children with myopia to evaluate the safety of this therapy.

METHODS

This prospective study included 40 school-age children with myopia (80 eyes), aged 7-14 years, who received therapy using a LLLT instrument. At baseline and therapy for 1 month, 3 months, 6 months, all children underwent comprehensive ophthalmological examinations, including slit-lamp examination, uncorrected visual acuity, best-corrected visual acuity, spherical equivalent degree, axial length, and OCTA. The vessel densities of the superficial retinal capillary plexus, macular inner retinal thickness, and full-layer retinal thickness were measured.

RESULTS

The macular inner retinal thickness increased at 1 month and remained unchanged thereafter, It differed significantly in nine areas at 1, 3, and 6 months compared to the thicknesses before therapy (P < 0.05); however, we observed no significant differences between the different time points (P > 0.05). The macular full-layer retinal thickness increased at 1 month and remained unchanged thereafter; the changes showed significant differences at 1 month and 3 months compared to before therapy, for the inner nasal region (P < 0.05). The other eight areas showed significant differences at 1, 3, and 6 months compared with before therapy (P < 0.05); however, no significant difference was observed between the different time points after therapy (P > 0.05). The vessel density of the superficial retinal capillary plexus did not differ significantly among the four groups (P > 0.05).

CONCLUSIONS

LLLT therapy was safe. The school-aged children exhibited macular thickening after LLLT therapy, which had no significant effect on macular microcirculation.

Changes in retinal and choroidal optical coherence tomography angiography indices among young adults and children over 1 year

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.

Optical coherence tomography angiography findings in pediatric patients with graves ophthalmopathy

PURPOSE

The aim of this study was to evaluate peripapillary, macular microvascular structure, and retinal nerve fiber layer (RNFL) thickness profile in children with Graves Ophthalmopathy (GO).

MATERIAL AND METHODS

Thirty-six eyes of 18 children with GO were prospectively compared with 40 eyes of 20-age and sex-matched controls. The severity and activity of the disease were evaluated according to the criteria of the European Group on Graves' Ophthalmopathy (EUGOGO) and Clinical Activity Score (CAS). After complete ophthalmologic and endocrinologic examination, all patients underwent optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) measurements. Retinal nerve fiber layer (RNFL) thickness, macular superficial capillary plexus (SCP), deep capillary plexus (DCP), foveal avascular zone (FAZ) area, acircularity index (AI) of the FAZ and peripapillary microvascular structure were analyzed.

RESULTS

The mean age was 12.1 ± 2.4 years in the GO group and 11.2 ± 2.6 years in healthy control group (p = 0.11). Duration of disease was 8.9 ± 4.2 months in the GO group. All patients in GO group had mild and inactive ophthalmopathy. In temporal inferior quadrant, RNFL thickness was significantly thinner in the GO group compared to the control group (p = 0.03). No significant difference was seen between groups both peripapillary and macular microvascular structure (all p > 0.05).

CONCLUSION

GO has no effect on optic nerve thickness, peripapillary and macular vascular parameters except inferior temporal RNFL in children.

Evaluation of childhood developing via optical coherence tomography-angiography in Qamdo, Tibet, China: A prospective cross-sectional, school-based study

BACKGROUND

Optical coherence tomography angiography (OCTA) is a new and reliable machine used to evaluate retinal structure and macular perfusion in children. The use of OCTA under bad condition such as high altitude, low atmospheric oxygen, and low humidity, in children is rarely.

AIM

To quantify the macular micro-vasculature in healthy children of various ages using OCTA in Qamdo.

METHODS

Design: Prospective cross-sectional, school-based study. Three hundred and forty-seven normal students from 9 schools in 4 different areas in Qamdo were included. OCTA was performed on a 3 mm × 3 mm area centered on the macular region and macular cube 512 × 128 showed details in macular. Early treatment of diabetic retinopathy study Vessel Flow Density (VD) of the macular central vascular plexus density (CVD), inner vascular plexus density (IVD), full vascular plexus density (FVD), and the size of the foveal avascular zone (FAZ) were measured. All these results corrected by t/s = 3.382 × 0.01306 × (axial length-1.82). The differences were compared among various ages, sexes and living environments.

RESULTS

The mean FAZ area in all eyes was 0.27 mm2 ± 0.12 mm2. The mean foveal thickness (MFT) in the macular cube was 227.64 μm ± 23.51 μm. Compared with girls, boys had a lager FAZ (P = 0.0029). Among the different age groups, MFT (P < 0.001) and FVD (P < 0.0001), IVD (P < 0.0001), and CVD (P = 0.0050) increased with age. FAZ areas were not correlated with age (P = 0.8853) or others (MFT, area).

CONCLUSION

OCTA can use to evaluate macular perfusion in children. Our data bridge the gap between structural OCT and perfusion density in children in high altitude. Even though these were not a longitudinal study, it may provide us with hints about retina development during puberty and clinical implications of OCTA in children.

A variation of foveal morphology in a group of children with hypermetropia

PURPOSE

During routine eye examinations, we noticed widened and flattened foveal pits with loss of normal V-shaped foveal profile and a pseudohole-like appearance in some otherwise healthy hypermetropic children. Our purpose was to describe clinical significance and multimodal imaging features of this incidental finding.

METHODS

Prospectively, 25 eyes of 13 hypermetropic children with these foveal changes and 36 eyes of 19 hypermetropic children with normal foveal appearance were enrolled. The macular thickness measurements and foveal parameters including pit diameter, depth, base, and area obtained by optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany), macular superficial and deep vessel density (VD) and foveal avascular zone values obtained by optical coherence tomography angiography (Avanti RTVue‑XR; Optovue, Fremont, CA, USA) were noted. The correlations of these parameters with visual function were evaluated.

RESULTS

In the study group, significantly widened and flattened pit contours with decreased central foveal thickness (p = 0.01), and increased distance between foveal edges (p < 0.001) were observed. While the whole image superficial macular VD was similar between the groups (p = 0.74), a significant decrease in deep macular VD was observed in the study group (p = 0.01). None of these changes were correlated with visual acuity.

CONCLUSION

Wider and flattened foveal pits described here represent a newly defined variation in healthy hypermetropic children. Although a correlation with visual acuity was not evident, these changes in foveal profile are shown to be related with macular microvascular changes in deep capillary plexus. Awareness of these morphologic changes will help clinicians in the differential diagnosis of macular pseudohole.

Peripapillary and macular vascular parameters by optical coherence tomography angiography in primary congenital glaucoma

OBJECTIVE

To evaluate the differences in peripapillary and macular vascular parameters by optical coherence tomography angiography (OCTA) between patients with primary congenital glaucoma (PCG) and healthy controls; and to determine their diagnostic accuracy.

MATERIAL AND METHODS

Observational, cross-sectional study including 39 eyes with PCG and 78 healthy eyes. Only one eye per patient was included. All included patients underwent a comprehensive ophthalmic examination and peripapillary and macular analysis were performed by AngioplexTM OCTA (Cirrus HD-OCT 5000) with a 4.5 × 4.5 mm optic nerve head scan and 6 × 6 mm macular scan. Global data and quadrant data from peripapillary vascular parameters and global data and circular sectors data from macular superficial plexus parameters were compared between groups. The glaucoma discrimination capability of these parameters was calculated as areas under the receiver operating characteristics curve (AUC ROC).

RESULTS

Mean age was 14.1 ± 8.7 years for the PCG patients and 11.7 ± 6.2 years for controls (p = 0.093). All vascular peripapillary measurements (global and quadrants; all p < 0.001) and all macular measurements (p < 0.042) excepting perfusion density in the inner circle (p = 0.087), were reduced in the PCG group compared to controls. According to AUC ROC, peripapillary (all ≥ 0.706) and macular parameters (all ≥ 0.699) showed good diagnostic capacity. AUC ROC for the most discriminatory measurements corresponding to blood flux index (0.887) and whole macula vascular density (0.855) were similar (p = 0.085).

CONCLUSION

Peripapillary and macular vascular parameters by OCTA are decreased in patients with PCG, showing a good capacity to discriminate between normal and glaucomatous eyes.

The characteristics of dome-shaped macula in Chinese children aged 4-6 years using optical coherence tomography angiography

PURPOSE

To evaluate the characteristics of dome-shaped macula (DSM) in children aged 4-6 years with normal visual acuity using optical coherence tomography angiography.

METHOD

This is a cross-sectional study. A total of 19 children aged 4-6 years were included. The results of optical coherence tomography angiography images were analysed to identify and quantify retinal structural and vascular parameters in DSM children. The dome height, dome base, and sub-dome choroidal thickness were manually measured. Participants with DSM and those without DSM from our previous study were compared on these parameters.

RESULTS

Nineteen eyes of the preschool subjects with normal visual acuity showed horizontal DSM on optical coherence tomography (OCT). The DSM was significantly smooth and low in the children, and we did not observe differences between sex and age. Compared to the children without DSM, the average axial length was longer, and the average macular vessel density was lower in the DSM group, especially in the deep retinal vascular density. Additionally, the dome height was positively correlated with the sub-dome choroidal thickness. When the dome base/height was increased, the fovea avascular zone (FAZ) area was larger.

CONCLUSION

Dome-shaped macula was detected in the preschool children in the process of the emmetropization with normal visual acuity. The changes in macular structure and vasculature provide new ideas for further investigation into the characteristics of DSM formation.

Quantitative analysis of retinal microvascular structure and correlation with ocular parameters: A normative database of pediatric OCT angiography

PURPOSE

To analyze the vascular structure of the healthy pediatric population using optical coherence tomography angiography (OCTA), and to investigate its relationship with ocular parameters.

MATERIALS AND METHOD

This cross-sectional, prospective study included 142 eyes of 71 healthy subjects aged 8-18 years. All patients underwent a complete ocular assessment, biometric evaluation and OCTA analysis. Anterior chamber depth, axial length, corneal thickness values were also reported and their relationship with OCTA measurements was evaluated.

RESULTS

There was no statistical difference between girls and boys in terms of demographic characteristics (p>0.05). Neither vascular density in the deep and superficial capillary plexus nor FAZ area was significantly related to the ocular parameters or age of any patient in the study.

CONCLUSIONS

Despite the relatively small number of participants, this study may represent normative data for the Turkish pediatric population. It was also shown that vascular density and FAZ area in childhood are not affected by age, axis length, anterior chamber depth, cornea and foveal thickness.

Optical coherence tomography angiography in healthy children: normative data and age-related changes in microvascular structure of the optic disk and macula

PURPOSE

To determine normative data and reference ranges according to age groups by measuring the foveal avascular zone (FAZ), superficial capillary plexus vascular density (SCP-VD), deep capillary plexus vascular density (DVP-VD), radial peripapillary capillary plexus vessel density (RPC-VD), and peripapillary retinal nerve fiber layer (ppRNFL) in healthy children and to determine the age and sex-related changes of these values.

METHODS

This prospective study included data from 370 eyes of 370 healthy children (202 girls, 168 boys) aged 7-18 years. Participants were divided into four groups according to their age. Optical coherence tomography angiography (OCTA) measurements were taken using AngioVue (Avanti; Optivue).

RESULTS

No statistically significant difference was observed in terms of FAZ, SCP-VD, DCP-VD, RPC-VD, and ppRNFL thickness values according to the age groups (except the RPC-VD superior) (p > 0.05 for all). VDs in all deep parafoveal regions in groups 1 and 2 were higher in girls. While FAZ values were higher in girls in all age groups (statistically significant in groups 1, 3, and 4), ad SPD and DPD values were higher in boys in all age groups (statistically significant in group 1 and 2 for SPD, and group 1 and 3 for DPD).

CONCLUSIONS

We report normal reference ranges for macula and disk vessel density and ppRNFL parameters in healthy children aged 7-18 years using OCTA. These normative values could be useful in diagnosing retina and optic disk disease early in childhood.

Macular Microvasculature Features of the Eyes of Healthy Korean Children Using Optical Coherence Tomography Angiography

Purpose: We used optical coherence tomography angiography to analyze the macular microvasculature of normal eyes of healthy Korean children; we derived normative data stratified by age.Methods: We retrospectively analyzed the medical records of 68 children (126 eyes) aged from 3 to 15 years. Optical coherence tomography angiography was performed on 3-mm2 regions centered on the fovea. The vascular densities of the superficial and deep capillary plexuses and the foveal avascular zone were determined, and analyzed by age. We sought correlations between age, gender, axial length, and the spherical equivalent.Results: The foveal, superficial capillary plexus vessel densities were 17.41 ± 5.41, 20.53 ± 4.76, 21.78 ± 5.73, and 22.95 ± 3.91% in children aged 3-5, 6-8, 9-11, and 12-15 years, respectively. The vessel densities of the foveal deep capillary plexus were 30.20 ± 6.59, 34.54 ± 7.16, 35.81 ± 6.02, and 37.38 ± 5.16% in those aged 3-5, 6-8, 9-11, and 12-15 years, respectively. Significant differences by age were apparent (p = 0.002, p < 0.001, respectively). The foveal vessel densities of the superficial and deep capillary plexuses were positively correlated with axial length (R2 = 0.153, p < 0.001; R2 = 0.158, p < 0.001, respectively) and the foveal avascular zone area was negatively correlated with axial length (R2 = 0.085, p < 0.001).Conclusions: The vessel densities of the superficial and deep capillary plexuses measured via optical coherence tomography angiography in normal eyes of healthy Korean children differed by age, and correlated significantly with axial length.

Assessment of the retinal vasculature in healthy Chinese preschool children aged 4-6 years old using optical coherence tomography angiography

PURPOSE

To establish normal parameters of macular and optic disc vasculature by optical coherence tomography angiography (OCTA) in healthy preschool children aged 4-6 years old in China. OCTA reflects retinal metabolism and development in children at these ages and could be used clinically and in future studies to aid diagnosis and prediction of retinal abnormalities and developmental stagnation.

METHODS

In this cross-sectional study, we measured foveal, parafoveal, and perifoveal vessel density in the superficial capillary plexus (SCP); the deep capillary plexus (DCP), the foveal avascular zone (FAZ), and the radial capillary peripapillary (RPC) in the optic disc using investigational spectral-domain OCTA. The magnification effect of the FAZ area and microvasculature measurements was corrected by Littman and the modified Bennett formula.

RESULTS

A total of 242 eyes (116 males and 126 females, 5.31 ± 0.73 years) were recruited for the analysis. The mean macular vessel density was 48.10 ± 2.92% and 48.74 ± 6.51% in the SCP and the DCP, respectively. The RPC vessel density was 47.17 ± 2.52%, 47.99 ± 4.48%, and 48.41 ± 3.07% in the whole image, inside disc, and peripapillary, respectively; and the mean FAZ area was 0.28 ± 0.11 mm². A significant difference between male and female participants was found in the retinal vasculature (DCP, SCP, and RPC). None of these parameters were significantly different in age (P > 0.05), except that DCP slightly increased with aging. The right and left eyes had good consistency in the parameters of the macula and optic disc.

CONCLUSIONS

Our study establishes the macular and optic disc OCTA reference values in 4- to 6-year-old healthy preschool children. They may be used in longitudinal OCTA studies and clinical applications.

Quantification of macular perfusion in healthy children using optical coherence tomography angiography

Background

This study aimed at defining the variance of vessel density (VD) characteristics in the macula of children with normal eyes.

Methods

This was a cross-sectional study in which subjects with normal eyes aged 3–18 years were enrolled. The macula was scanned by optical coherence tomography angiography (OCTA). Four age groups as under 7 years, 7–10 years, 11–14 years and more than 14 years of age were defined. The influences of age, gender, and body mass index on VD were analyzed.

Results

A total of 108 normal eyes from 54 participants with a mean age of 10.9 years were enrolled in the study. At the superficial and deep retina capillary plexus (SCP and DCP) and choriocapillaris (CC), respectively, the mean VD of the fovea was 20.10%, 36.99%, and 75.67%; at parafovea, these measurements were 53.12%, 55.81%, and 69.76%; and at perifovea, these measures were 51.38%, 52.46%, and 73.47%. The median foveal avascular zone (FAZ) was 0.30 mm². No significant differences between superior-hemi VD and inferior-hemi VD were found in the studied plexuses. The VD at parafovea and perifovea CC differed significantly between groups. There was no variation in VD of macular retina and CC between eyes or sex. FAZ areas were different between genders.

Conclusions

No difference between eyes and genders in the retina and CC VD of macular area was noted. FAZ area was larger in male. Even though this is not a longitudinal study, it may provide us with hints about macular vascular development during puberty and clinical implications of OCTA in children.

Association between smoking history and optical coherence tomography angiography findings in diabetic patients without diabetic retinopathy

Purpose

To investigate any associations between cigarette smoking and retinal microvascular changes in diabetic patients without visible retinopathy.

Design

Retrospective, cross-sectional study.

Participants

1099 eyes from 1099 diabetic patients with no clinical evidence of diabetic retinopathy (DR) were included in this study.

Methods

Diabetic patients underwent optical coherence tomography angiography (OCTA) scanning at Zuckerberg San Francisco General Hospital and Trauma Center between April 2018 and September 2019. Patient demographic and clinical information was collected. Standard bivariate statistics and multivariate linear regression were performed.

Main outcome measures

OCTA parameters included metrics related to the foveal avascular zone (FAZ; area, perimeter, circularity), perfusion density (PD; full, center, inner), and vessel length density (VLD; full, center, inner).

Results

The study population included 750 non-smokers and 349 smokers. FAZ perimeter was the only OCTA parameter that was significantly different between the two groups on uncontrolled analysis (P = 0.033). Multivariate regression analyses revealed significant associations between lower VLD full (β = -0.31, P = 0.048), lower VLD inner (β = -0.35, P = 0.046) and a history of smoking. No significant associations between cigarette smoking and either FAZ or PD were detected.

Conclusions

Our results suggest that smoking is likely associated with deleterious changes in the retinal microvasculature of patients with a history of diabetes and no visible DR. Based on these findings, diabetic patients with a history of smoking may benefit from higher prioritization in terms of ophthalmic screening.

Repeatability of Macular and Optic Nerve Head Measurements by Optical Coherence Tomography Angiography in Healthy Children

Aims: To evaluate the repeatability of the peripapillary and macular vascular parameters using optical coherence tomography angiography (OCT-A) in healthy children.Materials and methods: Cross-sectional study including 34 eyes of 34 healthy children. After a complete medical examination, two consecutive OCT-A exams were done using AngioPlex Cirrus 5000 (Carl Zeiss Meditec, Dublin, CA, USA) in the same session. The scan area used was 6 × 6 mm for the analysis of the superficial vascular plexus (SVP) in the macula, and 4.5 × 4.5 mm for the peripapillary plexus. To study the repeatability of the measurements, the intraclass correlation coefficient (ICC) and the coefficient of variation (CV) of each pair of exams were calculated.Results: The mean age of the children included was 10.77 ± 2.49 years (range 6 to 15 years). Good and excellent ICCs were obtained for all the parameters considered. Peripapillary vascular parameters showed greater reproducibility than macular ones (global peripapillary perfusion density (pPD): ICC = 0.834 CV = 0.89% vs. whole macular area PD (w-mPD): ICC = 0.697 CV = 3.49%; global peripapillary flux index (FI): ICC = 0.858 CV = 1.28%; whole macular area vascular density (VD): ICC = 0.699 CV = 3.30%). Amongst the macular parameters, the characteristics of the foveal avascular zone (FAZ) were the ones showing higher rates of repeatability (FAZ circularity: ICC = 0.858 CV = 8.83%).Conclusion: OCT-A is a non-invasive, time-efficient technology that may be useful in the evaluation of the retinal and peripapillary vascular network in healthy children. The repeatability of the measures will allow the follow-up and evaluation of any change occurring in the macular or optic nerve perfusion.

Quantitative assessment and determinants of the papillary microvasculature in healthy subjects

BACKGROUND

It is critical to monitor the optic disc's vessel density using Optical coherence tomography angiography (OCTA) and evaluate its determinants. In the current study, we investigate the superficial vessel density (VD) of the papillary microvasculature and its determinants in healthy subjects of Southern China.

METHODS

This was a prospective, cross-sectional study. Superficial VD in healthy individuals' optic disc region was measured by OCTA. The factors associated with ocular and systemic parameters were analyzed using a generalized estimation equation (GEE) model.

RESULTS

A total of 510 eyes of 260 healthy subjects were analyzed in the study. The total VD in the optic disc area was 17.21 ± 2.15 mm- 1 (95% CI, 17.02-17.40 mm- 1). The VD in the inner ring and the outer ring of the optic disc were significantly higher compared with the central ring, while the VD of the superior quadrant and inferior quadrant was significantly higher compared with the temporal and nasal quadrant. After adjusting for the ocular factors and systemic factors, AL (β = - 0.4917, P = 0.0003), disc area (β = - 0.3748, P = 0.0143), CMT (β = - 0.0183, P = 0.0003) and SSI (β = 1.0588, P < 0.001) were significantly associated with total VD of the optic disc.

CONCLUSION

The mean total VD in the optic disc area was 17.21 ± 2.15 mm- 1 in healthy subjects, and the superior and inferior VD was significantly higher than the temporal and nasal VD. AL, disc area, CMT, and SSI may affect the total VD in the optic disc area and should be considered in clinical practice.

Quantitative Analysis of the Macular and Peripapillary Capillary Network with Optical Coherence Tomography Angiography in Chinese Adolescents: The Tuyou County Pediatric Eye (TYPE) Study

Aim

To use OCTA to collect normative data describing the vascular perfusion of the macula and optic disc in adolescents.

Methods

This cross-sectional, school-based study was conducted from Oct 15, 2019, to Nov 30, 2019, in Tuyou County, Baotou, China. All eligible participants underwent a comprehensive questionnaire and ocular examination. The vascular perfusion of the macula and optic disc was determined using a spectral-domain OCTA device.

Results

A total of 570 anatomically normal eyes without a history of pathologic disease from 570 adolescents (mean ± SD age, 15.1 ± 1.9 years; 298 girls [52.3%]) were enrolled. In the macula, the mean ± SD perifoveal perfusion density (PD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) was 44.2% ± 4.37% and 50.74% ± 3.98%, respectively. The mean ± SD foveal avascular zone (FAZ) was 0.32 mm² ± 0.11 mm². The mean ± SD peripapillary vessel density (PVD) was 54.98% ± 3.53%. The inferior hemiretinal SCP-PD, DCP-PD, FAZ, and PVD was larger in girls than boys (P = 0.006, P = 0.001, P < 0.001, and P = 0.006, respectively) Multiple regression analysis confirmed that sex independently affected the DCP-PD, FAZ, and PVD (P < 0.001, P < 0.001, and P = 0.029, respectively) and that axial length (AL) independently affected the FAZ area and PVD (P = 0.004 and P < 0.001, respectively).

Conclusion

Quantitative studies of the perifoveal vasculature in adolescents should consider the patient’s sex and AL. Our findings may provide useful information for the understanding and the management of retinal perfusion in Chinese adolescents.

Compensatory Changes in the Anterior Segment and Vascular System of the Eye in Myopic Children After Orthokeratology

Purpose: To analyze changes in the anterior segment, retinal vessel density, and choroidal thickness (ChT) after orthokeratology (Ortho-K). Methods: Myopic children were enrolled from Ruijin Hospital, Shanghai, China. Ortho-K lenses and single-vision spectacles were fitted for myopia correction. Ocular measurements were taken at baseline and 6 months, including axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), ChT, macular vessel density (MVD), and optic disc vessel density (OVD). Results: Seventy-six patients were enrolled in this study, including 40 in the Ortho-K group and 36 in the control group. At baseline, no parameters between the two groups were statistically different. After 6 months, changes in CCT and ACD decreased in the Ortho-K group compared with those in the control group (p < 0.05); LT and ChT in the Ortho-K group were thicker than those in the control group (p < 0.05), while there was no difference in MVD and OVD compared with those in the control group (p > 0.05). There were moderate positive correlations between ChT and LT and between ChT and OVD in the Ortho-K group (p < 0.05). Conclusion: The changes in the anterior and posterior segments of the eye after Ortho-K lens wearing suggest that the human eye has a powerful compensatory effect on the imposed defocus.

Normative Data Assessment of Peripapillary and Macular Vessel Density and Foveal Avascular Zone Metrics Using Optical Coherence Tomography Angiography in Children

PURPOSE

To quantify the vessel density of the macula and optic disc and foveal avascular zone (FAZ) in healthy children and to evaluate the effects of age, gender, axial length, body mass index (BMI), and refractive errors on vessel density and FAZ.

METHODS

This study enrolled 92 eyes of 92 participants (42 boys and 50 girls). Optical coherence tomography angiography (OCTA) was performed using AngioVue (Avanti; Optivue). FAZ area, nonflow area, superficial and deep vessel density, FAZ perimeter, acircularity index of FAZ, foveal density, and radial peripapillary capillary vessel density were analyzed by gender. Correlations between the investigated OCTA parameters and age, axial length, and BMI were evaluated.

RESULTS

Girls had significantly larger nonflow and FAZ area than boys (P = .01 and .02). Superficial and deep vessel density at the fovea was significantly higher in boys compared to girls (P = .01 and .03). Inferior temporal and superior temporal Radial peripapillary capillary vessel densities were significantly higher in girls than boys (P = .01 and .03). No significant difference was found in the macular and optic disc vessel density measurements within refractive groups (P > .05, for all). Regarding the correlation of age with FAZ and vessel density parameters, only nonflow area was positively correlated with age (r = 0.22, P = .03).

CONCLUSIONS

This study provides normative data for children. Although boys had greater foveal vessel density, girls had greater FAZ area and nonflow area. Refractive status of the eye and BMI did not influence the OCTA parameters. Although nonflow area was positively correlated with age, other parameters were steady within the ages of 7 to 18 years. [J Pediatr Ophthalmol Strabismus. 2020;57(6):388-398.].

Subclinical retinal microvascular alterations assessed by optical coherence tomography angiography in children with systemic hypertension

PURPOSE

To compare the foveal avascular zone (FAZ) macular and peripapillary vessel density between children with high blood pressure and healthy subjects.

METHODS

A total of 40 eyes of 20 children with hypertension and 40 eyes of 20 age- and sex-matched healthy controls were included. Capillary vessel density (CVD) in superficial (SCP) and deep (DCP) retinal capillary plexus, peripapillary region, and FAZ were analyzed by optical coherence tomography angiography.

RESULTS

The mean ages were 15.2 ± 1.5 years (range, 10-18) in patients with hypertension and 14.4 ± 2.8 years (range, 10-18) in healthy controls (P = 0.742). The mean FAZ area measured 0.25 ± 0.10 mm² in children with hypertension and 0.25 ± 0.09 mm² in healthy controls (P = 0.765). There was no significant difference between study groups in any measure of the macular SCP (P > 0.05 for all); however, the mean whole image, inferior hemisphere, and para- and perifoveal measurements of the macular DCP were significantly lower in children with hypertension than in controls (P < 0.05 for all).

CONCLUSIONS

Although there was no evidence of hypertensive retinopathy, subthreshold microvascular alterations were found in the DCP of the retinal circulation in pediatric hypertensives. These alterations should be considered as prognostic cues when defining whole systemic response to high blood pressure in childhood.