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Gupta P, Thakar M, Rajurkar K, Jaisingh K, Shaw E, Dipu TA. Analysis of foveal avascular zone by using spectral-domain optical coherence tomography angiography in healthy Indian eyes. Indian J Ophthalmol 2024; 72:838-843. [PMID: 38454842 DOI: 10.4103/ijo.ijo_2212_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/10/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To analyze FAZ superficial (s) and deep (d) area and dimensions by using spectral-domain optical coherence tomography angiography (OCTA) in healthy eyes and to assess effect of age, gender, axial length (AL), central foveal thickness (CFT), and central choroidal thickness (CCT) on FAZ. We aimed to study FAZ dimensions with OCTA in healthy Indian eyes with the purpose of creating a normative database. SETTINGS AND DESIGN Observational cross-sectional study. METHODS In total, 200 healthy eyes in the age group of 20-60 years having best corrected visual acuity better than 6/12 (Snellen's) with no systemic illness/intraocular surgery were included. FAZ parameters were calculated using OCTA, and the same was evaluated for any correlation with different ocular parameters mentioned above. The data were reported as frequencies/percentages and mean ± SD. The association between quantitative variables was evaluated using Pearson's correlation coefficient. RESULTS The dFAZ area (0.56 ± 0.12 mm 2 ) was larger than the sFAZ area (0.42 ± 0.13 mm 2 ). Females had larger FAZ than males. AL and CFT had a negative correlation, whereas CCT had a positive correlation with FAZ. Age did not influence FAZ. sFAZ and dFAZ varied significantly in healthy eyes. CONCLUSION FAZ parameters calculated using OCTA in healthy Indian eyes suggested that the area and dimensions in both SCP and DCP are larger in individuals from the Indian subcontinent when compared to other parts of the world. FAZ area and dimensions, when compared to previous studies, were variable. Thus, there is a need to establish normative data for ethnicity for proper interpretation of FAZ using OCTA.
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Affiliation(s)
- Priyadarshi Gupta
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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Ovik T, Lind A, Popovic Z, Dahlgren J, Aring E, Andersson Grönlund M. Foveal thickness and vascular variables in adolescents born moderate-to-late preterm. Acta Ophthalmol 2024. [PMID: 38683112 DOI: 10.1111/aos.16702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE It is well established that children born very preterm are at increased risk for ocular abnormalities including altered foveal morphology. However, little is known about how children born moderate-to-late preterm (MLP), gestational age 32 + 0-36 + 6 weeks, are affected later in life. This study investigates foveal avascular zone (FAZ) area, vascular density (VD), central foveal thickness (CFT) and ganglion cell layer thickness (GCL++) of adolescents born MLP without history of retinopathy of prematurity and compare the results with full-term controls. METHODS In a prospective population-based cohort study, 50 adolescents (26 girls; mean age 16.5 years) born MLP were examined with optical coherence tomography (OCT) and OCT angiography (OCT-A). FAZ and VD were obtained from OCT-A scans and adjusted for ocular magnification. CFT and GCL++ were obtained from the OCT scans. The results from the MLP individuals were compared with the results from 49 healthy full-term controls (29 girls; mean age 16.7 years). RESULTS The results showed statistically significant differences in FAZ area (0.22 vs 0.28 mm2; p = 0.0032) and CFT (198.1 vs 187.1 μm; p = 0.0010) between the MLP group and controls. Strong correlations between FAZ area and CFT (r = -0.773, p < 0.0001) and GCL++ (r = -0.924, p < 0.0001) were found in the MLP group. There were no differences in VD. CONCLUSIONS Our results show that adolescents born MLP have a smaller FAZ area and an increased CFT compared with full-term controls. These results indicate that adolescents born MLP have similar parafoveal changes as children born extreme or very preterm.
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Affiliation(s)
- Titus Ovik
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alexandra Lind
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Zoran Popovic
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Aring
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Li S, Zhao W, Jian T, Xu F, Li Z, Yang X, Wang S, Wu W, Wang J, Lou J, Li J. Quantitative assessment of retinochoroidal microvasculature in patients with carotid artery stenosis using OCT angiography. Photodiagnosis Photodyn Ther 2024; 46:104082. [PMID: 38588872 DOI: 10.1016/j.pdpdt.2024.104082] [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: 02/22/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To investigate the alterations in retinochoroidal parameters measured by optical coherence tomography (OCT) and OCT angiography (OCTA) in patients with carotid artery stenosis (CAS) and assess their associations with digital subtraction angiography (DSA) data. METHOD This study enrolled patients diagnosed with CAS and age-matched healthy controls. Both groups underwent OCT and OCTA examinations. DSA and assessment of carotid artery stenosis were performed only in the CAS group. The study evaluated various retinochoroidal parameters from OCT and OCTA, including linear vessel density (LVD), foveal avascular zone (FAZ), choroidal thickness (ChT), and retinal nerve fiber layer (RNFL) thickness. DSA-derived measures included cervical segment (C1) diameter, cavernous segment (C4) diameter, stenosis percentage, ophthalmic artery (OA) filling time, C1-OA filling time, and residual stenosis. RESULTS A total of 42 eyes from 30 CAS patients and 60 eyes from 30 healthy controls were included. Patients with CAS displayed significantly decreased LVD compared to controls (p < 0.001). Additionally, the CAS group had thinner choroid and RNFL (p = 0.047 and p < 0.001, respectively). Macular LVD negatively correlated with both stenosis percentage and C1-OA filling time (p = 0.010 and p = 0.014, respectively). In patients who underwent carotid artery stenting, preoperative ChT significantly correlated with residual stenosis (Pearson r = -0.480, p = 0.020). CONCLUSION OCT and OCTA provide a quantitative assessment of retinochoroidal microstructural changes associated with CAS, suggesting potential for noninvasive evaluation of the disease. This might contribute to the prevention of irreversible ocular complications and early detection of CAS. Furthermore, ChT may not only aid in diagnosing CAS more reliably but also offer prognostic information.
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Affiliation(s)
- Shiqiang Li
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenjuan Zhao
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tianzi Jian
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fabao Xu
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhiwen Li
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xueying Yang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shaopeng Wang
- Zibo Central Hospital, Binzhou Medical University, Zibo, Shandong province, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Jiawei Wang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Jianwei Lou
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Jianqiao Li
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Li M, Huang K, Xu Q, Yang J, Zhang Y, Ji Z, Xie K, Yuan S, Liu Q, Chen Q. OCTA-500: A retinal dataset for optical coherence tomography angiography study. Med Image Anal 2024; 93:103092. [PMID: 38325155 DOI: 10.1016/j.media.2024.103092] [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: 12/23/2022] [Revised: 11/10/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
Optical coherence tomography angiography (OCTA) is a novel imaging modality that has been widely utilized in ophthalmology and neuroscience studies to observe retinal vessels and microvascular systems. However, publicly available OCTA datasets remain scarce. In this paper, we introduce the largest and most comprehensive OCTA dataset dubbed OCTA-500, which contains OCTA imaging under two fields of view (FOVs) from 500 subjects. The dataset provides rich images and annotations including two modalities (OCT/OCTA volumes), six types of projections, four types of text labels (age/gender/eye/disease) and seven types of segmentation labels (large vessel/capillary/artery/vein/2D FAZ/3D FAZ/retinal layers). Then, we propose a multi-object segmentation task called CAVF, which integrates capillary segmentation, artery segmentation, vein segmentation, and FAZ segmentation under a unified framework. In addition, we optimize the 3D-to-2D image projection network (IPN) to IPN-V2 to serve as one of the segmentation baselines. Experimental results demonstrate that IPN-V2 achieves an about 10% mIoU improvement over IPN on CAVF task. Finally, we further study the impact of several dataset characteristics: the training set size, the model input (OCT/OCTA, 3D volume/2D projection), the baseline networks, and the diseases. The dataset and code are publicly available at: https://ieee-dataport.org/open-access/octa-500.
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Affiliation(s)
- Mingchao Li
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Kun Huang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Qiuzhuo Xu
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Jiadong Yang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Yuhan Zhang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Zexuan Ji
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
| | - Keren Xie
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, NanJing 210029, China.
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, NanJing 210029, China.
| | - Qinghuai Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, NanJing 210029, China.
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, NanJing 210094, China.
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Ninomiya T, Kiyota N, Sharma P, Omodaka K, Himori N, Yasuda M, Kunikata H, Nakazawa T. The Relationship Between Artificial Intelligence-Assisted OCT Angiography-Derived Foveal Avascular Zone Parameters and Visual-Field Defect Progression in Eyes with Open-Angle Glaucoma. OPHTHALMOLOGY SCIENCE 2024; 4:100387. [PMID: 38524379 PMCID: PMC10960060 DOI: 10.1016/j.xops.2023.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 03/26/2024]
Abstract
Purpose To investigate clinical factors associated with foveal avascular zone (FAZ) parameters obtained using OCT angiography (OCTA) with assistance from a previously developed artificial intelligence (AI) platform in eyes with open-angle glaucoma (OAG). Design Retrospective longitudinal. Participants This study followed up 885 eyes of 558 patients with OAG for ≥ 2 years; all eyes underwent ≥ 5 Humphrey visual-field (VF) tests and had 3.0 × 3.0 mm macular OCTA scans available. Methods Average total deviation (TD) in the superior, superocentral, inferocentral, and inferior sectors of the Humphrey 24-2 program was calculated. We collected 3.0 × 3.0 mm macular OCTA images from each patient and used a previously developed AI platform with these images to obtain FAZ parameters, including FAZ area, FAZ circularity index (CI), and FAZ perimeter. Multivariable linear mixed-effects models were used to analyze the relationship between FAZ parameters, TD or TD slope in each quadrant, and systemic factors, adjusting for potential confounding factors, including axial length. Main Outcome Measures Ophthalmic and systemic variables, FAZ parameters, and TD or TD slope in each quadrant. Results The multivariable model showed that FAZ parameters were correlated with both TD and TD slope in the inferocentral quadrant (β = -0.244 - 0.168, P < 0.001). Both upper-half and lower-half FAZ parameters were better associated with TD-inferocentral and TD-inferocentral slope than TD-superocentral or TD-superocentral slope in terms of β size and statistical significance, indicating that there was no evident vertical anatomical correspondence between TD in the central quadrant and FAZ parameters. Foveal avascular zone area enlargement was associated with female gender (β = 0.242, P = 0.003). Loss of FAZ circularity was associated with both aging and comorbid sleep apnea syndrome (SAS) (yes: 1, no: 0) (β = -0.188, P < 0.001; β = -0.261, P = 0.031, respectively). Foveal avascular zone perimeter elongation was associated with aging and female gender (β = 0.084, P = 0.040; β = 0.168, P = 0.042, respectively). Conclusions Artificial intelligence-assisted OCTA-measured FAZ enlargement and irregular shape might be good markers of ocular hypoperfusion and associated inferocentral VF defect progression in eyes with OAG. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Takahiro Ninomiya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Parmanand Sharma
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Aging Vision Healthcare, Tohoku University Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Sui J, Li H, Bai Y, He Q, Sun Z, Wei R. Morphological characteristics of the foveal avascular zone in pathological myopia and its relationship with macular structure and microcirculation. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06403-2. [PMID: 38367069 DOI: 10.1007/s00417-024-06403-2] [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: 11/14/2023] [Revised: 01/09/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024] Open
Abstract
PURPOSE To explore the characteristics of macular structure, microcirculation, and foveal avascular zone (FAZ) morphology in pathological myopia and to research the associations between these factors and pathological myopia. METHODS This is a cross-sectional study. The study included 103 eyes with non-high myopia and 206 eyes with high myopia (139 with simple high myopia and 67 with pathological myopia). Macular structural and microcirculation parameters were determined using optical coherence tomography angiography (OCTA). The FAZ morphological parameters were measured manually using Image J software. Correlations between pathological myopia and various factors were analyzed. RESULTS Patients with pathological myopia had a thinner retinal thickness (RT) and choroidal thickness (CT) and a lower retinal superficial vascular density (SVD), retinal deep vascular complex density (DVD), choriocapillaris perfusion area (CCPA), and choroidal vascularity index (CVI) (all P < 0.05). Patients with pathological myopia had a larger FAZ area, perimeter, major axis, minor axis, acircularity index (AI), and lower circularity index (CI) (all P < 0.01). The axial length (AL), the major axis of the superficial FAZ, CI, and AI were significantly correlated with myopia severity (all P < 0.05). CONCLUSIONS Patients with pathological myopia exhibited worse macular microcirculation and thinner macular retina and choroid. The FAZ in pathological myopia was larger and more irregular. The AL, CI, and AI were significantly associated with myopia severity. Thus, CI and AI might serve as new indicators for monitoring the progression of myopia. Further investigations should be performed. TRIAL REGISTRATION Clinical Trials.gov Identifier: ChiCTR2100046590.
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Affiliation(s)
- Jinyuan Sui
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Haoru Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Yang Bai
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Qing He
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Ziwen Sun
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, 300384, China.
- Tianjin Binhai High-Tech Industrial Development Zone, No. 251 Fukang Road, Huayuan Industrial Zone (Nankai District), Tianjin, China.
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Joseph S, Robbins CB, Haystead A, Hemesath A, Allen A, Kundu A, Ma JP, Scott BL, Moore KPL, Agrawal R, Gunasan V, Stinnett SS, Grewal DS, Fekrat S. Characterizing differences in retinal and choroidal microvasculature and structure in individuals with Huntington's Disease compared to healthy controls: A cross-sectional prospective study. PLoS One 2024; 19:e0296742. [PMID: 38289919 PMCID: PMC10826956 DOI: 10.1371/journal.pone.0296742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE To characterize retinal and choroidal microvascular and structural changes in patients who are gene positive for mutant huntingtin protein (mHtt) with symptoms of Huntington's Disease (HD). METHODS This study is a cross-sectional comparison of patients who are gene positive for mHtt and exhibit symptoms of HD, either motor manifest or prodromal (HD group), and cognitively normal individuals without a family history of HD (control group). HD patients were diagnosed by Duke movement disorder neurologists based on the Unified Huntington's Disease Rating Scale (UHDRS). Fovea and optic nerve centered OCT and OCTA images were captured using Zeiss Cirrus HD-5000 with AngioPlex. Outcome metrics included central subfield thickness (CST), peripapillary retinal nerve fiber layer (pRNFL) thickness, ganglion cell-inner plexiform layer (GCIPL) thickness, and choroidal vascularity index (CVI) on OCT, and foveal avascular zone (FAZ) area, vessel density (VD), perfusion density (PD), capillary perfusion density (CPD), and capillary flux index (CFI) on OCTA. Generalized estimating equation (GEE) models were used to account for inter-eye correlation. RESULTS Forty-four eyes of 23 patients in the HD group and 77 eyes of 39 patients in the control group were analyzed. Average GCIPL thickness and FAZ area were decreased in the HD group compared to controls (p = 0.001, p < 0.001). No other imaging metrics were significantly different between groups. CONCLUSIONS Patients in the HD group had decreased GCIPL thickness and smaller FAZ area, highlighting the potential use of retinal biomarkers in detecting neurodegenerative changes in HD.
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Affiliation(s)
- Suzanna Joseph
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Cason B. Robbins
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Alice Haystead
- iMIND Research Group, Durham, NC, United States of America
| | - Angela Hemesath
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Ariana Allen
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Anita Kundu
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Justin P. Ma
- iMIND Research Group, Durham, NC, United States of America
| | - Burton L. Scott
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States of America
| | - Kathryn P. L. Moore
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States of America
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Vithiya Gunasan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandra S. Stinnett
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Dilraj S. Grewal
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States of America
- iMIND Research Group, Durham, NC, United States of America
- Department of Neurology, Duke University School of Medicine, Durham, NC, United States of America
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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: 0] [Impact Index Per Article: 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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Emre S, Altin C, Ulusoy MO, Aydin E. Optical coherence tomography-angiography findings of prediabetic patients. Oman J Ophthalmol 2024; 17:96-101. [PMID: 38524313 PMCID: PMC10957036 DOI: 10.4103/ojo.ojo_197_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/17/2023] [Accepted: 01/02/2024] [Indexed: 03/26/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate prediabetic patients for microvascular changes using optical coherence tomography-angiography (OCT-A) and compare with diabetic patients and healthy controls. METHODS OCT-A images of 60 eyes of 30 patients with diabetes mellitus (DM), 72 eyes of 36 prediabetic patients, and 108 eyes of 54 healthy controls were retrospectively evaluated and compared in this study. A swept-source OCTA (Triton, Topcon) instrument was used for collecting OCT-A images. Duration of the diabetic or prediabetic period, glycated hemoglobin, fasting blood glucose level, postprandial glucose (PPG) level, high-density lipoprotein, low-density lipoprotein, triglyceride, and creatinine values of all participants were recorded. RESULTS Microaneurysm, nonperfusion areas, perifoveal capillary disruption, and capillary network disorganization were detected in both prediabetics and diabetics but statistically more common in diabetic patients. Neovascularization and intraretinal microvascular anomalies were detected only in diabetic patients. CONCLUSIONS OCT-A seemed to be effective in detecting microvascular changes in diabetic patients. More importantly, results showed us that in prediabetic patients, microvascular changes can be seen before the onset of DM and before or concurrently with neurodegenerative changes.
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Affiliation(s)
- Sinan Emre
- Department of Ophthalmology, School of Medicine, Baskent University, Izmir, Turkey
| | - Cihan Altin
- Department of Cardiology, School of Medicine, Baskent University, Izmir, Turkey
| | - Mahmut Oguz Ulusoy
- Department of Ophthalmology, Bursa Yüksek Ihtisas Research Hospital, Bursa, Turkey
| | - Elcin Aydin
- Department of Radiology, School of Medicine, Baskent University, Izmir, Turkey
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10
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Nishida T, Moghimi S, Walker E, Gunasegaran G, Wu JH, Kamalipour A, Mahmoudinezhad G, Zangwill LM, Weinreb RN. Association of foveal avascular zone change and glaucoma progression. Br J Ophthalmol 2023:bjo-2023-323970. [PMID: 38164585 PMCID: PMC11192860 DOI: 10.1136/bjo-2023-323970] [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: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/AIMS To investigate the association between longitudinal changes of foveal avascular zone (FAZ) area and the rate of structural and functional progression in glaucoma. METHODS A longitudinal cohort included 115 eyes (46 glaucoma suspect and 66 primary open-angle glaucoma) of 81 patients having ≥2 year follow-up, and ≥4 visits with optical coherence tomography angiography and visual field (VF). Eyes in the longitudinal cohort with a slope greater than that found in 95 percentile of separate healthy test-retest series for FAZ area were categorised into FAZ progressors; all other eyes were defined as FAZ non-progressors. A generalised linear mixed-effect model was used to investigate the association of FAZ progressors with demographic and clinical characteristics. RESULTS Faster ganglion cell complex (GCC) thinning and faster VF mean deviation (MD) loss were found in eyes with FAZ progressors compared with FAZ non-progressors (mean difference: -0.7 (95% CI, -1.4 to -0.1) µm/y; p=0.026, -0.3 (-0.5 to -0.1) dB/y; p=0.017, respectively), while whole image vessel density was not associated with FAZ progressors (p=0.929). SD of intraocular pressure (IOP) and IOP range were also associated with FAZ progressors in separate multivariable models (OR: 1.54 (1.02 to 2.32) per 1 mm Hg higher, p=0.041; OR: 1.20 (1.01 to 1.41) per 1 mm Hg higher; p=0.035, respectively). CONCLUSIONS Significant FAZ increase was weakly associated with moderately faster rates of both GCC thinning and VF MD loss, but not macular vessel density change in glaucoma eyes. Additional studies are needed to elucidate the pathophysiological associations between macula GCC thinning and FAZ area increases in glaucoma.
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Affiliation(s)
- Takashi Nishida
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Sasan Moghimi
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Evan Walker
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Gopikasree Gunasegaran
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Jo-Hsuan Wu
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Alireza Kamalipour
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Golnoush Mahmoudinezhad
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Linda M Zangwill
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Robert N Weinreb
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
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11
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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 DOI: 10.1016/j.preteyeres.2023.101206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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12
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Szydełko-Paśko U, Przeździecka-Dołyk J, Dołyk A, Małyszczak A, Misiuk-Hojło M. Evaluation of Choroidal and Retinal Features in Patients with Primary Vasculitis-An Original Optical Coherence Tomography and Optical Coherence Tomography Angiography Study. J Clin Med 2023; 12:6827. [PMID: 37959292 PMCID: PMC10648798 DOI: 10.3390/jcm12216827] [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: 09/15/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Ocular manifestations have been described in the course of various types of vasculitis. However, there seems to be no routine ophthalmological examinations for patients suffering from those diseases. To ensure holistic care we aimed to investigate any retinal and choroidal abnormalities in patients suffering from primary vasculitis. The objective was to use non-invasive methods, which would not be time- and cost-consuming, yet would be helpful in routine tests. We conducted a prospective and observational study in 41 patients (78 eyes) with 5 types of primary vasculitis, including: Takayasu's arteritis; giant cell arteritis; Buerger's disease; granulomatosis with polyangiitis; and polyarteritis nodosa. A total of 44 healthy individuals were enrolled in the control group for comparison (88 eyes). With the use of optical coherence tomography, optical coherence tomography angiography, and MATLAB, the following parameters were assessed: choroidal thickness; vascularity index; area and perimeter of foveal avascular zone; and circularity index. The following parameters were lower in the study group compared to the control group: mean nasal and temporal CTs; mean central, temporal, and nasal CVI; and mean CI. In contrast, the results of mean central CT as well as the area and perimeter of FAZ were higher in the study group. The differences were statistically significant in the case of all parameters except for CI. Conducting routine ophthalmological examinations in patients diagnosed with vasculitis by assessment of the retina and choroid by measuring parameters like CT, CVI, area and perimeter of FAZ, and CI could be beneficial, as it may detect pathological changes before any ocular symptoms alarm the patients. CVI seems to be especially promising for choroidal evaluation, as it appears to be less influenced by various factors compared to CT.
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Affiliation(s)
| | - Joanna Przeździecka-Dołyk
- Department of Optics and Photonics, Wrocław Univeristy of Science and Technology, 50-370 Wrocław, Poland
| | - Andrzej Dołyk
- Clinic of Angiology, Systemic Hypertension and Diabetology, Wrocław Teaching Hospital, 50-556 Wrocław, Poland
| | - Artur Małyszczak
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
| | - Marta Misiuk-Hojło
- Department of Ophthalmology, Wrocław Medical University, 50-556 Wrocław, Poland
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13
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Zagst AJ, Smith JD, Wang R, Harrison WW. Foveal avascular zone size and mfERG metrics in diabetes and prediabetes: a pilot study of the relationship between structure and function. Doc Ophthalmol 2023; 147:99-107. [PMID: 37495830 DOI: 10.1007/s10633-023-09943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Previous studies have demonstrated functional and structural retinal changes in type 2 diabetes (T2DM). However, less is understood in prediabetes, which is an important precursor to T2DM. Here, we evaluate the microvasculature structure of the foveal avascular zone (FAZ) and how it is correlated with retinal function as measured by the multifocal electroretinogram (mfERG) across levels of glucose dysfunction to uncover how T2DM and prediabetes alter this structure-function relationship. METHODS 33 subjects were included: 9 controls, 12 prediabetes, 12 T2DM with no retinopathy or edema. Subjects were aged 30-70 years, had BCVA of 20/25 or better, and had no confounding ocular conditions. Blood was collected via fingerstick to determine Hemoglobin A1c (HbA1c), which was used along with previous diagnosis, to determine study grouping. Optical coherence tomography angiography (OCTA) was used to analyze the FAZ area and was corrected for refractive error. FAZ area was measured by hand using the Heidelberg Spectralis software. mfERG (VERIS 6.3) metrics implicit time (IT) and amplitude were evaluated in the foveal region, macular region, and averaged over the posterior pole of the right eye. Regression analysis was performed between each study group parameter to determine relationships, and t tests with corrections were used to compare groups. RESULTS FAZ area (superficial plexus) was negatively correlated with mfERG posterior pole amplitude (p < 0.01, R2 = 0.30), foveal amp (p = 0.02 R2 = 0.17) and macular amplitude (p = 0.02 R2 = 0.18) across all 33 study subjects. FAZ and mfERG metrics were not significantly different between study groups in this cohort except for IT, which was more delayed in the diabetes group compared to other groups. CONCLUSION FAZ area is correlated with mfERG amplitudes but not IT. This suggests a link between the structural metrics and retinal function. Longitudinal follow-up work would be helpful to determine the timing of these changes in prediabetes.
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Affiliation(s)
- Allison Jussel Zagst
- Department of Clinical Sciences, University of Houston College of Optometry, 4401 Martin Luther King Blvd, Houston, TX, 77204-2020, USA
| | - Jennyffer D Smith
- Department of Clinical Sciences, University of Houston College of Optometry, 4401 Martin Luther King Blvd, Houston, TX, 77204-2020, USA
| | - Rachel Wang
- Department of Clinical Sciences, University of Houston College of Optometry, 4401 Martin Luther King Blvd, Houston, TX, 77204-2020, USA
| | - Wendy W Harrison
- Department of Clinical Sciences, University of Houston College of Optometry, 4401 Martin Luther King Blvd, Houston, TX, 77204-2020, USA.
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14
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Abdel-Kader AA, Ramsey DJ, Yussuf WA, Mohalhal AA, Eldaly MA, Elnahry AG. Diabetic microaneurysms detected by fluorescein angiography spatially correlate with regions of macular ischemia delineated by optical coherence tomography angiography. Indian J Ophthalmol 2023; 71:3085-3090. [PMID: 37530285 PMCID: PMC10538827 DOI: 10.4103/ijo.ijo_3155_22] [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: 12/02/2022] [Revised: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To characterize the relationship between diabetic macular ischemia (DMI) delineated by optical coherence tomography angiography (OCTA) and microaneurysms (MAs) identified by fundus fluorescein angiography (FFA). Methods Patients with diabetic retinopathy (DR) who underwent OCTA and FFA were retrospectively identified. FFA images were cropped and aligned with their respective OCTA images using i2k Align Retina software (Dual-Align, Clifton Park, NY, USA). Foveal avascular zone (FAZ) and ischemic areas were manually delineated on OCTA images, and MAs were marked on the corresponding FFA images before overlaying paired scans for analysis (ImageJ; National Institutes of Health, Bethesda, MD, USA). Results Twenty-eight eyes of 20 patients were included. The average number of MAs identified in cropped FFA images was 127 ± 42. More DMI was noted in the superficial capillary plexus (SCP; 36 ± 13%) compared to the deep capillary plexus (DCP; 28 ± 14%, P < 0.001). Similarly, more MAs were associated with ischemic areas in SCP compared to DCP (92.0 ± 35.0 vs. 76.8 ± 36.5, P < 0.001). Most MAs bordered ischemic areas; fewer than 10% localized inside these regions. As DMI area increased, so did associated MAs (SCP: r = 0.695, P < 0.001; DCP: r = 0.726, P < 0.001). Density of MAs surrounding FAZ (7.7 ± 6.0 MAs/mm2) was similar to other DMI areas (SCP: 7.0 ± 4.0 MAs/mm2, P = 0.478; DCP: 9.2 ± 10.9 MAs/mm2, P = 0.394). Conclusion MAs identified in FFA strongly associate with, and border areas of, DMI delineated by OCTA. Although more MAs are localized to SCP ischemia, the concentration of MAs associated with DCP ischemia is greater. By contrast, few MAs are present inside low-flow regions, likely because capillary loss is associated with their regression.
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Affiliation(s)
- Ahmed A Abdel-Kader
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - David J Ramsey
- Division of Ophthalmology, Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Wael A Yussuf
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Mohalhal
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Eldaly
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
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15
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Kapsala Z, Pallikaris A, Tsilimbaris MK. Assessment of a Novel Semi-Automated Algorithm for the Quantification of the Parafoveal Capillary Network. Clin Ophthalmol 2023; 17:1661-1674. [PMID: 37313218 PMCID: PMC10259575 DOI: 10.2147/opth.s407695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction We present a novel semi-automated computerized method for the detection and quantification of parafoveal capillary network (PCN) in fluorescein angiography (FA) images. Material and Methods An algorithm detecting the superficial parafoveal capillary bed in high-resolution grayscale FA images and creating a one-pixel-wide PCN skeleton was developed using MatLab software. In addition to PCN detection, capillary density and branch point density in two circular areas centered on the center of the foveal avascular zone of 500μm and 750μm radius was calculated by the algorithm. Three consecutive FA images with distinguishable PCN from 56 eyes from 56 subjects were used for analysis. Both manual and semi-automated detection of the PCN and branch points was performed and compared. Three different intensity thresholds were used for the PCN detection to optimize the method defined as mean(I)+0.05*SD(I), mean(I) and mean(I)-0.05*SD(I), where I is the grayscale intensity of each image and SD the standard deviation. Limits of agreement (LoA), intraclass correlation coefficient (ICC) and Pearson's correlation coefficient (r) were calculated. Results Using mean(I)-0.05*SD(I) as threshold the average difference in PCN density between semi-automated and manual method was 0.197 (0.316) deg-1 at 500μm radius and 0.409 (0.562) deg-1 at 750μm radius. The LoA were -0.421 to 0.817 and -0.693 to 1.510 deg-1, respectively. The average difference of branch point density between semi-automated and manual method was zero for both areas; LoA were -0.001 to 0.002 and -0.001 to 0.001 branch points/degrees2, respectively. The other two intensity thresholds provided wider LoA for both metrics. The semi-automated algorithm showed great repeatability (ICC>0.91 in the 500μm radius and ICC>0.84 in the 750μm radius) for both metrics. Conclusion This semi-automated algorithm seems to provide readings in agreement with those of manual capillary tracing in FA. Larger prospective studies are needed to confirm the utility of the algorithm in clinical practice.
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Affiliation(s)
- Zoi Kapsala
- Department of Neurology and Sensory Organs, Medical School, University of Crete, Heraklion, Greece
| | - Aristofanis Pallikaris
- Department of Neurology and Sensory Organs, Medical School, University of Crete, Heraklion, Greece
- Vardinoyiannion Eye Institute of Crete, Medical School, University of Crete, Heraklion, Greece
| | - Miltiadis K Tsilimbaris
- Department of Neurology and Sensory Organs, Medical School, University of Crete, Heraklion, Greece
- Vardinoyiannion Eye Institute of Crete, Medical School, University of Crete, Heraklion, Greece
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16
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Eid P, Creuzot-Garcher C, Aho LS, Gabrielle PH, Charpin E, Haddad D, Steinberg LA, Bron A, Verges B, Arnould L. Early Retinal Microvascular Changes Assessed with Swept-Source OCT Angiography in Type 1 Diabetes Patients without Retinopathy. J Clin Med 2023; 12:jcm12072687. [PMID: 37048770 PMCID: PMC10094932 DOI: 10.3390/jcm12072687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Type 1 diabetes is a chronic disease that can lead to vision loss when diabetic retinopathy develops. Retinal microvascular alterations occur before the appearance of clinical signs on a fundus examination. This study aimed to analyze retinal vascular parameters on optical coherence tomography angiography (OCT-A) in patients with type 1 diabetes without diabetic retinopathy in comparison with non-diabetic volunteers. This cross-sectional study was conducted at Dijon University Hospital from 2018 to 2020. Vascular densities were measured using macular OCT-A. In total, 98 diabetes patients and 71 non-diabetic volunteers were enrolled. A statistically significant lower vascular density of the inner circle was found in the superficial capillary plexus (SCP) in the diabetes group (p < 0.01). There was a statistically significant correlation between central vascular density in the deep capillary plexus (DCP) and total daily insulin intake (p = 0.042); furthermore, use of the FreeStyle Libre (FSL) device was associated with higher vascular densities in both the SCP (p = 0.034 for outer circle density) and DCP (p < 0.01 for inner circle density and p = 0.023 for outer circle density). Retinal microvascularization was early-altered in type 1 diabetes, and using the FSL device seemed to preserve retinal microvascularization.
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Affiliation(s)
- Pétra Eid
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Ludwig Serge Aho
- Epidemiology Department, University Hospital, 21000 Dijon, France
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Estelle Charpin
- Endocrinology-Diabetology Department, University Hospital, 21000 Dijon, France
| | - Déa Haddad
- Ophthalmology Department, University Hospital, 21000 Dijon, France
| | | | - Alain Bron
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Bruno Verges
- Endocrinology-Diabetology Department, University Hospital, 21000 Dijon, France
- INSERM, LNC-UMR1231, 21000 Dijon, France
| | - Louis Arnould
- Ophthalmology Department, University Hospital, 21000 Dijon, France
- INSERM, CIC1432, Clinical Epidemiology Unit, Dijon University Hospital, 21000 Dijon, France
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Ćurić A, Bjeloš M, Bušić M, Kuzmanović Elabjer B, Rak B, Vukojević N. Long-Term Functional Hyperemia after Uncomplicated Phacoemulsification: Benefits beyond Restoring Vision. Diagnostics (Basel) 2022; 12:diagnostics12102449. [PMID: 36292138 PMCID: PMC9600879 DOI: 10.3390/diagnostics12102449] [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: 09/22/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of the study was to investigate the long-term effects of uncomplicated phacoemulsification on macular perfusion using optical coherence tomography angiography (OCTA) in healthy aging subjects. OCTA was performed before phacoemulsification and 1 week, 1 month, 3 months, and 6 months after. Superficial vascular complex (formed of nerve fiber layer vascular plexus and superficial vascular plexus), deep vascular complex (formed of intermediate capillary plexus and deep capillary plexus), as well as choriocapillaris (CC) and large choroidal blood vessels were recorded. Significant changes of vascular parameters in 95 eyes of 95 patients reached plateau 1 week after surgery and remained stable up to 6 months, occurring in all retinal layers but not in choroid and CC. Statistically significant increases in retinal vessels area, vessels percentage area, total number of junctions, junctions density, and total and average vessels length were found, followed by the total number of end points and mean lacunarity decline, proving an increase in blood supply. The study confirmed that uncomplicated phacoemulsification leads to a long-term increase in macular retinal perfusion. The results might ease the decision regarding timing for cataract surgery as long-term perfusion benefits can be achieved. Furthermore, study results provide a normative database of retinal and choroidal vasculature in healthy aging patients.
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Affiliation(s)
- Ana Ćurić
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Mirjana Bjeloš
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Correspondence:
| | - Mladen Bušić
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Biljana Kuzmanović Elabjer
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Benedict Rak
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, University Hospital “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia
| | - Nenad Vukojević
- Department of Ophthalmology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Duan H, Xie J, Zhou Y, Zhang H, Liu Y, Tang C, Zhao Y, Qi H. Characterization of the Retinal Microvasculature and FAZ Changes in Ischemic Stroke and Its Different Types. Transl Vis Sci Technol 2022; 11:21. [PMID: 36239966 PMCID: PMC9586132 DOI: 10.1167/tvst.11.10.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to assess morphological changes in the retinal microvasculature and foveal avascular zone (FAZ) in patients with ischemic stroke and its different subtypes. Methods Thirty-three patients with ischemic stroke (14 with nonlacunar infarction and 19 with lacunar infarction) and 27 control participants were enrolled in this study. Based on optical coherence tomography angiography (OCTA), three vascular parameters, including vascular area density, vascular fractal dimension (VFD), and vascular orientation distribution (VOD), and four FAZ-related parameters, including FAZ area, FAZ axis ratio (FAR), FAZ circularity (FC), and FAZ roundness, in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were extracted and analyzed. Results Logistic regression results showed that worse best-corrected visual acuity (odds ratio [OR], 0.21), higher FAR (OR, 2.77) and lower FC (OR, 0.36) of the DCP were associated with ischemic stroke. Furthermore, lower VOD of the SCP was significantly associated with lacunar infarction compared with nonlacunar infarction. Conclusions Our study shows that the FAR and FC of the DCP may be potential biomarkers of ischemic stroke. Moreover, we demonstrated that OCT showed specific damage patterns in retinal microvascular and macular morphology in different subtypes of ischemic stroke. Translational Relevance This work lays the foundation for the pathophysiological characteristics of cerebrovascular diseases assisted by retinal imaging and artificial intelligence.
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Affiliation(s)
- Hongyu Duan
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.,Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Jianyang Xie
- Cixi Institute of BioMedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Yifan Zhou
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Hui Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yiyun Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Chuhao Tang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Yitian Zhao
- Cixi Institute of BioMedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Hong Qi
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.,Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
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Verma A, Magesan K, Amose T, Alagorie AR, Gnanaraj R, Sadda SR, Sen P. Age-related assessment of foveal avascular zone and surrounding capillary networks with swept source optical coherence tomography angiography in healthy eyes. Eye (Lond) 2022; 36:1857-1864. [PMID: 35948688 PMCID: PMC9500041 DOI: 10.1038/s41433-022-02146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/09/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022] Open
Abstract
AIM To assess the macular capillary networks and foveal avascular zone (FAZ) with swept-source optical coherence tomography angiography in healthy eyes. METHODS This cross-sectional, prospective, observational study enrolled 222 eyes of 116 healthy participants with no ocular or systemic disease. SS-OCTA images were captured using the PLEX Elite 9000 (Carl Zeiss Meditec Inc., Dublin, CA, USA) with a 6 × 6 mm pattern centered on the foveal center. Vessel length density (VLD), perfusion density (PD), and FAZ parameters were analyzed using the manufacturer's automated software. RESULTS A significant negative correlation was observed between age and average VLD in the superficial plexus, and average PD in both the superficial plexus and the whole retina. A significant positive correlation between age and foveal avascular zone perimeter and area was also noted. Age-wise comparisons showed a trend for an increase in VLD and PD until 40 years of age, with a subsequent decrease in the older age in the macular region. The central subfield showed a decrease in the vessel density measurements in the 21-40 age group. FAZ area and perimeter were the mirror inverse of the central subfield vessel density measurements with a numerically greater area and perimeter in the 21-40 age group compared to the 0-20 and 41-60 age groups. FAZ circularity was significantly reduced after 40 years of age. CONCLUSION Age-related changes in the vessel density and FAZ parameters in the healthy macula are complex and vary with the macular location. These results carry significance when interpreting the data from diseased eyes.
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Affiliation(s)
- Aditya Verma
- Shri Bhagwan Mahavir VitreoRetinal Services, Medical Research Foundation, Tamil Nadu, India.
| | - Kowsigan Magesan
- Elite School of Optometry, Unit of Medical Research Foundation, Tamil Nadu, India
| | - T Amose
- Elite School of Optometry, Unit of Medical Research Foundation, Tamil Nadu, India
| | | | - Ramya Gnanaraj
- Shri Bhagwan Mahavir VitreoRetinal Services, Medical Research Foundation, Tamil Nadu, India
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Parveen Sen
- Shri Bhagwan Mahavir VitreoRetinal Services, Medical Research Foundation, Tamil Nadu, India
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Sodhi PK, Shaw E, Gautam A, Yadav A, R AT, Rao KC, Sharma S, Tewari R. Evaluating the Quantitative Foveal Avascular Zone and Retino-Choroidal Vessel Density Using Optical Coherence Tomography Angiography in a Healthy Indian Population. Cureus 2022; 14:e27669. [PMID: 36072178 PMCID: PMC9440613 DOI: 10.7759/cureus.27669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/05/2022] Open
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Tombolini B, Borrelli E, Sacconi R, Bandello F, Querques G. Diabetic macular ischemia. Acta Diabetol 2022; 59:751-759. [PMID: 35133500 DOI: 10.1007/s00592-021-01844-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
AIM Since its relevance on diagnosis and prognosis of diabetic retinopathy (DR), this review will examine a multimodal imaging approach to detect diabetic macular ischemia (DMI). METHODS A PubMed engine search was carried out using the term "macular ischemia" paired with "diabetes," and "diabetic macular ischemia" paired to "fluorescein angiography," "ultra-wide field fluorescein angiography," "optical coherence tomography angiography," "octa," "2D octa," "ultra-wide field octa," "3D octa," "visual acuity." All studies published in English up to October 2021 irrespective of their publication status were reviewed, and relevant publications were included in this review. RESULTS Recently, new technologies have been proposed as an alternative to fluorescein angiography (FA), which is an actual diagnostic gold standard technique. Nowadays, optical coherence tomography angiography (OCTA) has emerged as the most promising and reliable procedure able to provide a qualitative and quantitative description of DMI. Newer three-dimensional (3D) OCTA approach will be discussed too. Moreover, we will discuss how OCTA might identify preclinical alterations before the onset of DR and allow prediction about the progression of disease. CONCLUSION OCTA has significantly expanded our knowledge on diabetic macular ischemia.
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Affiliation(s)
- Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Ophthalmology Unit, Division of Head and Neck, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Zippel N, Kenny CH, Wu H, Garneau M, Kroe-Barrett R, Gupta P, Low S, Bakker RA, Thomas L. Sema3A Antibody BI-X Prevents Cell Permeability and Cytoskeletal Collapse in HRMECs and Increases Tip Cell Density in Mouse Oxygen-Induced Retinopathy. Transl Vis Sci Technol 2022; 11:17. [PMID: 35727188 PMCID: PMC9233289 DOI: 10.1167/tvst.11.6.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Semaphorin 3A (Sema3A) is an axonal guidance molecule that inhibits angiogenesis by vasorepulsion and blocks revascularization in the ischemic retina. BI-X is an intravitreal anti-Sema3A agent under clinical investigation in patients with proliferative diabetic retinopathy (PDR) and diabetic macular ischemia (DMI). Methods Surface plasmon resonance was used to determine binding affinity of BI-X to human and murine Sema3A. In vitro, human retinal microvascular endothelial cells (HRMECs) were used to assess effects of BI-X on cell permeability and cytoskeletal collapse induced by Sema3A. In vivo, intravitreal BI-X or an anti-trinitrophenol control antibody was administered in both eyes in mice with oxygen-induced retinopathy (OIR). Retinal flat mounts were prepared, and avascular area and tip cell density were determined using confocal laser-scanning microscopy. Results Dissociation constants for BI-X binding to human and murine Sema3A were 29 pM and 27 pM, respectively. In vitro, BI-X prevented HRMEC permeability and cytoskeletal collapse induced by Sema3A. In vivo, BI-X increased tip cell density by 33% (P < 0.001) and reduced avascular area by 12% (not significant). A significant negative correlation was evident between avascular area and tip cell density (r2 = 0.4205, P < 0.0001). Conclusions BI-X binds to human Sema3A with picomolar affinity and prevents cell permeability and cytoskeletal collapse in HRMECs. BI-X also enhances revascularization in mice with OIR. Translational Relevance BI-X is a potent inhibitor of human Sema3A that improves revascularization in a murine model of OIR; BI-X is currently being investigated in patients with laser-treated PDR and DMI.
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Affiliation(s)
- Nina Zippel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Helen Wu
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Michel Garneau
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Priyanka Gupta
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Sarah Low
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Remko A Bakker
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Leo Thomas
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
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Association of microvascular biomarkers in fluorescein angiography with macrovascular-related mortality in clinical routine data. PLoS One 2022; 17:e0266423. [PMID: 35511907 PMCID: PMC9071156 DOI: 10.1371/journal.pone.0266423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/19/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Early detection of microvascular changes in the retina may be important for the risk assessment of cardiovascular health. Therefore, the purpose of this study was to investigate imaging biomarkers in fluorescein angiography (FA) as potential predictors for cardiovascular mortality. Methods In this retrospective, matched case-control study, we included FA images from clinical routine data between 2007 and 2018 of 100 patients who died of macrovascular events (Group 1) and 100 age- and sex-matched controls (Group 2). All patients were under treatment for different, mostly retinal, ocular diseases. FA images were used for the measurement of the foveal avascular zone (FAZ) and the arteriolar and venular caliber. Results Patients mean age on examination day was 69.5 ± 8.3 years with a 1:1 female:male subject ratio. Mean FAZ area of our sample was 0.340 ± 0.135 mm2 for Group 1 and 0.264 ± 0.137 mm2 for Group 2 (P < 0.001), showing a larger FAZ area in patients who subsequently died of macrovascular-related systemic diseases. Conclusions Individuals effected by a macrovascular-related disease show a larger FAZ on FA examinations before the event compared to patients which are unaffected. Our results highlight a possible role of the FAZ as additional biomarker for the cardiovascular condition.
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Elsharkawy M, Elrazzaz M, Sharafeldeen A, Alhalabi M, Khalifa F, Soliman A, Elnakib A, Mahmoud A, Ghazal M, El-Daydamony E, Atwan A, Sandhu HS, El-Baz A. The Role of Different Retinal Imaging Modalities in Predicting Progression of Diabetic Retinopathy: A Survey. SENSORS (BASEL, SWITZERLAND) 2022; 22:3490. [PMID: 35591182 PMCID: PMC9101725 DOI: 10.3390/s22093490] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Diabetic retinopathy (DR) is a devastating condition caused by progressive changes in the retinal microvasculature. It is a leading cause of retinal blindness in people with diabetes. Long periods of uncontrolled blood sugar levels result in endothelial damage, leading to macular edema, altered retinal permeability, retinal ischemia, and neovascularization. In order to facilitate rapid screening and diagnosing, as well as grading of DR, different retinal modalities are utilized. Typically, a computer-aided diagnostic system (CAD) uses retinal images to aid the ophthalmologists in the diagnosis process. These CAD systems use a combination of machine learning (ML) models (e.g., deep learning (DL) approaches) to speed up the diagnosis and grading of DR. In this way, this survey provides a comprehensive overview of different imaging modalities used with ML/DL approaches in the DR diagnosis process. The four imaging modalities that we focused on are fluorescein angiography, fundus photographs, optical coherence tomography (OCT), and OCT angiography (OCTA). In addition, we discuss limitations of the literature that utilizes such modalities for DR diagnosis. In addition, we introduce research gaps and provide suggested solutions for the researchers to resolve. Lastly, we provide a thorough discussion about the challenges and future directions of the current state-of-the-art DL/ML approaches. We also elaborate on how integrating different imaging modalities with the clinical information and demographic data will lead to promising results for the scientists when diagnosing and grading DR. As a result of this article's comparative analysis and discussion, it remains necessary to use DL methods over existing ML models to detect DR in multiple modalities.
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Affiliation(s)
- Mohamed Elsharkawy
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
| | - Mostafa Elrazzaz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
| | - Ahmed Sharafeldeen
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
| | - Marah Alhalabi
- Electrical, Computer and Biomedical Engineering Department, College of Engineering, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.); (M.A.)
| | - Fahmi Khalifa
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
| | - Ahmed Soliman
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
| | - Ahmed Elnakib
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
| | - Mohammed Ghazal
- Electrical, Computer and Biomedical Engineering Department, College of Engineering, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.); (M.A.)
| | - Eman El-Daydamony
- Information Technology Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt; (E.E.-D.); (A.A.)
| | - Ahmed Atwan
- Information Technology Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt; (E.E.-D.); (A.A.)
| | - Harpal Singh Sandhu
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA; (M.E.); (M.E.); (A.S.); (F.K.); (A.S.); (A.E.); (A.M.); (H.S.S.)
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Hofer D, Schmidt-Erfurth U, Orlando JI, Goldbach F, Gerendas BS, Seeböck P. Improving foveal avascular zone segmentation in fluorescein angiograms by leveraging manual vessel labels from public color fundus pictures. BIOMEDICAL OPTICS EXPRESS 2022; 13:2566-2580. [PMID: 35774310 PMCID: PMC9203117 DOI: 10.1364/boe.452873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Abstract
In clinical routine, ophthalmologists frequently analyze the shape and size of the foveal avascular zone (FAZ) to detect and monitor retinal diseases. In order to extract those parameters, the contours of the FAZ need to be segmented, which is normally achieved by analyzing the retinal vasculature (RV) around the macula in fluorescein angiograms (FA). Computer-aided segmentation methods based on deep learning (DL) can automate this task. However, current approaches for segmenting the FAZ are often tailored to a specific dataset or require manual initialization. Furthermore, they do not take the variability and challenges of clinical FA into account, which are often of low quality and difficult to analyze. In this paper we propose a DL-based framework to automatically segment the FAZ in challenging FA scans from clinical routine. Our approach mimics the workflow of retinal experts by using additional RV labels as a guidance during training. Hence, our model is able to produce RV segmentations simultaneously. We minimize the annotation work by using a multi-modal approach that leverages already available public datasets of color fundus pictures (CFPs) and their respective manual RV labels. Our experimental evaluation on two datasets with FA from 1) clinical routine and 2) large multicenter clinical trials shows that the addition of weak RV labels as a guidance during training improves the FAZ segmentation significantly with respect to using only manual FAZ annotations.
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Affiliation(s)
- Dominik Hofer
- Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - José Ignacio Orlando
- Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
- Yatiris Group, PLADEMA Institute, CON-ICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Gral. Pinto 399, Tandil, Buenos Aires, Argentina
| | - Felix Goldbach
- Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Bianca S. Gerendas
- Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Philipp Seeböck
- Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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Li W, Zhang H, Li F, Wang L. RPS-Net: An effective retinal image projection segmentation network for retinal vessels and foveal avascular zone based on OCTA data. Med Phys 2022; 49:3830-3844. [PMID: 35297061 DOI: 10.1002/mp.15608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Optical coherence tomography angiography (OCTA) is an advanced imaging technology that can present the three-dimensional (3D) structure of retinal vessels (RVs). Quantitative analysis of retinal vessel density and foveal avascular zone (FAZ) area is of great significance in clinical diagnosis and the automatic semantic segmentation at the pixel level helps quantitative analysis. The existing segmentation methods cannot effectively use the volume data and projection map data of the OCTA image at the same time and lack the trade-off between global perception and local details, which lead to problems such as discontinuity of segmentation results and deviation of morphological estimation. PURPOSE In order to better assist physicians in clinical diagnosis and treatment, the segmentation accuracy of RVs and FAZ needs to be further improved. In this work, we propose an effective retinal image projection segmentation network (RPS-Net) to achieve accurate RVs and FAZ segmentation. Experiments show that this network exhibits good performance and outperforms other existing methods. METHODS Our method considers three aspects. First, we use two parallel projection paths to learn global perceptual features and local supplementary details. Secondly, we use the dual-way projection learning module (DPLM) to reduce the depth of the 3D data and learn image spatial features. Finally, we merged the two-dimensional features learned from the volume data with the two-dimensional projection data, and used a U-shaped network to further learn and generate the final result. RESULTS We validated our model on the OCTA-500, which is a large multi-modal, multi-task retinal dataset. The experimental results showed that our method achieved state-of-the-art performance, the mean Dice coefficients for RVs are 89.89 ± 2.60 (%) and 91.40 ± 9.18 (%) on the two subsets, while the Dice coefficients for FAZ are 91.55 ± 2.05 (%) and 97.80 ± 2.75 (%), respectively. CONCLUSIONS Our method can make full use of the information of 3D data and 2D data to generate segmented images with higher continuity and accuracy. Code is available at https://github.com/hchuanZ/MFFN/tree/master. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Weisheng Li
- Chongqing Key Laboratory of Image Cognition, Chongqing University of Posts and Telecommunications, Chongqing, 400000, China
| | - Hongchuan Zhang
- Chongqing Key Laboratory of Image Cognition, Chongqing University of Posts and Telecommunications, Chongqing, 400000, China
| | - Feiyan Li
- Chongqing Key Laboratory of Image Cognition, Chongqing University of Posts and Telecommunications, Chongqing, 400000, China
| | - Linhong Wang
- Chongqing Key Laboratory of Image Cognition, Chongqing University of Posts and Telecommunications, Chongqing, 400000, China
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Attia Ali Ahmed M, Shawkat Abdelhaleem A. Evaluation of Microvascular and Visual Acuity Changes in Patients with Early Diabetic Retinopathy: Optical Coherence Tomography Angiography Study. Clin Ophthalmol 2022; 16:429-440. [PMID: 35210748 PMCID: PMC8860397 DOI: 10.2147/opth.s353426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Comparison of early microvascular changes detected by optical coherence tomography angiography (OCTA) in patients with mild non-proliferative diabetic retinopathy (NPDR) with healthy volunteers. Patients and Methods Forty-four eyes of 44 type-2 diabetic patients with mild non-proliferative diabetic retinopathy and 30 eyes of 30 age-matched healthy controls were imaged using OCTA to quantify microvascular changes and the FAZ quantitative parameters (area, perimeter, and circularity index); the values of patients and controls were then compared. Results Macular vessel density, perfusion index, and circularity index values were reduced and positively correlated with visual acuity in patients (15.4 ± 2.6, 38.0 ± 6.7, 0.6 ± 0.06 and p = 0.003, 0.001, and 0.003, respectively). However, FAZ area and perimeter were found to be larger in patients than controls (0.30 ± 0.08, 2.5 ± 0.3 and p < 0.001). Conclusion OCTA quantified vessel density and perfusion density were found to be correlated with visual acuity and FAZ parameters in patients with early NPDR; this could help in detecting early disease progression and modifying treatment decisions.
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Affiliation(s)
- Mohamed Attia Ali Ahmed
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt
- Correspondence: Mohamed Attia Ali Ahmed, Email ;
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The relationship between perifoveal capillary ring alterations and visual acuity in diabetic retinopathy. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp201030003p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The relationship between the foveal avascular zone (FAV) and visual acuity (VA) in retinal dis-eases remains a matter of discussion. The aim of this study was to determine the impact of diabetic macular ischemia (DMI) on VA through the analysis of the perifoveal capillary network in various stages of diabetic retinopathy - DR (non-proliferative diabetic retinopathy ? NPDR and proliferative diabetic retinopathy ? PDR). Methods. Qualitative and quantitative analysis of 143 angiograms of patients with different stages of DR was performed. The degree of macular ischemia was assessed by the analysis of 2 parameters: perifoveal capillary ring, ie, the FAZ outline irregularity, and capillary loss. Finally, a comparison was made between the degree of macular ischemia with the best-corrected VA, depending on macular thickness. Results. In the eyes with mild and moderate NPDR, without significant macular thickening, no statistically significant decrease in VA caused by macular ischemia was noticed (p = 0.81). Opposite, in a subgroup with severe NPDR and PDR, without significant macular thickening, a statistically significant difference was presented among eyes with moderate and severe macular ischemia compared to eyes with lower grades of macular ischemia (p = 0.021 and p = 0.018, respectively). In the eyes with moderate NPDR and mild macular ischemia, the increase in macular thickness resulted in a statistically insignificant decrease in VA compared to eyes with a normal macular thickness (p = 0.088). However, in the eyes with severe NPDR, every pathological increase in macular thickness caused a statistically significant decrease in VA, regardless of the degree of macular ischemia (p = 0.018?0.040). A similar relationship was also found in the eyes with PDR (p = 0.017?0.042). In the eyes with a statistically significant decrease in VA, most of the examined eyes (98%) had the FAZ outline irregularity in the nasal perifoveal subfield. Conclusion. In the absence of significant macular thickening, the destruction of one-half of the perifoveal capillary network, or greater, is associated with reduced VA. The location of macular ischemic changes in the nasal parts of the perifoveal capillary ring plays a crucial role in its effects on visual function.
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Optical Coherence Tomography Angiography in Diabetic Patients: A Systematic Review. Biomedicines 2021; 10:biomedicines10010088. [PMID: 35052768 PMCID: PMC8773551 DOI: 10.3390/biomedicines10010088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Diabetic retinopathy (DR) is the leading cause of legal blindness in the working population in developed countries. Optical coherence tomography (OCT) angiography (OCTA) has risen as an essential tool in the diagnosis and control of diabetic patients, with and without DR, allowing visualisation of the retinal and choroidal microvasculature, their qualitative and quantitative changes, the progression of vascular disease, quantification of ischaemic areas, and the detection of preclinical changes. The aim of this article is to analyse the current applications of OCTA and provide an updated overview of them in the evaluation of DR. Methods: A systematic literature search was performed in PubMed and Embase, including the keywords “OCTA” OR “OCT angiography” OR “optical coherence tomography angiography” AND “diabetes” OR “diabetes mellitus” OR “diabetic retinopathy” OR “diabetic maculopathy” OR “diabetic macular oedema” OR “diabetic macular ischaemia”. Of the 1456 studies initially identified, 107 studies were screened after duplication, and those articles that did not meet the selection criteria were removed. Finally, after looking for missing data, we included 135 studies in this review. Results: We present the common and distinctive findings in the analysed papers after the literature search including the diagnostic use of OCTA in diabetes mellitus (DM) patients. We describe previous findings in retinal vascularization, including microaneurysms, foveal avascular zone (FAZ) changes in both size and morphology, changes in vascular perfusion, the appearance of retinal microvascular abnormalities or new vessels, and diabetic macular oedema (DME) and the use of deep learning technology applied to this disease. Conclusion: OCTA findings enable the diagnosis and follow-up of DM patients, including those with no detectable lesions with other devices. The evaluation of retinal and choroidal plexuses using OCTA is a fundamental tool for the diagnosis and prognosis of DR.
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Diabetic macular ischaemia- a new therapeutic target? Prog Retin Eye Res 2021; 89:101033. [PMID: 34902545 DOI: 10.1016/j.preteyeres.2021.101033] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/21/2022]
Abstract
Diabetic macular ischaemia (DMI) is traditionally defined and graded based on the angiographic evidence of an enlarged and irregular foveal avascular zone. However, these anatomical changes are not surrogate markers for visual impairment. We postulate that there are vascular phenotypes of DMI based on the relative perfusion deficits of various retinal capillary plexuses and choriocapillaris. This review highlights several mechanistic pathways, including the role of hypoxia and the complex relation between neurons, glia, and microvasculature. The current animal models are reviewed, with shortcomings noted. Therefore, utilising the advancing technology of optical coherence tomography angiography (OCTA) to identify the reversible DMI phenotypes may be the key to successful therapeutic interventions for DMI. However, there is a need to standardise the nomenclature of OCTA perfusion status. Visual acuity is not an ideal endpoint for DMI clinical trials. New trial endpoints that represent disease progression need to be developed before irreversible vision loss in patients with DMI. Natural history studies are required to determine the course of each vascular and neuronal parameter to define the DMI phenotypes. These DMI phenotypes may also partly explain the development and recurrence of diabetic macular oedema. It is also currently unclear where and how DMI fits into the diabetic retinopathy severity scales, further highlighting the need to better define the progression of diabetic retinopathy and DMI based on both multimodal imaging and visual function. Finally, we discuss a complete set of proposed therapeutic pathways for DMI, including cell-based therapies that may provide restorative potential.
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Evaluation of retinal microvascular structures by optical coherence tomography angiography in primary Sjögren's syndrome. Int Ophthalmol 2021; 42:1147-1159. [PMID: 34746971 DOI: 10.1007/s10792-021-02100-9] [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: 07/23/2020] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES There are insufficient data in the literature on how retinal capillaries are affected in primary Sjögren's syndrome (PSS). The aim of this study was to evaluate the retinal capillary density (CD) in PSS using optical coherence tomography angiography (OCTA). METHODS In this case-control study, 26 eyes from 13 PSS patients and 39 eyes from 20 healthy controls (HCs) were included. The CD in the regions of the superior capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillaries (RPC) as well as assessment parameters of the foveal avascular zone (FAZ) were examined by OCTA. RESULTS The mean CD (%) was 50.2 ± 4.2 and 50.5 ± 3.4 in the SCP (p = 0.904), 49.2 ± 7.5 and 53.9 ± 5.7 in the DCP (p = 0.006) and 50.8 ± 2.1 and 49.8 ± 2.2 in the RPC (p = 0.088) regions in patients with PSS and HCs, respectively. In patients with PSS and HCs, the mean sizes of the FAZ were 0.243 ± 0.07 mm2 and 0.283 ± 0.13 mm2 (p = 0.142), and the mean sizes of the non-flow area were 0.480 ± 0.11 mm2 and 0.509 ± 0.13 mm2, respectively (p = 0.359). The correlation coefficients (Rho) of retinal CD in the SCP, DCP and RPC regions with disease duration were - 0.545 (p = 0.004), - 0.389 (p = 0.050) and - 0.795 (p < 0.001), respectively. CONCLUSION The retinal CD in PSS is lower than that in the healthy population in deep retinal capillaries, and retinal CD shows a negative correlation with disease duration in PSS. CLINICAL TRIALS REGISTRATION This study was not registered to clinicaltrials.gov.
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Aschauer J, Aschauer S, Pollreisz A, Datlinger F, Gatterer C, Mylonas G, Egner B, Hofer D, Steiner I, Hengstenberg C, Schmidt-Erfurth U. Identification of Subclinical Microvascular Biomarkers in Coronary Heart Disease in Retinal Imaging. Transl Vis Sci Technol 2021; 10:24. [PMID: 34787666 PMCID: PMC8606892 DOI: 10.1167/tvst.10.13.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Cardiovascular disease and foremost coronary heart disease (CHD) are the worldwide leading causes of death. The aim of this study was to use non-invasive, multimodel retinal imaging to define microvascular features in patients with and without coronary angiography (CA)-confirmed CHD. Methods In this prospective, cross-sectional pilot study we included adult patients who presented to a tertiary referral center for elective CA due to suspected CHD. All patients underwent widefield fundus photography for retinopathy grading. Optical coherence tomography angiography was used to measure vessel density (VD) of the individual capillary plexuses in 6 × 6-mm macular volume scans. Adaptive optics imaging was performed to assess the first-order arteriolar lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and wall cross-section area, as well as to qualitatively describe vessel morphology. Results Of the included 45 patients (13 females; 65 ± 10 years old), 27 were confirmed with CHD in elective CA. The most prevalent retinal vascular pathologies were arteriovenous nickings, focal arterial narrowings, and microaneurysms. VD in the superficial capillary plexus, deep capillary plexus, and choriocapillaris was lower in CHD patients, although the odds ratios were not significantly different from 1 (P = 0.06–0.92). Median arterial LD, TD, and WLR values were 98.3 µm (interquartile range [IQR] = 13.0), 122.9 µm (IQR = 17.6), and 0.26 µm (IQR = 0.07), respectively, with a trend toward a higher WLR in CHD patients. Conclusions In a cardiovascular risk population, high-resolution quantitative and qualitative microvascular phenotyping in the retina may provide valuable subclinical indicators for coronary artery impairment, although larger clinical trials are needed. Translational Relevance Subclinical retinal microvascular changes may serve as non-invasive, cost-effective biomarkers for risk stratification of patients with CHD.
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Affiliation(s)
- Julia Aschauer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Stefan Aschauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Felix Datlinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Constantin Gatterer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Berit Egner
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Dominik Hofer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Irene Steiner
- CeMSIIS, Institute for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Wang Z, Lin L, Wu J, Tang X. Multi-task Learning Based Ocular Disease Discrimination and FAZ Segmentation Utilizing OCTA Images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2790-2793. [PMID: 34891828 DOI: 10.1109/embc46164.2021.9631043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this paper, we proposed and validated a multi-task based deep learning method for simultaneously segmenting the foveal avascular zone (FAZ) and classifying three ocular disease related states (normal, diabetic, and myopia) utilizing optical coherence tomography angiography (OCTA) images. The essential motivation of this work is that reliable predictions on disease states may be made based on features extracted from a segmentation network, by sharing a same encoder between the classification network and the segmentation network. In this study, a cotraining network structure was designed for simultaneous ocular disease discrimination and FAZ segmentation. Specifically, we made use of a classification head following a segmentation network's encoder, so that the classification branch used the feature information extracted in the segmentation branch to improve the classification results. The performance of our proposed network structure has been tested and validated on the FAZID dataset, with the best Dice and Jaccard being 0.9031±0.0772 and 0.8302 ±0.0990 for FAZ segmentation, and the best Accuracy and Kappa being 0.7533 and 0.6282 for classifying three ocular disease related states.Clinical Relevance- This work provides a useful tool for segmenting FAZ and discriminating three ocular disease related states utilizing OCTA images, which has a great clinical potential in ocular disease screening and biomarker delivering.
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Mahjoub A, Cherni I, Khayrallah O, Ben Abdesslam N, Mahjoub A, Anas R, Ghorbel M, Mahjoub H, Knani L, Krifa F. Contribution of optical coherence tomography angiography OCT-A in diabetic maculopathy. Ann Med Surg (Lond) 2021; 70:102904. [PMID: 34703579 PMCID: PMC8519827 DOI: 10.1016/j.amsu.2021.102904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Diabetic retinopathy (DR) increases the risk of blindness by 25 times. Advanced researchs are justified for better management, leading to the role of Optical Coherence Tomography-Angiography (OCT-A), a new non-invasive imaging technique exploring retinal vascularization. Our purpose is to identify microvascular macular anomalies of DR on OCT-A with qualitative and quantitative evaluation of their impact on retinal vascularization. Patients and methods This is a descriptive cross-sectional study where 120 eyes of 66 diabetic patients were enrolled. All patients were diabetic and went through OCT-A imaging. Results Microanevrysms were identified in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) where they were more frequently visualized. Macular edema was present in 16,7% of cases in the SCP, and in 30% in DCP. Edema spaces were more frequently present in DCP (p < 0,05). Capillary nonperfusion areas were identified in 82,5% of cases in SCP and in 60% of cases in DCP. The main peri-foveal vascular density was 18,95 ± 5,37%. The main surface of foveal avascular zone (FAZ) in the SCP was 462,52 μm2 and was 555,04 ± 329,11 μm2 in the DCP where it was larger. Conclusion OCT-A is a modern imaging tool that could be used for the diagnosis and monitoring of DR as well as the understanding of its pathophysiology. Retinal microvascular abnormalities on OCT-A are observed in diabetic retinopathy and are proportional to its severity. Deep capillary plexus was more severely affected than superficial capillary plexus. The assessment of macular ischemia could be based on the identification of areas of vascular rarefaction. Quantitative assessment of vascular density and the study of the foveal avascular zone can assess the macular ischemia
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Affiliation(s)
| | | | - Oumayma Khayrallah
- Corresponding author. Ophtalmology department, Farhat Hached Hospital of Sousse, Faculty of medicine of Sousse, Tunisia.
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Laotaweerungsawat S, Psaras C, Haq Z, Liu X, Stewart JM. Racial and ethnic differences in foveal avascular zone in diabetic and nondiabetic eyes revealed by optical coherence tomography angiography. PLoS One 2021; 16:e0258848. [PMID: 34679118 PMCID: PMC8535464 DOI: 10.1371/journal.pone.0258848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose The purpose of this study was to examine whether racial and ethnic differences in retinal microvasculature are detectable with quantitative measures derived from optical coherence tomography angiography (OCTA). Methods OCTA scans and fundus photography were obtained in 447 eyes from 271 patients with and without diabetes between April and October 2018. Fundus photos were graded by the hospital reading center for diabetic retinopathy (DR) severity. Eight OCTA parameters relating to the foveal avascular zone (FAZ), superficial vascular perfusion, and deep vascular perfusion were analyzed for significant differences between race and ethnicity groups, self-reported by patients and organized according to National Center for Health Statistics groupings. Multiple regression was then used to adjust estimates for possible confounding by age, gender, hypertension, and last hemoglobin A1c level. Results Significant differences in FAZ area were found between white and non-white patients. After adjustment, the differences between white and all non-white groups were statistically significant (p<0.05) among patients with mild to moderate DR. In those without diabetes, the Hispanic and Asian groups had significantly larger FAZ areas (p<0.005) than NH white patients. In those with mild to moderate non-proliferative diabetic retinopathy (NPDR), NH Black, Hispanic, and Asian patients also had significantly larger FAZ areas than NH white patients (p<0.005). Conclusion Significant differences in FAZ area exist among different racial and ethnic groups. These results highlight the importance of considering and further studying race and ethnicity in OCTA analyses of the retinal microvasculature.
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Affiliation(s)
- Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, United States of America
- Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Catherine Psaras
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, United States of America
| | - Zeeshan Haq
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, United States of America
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, San Francisco, CA, United States of America
- * E-mail:
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Jia X, Wei Y, Song H. Optical coherence tomography angiography evaluation of the effects of phacoemulsification cataract surgery on macular hemodynamics in Chinese normal eyes. Int Ophthalmol 2021; 41:4175-4185. [PMID: 34350527 DOI: 10.1007/s10792-021-01987-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To quantitatively evaluate the possible effects of phacoemulsification cataract surgery on macular hemodynamics using optical coherence tomography angiography (OCTA). METHODS This was a prospective observational study. Superficial and deep macular vascular densities, as well as parameters of foveal avascular zone (FAZ), were measured preoperatively (baseline) and at 1 day, 1 week, and 4 weeks postoperatively in normal eyes (≥ 22 mm and ≤ 24 mm) of patients scheduled for phacoemulsification cataract surgery with intraocular lens implantation. The correlations between the rate of change of pre- and postoperative vascular densities and surgical parameters were analyzed. RESULTS A total of 107 eyes of 107 patients were included in this study. Compared to the baseline measurements, no statistically significant variation was found in macular vascular densities at 1 day after the surgery (P > 0.05). Both superficial and deep macular vascular densities were significantly increased postoperatively at weeks 1 and week 4 (P < 0.05; P < 0.05); however, no statistically significant differences were detected in any of the FAZ parameters between the baseline measurements and the entire follow-up period (P > 0.05 for all). Also, no statistically significant correlations were established between main surgical parameters and macular vascular densities changes. CONCLUSIONS In normal eyes, macular blood perfusion gradually increased after phacoemulsification cataract surgery and was stabilized in one week. The foveal avascular zone was stabilized before and after the surgery. The main parameters and intraoperative perfusion of phacoemulsification surgery may not be the key factors affecting macular hemodynamics.
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Affiliation(s)
- Xinyu Jia
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, 4 Gansu Road, 300020, Heping, Tianjin, China.,Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yinjuan Wei
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, 4 Gansu Road, 300020, Heping, Tianjin, China.,Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Hui Song
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, 4 Gansu Road, 300020, Heping, Tianjin, China. .,Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.
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Arthur E, Alber J, Thompson LI, Sinoff S, Snyder PJ. OCTA reveals remodeling of the peripheral capillary free zones in normal aging. Sci Rep 2021; 11:15593. [PMID: 34341456 PMCID: PMC8329222 DOI: 10.1038/s41598-021-95230-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
The retinal neurovascular unit consists of blood vessel endothelial cells, pericytes, neurons, astrocytes, and Müller cells that form the inner retinal blood barrier. A peripheral capillary free zone (pCFZ) represents the distance that oxygen and nutrients must diffuse to reach the neural retina, and serves as a metric of retinal tissue oxygenation. The pCFZs are formed based on oxygen saturation in the retinal arterioles and venules. Because retinal arterioles contain a larger concentration of oxygenated blood than venules, there is a reduced need for capillaries to exist closely to arterioles compared to venules. Therefore, in a healthy individual, larger periarteriole CFZs are expected compared to perivenule CFZs. With normal aging, there is atrophy of the inner retinal neurons, and consequently reduced extraction of oxygen and nutrients from the retinal vessels (i.e., increased oxygen saturation). Therefore, we hypothesized that the peripheral CFZ will remodel with normal aging. Using Optical Coherence Tomography Angiography, we showed that the pCFZs do remodel in normal aging with large (perivenule: η2p = 0.56) and moderate (periarteriole: η2p = 0.12) effect sizes, opening the possibility that such changes may be further increased by neurodegenerative diseases that adversely impact the health of the retinal neural cell layers.
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Affiliation(s)
- Edmund Arthur
- grid.20431.340000 0004 0416 2242Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI USA ,grid.20431.340000 0004 0416 2242George and Anne Ryan Institute for Neuroscience, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 USA ,grid.273271.20000 0000 8593 9332Butler Hospital Memory and Aging Program, Providence, RI USA
| | - Jessica Alber
- grid.20431.340000 0004 0416 2242Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI USA ,grid.20431.340000 0004 0416 2242George and Anne Ryan Institute for Neuroscience, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 USA ,grid.273271.20000 0000 8593 9332Butler Hospital Memory and Aging Program, Providence, RI USA
| | - Louisa I. Thompson
- grid.273271.20000 0000 8593 9332Butler Hospital Memory and Aging Program, Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Stuart Sinoff
- grid.432466.10000 0004 0382 745XBayCare Health, Clearwater, FL USA
| | - Peter J. Snyder
- grid.20431.340000 0004 0416 2242Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI USA ,grid.20431.340000 0004 0416 2242George and Anne Ryan Institute for Neuroscience, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 USA
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Li ZB, Lin ZJ, Li N, Yu H, Wu YL, Shen X. Evaluation of retinal and choroidal changes in patients with Alzheimer's type dementia using optical coherence tomography angiography. Int J Ophthalmol 2021; 14:860-868. [PMID: 34150541 DOI: 10.18240/ijo.2021.06.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the changes in fundus parameters in patients with Alzheimer's type dementia (ATD) using optical coherence tomography angiography (OCTA), to record flash electroretinograms (ERG) using the RETeval system and to explore changes in retinal function. METHODS Twenty-nine patients with ATD and 26 age-matched normal subjects were enrolled. All subjects underwent OCTA scans to analyse the superficial retinal vessel parameters in the macular area, including the vessel length density, the vessel perfusion density and the area of foveal avascular zone (FAZ), as well as the choroidal thickness. The differences between the patients with ATD and the normal control group were compared and explored the relevant factors affecting vessel parameters. We also recorded the flash ERGs using the RETeval system and intended to explore changes in retinal function by analysing the ERG image amplitude in patients with ATD. RESULTS The vessel parameters [P vessel length density=0.005 and P vessel perfusion density=0.006) and average choroid thickness (P<0.001) in the macular area of the ATD group was less than the control group. The FAZ area was statistically significantly enlarged in the ATD group (P<0.001). These parameters were correlated with the Mini-Mental State Examination (MMSE) score and the Montreal Cognitive Assessment (MoCA). CONCLUSION Patients with ATD exhibit decreases in the parameters associated with fundus. In addition, these indicators significantly correlate with the MMSE score and the MoCA score. OCTA may be an adjunct tool with strong potential to track changes in the diagnosis and monitoring the progression of the disease.
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Affiliation(s)
- Ze-Bing Li
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhong-Jing Lin
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Na Li
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Huan Yu
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yan-Lin Wu
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xi Shen
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Foveal Avascular Zone and Choroidal Thickness Are Decreased in Subjects with Hard Drusen and without High Genetic Risk of Developing Alzheimer's Disease. Biomedicines 2021; 9:biomedicines9060638. [PMID: 34199664 PMCID: PMC8229973 DOI: 10.3390/biomedicines9060638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 01/08/2023] Open
Abstract
A family history (FH+) of Alzheimer’s disease (AD) and ɛ4 allele of the ApoE gene are the main genetic risk factors for developing AD, whereas ɛ4 allele plays a protective role in age-related macular degeneration. Ocular vascular changes have been reported in both pathologies. We analyzed the choroidal thickness using optical coherence tomography (OCT) and the foveal avascular zone (FAZ) using OCT-angiography and compared the results with ApoE gene expression, AD FH+, and the presence or absence of hard drusen (HD) in 184 cognitively healthy subjects. Choroidal thickness was statistically significantly different in the (FH−, ɛ4−, HD+) group compared with (i) both the (FH−, ɛ4−, HD−) and the (FH+, ɛ4+, HD+) groups in the superior and inferior points at 1500 μm, and (ii) the (FH+, ɛ4−, HD+) group in the superior point at 1500 μm. There were statistically significant differences in the superficial FAZ between the (FH+, ɛ4−, HD+) group and (i) the (FH+, ɛ4−, HD−) group and (ii) the (FH+, ɛ4+, HD−) group. In conclusion, ocular vascular changes are not yet evident in participants with a genetic risk of developing AD.
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Kim DY, Kim KS, Youm JH. Diagnostic Availability of Optical Coherence Angiography in Type 1 and 2 Choroidal Neovascularization. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.3.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Petrou P, Angelidis CD, Andreanos K, Kanakis M, Kandarakis S, Karamaounas A, Papakonstantinou E, Mamas N, Droutsas K, Georgalas I. Reduction of Foveal Avascular Zone After Vitrectomy Demonstrated by Optical Coherence Tomography Angiography. Cureus 2021; 13:e13757. [PMID: 33717769 PMCID: PMC7943050 DOI: 10.7759/cureus.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To investigate the effect of pars plana vitrectomy on foveal circulation, and in particular the foveal avascular zone (FAZ), using optical coherence tomography angiography (OCTA). Methods: This was a prospective, non-randomized, comparative case series of patients that underwent vitrectomy. Twenty-six eyes of 26 patients that underwent vitrectomy were studied postoperatively by OCTA. Our patients underwent 23 or 25G pars plana vitrectomy (PPV) for any posterior segment pathology. Three-dimensional OCTAs (DRI Triton Swept Source OCT; Topcon) of the capillary plexus were obtained three months post-operatively. The FAZ measurements of the fellow eyes were used as controls. Main outcome measures: Change in FAZ area between vitrectomized eyes and controls. Results: From a total of 26 patients, 17 underwent vitrectomy due to retinal detachment (RD). Almost all patients demonstrated a statistically significant reduction in FAZ size based on the OCTA measurements. Τhe mean difference in FAZ size for the superficial capillary plexus (SCP) was -93.77 ± 71.73 μm and for the deep capillary plexus (DCP) -88.87 ± 75.41 μm, both statistically significant (p=0.000), while the amount of reduction in μm was the same for both SCP and DCP. Conclusion: The foveal avascular zone seems to be reduced following vitrectomy as shown by optical coherence tomography angiography. It is postulated that this may be the result of changes in the physiology of the vitrectomized eye, and that this change should be attributed to the removal of the vitreous itself rather than other structures such as the internal limiting membrane.
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Affiliation(s)
- Petros Petrou
- Ophthalmology, "G. Gennimatas" General Hospital of Athens, Athens, GRC
| | - Constantine D Angelidis
- Ophthalmology, "G. Gennimatas" General Hospital of Athens, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Konstantinos Andreanos
- Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Menelaos Kanakis
- Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Stylianos Kandarakis
- Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | | | - Nikolaos Mamas
- Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Konstantinos Droutsas
- Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Ilias Georgalas
- Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Chen S, Moult EM, Zangwill LM, Weinreb RN, Fujimoto JG. Geometric Perfusion Deficits: A Novel OCT Angiography Biomarker for Diabetic Retinopathy Based on Oxygen Diffusion. Am J Ophthalmol 2021; 222:256-270. [PMID: 32918905 DOI: 10.1016/j.ajo.2020.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To develop geometric perfusion deficits (GPD), an optical coherence tomography angiography (OCTA) biomarker based on oxygen diffusion, and to evaluate its utility in a pilot study of healthy subjects and patients with diabetic retinopathy (DR). DESIGN Retrospective cross-sectional study. METHODS Commercial spectral-domain optical coherence tomography angiography (OCTA) instruments were used to acquire repeated 3 × 3-mm2 and 6 × 6-mm2 motion-corrected macular OCTA volumes. En face OCTA images corresponding to the superficial capillary plexus (SCP), deep capillary plexus (DCP), and full retinal projections were obtained using automatic segmentation. For each projection, the GPD percentage and the vessel density percentage, the control metric, were computed, and their values were compared between the normal and DR eyes. The repeated OCTA acquisitions were used to assess the test-retest repeatability of the GPD and vessel density percentages. RESULTS Repeated OCTA scans of 15 normal eyes and 12 DR eyes were obtained. For all en face projections, GPD percentages were significantly higher in DR eyes than in normal eyes; vessel density percentages were significantly lower in all but 1 projection (DCP). Large GPD areas were used to identify focal perfusion deficits. Test-retest analysis showed that the GPD percentage had superior repeatability than the vessel density percentage in most cases. A strong negative correlation between the GPD percentage and the vessel density percentage was also found. CONCLUSIONS Geometric perfusion deficits, an OCTA biomarker based on oxygen diffusion, provides a quantitative metric of macular microvascular remodeling with a strong physiological underpinning. The GPD percentage may serve as a useful biomarker for detecting and monitoring DR.
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Temel E, Batıoğlu F. Optical coherence tomography angiography findings of diabetic patients with and without retinopathy. Eur J Ophthalmol 2021; 31:3124-3132. [PMID: 33508972 DOI: 10.1177/1120672121990562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To emphasize the importance of optical coherence tomography angiography (OCTA) in the diagnosis and follow-up of diabetic individuals with and without retinopathy. METHODS Retrospective, cross-sectional, observational study of healthy persons and diabetic individuals with and without retinopathy. Area of the foveal avascular zone (FAZ) (mm²), non-perfused areas in the superficial capillary plexus (SCP), mean vessel density (VD) in the SCP, and deep capillary plexus (DCP) were calculated. In eyes with diabetic retinopathy (DR), measurements at baseline, 3rd, 6th, 9th, and 12th months were evaluated. RESULTS This study conducted on 39 eyes of 23 patients with DR (group 1), 59 eyes of 30 diabetic individuals without DR (group 2), and 51 eyes of 27 healthy persons (group 3). When the mean area of the FAZ at baseline was compared between groups, the difference among groups 1 and 3 (p < 0.001) and the difference among groups 2 and 3 (p = 0.001) were statistically significant. There was no significant difference among the measurements of mean area of the FAZ, mean non-perfused area in the SCP, mean VD in SCP, and DCP at baseline, 3rd, 6th, 9th, and 12th months in group 1. CONCLUSION OCTA is a developing technology that can detect early microvascular changes in diabetic patients.
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Affiliation(s)
- Emine Temel
- Department of Opthalmology, Kırşehir Ahi Evran Training and Research Hospital, Kırşehir, Turkey
| | - Figen Batıoğlu
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Kuonen A, Bergin C, Ambresin A. Perifoveal capillary changes in diabetic patients and association between severity and type of diabetes, visual acuity, and enlargement of non-flow area in the retinal capillary plexuses. J Fr Ophtalmol 2021; 44:367-375. [PMID: 33494976 DOI: 10.1016/j.jfo.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the perifoveal capillary bed and to analyze areas of non-flow using optical coherence tomography angiography (OCT-A) in patients presenting with diabetic retinopathy (DR), correlating them to the severity of DR, type of diabetes and visual acuity (VA). PATIENTS AND METHODS The non-flow area (NFA) and foveal avascular zone (FAZ) in the superficial (SCP) and deep capillary plexus (DCP) were calculated using OCT-A imaging of patients with DR followed between July 2015 and March 2016 at the Jules Gonin Eye Hospital (Lausanne, Switzerland). Disease severity was classified using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Analysis of variance was used to correct for correlation between eyes. RESULTS Seventy-eight eyes of 53 patients were included (29 men; 44 right eyes). There were 45 eyes with non-proliferative DR (NPDR; stage 1 [n=14], stage 2 [n=7], and stage 3 [n=24]) and 33 with proliferative DR (PDR; stage 1 [n=17], stage 2 [n=16]) included, among which 26 had type I diabetes and 52 type II diabetes. The mean Best Corrected Visual Acuity (BCVA) was 78.5 letters. The mean NFA in the SCP differed according to diabetes type and stage of DR (type 1 diabetes: NPDR, 0.76±0.3, PDR, 1.24±0.7; type 2 diabetes: NPDR, 1.46±0.7, PDR, 1.57±0.7). CONCLUSION The NFA, measured by OCTA, may be a useful indicator of DR severity, especially in the superficial capillary plexus. Loss of visual acuity might be correlated with increasing NFA (excluding the FAZ or not), primarily among patients with type II diabetes and NPDR.
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Affiliation(s)
- A Kuonen
- Department of Ophthalmology, University of Lausanne, Medical Retina Unit, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - C Bergin
- Department of Ophthalmology, University of Lausanne, Medical Retina Unit, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - A Ambresin
- Department of Ophthalmology, University of Lausanne, Medical Retina Unit, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland; RétinElysée, 14 Avenue d'Ouchy, CH-1006 Lausanne, Switzerland.
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Sidorczuk P, Pieklarz B, Konopinska J, Saeed E, Mariak Z, Dmuchowska D. Foveal Avascular Zone Does Not Correspond to Choroidal Characteristics in Patients with Diabetic Retinopathy: A Single-Center Cross-Sectional Analysis. Diabetes Metab Syndr Obes 2021; 14:2893-2903. [PMID: 34234487 PMCID: PMC8254029 DOI: 10.2147/dmso.s318860] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of the study was to compare two non-overlapping blood supply systems of the retina to obtain a better insight into the relation between diabetic macular retinopathy and choroidopathy. Specifically, the study focused on the relationships between (1) retinal vascular changes around the fovea in fluorescein angiography (FA) and (2) choroidal thickness, volume and other parameters assessed by optical coherence tomography (OCT). PATIENTS AND METHODS The retrospective cross-sectional single-center study included 210 eyes from 152 patients with diabetic retinopathy (mean age 60.7±12.4 years, 49.3% of women; foveal avascular zone [FAZ] outline: 44.3% grade ≤2, 55.7% grade ≥3). The outline of FAZ, a measure of capillary loss due to ischemic processes, was analyzed on FA according to the Early Treatment Diabetic Retinopathy Study Research Group (ETDRS) standards. The eyes were stratified according to the FAZ outline and size and the presence of clinically significant diabetic macular edema (CSME). Then, resultant groups were compared in terms of the spectral domain OCT parameters: choroidal thickness and volume (within ETDRS subfields), luminal, stromal and total choroidal areas and choroidal vascularity index (based on the foveal scan). Statistical analysis was based on univariate models with the choroidal parameters as independent variables, and age, sex, panretinal photocoagulation, the severity of diabetic retinopathy and CSME as covariates. RESULTS No significant relationships were found between the FAZ outline and area and choroidal characteristics of patients with diabetic retinopathy. In patients without CSME, no correlation was observed between the FAZ area and choroidal characteristics. In patients with CSME, no correlation was found between the FAZ area and choroidal characteristics other than the choroidal vascularity index. CONCLUSION In patients with diabetic retinopathy, damage to the macular retinal vasculature (FAZ) does not seem to be associated with changes in the choroidal vasculature, and these two processes appear to occur independently.
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Affiliation(s)
- Patryk Sidorczuk
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Barbara Pieklarz
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Joanna Konopinska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Emil Saeed
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Zofia Mariak
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
| | - Diana Dmuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, 15-276, Poland
- Correspondence: Diana Dmuchowska Department of Ophthalmology, Medical University of Białystok, 24a M. Sklodowskiej-Curie, Bialystok, 15-276, PolandTel +48857468372Fax +48857468604 Email
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Aschauer J, Pollreisz A, Karst S, Hülsmann M, Hajdu D, Datlinger F, Egner B, Kriechbaum K, Pablik E, Schmidt-Erfurth UM. Longitudinal analysis of microvascular perfusion and neurodegenerative changes in early type 2 diabetic retinal disease. Br J Ophthalmol 2020; 106:528-533. [PMID: 33293271 DOI: 10.1136/bjophthalmol-2020-317322] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
AIM To prospectively monitor subclinical changes in capillary perfusion and retinal layer thickness in patients with type 2 diabetes and early diabetic retinal disease over 2 years. METHODS In this longitudinal study we performed biannual retinal vascular imaging using optical coherence tomography angiography (RTVue) to analyse the foveal avascular zone (FAZ) area, perimeter, acircularity index (AI) and parafoveal superficial/deep vessel density (VD). Spectral-domain optical coherence tomography (Spectralis) was used to measure the thickness of nine macular layers and the peripapillary nerve fibre layer. RESULTS Among 117 eyes (58 left) of 59 patients (21 female), 105 had no diabetic retinopathy (DR), 6 mild and 6 moderate non-proliferative DR at baseline. We found DR progression in 13 eyes at year 2. The FAZ area (+0.008±0.002 mm2/year, p<0.0001), perimeter (+0.036±0.010 mm/year, p=0.006) and AI (+0.005±0.002/year, p=0.0280) increased significantly. A pronounced decrease was found in the superficial (-1.425±0.290%/year, p<0.0001) but not the deep VD. Inner neuroretinal loss was confined to the ganglion cell (-0.539±0.150 µm/year, p=0.0004) and the inner plexiform layer (-0.361±0.127 µm/year, p=0.0045). In the outer retina, we observed a statistically significant decrease in thickness in the outer plexiform, photoreceptor layer and pigment epithelium of -0.921±0.161 µm/year, -0.325±0.139 µm/year and -0.385±0.084 µm/year, respectively. CONCLUSION Subclinical signs of microangiopathy and neurodegeneration appear in parallel and are highly progressive even in the earliest stages of diabetic retinal disease.Trial registration number EudraCT20156000239634.
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Affiliation(s)
- Julia Aschauer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Sonja Karst
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Martin Hülsmann
- Division of Cardiology, Department of Internal Medicine, Medical University of Vienna, Wien, Wien, Austria
| | - Dorottya Hajdu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Felix Datlinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Berit Egner
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
| | - Katharina Kriechbaum
- Department of Ophthalmology and Optometry, Medical University of Vienna, Wien, Wien, Austria
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Foveal Avascular Zone Measurement Via Optical Coherence Tomography Angiography and its Relationship With the Visual Field in Eyes With Open-angle Glaucoma. J Glaucoma 2020; 29:492-497. [PMID: 32205832 DOI: 10.1097/ijg.0000000000001492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRECIS The foveal avascular zone (FAZ) in optical coherence tomography angiography is significantly correlated with retinal inner layer thickness, Humphrey field analyzer (HFA) 10-2 sensitivity threshold, and mean deviation (MD) value in open-angle glaucoma patients. PURPOSE The purpose of this study was to measure the FAZ area using optical coherence tomography angiography and investigate its relationship with retinal inner layer thickness and visual field defects in eyes with open-angle glaucoma. PARTICIPANTS AND METHODS A total of 52 eyes with open-angle glaucoma from 52 patients. FAZ area was measured using optical coherence tomography angiography in angio-macula mode. Thicknesses of retinal nerve fiber layer (RNFL), ganglion cell layer plus inner plexiform layer (GCL+IPL), and ganglion cell complex (GCC) were determined using a 7 mm×7 mm macular (V) map via 3D-OCT. Correlations of FAZ area with sensitivity threshold measurements, foveal threshold (FT), and MD value in the HFA10-2 visual field were analyzed for each inner retinal layer. RESULTS FAZ area was 0.26±0.07 mm; overall mean thicknesses were 19.14±6.55 μm (RNFL), 57.34±5.93 µm (GCL+IPL), and 75.87±10.96 μm (GCC); mean FT was 35.23±3.15 dB, and sensitivity threshold was 20.81±7.22 dB in the HFA10-2 visual field. FAZ area was significantly correlated with the thickness of individual retinal layers in the entire field (RNFL, P<0.001; GCL+IPL, P<0.001; GCC, P<0.001), sensitivity threshold (P=0.01), FT (P<0.001), and MD value (P=0.011). CONCLUSION FAZ area was significantly negatively correlated with retinal inner layer thickness, sensitivity threshold, FT, and MD value in the HFA10-2 visual field.
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Pongsachareonnont P, Charoenphol P, Hurst C, Somkijrungroj T. The Effect of Anti-Vascular Endothelial Growth Factor on Retinal Microvascular Changes in Diabetic Macular Edema Using Swept-Source Optical Coherence Tomography Angiography. Clin Ophthalmol 2020; 14:3871-3880. [PMID: 33235428 PMCID: PMC7678686 DOI: 10.2147/opth.s270410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This study evaluates the effect of anti-vascular endothelial growth factor (anti-VEGF) therapy on microaneurysm changes and foveal avascular zone (FAZ) using optical coherence tomography angiography (OCTA) in patients with diabetic macular edema (DME). Design Prospective observational study. Materials and Methods This study involved patients with DME undergoing anti-VEGF treatment (aflibercept, ranibizumab, and bevacizumab). Macula OCTA images were obtained before (visit 0) and 1 month after (visit 1) anti-VEGF injection. Microaneurysm counts were performed, and the FAZ was evaluated in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). The differences in microaneurysms, FAZ, and clinical correlations were analyzed. Results A total of 152 eyes were analyzed. The patients' mean age was 59 years. Bevacizumab was used in 69.7%, ranibizumab in 15.1%, and aflibercept in 15.1%. There was a significant reduction in the FAZ in the SCP and DCP between visits 0 and 1. All anti-VEGF medications reduced the number of microaneurysms (p<0.01). After treatment, changes in the FAZ in SCP and DCP corresponded with changes in visual acuity (p<0.01). Conclusion Microaneurysms as detected by OCTA might serve as a biomarker for a clinical response to anti-VEGF treatment in the short term. The FAZ might also predict visual acuity improvement after anti-VEGF injection. Trial Registration Thai Clinical Trials Registry (TCTR20161010005).
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Affiliation(s)
- Pear Pongsachareonnont
- Vitreoretinal Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pulthip Charoenphol
- Vitreoretinal Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Cameron Hurst
- Biostatistics Center, Department of Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thanapong Somkijrungroj
- Vitreoretinal Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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ANATOMICAL AND FUNCTIONAL TESTING IN DIABETIC PATIENTS WITHOUT RETINOPATHY: Results of Optical Coherence Tomography Angiography and Visual Acuity Under Varying Contrast and Luminance Conditions. Retina 2020; 39:2022-2031. [PMID: 30015764 DOI: 10.1097/iae.0000000000002258] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess early retinal microvascular and functional changes in diabetic patients without clinical evidence of diabetic retinopathy with optical coherence tomography angiography and central visual analyzer. METHODS This was an observational case-control study of diabetic patients without diabetic retinopathy and nondiabetic controls. Patients underwent optical coherence tomography angiography imaging and visual acuity testing using the central visual analyzer. The foveal avascular zone area and the capillary density in the superficial and deep capillary plexuses were measured manually by a masked grader. RESULTS Sixty eyes from 35 diabetic patients were included in the study group, and 45 eyes from 31 nondiabetic patients were included in the control group. The foveal avascular zone area was not significantly different between the diabetic group and controls (both P > 0.05). The mean capillary density in the deep capillary plexus was significantly lower in diabetic eyes compared with control eyes (P = 0.04). The mean visual acuity in all central visual analyzer modules was significantly decreased in diabetic patients compared with controls (all P < 0.05). CONCLUSION Optical coherence tomography angiography was able to detect retinal microvascular changes in the deep capillary plexus, and the central visual analyzer showed signs of decreased visual acuity under conditions simulating suboptimal contrast and glare in diabetic patients without diabetic retinopathy.
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Foveal avascular zone analysis by optical coherence tomography angiography in patients with type 1 and 2 diabetes and without clinical signs of diabetic retinopathy. Int Ophthalmol 2020; 41:649-658. [PMID: 33156947 DOI: 10.1007/s10792-020-01621-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/05/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To analyze the early macular microvascular alterations in patients with type 1 and 2 diabetes mellitus (DM) without diabetic retinopathy (DR), using optical coherence tomography angiography (OCT-A), and compare these with nondiabetic patients. METHODS This prospective study involved 93 patients with type 1 diabetes (DM1), 104 patients with type 2 diabetes (DM2) without signs of DR, and 71 healthy subjects for the control group. The foveal avascular zone (FAZ) area and the vessel density (VD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were evaluated. RESULTS The SCP and DCP FAZ areas were significantly larger in the DM1 group in comparison with the controls (p = .001), while no significant differences were observed between the DM2 group and the healthy control group (p = .12). Additionally, no significant differences in FAZ area were found between the DM1 and DM2 groups (p = .26). The VD was significantly reduced in DM1 and DM2 groups compared to controls. A direct correlation was found between the duration of diabetes and SCP FAZ area (r = 0.44; R2 = 0.19; p = .0001). Statistically significant differences in the FAZ area at SCP and DCP were observed when comparing patients with a diabetes duration > 10 years and < 10 years in the DM2 group (p = .0001, respectively) and only in the FAZ area at the DCP in the DM1 group (p = .0001). CONCLUSION Diabetic patients without DR demonstrate early microvascular alteration in the macular area on OCT-A, which is more pronounced in type I DM, and correlates with the duration of the disease.
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