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Szilágyi A, Takács B, Szekeres R, Tarjányi V, Nagy D, Priksz D, Bombicz M, Kiss R, Szabó AM, Lehoczki A, Gesztelyi R, Juhász B, Szilvássy Z, Varga B. Effects of voluntary and forced physical exercise on the retinal health of aging Wistar rats. GeroScience 2024:10.1007/s11357-024-01208-x. [PMID: 38795184 DOI: 10.1007/s11357-024-01208-x] [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: 12/08/2023] [Accepted: 05/13/2024] [Indexed: 05/27/2024] Open
Abstract
Aging is accompanied by an increased prevalence of degenerative conditions, including those affecting ocular health, which significantly impact quality of life and increase the burden on healthcare systems. Among these, retinal aging is of particular concern due to its direct link to vision impairment, a leading cause of disability in the elderly. Vision loss in the aging population is associated with heightened risks of cognitive decline, social isolation, and morbidity. This study addresses the critical gap in our understanding of modifiable lifestyle factors, such as physical exercise, that may mitigate retinal aging and its related pathologies. We investigated the effects of different exercise regimens-voluntary (recreational-type) and forced (high-intensity)-on the retinal health of aging Wistar rats (18-month-old), serving as a model for studying the translational potential of exercise interventions in humans. Male Wistar rats were divided into four groups: a young control (3-month-old) for baseline comparison, an aged sedentary control, an aged group engaging in voluntary exercise via a running wheel in their cage, and an aged group subjected to forced exercise on a treadmill for six sessions of 20 min each per week. After a 6-month experimental period, we assessed retinal function via electroretinography (ERG), measured retinal thickness histologically, and analyzed protein expression changes relevant to oxidative stress, inflammation, and anti-aging mechanisms. Our findings reveal that voluntary exercise positively impacts retinal function and morphology, reducing oxidative stress and inflammation markers while enhancing anti-aging protein expression. In contrast, forced exercise showed diminished benefits. These insights underscore the importance of exercise intensity and preference in preserving retinal health during aging. The study highlights the potential of recreational physical activity as a non-invasive strategy to counteract retinal aging, advocating for further research into exercise regimens as preventative therapies for age-related ocular degenerations.
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Affiliation(s)
- Anna Szilágyi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Barbara Takács
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Réka Szekeres
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Vera Tarjányi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Dávid Nagy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Dániel Priksz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Mariann Bombicz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Rita Kiss
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Adrienn Mónika Szabó
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Andrea Lehoczki
- Departments of Hematology and Stem Cell Transplantation, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary
| | - Rudolf Gesztelyi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Béla Juhász
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Zoltán Szilvássy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary
| | - Balázs Varga
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Nagyerdei Krt 98., 4032, Debrecen, Hungary.
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Barresi C, Chhablani J, Dolz-Marco R, Gallego-Pinazo R, Berni A, Bandello F, Borrelli E. Retinal neurodegeneration in age-related macular degeneration. Eur J Ophthalmol 2024; 34:624-630. [PMID: 37394731 DOI: 10.1177/11206721231186166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Age-related macular degeneration (AMD) is a complex and multifactorial disease characterized by the damage of the unit comprised of the photoreceptors, retinal pigment epithelium (RPE), Bruch's membrane, and choriocapillaris. Although the outer retina appears to be mainly affected in this disorder, several evidences exhibit that also the inner retina may be impaired. In this review we will provide a description of the prominent histologic and imaging findings suggesting an inner retinal loss in these eyes. In details, structural optical coherence tomography (OCT) technology proved either the inner and outer retina is impacted by AMD and that these two impairments are associated. Therefore, the purpose of this review is to provide a description of the role of neurodegeneration in AMD in order to better understand the relationship between neuronal loss and the outer retinal damage in this disease.
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Affiliation(s)
- Costanza Barresi
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Alessandro Berni
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Borrelli
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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Taylor TRP, Menten MJ, Rueckert D, Sivaprasad S, Lotery AJ. The role of the retinal vasculature in age-related macular degeneration: a spotlight on OCTA. Eye (Lond) 2024; 38:442-449. [PMID: 37673970 PMCID: PMC10858204 DOI: 10.1038/s41433-023-02721-7] [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: 04/19/2023] [Revised: 06/27/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023] Open
Abstract
Age-related macular degeneration (AMD) remains a disease with high morbidity and an incompletely understood pathophysiological mechanism. The ocular blood supply has been implicated in the development of the disease process, of which most research has focused on the role of the choroid and choriocapillaris. Recently, interest has developed into the role of the retinal vasculature in AMD, particularly with the advent of optical coherence tomography angiography (OCTA), which enables non-invasive imaging of the eye's blood vessels. This review summarises the up-to-date body of work in this field including the proposed links between observed changes in the retinal vessels and the development of AMD and potential future directions for research in this area. The review highlights that the strongest evidence supports the observation that patients with early to intermediate AMD have reduced vessel density in the superficial vascular complex of the retina, but also emphasises the need for caution when interpreting such studies due to their variable methodologies and nomenclature.
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Affiliation(s)
- Thomas R P Taylor
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Martin J Menten
- BioMedIA, Imperial College London, London, UK
- Institute for AI and Informatics in Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Daniel Rueckert
- BioMedIA, Imperial College London, London, UK
- Institute for AI and Informatics in Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
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Lu J, Cheng Y, Hiya FE, Shen M, Herrera G, Zhang Q, Gregori G, Rosenfeld PJ, Wang RK. Deep-learning-based automated measurement of outer retinal layer thickness for use in the assessment of age-related macular degeneration, applicable to both swept-source and spectral-domain OCT imaging. BIOMEDICAL OPTICS EXPRESS 2024; 15:413-427. [PMID: 38223170 PMCID: PMC10783897 DOI: 10.1364/boe.512359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024]
Abstract
Effective biomarkers are required for assessing the progression of age-related macular degeneration (AMD), a prevalent and progressive eye disease. This paper presents a deep learning-based automated algorithm, applicable to both swept-source OCT (SS-OCT) and spectral-domain OCT (SD-OCT) scans, for measuring outer retinal layer (ORL) thickness as a surrogate biomarker for outer retinal degeneration, e.g., photoreceptor disruption, to assess AMD progression. The algorithm was developed based on a modified TransUNet model with clinically annotated retinal features manifested in the progression of AMD. The algorithm demonstrates a high accuracy with an intersection of union (IoU) of 0.9698 in the testing dataset for segmenting ORL using both SS-OCT and SD-OCT datasets. The robustness and applicability of the algorithm are indicated by strong correlation (r = 0.9551, P < 0.0001 in the central-fovea 3 mm-circle, and r = 0.9442, P < 0.0001 in the 5 mm-circle) and agreement (the mean bias = 0.5440 um in the 3-mm circle, and 1.392 um in the 5-mm circle) of the ORL thickness measurements between SS-OCT and SD-OCT scans. Comparative analysis reveals significant differences (P < 0.0001) in ORL thickness among 80 normal eyes, 30 intermediate AMD eyes with reticular pseudodrusen, 49 intermediate AMD eyes with drusen, and 40 late AMD eyes with geographic atrophy, highlighting its potential as an independent biomarker for predicting AMD progression. The findings provide valuable insights into the ORL alterations associated with different stages of AMD and emphasize the potential of ORL thickness as a sensitive indicator of AMD severity and progression.
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Affiliation(s)
- Jie Lu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Yuxuan Cheng
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Farhan E. Hiya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gissel Herrera
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Qinqin Zhang
- Research and Development, Carl Zeiss Meditec, Inc., Dublin, CA, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
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Li B, Du Y, Gou W, Yan L, You H, Bai M, Xie C, Li H. Effect of Internal Limiting Membrane Peeling or Not on Blood Flow Signal in Macular Area of Diabetic Patients with Preretinal Membrane. Curr Eye Res 2023; 48:584-590. [PMID: 36729584 DOI: 10.1080/02713683.2023.2175367] [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: 02/03/2023]
Abstract
PURPOSE To study the effect of intraoperative internal limiting membrane (ILM) peeling on the macular vascular structure in patients with diabetic epiretinal membrane (ERM). METHODS Patients with diabetic ERM were divided into an ERM + ILM peeling group (18 eyes) and an ERM peeling group (19 eyes), all of whom underwent standard vitrectomy and were followed up until 6 months postoperatively. Best-corrected visual acuity (BCVA), Central macular thickness (CMT), Vessel density (VD) and vessel length density (VLD) of the superficial as well as deep retinal capillary plexus were compared between the two groups. RESULTS There was no significant difference in BCVA (p = .188, .410, .901, .916) and CMT (p = .164, .128, .110, .105) between the two groups at the week 1, month 1, month 3 and month 6 after operation. In the superficial capillary plexus (SCP), the change in VD (p = .106) and VLD (p = .438) was not affected by ILM peeling, and there was no significant difference in VD (p = .154, .063, .100, .162) and VLD (p = .386, .263, .431, .391) between the two groups during the four follow-up after operation. For the deep capillary plexus (DCP), there was an effect of ILM peeling on the changes in VD (p = .024) and VLD (p = .012), ILM peeling delayed the recovery time of the VD and VLD; The VD (p = .026, .000, .003) and VLD (p = .005, .000, .000) of ERM + ILM peeling group were lower than those of ERM peeling group from the month 1 to the month 6 after operation. CONCLUSION Intraoperative peeling of the ILM in patients with diabetic ERM delayed the improvement of blood flow signal in the DCP but did not affect the recovery of postoperative BCVA and CMT.
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Affiliation(s)
- Bo Li
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Yanjun Du
- Department of Cardiovascular Medicine, Suining Third People's Hospital, Suining, P.R. China
| | - Wenjun Gou
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Liying Yan
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Hui You
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Mengtian Bai
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Chen Xie
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Heng Li
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
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Kim JT, Jun JH, Lee SC, Lee MW. Retinal microvasculature and choriocapillaris impairments according to the stage of dry age-related macular degeneration. Clin Exp Ophthalmol 2023; 51:36-43. [PMID: 36067116 DOI: 10.1111/ceo.14165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to analyse the retinal microvasculature and choriocapillaris according to the dry age-related macular degeneration (AMD) stage and to identify factors associated with their microvasculatures. METHODS Patients were divided into four groups: normal controls, early, intermediate and advanced AMD groups. The vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris was compared using optical coherence tomography angiography among the groups. Linear regression analysis was performed to identify factors associated with the VD. RESULTS The VDs of the SCP were 22.1 ± 5.7, 19.1 ± 5.4, 18.0 ± 6.4 and 12.2 ± 6.4% (p < 0.001); the VDs of the DCP were 22.4 ± 4.5, 20.7 ± 4.3, 18.1 ± 5.3 and 14.6 ± 5.8% (p < 0.001); the VDs of the choriocapillaris were 29.4 ± 3.7, 26.4 ± 4.8, 24.5 ± 4.9 and 24.2 ± 3.7% (p < 0.001) in the control, early, intermediate, and advanced groups, respectively. AMD stage and age were significantly associated with the VDs of all layers, and the VDs of the SCP and DCP were associated with visual acuity (both p < 0.001). Additionally, hypertension was associated with the VDs of the DCP (p = 0.027) and choriocapillaris (p = 0.024). CONCLUSIONS The retinal microvasculature and choriocapillaris tended to become more impaired as the AMD stage progressed. Age was significantly associated with the microvasculature impairments of all layers, and hypertension was significantly associated with impairments of the DCP microvasculature and choriocapillaris.
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Affiliation(s)
- Jung-Tae Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Ji-Ho Jun
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Sung-Chul Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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Examination of Inner Retinal Layers in Unilateral Wet Age-Related Macular Degeneration Treated with Anti-VEGF, Compared to Fellow Untreated Eyes. Int J Mol Sci 2022; 24:ijms24010402. [PMID: 36613846 PMCID: PMC9820643 DOI: 10.3390/ijms24010402] [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: 12/02/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
The main aim of this study was to characterize the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness in the macular area eyes affected by wet age-related macular degeneration (wAMD) treated with anti-VEGF and compare the results with the control of fellow untreated eyes affected by early stages of dry age-related macular degeneration (dAMD). Additionally, we aimed to estimate if the number of injections received and other factors, including age, best-corrected visual acuity (BCVA), or sex, may affect the differences in the obtained measurements of retinal nerve fiber layer thickness. We prospectively included 106 eyes of 53 patients with unilateral wet age-related macular degeneration. The fellow eyes with non-advanced dry age-related macular degeneration served as a control group in a cross-sectional study. RNFL and GCL in the macular region were evaluated using optical coherence tomography, with outcomes expressed as differences in the thickness of both examined layers between the study and control groups. We found thinner GCL in wAMD vs. dAMD (p < 0.001). In turn, the RNFL layer did not show any statistically significant differences between the two groups (p = 0.409). Similarly, we found a statistically significant correlation between the number of injections and the layer thickness (p = 0.106). Among all assessed parameters, age over 73 was the only factor significantly affecting the thickness of the retinal nerve fiber layer in both groups (p = 0.042). The morphology of the inner layers of the retina in dry and wet AMD seems to differ, possibly due to differences in the etiopathogenesis of these two forms of the disease. In our study, the retinal ganglion cell layer was thinner in the treated vs. fellow eye (with dry AMD), while the nerve fiber layer was not significantly different between the groups. The number of anti-VEGF injections had no effect on the thickness of the macular nerve fiber layer.
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Malek G, Campisi J, Kitazawa K, Webster C, Lakkaraju A, Skowronska-Krawczyk D. Does senescence play a role in age-related macular degeneration? Exp Eye Res 2022; 225:109254. [PMID: 36150544 PMCID: PMC10032649 DOI: 10.1016/j.exer.2022.109254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 12/29/2022]
Abstract
Advanced age is the most established risk factor for developing age-related macular degeneration (AMD), one of the leading causes of visual impairment in the elderly, in Western and developed countries. Similarly, after middle age, there is an exponential increase in pathologic molecular and cellular events that can induce senescence, traditionally defined as an irreversible loss of the cells' ability to divide and most recently reported to also occur in select post-mitotic and terminally differentiated cells, such as neurons. Together these facts raise the question as to whether or not cellular senescence, may play a role in the development of AMD. A number of studies have reported the effect of ocular-relevant inducers of senescence using primarily in vitro models of poorly polarized, actively dividing retinal pigment epithelial (RPE) cell lines. However, in interpretating the data, the fidelity of these culture models to the RPE in vivo, must be considered. Fewer studies have explored the presence and/or impact of senescent cells in in vivo models that present with phenotypic features of AMD, leaving this an open field for further investigation. The goal of this review is to discuss current thoughts on the potential role of senescence in AMD development and progression, with consideration of the model systems used and their relevance to human disease.
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Affiliation(s)
- Goldis Malek
- Duke Eye Center, Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA; Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
| | - Judith Campisi
- Buck Institute for Research on Aging, Novato, CA, USA; Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Koji Kitazawa
- Buck Institute for Research on Aging, Novato, CA, USA; Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Corey Webster
- Buck Institute for Research on Aging, Novato, CA, USA
| | - Aparna Lakkaraju
- Departments of Ophthalmology and Anatomy, School of Medicine, University of California, San Francisco, CA, USA
| | - Dorota Skowronska-Krawczyk
- Department of Physiology and Biophysics, Department of Ophthalmology, Center for Translational Vision Research, School of Medicine, University of California, Irvine, CA, USA
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Toulouie S, Chang S, Pan J, Snyder K, Yiu G. Relationship of Retinal Vessel Caliber with Age-Related Macular Degeneration. J Ophthalmol 2022; 2022:8210599. [PMID: 35957743 PMCID: PMC9357695 DOI: 10.1155/2022/8210599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Evaluate the relationship between retinal vascular caliber and age-related macular degeneration (AMD) severity or progression. Methods A retrospective secondary analysis of 1172 fundus photographs and clinical data from the prospective Age-Related Eye Disease Study (AREDS). Central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole-to-venule ratio (AVR) were measured using the Parr-Hubbard-Knudtson formula. Univariate and multivariate regressions were used to determine the association of CRAE, CRVE, and AVR with age, sex, smoking status, presence of cilioretinal artery, and AMD severity at baseline and 5 years using the 9-step AMD severity score. Results Only CRAE and CRVE were higher in men (P < 0.001), current smokers (P < 0.001), and the eyes with a cilioretinal artery (P=0.009 - 0.043). AMD severity was greater in older patients (P=0.001), current smokers (P=0.012), the eyes without a cilioretinal artery (P=0.001), and lower AVR (P=0.034) on multivariate regression but was not influenced by CRAE or CRVE (P=0.240 - 0.500). Choroidal neovascularization (CNV) presence was associated with older age (P=0.003) and absence of a cilioretinal artery (P=0.009), while central geographic atrophy (CGA) was associated with narrower CRAE (P=0.002) and possibly AVR (P=0.046). None of the retinal vessel parameters were predictive of AMD severity score or new onset of CNV or CGA at 5 years. Conclusion A lower arteriole-to-venule ratio may be associated with AMD severity, with narrower arterioles seen in the eyes with geographic atrophy, suggesting a role of the retinal vasculature in AMD pathophysiology. This trial is registered with ClinicalTrials.gov Identifier: NCT00000145.
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Affiliation(s)
- Sara Toulouie
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
- California Northstate University, College of Medicine, Elk Grove, CA, USA
| | - Sean Chang
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Julia Pan
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Kiersten Snyder
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
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Wichrowska M, Wichrowski P, Kocięcki J. Morphological and Functional Assessment of the Optic Nerve Head and Retinal Ganglion Cells in Dry vs Chronically Treated Wet Age-Related Macular Degeneration. Clin Ophthalmol 2022; 16:2373-2384. [PMID: 35924182 PMCID: PMC9342869 DOI: 10.2147/opth.s372626] [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: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study comprised the anatomical and functional assessment of the optic nerves and macular ganglion cells in the population of patients with unilateral wet age-related macular degeneration (wAMD) and comparison of its results to those obtained from the fellow eye with non-advanced dry age-related macular degeneration (dAMD). Furthermore, we aimed to determine if the number of administered injections contributed to the potential differences between the examined eyes. Methods The study was based on 104 eyes of 52 patients in a cross-sectional study. The eyes with chronically treated wAMD were the main subject of the study, while fellow eyes affected with non-advanced dAMD served as the control group. Primary morphological outcomes comprised differences in peripapillary retinal nerve fiber layer (RNFL) and GCC layers between the studied groups (treated and control). In turn, primary functional outcomes included differences in implicit times and amplitudes of the P100 wave of pattern visual evoked potentials (PVEP) and N95 wave of pattern electroretinogram (PERG) between treated and control groups. Results We did not find any differences in total RNFL thickness between wAMD and dAMD groups. The number of injections only affected the RNFL in the nasal quadrant of the optic disc (p = 0.023). We did not find any differences regarding GCL thickness in both groups. In the study group, a longer implicit time of the P100 of PVEP (p = 0.014) and a shorter amplitude of the P50-N95 wave of PERG (p = 0.005) were detected. The total number of injections had no significant effect on these two values. Conclusion We detected worse functional parameters of the optic nerve and retinal ganglion cells in eyes with wAMD, with lack of significant differences in anatomical (RNFL, GCL) parameters compared to the control group. However, the number of injections did not contribute to the differences found.
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Affiliation(s)
- Małgorzata Wichrowska
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznań, Poland
- Doctoral School, Poznan University of Medical Sciences, Poznań, Poland
- Correspondence: Małgorzata Wichrowska, Department of Ophthalmology, Poznan University of Medical Sciences, Ul. Szamarzewskiego 84, Poznań, 60-569, Poland, Tel +48 61 101 98 00, Fax +48 61 101 98 13, Email
| | - Przemysław Wichrowski
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznań, Poland
- I Clinic of Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznań, Poland
| | - Jarosław Kocięcki
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznań, Poland
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Retinal Vessel Density in Age-Related Macular Degeneration Patients with Geographic Atrophy. J Clin Med 2022; 11:jcm11061501. [PMID: 35329825 PMCID: PMC8949909 DOI: 10.3390/jcm11061501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/26/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
We compared the retinal vessel density and inner retinal thickness in patients who had one eye with geographic atrophy (GA) and a fellow eye with intermediate age-related macular degeneration (iAMD). The vessel density from the superficial vascular complex (SVC) and deep vascular complex (DVC) through optical coherence tomography angiography and the thickness of the nerve fiber layer, ganglion cell-inner plexiform layer (GCIPL), inner nuclear layer (INL), outer nuclear layer (ONL) on a structural optical coherence tomography thickness map were measured in 28 eyes of 14 GA patients with iAMD in the fellow eye. GA eyes had significantly lower vessel density in the SVC (26.2 ± 3.9% vs. 28.3 ± 4.4%; p = 0.015) and DVC (24.2 ± 2.6% vs. 26.8 ± 1.9%; p = 0.003) than fellow eyes (iAMD). GCIPL and ONL were significantly thinner in GA eyes than in the fellow eyes (p = 0.032 and 0.024 in the foveal areas, p = 0.029 and 0.065 in the parafovea areas, respectively). Twenty-four eyes of 12 patients were followed up for 2 years and seven of the fellow eyes (58.3%) developed GA during the follow-up period and showed reduced vessel density in the SVC (26.4 ± 3.0% vs. 23.8 ± 2.9%; p = 0.087) and DVC (25.8 ± 2.2% vs. 22.4 ± 4.4%; p = 0.047) compared to baseline. Vessel density and GCIPL thickness map measurements are potential GA markers in non-neovascular AMD.
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12
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Enz TJ, Bittner M, Tribble JR, Williams PA, Thiel MA, Schmid MK, Bachmann LM, Bochmann F. Comparative Assessment of Retinal Blood Flow Velocity Changes Following Brimonidine and Brinzolamide Administration Using Retinal Function Imaging. Transl Vis Sci Technol 2022; 11:1. [PMID: 35103799 PMCID: PMC8819484 DOI: 10.1167/tvst.11.2.1] [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] [Indexed: 12/05/2022] Open
Abstract
Purpose Impaired ocular blood flow has been associated with the etiopathogenesis of glaucoma. Topical brimonidine lowers intraocular pressure, a major glaucoma risk factor. However, brimonidine's influence on retinal blood flow remains to be fully elucidated. Our aim was to compare the effect of topical brimonidine and brinzolamide administration on retinal blood flow velocity in second and third order vessels in healthy adults using the retinal function imager. Methods In 10 healthy probands between 23 and 32 years of age, one eye was randomly selected to receive 2 treatment rounds with 3 single doses of brimonidine 2 mg/mL and brinzolamide 10 mg/mL at 12-hour intervals each. The fellow eyes served as intra-individual controls. Immediately before the first drop and 2 hours after the last drop of each treatment round, all subjects were examined, including Goldmann tonometry, Pascal tonometry, assessment of retinal blood flow velocity using the retinal function imager, as well as blood pressure and pulse measurements. Results Intraocular pressure decreased significantly in treated eyes while remaining stable in control eyes, indicating reliable application of brimonidine and brinzolamide drops. In contrast, retinal blood flow velocities did not demonstrate any significant differences between groups after both treatment rounds. Conclusions Neither brimonidine nor brinzolamide appear to alter retinal blood flow velocity in a clinically relevant manner. The slight velocity changes detected in our study are likely physiologic fluctuations. Our findings do not support the rationale of a detrimental effect of topical brimonidine on ocular blood flow and hence brimonidine may be further administered for lowering intraocular pressure with the appropriate caution. However, our study is strongly limited by the small sample size and, thus, further research with larger cohorts of healthy volunteers and patients with glaucoma is needed to confirm the results. Translational Relevance The study provides information about the effect of the topically administered antiglaucoma medications brimonidine and brinzolamide on the ocular blood flow and its regulation. The findings indicate that beside the lowering of IOP there is no evidence for an additional effect on the development of glaucoma.
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Affiliation(s)
- Tim J Enz
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland.,Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mario Bittner
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - James R Tribble
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Pete A Williams
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Michael A Thiel
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Martin K Schmid
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Lucas M Bachmann
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Frank Bochmann
- Department of Ophthalmology, Cantonal Hospital Lucerne, Lucerne, Switzerland
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13
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Di Perna L, Melillo P, Gesualdo C, Palmieri F, Testa F, Bifani M, Rossi S, Simonelli F. Correlation Between Choriocapillaris Density and Retinal Sensitivity in Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:2. [PMID: 34061948 PMCID: PMC8185398 DOI: 10.1167/tvst.10.7.2] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to investigate the relationship between perfusion of the choriocapillaris (CC) and retinal sensitivity in eyes with intermediate age-related macular degeneration (iAMD). Methods This prospective study included patients with iAMD and healthy controls. All enrolled subjects underwent optical coherence tomography angiography (OCT-A) in order to compute the percent perfused choriocapillaris area (PPCA). In patients with iAMD, microperimetry (MP) testing was performed in order to quantify: mean retinal sensitivity (MRS), over an area of 10 degrees; mean macular sensitivity (MMS), over the macular area scanned with OCT-A; and retinal sensitivity (RS) in each macular point. Results Eighteen eyes of 13 patients were included in the analysis. In addition, 18 eyes of 12 healthy subjects were enrolled as controls. No statistically significant difference (P value > 0.2) was observed in age between patients (73.9 ± 2.0 years) and controls (70.1 ± 2.8 years). We observed significantly lower values of PPCA between patients with iAMD and healthy controls (42.0% ± 3.8% vs. 66.4% ± 3.0%; -β = 23.8%; P value < 0.001). Among iAMD eyes, higher values of PPCA were significantly associated with higher values of MRS (P value = 0.002) and MMS (P value = 0.013). Finally, higher values of RS in each macular point analyzed with MP were significantly (P value < 0.001) associated with higher values of PPCA computed in circular regions of interest (ROIs) centered in each analyzed MP point with radii of 0.5 degrees and 1.0 degree. Conclusions Using OCT-A, we demonstrated a significant association between CC impairment and macular dysfunction, quantified by MP, in iAMD eyes. Translational Relevance OCT-A could be a useful tool for detecting CC alterations and to monitor disease progression.
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Affiliation(s)
- Luigi Di Perna
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Paolo Melillo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Carlo Gesualdo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Filomena Palmieri
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Mario Bifani
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Settimio Rossi
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
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Retinal Vascularization Analysis on Optical Coherence Tomography Angiography before and after Intraretinal or Subretinal Fluid Resorption in Exudative Age-Related Macular Degeneration: A Pilot Study. J Clin Med 2021; 10:jcm10071524. [PMID: 33917364 PMCID: PMC8038669 DOI: 10.3390/jcm10071524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
The aim was to analyze the variations in macular vascularization on optical coherence tomography angiography (OCTA) according to the presence of intraretinal fluid (IRF) induced by exudative age-related macular degeneration (AMD). We included exudative AMD patients with IRF and/or subretinal fluid (SRF) and age-matched control eyes. All patients underwent a macular 6 × 6 mm swept-source OCTA. The mean perfusion density (MPD) and mean vascular density (MVD) were calculated in the superficial (SCP) and the deep (DCP) capillary plexus at two timepoints: during an episode of exudation (T0) and after its total resorption (T1). A total of 22 eyes in the IRF ± SRF group, 11 eyes in the SRF group and 11 eyes in the healthy group were analyzed. At T0, the IRF ± SRF group showed significantly lower MPD and MVD than healthy eyes in the SCP (p < 0.001) and DCP (p < 0.001). At T1, MPD and MVD significantly increased from T0 in the SCP (p = 0.027 and p = 0.0093) and DCP (p = 0.013 and p = 0.046) but remained statistically lower than in the healthy eyes. For the SRF group, only the DCP showed significantly lower MPD (p = 0.012) and MVD (p = 0.046) in comparison to the healthy eyes at T0. The present study shows that retinal vascular changes do occur in the case of exudative AMD.
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15
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Trinh M, Kalloniatis M, Nivison-Smith L. Radial Peripapillary Capillary Plexus Sparing and Underlying Retinal Vascular Impairment in Intermediate Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2021; 62:2. [PMID: 33792619 PMCID: PMC8024775 DOI: 10.1167/iovs.62.4.2] [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: 12/02/2022] Open
Abstract
Purpose To examine location-specific retinal vascular changes in intermediate age-related macular degeneration (iAMD) using age-matched, high-density en face optical coherence tomography angiography (OCTA) cluster analysis. Methods En face OCTA images of the 6 × 6 mm macular area were retrospectively acquired from 60 iAMD eyes and 60 age-matched normal eyes and then subdivided into 126 × 126 (47.62 × 47.62 µm) grids within the superficial and deep vascular complex. Grid-wise vessel perfusion (VP) were compared between iAMD and normal eyes from the corresponding 10-yearly age cohort, forming difference plots. Difference plots were further separated by normative topographical map spatial clusters (C1-6), derived from normaldatabase eyes (n = 236, 20–81 years old). Results Overall difference plots showed decreased VP in the superficial (−12.19%) and deep vascular complex (−6.44%) of iAMD compared to normal eyes (P < 0.0001 both comparisons). Cluster-based difference plots highlighted nonuniform changes in the superficial vascular complex, with sparing of VP at the nasal macula (corresponding to the radial peripapillary capillary plexus) versus decreased VP toward the temporal macula and foveal avascular zone (FAZ) (C1–6 all comparisons P < 0.0001, except C1 vs. C2P > 0.99 and C4 vs. C5P = 0.11). The deep vascular complex displayed diffusely decreased VP, greater at the FAZ (P < 0.0001). Conclusions High-density en face OCTA cluster analysis suggests relative sparing of the radial peripapillary capillary plexus and impairment of underlying retinal vasculature, supporting potential anterograde transsynaptic degeneration in iAMD. These location-specific data may better guide future diagnostic and management protocol of iAMD.
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Affiliation(s)
- Matt Trinh
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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16
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Chiang TTK, Keenan TD, Agrón E, Liao J, Klein B, Chew EY, Cukras CA, Wong WT. Macular Thickness in Intermediate Age-Related Macular Degeneration Is Influenced by Disease Severity and Subretinal Drusenoid Deposit Presence. Invest Ophthalmol Vis Sci 2021; 61:59. [PMID: 32602904 PMCID: PMC7415904 DOI: 10.1167/iovs.61.6.59] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate how macular thickness varies with intermediate age-related macular degeneration (iAMD) severity and the presence of subretinal drusenoid deposits (SDDs). Methods A longitudinal prospective study of 143 participants >50 years of age with no to intermediate AMD who were followed with multimodal imaging and functional testing. Participants were stratified by iAMD severity according to imaging features. Macular thicknesses measurements over the central circles with 1-mm, 3-mm, and 6-mm diameters obtained from ocular coherence tomography imaging were compared across severity categories using cross-sectional (143 eyes) and longitudinal (subset of 77 eyes followed for 4 years) multivariate analyses. Results Compared with control eyes without large drusen or SDDs (Group 0), central maculas of lower risk eyes with unilateral large drusen (Group 1) were thicker (P = 0.014), whereas higher risk eyes with SDDs (Group SDD) were thinner (P = 0.02) in cross-sectional multivariate analyses. In longitudinal analyses, maculas with SDDs thinned more rapidly over 4 years relative to control eyes (P = 0.0058), which did not show significant thinning. More rapid central macular thinning was associated with worse baseline best-corrected visual acuity (BCVA) (P = 0.016) and more rapid BCVA decline (P = 0.0059). Conclusions Macular thickness in iAMD varies with disease severity, showing small increases in eyes with large drusen and decreases in eyes with SDDs. Active processes possibly related to neuroinflammation and neurodegeneration may be contributory. Longitudinal central macular thickness evaluation is an accessible outcome measure relevant to functional measures and is potentially useful for iAMD interventional studies.
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17
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Fang IM, Hsu HY, Chiang WL, Shih YL, Han CL. Correlation between Visual Acuity and Optical Coherence Tomography Angiography Parameters in Unilateral Idiopathic Epiretinal Membrane. J Clin Med 2020; 10:jcm10010026. [PMID: 33374267 PMCID: PMC7795438 DOI: 10.3390/jcm10010026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/19/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The tangential traction by idiopathic epiretinal membrane (iERM) may alter the hemodynamics of the macula. We investigated the correlation between visual acuity and the optical coherence tomography angiography (OCTA) parameters in unilateral iERM. Methods: We included 61 eyes of 61 consecutive patients with unilateral iERM between January 2018 and December 2018. The flow area of the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and choroidal capillary plexus (CCP) were measured using OCTA. The normal fellow eyes were used for comparison. The iERM patients were divided into those with a presence of foveal concavity and those with a loss of foveal concavity. Results: When compared with fellow eyes, the flow areas showed a statistically significant decrease in the SCP and CCP of those with iERM (p = 0.037 and p = 0.011, respectively). In the DCP, no significant reduction in flow area was found in iERM (p = 0.054). The flow area of the CCP was the only factor significantly associated with best vision (p = 0.012). No significant differences in the flow areas of the SCP, DCP, and CCP were found between the presence and loss of foveal concavity. Conclusions: The flow area of the CCP is an important determinant of vision, emphasizing the crucial role of choroidal circulation in iERM. Moreover, mechanical stretch by iERM is not the only mechanism affecting the flow area.
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Affiliation(s)
- I-Mo Fang
- Department of Ophthalmology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tonde Road, Nankang District, Taipei 10002, Taiwan; (H.-Y.H.); (W.-L.C.); (C.-L.H.)
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 11556, Taiwan;
- Department of Special Education, University of Taipei, Taipei 11153, Taiwan
- Correspondence: ; Tel.: +886-2-2786-1288 (ext. 8271)
| | - Hsin-Yi Hsu
- Department of Ophthalmology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tonde Road, Nankang District, Taipei 10002, Taiwan; (H.-Y.H.); (W.-L.C.); (C.-L.H.)
| | - Wan-Ling Chiang
- Department of Ophthalmology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tonde Road, Nankang District, Taipei 10002, Taiwan; (H.-Y.H.); (W.-L.C.); (C.-L.H.)
| | - Yi-Ling Shih
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 11556, Taiwan;
| | - Chia-Ling Han
- Department of Ophthalmology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tonde Road, Nankang District, Taipei 10002, Taiwan; (H.-Y.H.); (W.-L.C.); (C.-L.H.)
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18
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Optical Coherence Tomography Angiography in Intermediate and Late Age-Related Macular Degeneration: Review of Current Technical Aspects and Applications. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10248865] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Optical coherence tomography angiography (OCTA) is a non-invasive diagnostic instrument that has become indispensable for the management of age-related macular degeneration (AMD). OCTA allows quickly visualizing retinal and choroidal microvasculature, and in the last years, its use has increased in clinical practice as well as for research into the pathophysiology of AMD. This review provides a discussion of new technology and application of OCTA in intermediate and late AMD.
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19
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Courtie E, Veenith T, Logan A, Denniston AK, Blanch RJ. Retinal blood flow in critical illness and systemic disease: a review. Ann Intensive Care 2020; 10:152. [PMID: 33184724 PMCID: PMC7661622 DOI: 10.1186/s13613-020-00768-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessment and maintenance of end-organ perfusion are key to resuscitation in critical illness, although there are limited direct methods or proxy measures to assess cerebral perfusion. Novel non-invasive methods of monitoring microcirculation in critically ill patients offer the potential for real-time updates to improve patient outcomes. MAIN BODY Parallel mechanisms autoregulate retinal and cerebral microcirculation to maintain blood flow to meet metabolic demands across a range of perfusion pressures. Cerebral blood flow (CBF) is reduced and autoregulation impaired in sepsis, but current methods to image CBF do not reproducibly assess the microcirculation. Peripheral microcirculatory blood flow may be imaged in sublingual and conjunctival mucosa and is impaired in sepsis. Retinal microcirculation can be directly imaged by optical coherence tomography angiography (OCTA) during perfusion-deficit states such as sepsis, and other systemic haemodynamic disturbances such as acute coronary syndrome, and systemic inflammatory conditions such as inflammatory bowel disease. CONCLUSION Monitoring microcirculatory flow offers the potential to enhance monitoring in the care of critically ill patients, and imaging retinal blood flow during critical illness offers a potential biomarker for cerebral microcirculatory perfusion.
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Affiliation(s)
- E Courtie
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Veenith
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Logan
- Axolotl Consulting Ltd, Droitwich, WR9 0JS, Worcestershire, UK
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - A K Denniston
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK
| | - R J Blanch
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
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Parisi V, Ziccardi L, Costanzo E, Tedeschi M, Barbano L, Manca D, Di Renzo A, Giorno P, Varano M, Parravano M. Macular Functional and Morphological Changes in Intermediate Age-Related Maculopathy. Invest Ophthalmol Vis Sci 2020; 61:11. [PMID: 32396630 PMCID: PMC7405611 DOI: 10.1167/iovs.61.5.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose The purpose of this study was to evaluate macular preganglionic function and to verify its relationship with retinal and choroidal morphology in patients with intermediate age-related macular degeneration (iAMD) patients. Methods All included patients performed multifocal electroretinogram (mfERG) for investigating on macular function from the central 15° of foveal eccentricity, spectral domain optical coherence tomography (SD-OCT) for studying retinal structure, enhanced depth imaging OCT (EDI-OCT) for the measure of choroidal vascularity index (CVI), and OCT-angiography (OCTA) for the evaluation of vessel density (VD) in the superficial and deep capillary plexus, and choriocapillaris (CC) layer. Results Twenty-seven patients with iAMD and 20 age-matched control eyes were analyzed. Significantly (P < 0.01) delayed and reduced mfERG responses in the central 0 to 2.5°, paracentral 2.5 to 5°, and overall 0 to 5° areas, as well as increased CVI values in both foveal (1 mm centered to the fovea) and fovea + parafovea areas (3 mm centered to the fovea), increased foveal and parafoveal (annular area of 1-3 mm centered to the fovea) retinal pigment epithelium thickness, and volume and parafoveal outer retinal volume were found in iAMD eyes as compared to controls. Moreover, iAMD eyes showed significantly (P < 0.01) reduced foveal and parafoveal OCTA-VD values in the CC layer when compared to controls. In the iAMD group, not significant (P > 0.01) correlations were found between morphological and functional parameters. Conclusions Our findings support a dysfunction of photoreceptors and bipolar cells in both foveal and parafoveal areas in the presence of outer retina, CC, and choroidal structural changes, however, not significantly correlated. The observed enlargement of luminal choroidal area (measured by CVI) is possibly compensatory to CC vascular insufficiency.
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21
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Choi EY, Park SE, Lee SC, Koh HJ, Kim SS, Byeon SH, Kim M. Association Between Clinical Biomarkers and Optical Coherence Tomography Angiography Parameters in Type 2 Diabetes Mellitus. Invest Ophthalmol Vis Sci 2020; 61:4. [PMID: 32150245 PMCID: PMC7401845 DOI: 10.1167/iovs.61.3.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the clinical significance of the changes in the macular microvasculature in patients with diabetes mellitus type 2 without diabetic retinopathy. Methods Fifty-five patients with diabetes mellitus type 2 without diabetic retinopathy and 48 healthy individuals were enrolled in a prospective cross-sectional study. We identified the changes of optical coherence tomography angiography parameters (foveal avascular zone [FAZ] area and circularity, vessel density, and perfusion index) of the 6 × 6-mm macular scan. Correlation and multiple regression analyses were performed between optical coherence tomography angiography parameters and previously known diabetes mellitus type 2-related demographic and systemic characteristics, and serum biochemical markers. Results FAZ parameters and perfusion index of the superficial and deep vascular plexus showed significant correlation with serum insulin level, and homeostasis model assessment indices. In multiple linear regression analysis, low insulin levels predicted increased FAZ areas in both the superficial (β = –0.007; P = 0.030) and deep layers (β = –0.010; P = 0.018) and a decreased perfusion index in the deep layer (β = 0.003; P = 0.001). Conclusions The expansion and loss of circularity of the FAZ and the decrease in the perfusion index may be affected by insulin resistance and secretory capacity in patients with diabetes mellitus type 2 with no diabetic retinopathy.
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22
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Reiter GS, Told R, Schlanitz FG, Baumann L, Schmidt-Erfurth U, Sacu S. Longitudinal Association Between Drusen Volume and Retinal Capillary Perfusion in Intermediate Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2019; 60:2503-2508. [PMID: 31185089 DOI: 10.1167/iovs.18-26237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate vascular changes in the superficial and deep retinal capillary plexus (SCP, DCP) and their association with drusen volume changes in intermediate age-related macular degeneration (iAMD). Methods Patients with iAMD were examined at baseline and 12 months thereafter. Drusen volume was extracted from 20° × 20° OCT scans using a 3-mm ETDRS grid using a customized algorithm with manual correction. Vessel density (VD) and flow area (FA) were extracted from 3 × 3 mm SD-OCT-A scans after manual correction of the segmentation. Associations were investigated using multiple regression models. Results We used 31 eyes of 31 patients for evaluation. The mean age at baseline was 74.9 ± 5.4 years; 26 patients were female. Baseline visual acuity (VA) was 0.05 ± 0.08 logMAR (Snellen equivalent approximately 20/22). The initial mean 3-mm central drusen volume was 0.144 ± 0.136 mm3. A significant association with the signal strength index was consistently found, therefore all capillary measurements were corrected. VD in the same area was 49.88% ± 7.38% and 55.43% ± 9.31% for the SCP and DCP, respectively. The baseline FA resulted in 3.292 ± 0.218 mm2 and 3.433 ± 0.224 mm2 for the SCP and DCP, respectively. No association was found between changes in drusen volume and FA or VD after 12 months (all P > 0.05). VA worsened (P = 0.013) and the foveal FA of the SCP increased significantly (P = 0.014). Conclusions No significant association was found between the increase in drusen volume in iAMD and capillary retinal perfusion over a 12-month follow-up. Although VA decreased statistically over this time period, the foveal FA of the SCP increased.
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Affiliation(s)
- Gregor Sebastian Reiter
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Reinhard Told
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ferdinand Georg Schlanitz
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Lukas Baumann
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Mastropasqua R, D’Aloisio R, Viggiano P, Borrelli E, Iafigliola C, Di Nicola M, Aharrh-Gnama A, Di Marzio G, Toto L, Mariotti C, Carpineto P. Early retinal flow changes after vitreoretinal surgery in idiopathic epiretinal membrane using swept source optical coherence tomography angiography. J Clin Med 2019; 8:jcm8122067. [PMID: 31771299 PMCID: PMC6947278 DOI: 10.3390/jcm8122067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/11/2019] [Accepted: 11/18/2019] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The aim of this observational cross-sectional work was to investigate early retinal vascular changes in patients undergoing idiopathic epiretinal membrane (iERM) surgery using swept source optical coherence tomography angiography (SS-OCTA); (2) Methods: 24 eyes of 24 patients who underwent vitrectomy with internal limiting membrane (ILM) peeling were evaluated pre- and postoperatively using SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 6x6-mm OCTA volume scans were acquired by two observers independently. The en face images of superficial capillary plexus (SCP) were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. Perfusion density (PD), vessel length density (VLD), vessel diameter index (VDI) and vessel tortuosity (VT) of SCP were evaluated in both the parafoveal (2.5 mm diameter) and perifoveal areas (5.5 mm diameter); (3) Results: At OCTA analysis statistically significant differences were found between controls and diseased eyes for all parameters in parafoveal and perifoveal regions (p < 0.001; p < 0.05) except for perifoveal VLD. During 6-month follow up, both anatomical/perfusion and functional parameters showed a statistically significant improvement if compared to preoperative values. In detail, at one-month post vitrectomy, VLD and VT significantly changed in parafoveal region (p = 0.043; p = 0.045), while PD and VDI showed a trend of increase in both parafoveal and perifoveal region. At 6 months after surgery, PD, VLD and VT of parafoveal region significantly improved (p = 0.021, p = 0.018, p = 0.047 respectively). (4) Conclusions: SS-OCTA provides a quantitative and qualitative analysis of the superficial capillary plexus allowing for early vascular changes assessment after vitrectomy with iERM and ILM peeling.
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Affiliation(s)
- Rodolfo Mastropasqua
- Eye Clinic, Polytechnic University of Marche, 60126 Ancona, Italy; (R.M.)
- Institute of Ophthalmology, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Rossella D’Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (P.V.); (C.I.); (A.A.-G.); (G.D.M.); (L.T.); (P.C.)
- Correspondence:
| | - Pasquale Viggiano
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (P.V.); (C.I.); (A.A.-G.); (G.D.M.); (L.T.); (P.C.)
| | - Enrico Borrelli
- Department of Ophthalmology, University Vita Salute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Carla Iafigliola
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (P.V.); (C.I.); (A.A.-G.); (G.D.M.); (L.T.); (P.C.)
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University G. d’Annunzio Chieti-Pescara, 66100 Chieti, Italy;
| | - Agbéanda Aharrh-Gnama
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (P.V.); (C.I.); (A.A.-G.); (G.D.M.); (L.T.); (P.C.)
| | - Guido Di Marzio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (P.V.); (C.I.); (A.A.-G.); (G.D.M.); (L.T.); (P.C.)
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (P.V.); (C.I.); (A.A.-G.); (G.D.M.); (L.T.); (P.C.)
| | - Cesare Mariotti
- Eye Clinic, Polytechnic University of Marche, 60126 Ancona, Italy; (R.M.)
| | - Paolo Carpineto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d’Annunzio Chieti-Pescara, 66100 Chieti, Italy; (P.V.); (C.I.); (A.A.-G.); (G.D.M.); (L.T.); (P.C.)
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Lee TH, Lim HB, Nam KY, Kim K, Kim JY. Factors Affecting Repeatability of Assessment of the Retinal Microvasculature Using Optical Coherence Tomography Angiography in Healthy Subjects. Sci Rep 2019; 9:16291. [PMID: 31704998 PMCID: PMC6841961 DOI: 10.1038/s41598-019-52782-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/16/2019] [Indexed: 01/02/2023] Open
Abstract
Various factors can affect repeatability of optical coherence tomography angiography (OCTA) measurements, and they have not been studied sufficiently. We aimed to investigate the factors associated with the repeatability of automated superficial retinal vessel density (VD) and foveal avascular zone (FAZ) metrics acquired from OCTA. A total of 141 normal eyes from 141 healthy subjects were included, and two consecutive macular 6 × 6-mm angiography scans were performed. VD, perfusion density (PD), and FAZ of the superficial capillary plexus were calculated automatically. Reproducibility was assessed based on intraclass correlations (ICCs) and coefficients of variation (CVs). VD (ICC: 0.824, CV: 3.898) and PD (ICC: 0.845, CV: 4.042) over the entire 6-mm scan area showed better repeatability than VD (ICC: 0.752, CV: 17.470) and PD (ICC: 0.752, CV: 18.552) in the 1-mm scan, and with respect to the obtained FAZ metrics (ICC < 0.75, CV > 10.0%). Regression analyses showed that two factors, signal strength (p = 0.004) and average VD over the total 6-mm scan area (p < 0.001), were significantly correlated with the CV of the VD. Signal strength was associated with the repeatability of OCTA measurements and should be considered in the analysis of retinal VD and FAZ.
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Affiliation(s)
- Taek Hoon Lee
- Rhee's Eye Hospital, Daejeon, Republic of Korea.,Graduate School of Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hyung Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ki Yup Nam
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Kyeungmin Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung Yeul Kim
- Graduate School of Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea. .,Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
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25
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Shin YI, Kim JM, Lee MW, Jo YJ, Kim JY. Characteristics of the Foveal Microvasculature in Asian Patients with Dry Age-Related Macular Degeneration: An Optical Coherence Tomography Angiography Study. Ophthalmologica 2019; 243:145-153. [PMID: 31645037 DOI: 10.1159/000503295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/09/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate changes in the foveal microvasculature in patients with dry age-related macular degeneration (dry AMD) using optical coherence tomography angiography (OCTA). METHODS Eighty-three eyes with dry AMD and 83 age- and sex-matched normal eyes were enrolled. A 3 × 3 mm2 OCTA (Zeiss HD-OCT 5000 with AngioPlex; Carl Zeiss Meditec, Dublin, CA, USA) scan was used to acquire images. Vessel density (VD), perfusion density (PD), and the foveal avascular zone (FAZ) of the superficial capillary plexus were analyzed. RESULTS The VD of the full area, central area, and inner ring of the dry AMD patients (18.61, 8.41, and 20.45, respectively) were significantly lower than those of the controls (20.06, 11.09, and 22.51, respectively). The PD of the full area, central area, and inner ring of the dry AMD patients (0.34, 0.15, and 0.37, respectively) were also significantly lower than those of the controls (0.36, 0.19, and 0.40, respectively). The FAZ area and perimeter in the dry AMD patients (0.29 mm2 and 2.47 mm, respectively) were larger than those in the controls (0.23 mm2 and 2.09 mm, respectively). The FAZ circularity index in the dry AMD patients was smaller than that in the controls (0.61 vs. 0.66). Using univariate linear regression, age, best-corrected visual acuity (BCVA), central macular thickness (CMT), and ganglion cell-inner plexiform layer (GC-IPL) thickness were associated with both VD and PD of the full area. Using multivariate analysis, only GC-IPL thickness was significantly associated with the VD and PD of the full area (p = 0.001 and p = 0.004, respectively). CONCLUSIONS OCTA revealed changes in the foveal microcirculation of patients with dry AMD. Age, BCVA, CMT, and GC-IPL thickness should be considered when analyzing the OCTA data of patients with dry AMD. GC-IPL thickness is particularly important during clinical evaluation of VD and PD in patients with dry AMD.
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Affiliation(s)
- Yong-Il Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ju Mi Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Young-Joon Jo
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea,
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26
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Optical Coherence Tomography Angiography Macular Vascular Density Measurements and the Central 10-2 Visual Field in Glaucoma. J Glaucoma 2019; 27:481-489. [PMID: 29664832 DOI: 10.1097/ijg.0000000000000964] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the association between macula vascular density assessed by optical coherence tomography angiography (OCT-A) and central visual field (VF) threshold sensitivities in healthy, glaucoma suspect, and glaucoma patients. METHODS A total of 185 eyes from 38 healthy participants, 31 glaucoma suspects, 72 mild glaucoma patients, and 44 moderate/severe glaucoma patients from the Diagnostic Innovations in Glaucoma Study who underwent OCT-A images of the macula and 10-2 VF testing were enrolled in this observational cross-sectional study. The relationship between central VF mean sensitivity (MS) and superficial macula whole-image vessel density (wiVD), and the relationship between the MS of the 4 central points of the 10-2 VF (MS4) and parafoveal vessel density (pfVD), were assessed using linear regression models. RESULTS Mean wiVD (52.5%, 49.8%, 49.4% and 45.2%, respectively) and mean pfVD (54.9%, 52.1%, 51.8% and 47.7%, respectively) were found to be significantly higher in healthy eyes and glaucoma suspect eyes compared with glaucoma eyes with mild and moderate/severe disease [analysis of covariance (ANCOVA) P<0.001]. The univariate associations between 10-2 MS and wiVD (R=26.9%) and between 10-2 MS4 and pfVD (R=16.8%) were statistically significant (P<0.001 for both). After adjusting for scan quality, age, sex and intraocular pressure, superficial macula wiVD and pfVD were still independently associated with central VF loss. Macula wiVD performed better [area under the receiver operator characteristic (AUROC)=0.70] than ganglion cell complex thickness (AUROC=0.50) for differentiating between glaucoma suspect and healthy eyes (P=0.010). CONCLUSIONS Loss of OCT-A macula vessel density is associated with central 10-2 VF defects. Macula vessel density is a clinically relevant parameter that may enhance monitoring of glaucoma suspects and patients.
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27
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Trinh M, Kalloniatis M, Nivison-Smith L. Vascular Changes in Intermediate Age-Related Macular Degeneration Quantified Using Optical Coherence Tomography Angiography. Transl Vis Sci Technol 2019; 8:20. [PMID: 31404428 PMCID: PMC6685696 DOI: 10.1167/tvst.8.4.20] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/10/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose To examine changes in retinal vasculature and ganglion cell layer (GCL) thickness in intermediate age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA). Methods Zeiss Cirrus Angioplex OCTA 6 × 6 mm scans and a macula 512 × 128 cube scans of the central retina were taken of 63 eyes with intermediate AMD and 51 control eyes. For OCTA scans, the superficial and deep capillary plexus were automatically segmented and vascular density quantified as total number of pixels contributing to the blood flow signal detectable by OCTA. Images were then skeletonized and vessel length, diameter index, morphology, and branching complexity determined. Foveal avascular zone (FAZ) characteristics and GCL thickness were extracted from in-built Angioplex software. Results Vascular density was significantly reduced in the superficial capillary plexus of AMD eyes compared with normal eyes, particularly in the superior quadrant (42.4% ± 1.6% vs. 43.2% ± 1.4%; P < 0.05). A nonsignificant reduction was also seen in the deep capillary plexus (P = 0.06). Total vessel length and average vessel diameter were all significantly decreased in AMD eyes suggesting density changes were related to decreased vessel number and caliber. Vascular complexity and number of branch points was significantly decreased in the deep capillary plexus (P < 0.05) suggesting loss or significantly reduced flow of vessels. Average GCL thickness was also significantly reduced in the AMD eyes (P < 0.05). No significant changes in FAZ parameters were observed in AMD eyes. Conclusions This study suggests intermediate AMD affects both the quantity and morphology of inner retinal vasculature and may be associated with changes in inner retinal structure. This work builds upon the notion that AMD pathogenesis may extends beyond the outer retina. Translational Relevance Better understanding of retinal vascular changes in AMD can provide insights in the development of treatment and prevention protocols for these diseases.
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Affiliation(s)
- Matt Trinh
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Centre for Eye Health, University of New South Wales, Sydney, Australia
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28
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MORPHOLOGIC FEATURES OF THE RETINAL PIGMENT EPITHELIUM AND ASSOCIATED CHORIORETINAL CHARACTERISTICS IN EYES WITH EARLY AGE-RELATED MACULAR DEGENERATION AND SUBRETINAL DRUSENOID DEPOSITS. Retina 2019; 40:686-694. [PMID: 30950969 DOI: 10.1097/iae.0000000000002528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the features of the retinal pigment epithelium (RPE) on optical coherence tomography in eyes with early age-related macular degeneration with subretinal drusenoid deposit. METHODS We classified the eyes into three types: nonundulating RPE, undulating RPE, and wedge-shaped RPE. We compared the retinal vessel densities, retinal thickness, and choroidal thickness of a 3-mm-diameter zone. RESULTS We classified 33, 27, and 20 as nonundulating RPE, undulating RPE, and wedge-shaped RPE eyes, respectively. The vascular densities of the superficial and deep capillary plexus showed differences; nonundulating RPE group (23.93 ± 2.26% and 23.54 ± 1.78%), undulating RPE group (22.29 ± 2.80% and 21.94 ± 2.42%), and wedge-shaped RPE group (21.93 ± 2.70% and 20.63 ± 2.42%, P = 0.010 and P < 0.001). The mean retinal thickness and choroidal thickness were also different, nonundulating RPE group (298.26 ± 13.81 µm and 180.08 ± 55.49 µm), undulating RPE group (285.29 ± 21.88 µm and 148.45 ± 55.08 µm), and wedge-shaped RPE group (274.86 ± 20.62 µm and 135.75 ± 39.77 µm) (P = 0.001 and P = 0.007). CONCLUSION Altered features of the RPE on optical coherence tomography may indicate advancement in disease and be part of an overall degeneration process in these eyes.
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Kim TH, Son T, Lu Y, Alam M, Yao X. Comparative Optical Coherence Tomography Angiography of Wild-Type and rd10 Mouse Retinas. Transl Vis Sci Technol 2018; 7:42. [PMID: 30619662 PMCID: PMC6314228 DOI: 10.1167/tvst.7.6.42] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/02/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose To conduct longitudinal optical coherence tomography angiography (OCTA) to characterize dynamic changes of trilaminar vascular plexuses in wild-type (WT) and retinal degeneration 10 (rd10) mouse retinas. Methods Longitudinal in vivo OCT/OCTA measurements of WT and rd10 mouse retinas were conducted at postnatal day 14 (P14), P17, P21, P24, and P28. OCT images were used to quantify retinal thickness changes, while OCTA images were used to investigate vascular dynamics within the trilaminar vascular plexuses, that is, superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Blood vessel densities of all three plexus layers were quantitatively evaluated separately. The caliber of first-order blood vessel branches in the SVP layer was also measured. Results Vascular densities in all three plexuses continuously decreased with aging in both WT and rd10. However, abnormal density reduction in rd10 occurred at P17 in both ICP (P < 0.001) and DCP (P < 0.001). While the ICP of rd10 showed density recovery at P24, the DCP of rd10 showed significantly low density. Remarkable vascular narrowing in rd10 was also observed in the SVP, especially at P28. Conclusions The most severe vascular impairment happened in the DCP, while the ICP showed the transient recovery of vascular density after the onset of retinal degeneration. The SVP was most resistant to the retinal degeneration, but the first-order blood vessel branches within the SVP showed progressive narrowing. Translational Relevance Better understanding of the vascular changes correlated with retinal development, and retinal degeneration can provide insights in advanced development of treatment protocols of retinal degenerative diseases.
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Affiliation(s)
- Tae-Hoon Kim
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Taeyoon Son
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Yiming Lu
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Minhaj Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Rabiolo A, Gelormini F, Sacconi R, Cicinelli MV, Triolo G, Bettin P, Nouri-Mahdavi K, Bandello F, Querques G. Comparison of methods to quantify macular and peripapillary vessel density in optical coherence tomography angiography. PLoS One 2018; 13:e0205773. [PMID: 30335815 PMCID: PMC6193681 DOI: 10.1371/journal.pone.0205773] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/27/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose To compare macular and peripapillary vessel density values calculated on optical coherence tomography angiography (OCT-A) images with different algorithms, elaborate conversion formula, and compare the ability to discriminate healthy from affected eyes. Methods Cross-sectional study of healthy subjects, patients with diabetic retinopathy, and glaucoma patients (44 eyes in each group). Vessel density in the macular superficial capillary plexus (SCP), deep capillary plexus (DCP), and the peripapillary radial capillary plexus (RCP) were calculated with seven previously published algorithms. Systemic differences, diagnostic properties, reliability, and agreement of the methods were investigated. Results Healthy eyes exhibited higher vessel density values in all plexuses compared to diseased eyes regardless of the algorithm used (p<0.01). The estimated vessel densities were significantly different at all the plexuses (p<0.0001) as a function of method used. Inter-method reliability and agreement was mostly poor to moderate. A conversion formula was available for every method, except for the conversion between multilevel and fixed at the DCP. Substantial systemic, non-constant biases were evident between many algorithms. No algorithm outperformed the others for discrimination of patients from healthy subjects in all the retinal plexuses, but the best performing algorithm varied with the selected plexus. Conclusions Absolute vessel density values calculated with different algorithms are not directly interchangeable. Differences between healthy and affected eyes could be appreciated with all methods with different discriminatory abilities as a function of the plexus analyzed. Longitudinal monitoring of vessel density should be performed with the same algorithm. Studies adopting vessel density as an outcome measure should not rely on external normative databases.
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Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Francesco Gelormini
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
- Eye Clinic, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Giacinto Triolo
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Paolo Bettin
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Kouros Nouri-Mahdavi
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy
- * E-mail:
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Lamin A, Oakley JD, Dubis AM, Russakoff DB, Sivaprasad S. Changes in volume of various retinal layers over time in early and intermediate age-related macular degeneration. Eye (Lond) 2018; 33:428-434. [PMID: 30310161 DOI: 10.1038/s41433-018-0234-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate longitudinally volume changes in inner and outer retinal layers in early and intermediate age-related macular degeneration (AMD) compared to healthy control eyes using optical coherence tomography (OCT). METHODS 71 eyes with AMD and 31 control eyes were imaged at two time points: baseline and after 2 years. Automated OCT layer segmentation was performed using OrionTM. This software is able to measure volumes of retinal layers with distinct boundaries including Retinal Nerve Fibre Layer (RNFL), Ganglion Cell-Inner Plexiform Layer (GCIPL), Inner Nuclear Layer (INL), Outer Plexiform Layer (OPL), Outer Nuclear Layer (ONL), Photoreceptors (PR) and Retinal Pigment Epithelium-Bruch's Membrane complex (RPE-BM). The mean retinal layer volumes and volume changes at 2 years were compared between groups. RESULTS Mean GCIPL and INL volumes were lower, while PR and RPE-BM volumes were higher in AMD eyes than controls at baseline (all P < 0.05) and year 2 (all P < 0.05). In AMD eyes, RNFL and ONL volumes decreased by 0.0232 (P = 0.033) and 0.0851 (P = 0.001), respectively. In contrast, OPL and RPE-BM volumes increased in AMD eyes by 0.0391 (P = 0.000) and 0.0209 (P = 0.000) respectively. Moreover, there were significant differences in longitudinal volume change of OPL (P = 0.02), ONL (P = 0.008) and RPE-BM (P = 0.02) between AMD eyes and controls. CONCLUSIONS There were abnormal retinal layer volumes and volume changes in eyes with early and intermediate AMD.
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Affiliation(s)
- Ali Lamin
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
| | | | - Adam M Dubis
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,UCL Institute of Ophthalmology, London, UK
| | | | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK. .,UCL Institute of Ophthalmology, London, UK.
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Wintergerst MW, Pfau M, Müller PL, Berger M, de Sisternes L, Holz FG, Finger RP. Optical Coherence Tomography Angiography in Intermediate Uveitis. Am J Ophthalmol 2018; 194:35-45. [PMID: 30026083 DOI: 10.1016/j.ajo.2018.06.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the involvement of the retinal and choriocapillaris microvasculature in intermediate uveitis on optical coherence tomography angiography (OCT-A). DESIGN Case-control study. METHODS Patients and age-matched controls were imaged with swept-source OCT-A. Using ImageJ, superficial and deep retinal vasculature were semi-automatically analyzed for vessel (VD) and skeleton density (SD), vessel diameter index (VDI), and fractal dimension (FD). Choriocapillaris layer was automatically graded for mean signal intensity, signal intensity standard deviation, kurtosis of signal intensity distribution, and flow signal voids. RESULTS Twenty-nine intermediate uveitis eyes and 30 control eyes were included. Both superficial and deep retinal layers showed significant reduction in all OCT-A parameters (eg, superficial retinal layer: 0.31 vs 0.40 VD, 5.6e-8 vs 6.4e-8 SD, 5.4e6 vs 6.1e6 VDI, and 1.78 vs 1.79 FD, respectively, all P < .05). At the choriocapillaris layer a greater heterogeneity of perfusion with a shift toward a higher proportion of large confluent flow signal voids was present. Also in the absence of macular edema OCT-A parameters were reduced when compared with healthy controls (all parameters except for VDI in the superficial retinal layer and the choriocapillaris kurtosis and flow signal void analyses). CONCLUSIONS In intermediate uveitis, reduced vascular density and complexity in superficial as well as deep retinal layers and altered choriocapillaris perfusion are present. Moreover, these findings indicate impairment of the macular microvasculature even in the absence of macular edema. The results of our study may aid in the diagnosis as well as the monitoring of intermediate uveitis.
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Borrelli E, Mastropasqua R, Senatore A, Palmieri M, Toto L, Sadda SR, Mastropasqua L. Impact of Choriocapillaris Flow on Multifocal Electroretinography in Intermediate Age-Related Macular Degeneration Eyes. Invest Ophthalmol Vis Sci 2018; 59:AMD25-AMD30. [PMID: 29860309 DOI: 10.1167/iovs.18-23943] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the relationship between perfusion of the choriocapillaris (CC) and macular function in eyes with intermediate age-related macular degeneration. Methods In this prospective, observational, cross-sectional study, macular optical coherence tomography angiography images and multifocal electroretinograms were obtained in 20 eyes with intermediate age-related macular degeneration from 20 patients. The main outcome measures were (1) the percent nonperfused choriocapillaris area (PNPCA), which represents a measure of the total area of CC vascular dropout, and (2) the average size of the CC signal voids, which represent contiguous regions of CC dropout. Furthermore, amplitude and implicit time of multifocal electroretinograms N1 and P1 waves in the two central rings (R1 and R2) were included in the analysis. Results Of the 20 patients enrolled, only 17 eyes from 17 patients (13 women) were included in this analysis. Three patients were excluded because of poor scan quality. Mean ± SD age was 75.1 ± 7.9 years (range, 62-89 years). The best corrected visual acuity was 0.17 ± 0.13 logarithm of the minimum angle of resolution. In univariate analysis, both the PNPCA and average signal void size were found to have a significant direct relationship with N1 implicit time in the R2 ring (P = 0.006 and P = 0.035, respectively). Neither PNPCA nor the average signal void size was associated with P1 or N1 implicit times in R1. Conclusions In intermediate age-related macular degeneration eyes, PNPCA and average signal void size are related to N1 multifocal electroretinogram implicit times, which suggests an association between CC perfusion and photoreceptor function.
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Affiliation(s)
- Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Rodolfo Mastropasqua
- Whipps Cross University Hospital, Eye Treatment Centre, London, United Kingdom.,Ophthalmology Clinic, University of Marche, Ancona, Italy
| | - Alfonso Senatore
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Michele Palmieri
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
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Ahn SM, Lee SY, Hwang SY, Kim SW, Oh J, Yun C. Retinal vascular flow and choroidal thickness in eyes with early age-related macular degeneration with reticular pseudodrusen. BMC Ophthalmol 2018; 18:184. [PMID: 30055588 PMCID: PMC6064139 DOI: 10.1186/s12886-018-0866-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/20/2018] [Indexed: 12/11/2022] Open
Abstract
Background To investigate the characteristics of retinal vessels and retinal thickness in eyes with early age-related macular degeneration (AMD) with or without reticular pseudodrusen. Methods We retrospectively evaluated the clinical history and optical coherence tomography (OCT) and OCT angiography images of consecutive patients with early AMD. We calculated the retinal vessel densities of the superficial and deep capillary plexus with the ImageJ software (National Institutes of Health, Bethesda, MD, USA) and investigated the relationship with mean retinal thickness and subfoveal choroidal thickness. Results We included 135 early AMD eyes and classified 60 of them into a reticular pseudodrusen group and 75 into a non-reticular pseudodrusen group. The vascular densities of the superficial and deep capillary plexus in the reticular pseudodrusen group (32.35% ± 3.67 and 26.71% ± 2.88%) were not different from those of the non-reticular pseudodrusen group (33.18% ± 2.2% and % 27.43 ± 1.79%; P = 0.546 and P = 0.318, respectively). The retinal thickness of the reticular pseudodrusen group (287.31 μm ± 24.36 μm) did not differ from that of the non-reticular pseudodrusen group (294.27 μm ± 20.71 μm; P = 0.493), while subfoveal choroidal thickness in the reticular pseudodrusen group (158.13 μm ± 42.53 μm) was lower than that in the non-reticular pseudodrusen group (237.89 μm ± 60.94 μm; P < 0.001). Multivariate analysis revealed that lower vascular density of the superficial capillary plexus and subfoveal choroidal thickness were associated with retinal thinning in reticular pseudodrusen group (P = 0.003 and P = 0.036) and older age was associated with retinal thickness in the non-reticular pseudodrusen group (P = 0.005). Conclusions Retinal thinning in early AMD patients with reticular pseudodrusen was accompanied by choroidal and retinal vascular loss, which suggests a possible linkage of retinal thinning with vascular alterations. Electronic supplementary material The online version of this article (10.1186/s12886-018-0866-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- So Min Ahn
- Department of Ophthalmology, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Seoul, South Korea
| | - Suk Yeon Lee
- Department of Ophthalmology, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Seoul, South Korea
| | - Soon-Young Hwang
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Seong-Woo Kim
- Department of Ophthalmology, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Seoul, South Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Seoul, South Korea
| | - Cheolmin Yun
- Department of Ophthalmology, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Seoul, South Korea.
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Cohen SY, Miere A, Nghiem-Buffet S, Fajnkuchen F, Souied EH, Mrejen S. Clinical applications of optical coherence tomography angiography: What we have learnt in the first 3 years. Eur J Ophthalmol 2018; 28:491-502. [PMID: 29554812 DOI: 10.1177/1120672117753704] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A review of the literature from 2014 to 2016 was conducted, focusing on the results of optical coherence tomography angiography in different chorioretinal diseases. In only 3 years, optical coherence tomography angiography has been shown to be an effective tool for diagnosing choroidal neovascularization complicating age-related macular degeneration, pathologic myopia, and inflammatory conditions. The technique has sometimes been considered superior to conventional multimodal imaging, for example, in choroidal neovascularization associated with chronic central serous chorioretinopathy or multifocal choroiditis. In retinal vascular diseases, optical coherence tomography angiography has helped to understand the condition described as paracentral acute middle maculopathy and has been considered highly effective for the analysis of retinal vascular macular changes secondary to retinal vein occlusion or macular telangiectasia. Changes in the foveal avascular zone, also reported in diabetic maculopathy, have been shown to occur before any angiographic signs. A reduction in capillary vascular density has been reported in the fovea of eyes with malignant melanoma, but not in eyes with choroidal nevus. However, optical coherence tomography angiography is a recent technique that probably needs refinements and further studies. Nevertheless, the first 3 years of optical coherence tomography angiography use suggest its clinical relevance and useful applications in daily clinical practice.
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Affiliation(s)
- Salomon Y Cohen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France.,2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Alexandra Miere
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | | | | | - Eric H Souied
- 2 Department of Ophthalmology, University of Paris-Est, Creteil, France
| | - Sarah Mrejen
- 1 Ophthalmological Center for Imaging and Laser, Paris, France
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Cicinelli MV, Rabiolo A, Sacconi R, Lamanna F, Querques L, Bandello F, Querques G. Retinal vascular alterations in reticular pseudodrusen with and without outer retinal atrophy assessed by optical coherence tomography angiography. Br J Ophthalmol 2018; 102:1192-1198. [PMID: 29363531 DOI: 10.1136/bjophthalmol-2017-311317] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/30/2017] [Accepted: 12/28/2017] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the intraretinal structural and vascular alterations in patients featuring reticular pseudodrusen (RPD), RPD with outer retinal atrophy (ORA), and drusen. DESIGN Observational cross-sectional study. METHODS Clinical practice study including 68 eyes of 57 patients (22 eyes of 17 patients with RPD; 24 eyes of 21 patients with RPD+ORA; 22 eyes of 19 patients with drusen). Each patient underwent spectral-domain optical coherence tomography (OCT) and OCT angiography (OCT-A). Measurement of retinal layers' thickness was obtained by the automated segmentation protocol of the Spectralis OCT (Heidelberg Eye Explorer V.1.9.10.0). The superficial capillary plexus (SCP) and the deep capillary plexus (DCP) vessel density, as well as the size of the foveal avascular zone were calculated on 3×3 OCT-A. Main outcome was to compare vessel density at the SCP and DCP among the groups and controls. RESULTS At the SCP, the vessel density was lower in RPD and RPD+ORA patients with respect to controls (P=0.02 and P=0.003, respectively). At the DCP, meaningful disparity was found between the study groups and the healthy subjects in the vessel density (P<0.001, P=0.04 and P=0.001 for RPD, RDP+ORA and drusen, respectively). The ganglion cell layer (GCL) was thinner in all patients affected either by RPD, RPD+ORA or drusen compared with healthy subjects (P=0.02, P=0.03 and P=0.004, respectively). CONCLUSION Significant retinal vascular loss is a common feature of patients with non-exudative age-related macular degeneration, more pronounced in those featuring RPD and RPD+ORA. It is associated with retinal thinning, localised particularly at the GCL, compared with controls.
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Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Alessandro Rabiolo
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy.,Department of Ophthalmology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Francesca Lamanna
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
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Mastropasqua R, Borrelli E, Agnifili L, Toto L, Di Antonio L, Senatore A, Palmieri M, D'Uffizi A, Carpineto P. Radial Peripapillary Capillary Network in Patients with Retinitis Pigmentosa: An Optical Coherence Tomography Angiography Study. Front Neurol 2017; 8:572. [PMID: 29163338 PMCID: PMC5663731 DOI: 10.3389/fneur.2017.00572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/12/2017] [Indexed: 01/08/2023] Open
Abstract
Purpose To investigate radial peripapillary capillary (RPC) network in patients affected by retinitis pigmentosa (RP). Methods Eleven patients (22 eyes) with previous diagnosis of RP and 16 age-matched healthy subjects (16 eyes) were enrolled. The diagnosis of RP was made based on both clinical features and electrophysiological examination. All patients underwent a complete ophthalmologic examination, including optical coherence tomography angiography and visual field (VF). The primary outcomes were the RPC vessel density in the peripapillary and disk areas; the secondary outcomes were the peripapillary retinal nerve fiber layer (RNFL) thickness and the mean defect at VF. Results A total of 19 eyes of 11 RP patients (5 males, 6 females) and 16 eyes of 16 healthy subjects (10 males, 6 females) were included for the analysis. RPC vessel density in the disk area was 46.5 ± 7.1% in the RP group and 45.4 ± 10.6% in the control group (p = 0.754). RPC vessel density in the peripapillary area was significantly reduced in the RP group after the comparison with the control group (52.5 ± 5.0 and 57.2 ± 5.1%, respectively, p = 0.011). RNFL thickness was 85.9 ± 20.4 μm in the RP group and 104.0 ± 6.4 μm in the control group (p = 0.002). RPC vessel density was significantly correlated with RNFL thickness values in RP patients, both in the disk and in the peripapillary area (Rho = 0.599 and p = 0.007 in the disk area, Rho = 0.665 and p = 0.002 in the peripapillary area, respectively). Conclusion We showed that density of RPC is reduced in these patients in the peripapillary area. Moreover, the RPC vessel density correlates with the RNFL thickness.
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Affiliation(s)
| | - Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy.,Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, United States.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Luca Di Antonio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Alfonso Senatore
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Michele Palmieri
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Alessandro D'Uffizi
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Paolo Carpineto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
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Progressive Macula Vessel Density Loss in Primary Open-Angle Glaucoma: A Longitudinal Study. Am J Ophthalmol 2017; 182:107-117. [PMID: 28734815 DOI: 10.1016/j.ajo.2017.07.011] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To characterize the rate of macula vessel density loss in primary open-angle glaucoma (POAG), glaucoma-suspect, and healthy eyes. DESIGN Longitudinal, observational cohort from the Diagnostic Innovations in Glaucoma Study. METHODS One hundred eyes (32 POAG, 30 glaucoma-suspect, and 38 healthy) followed for at least 1 year with optical coherence tomography angiography (OCT-A) imaging on at least 2 visits were included. Vessel density was calculated in the macula superficial layer. The rate of change was compared across diagnostic groups using a multivariate linear mixed-effects model. RESULTS Baseline macula vessel density was highest in healthy eyes, followed by glaucoma-suspect and POAG eyes (P < .01). The rate of vessel density loss was significantly different from zero in the POAG, but not in the glaucoma-suspect or healthy eyes. The mean rate of change in macula whole en face vessel density was significantly faster in glaucoma eyes (-2.23%/y) than in glaucoma-suspect (0.87%/y, P = .001) or healthy eyes (0.29%/y, P = .004). Conversely, the rate of change in ganglion cell complex (GCC) thickness was not significantly different from zero in any diagnostic group, and no significant differences in the rate of GCC change among diagnostic groups were found. CONCLUSIONS With a mean follow-up of less than 14 months, eyes with POAG had significantly faster loss of macula vessel density than either glaucoma-suspect or healthy eyes. Serial OCT-A measurements also detected glaucomatous change in macula vessel density in eyes without evidence of change in GCC thickness.
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Abstract
PURPOSE To investigate the relationship between ganglion cell complex (GCC) thickness and photoreceptor alterations in eyes with intermediate age-related macular degeneration (AMD). DESIGN Retrospective case-control study. METHODS We collected data from 68 eyes with intermediate AMD from 68 patients with spectral-domain optical coherence tomography (SDOCT) imaging. A control group of 50 eyes from 50 healthy subjects was included for comparison. Our main outcome measures for comparison between groups were (1) the average and minimum GCC thickness and (2) the "normalized" reflectivity of the ellipsoid zone (EZ) en face image. RESULTS The average and minimum GCC thicknesses were thinner in AMD patients (69.54 ± 9.30 μm and 63.22 ± 14.11 μm, respectively) than in healthy controls (78.57 ± 6.28 μm and 76.28 ± 6.85 μm, P < .0001 and P < .0001, respectively). Agreement was found to be excellent in the "normalized" EZ reflectivity assessment (intraclass correlation coefficient = 0.986, coefficient of variation = 1.11). The EZ "normalized" reflectivity was 0.67 ± 0.11 in controls and 0.61 ± 0.09 in the AMD group (P = .006). In univariate analysis, EZ "normalized" reflectivity was found to have a significant direct relationship with average (P < .0001) and minimum (P < .0001) GCC thickness in AMD patients, but not in controls (P = .852 and P = .892, respectively). CONCLUSIONS Eyes with intermediate AMD exhibit GCC thinning, as well as a reduced EZ "normalized" reflectivity, and these parameters are correlated. This study supports the concept of postreceptor retinal neuronal loss as a contributor to retinal thinning in intermediate AMD.
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Mastropasqua L, Borrelli E, Carpineto P, Toto L, Di Antonio L, Mattei PA, Mastropasqua R. Microvascular changes after vitrectomy with internal limiting membrane peeling: an optical coherence tomography angiography study. Int Ophthalmol 2017. [PMID: 28631180 DOI: 10.1007/s10792-017-0608-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate superficial capillary plexus (SCP) changes occurring after internal limiting membrane (ILM) peeling for the treatment of idiopathic epiretinal membrane (ERM). METHODS A total of 15 eyes of 15 patients affected by idiopathic ERM (eight males and seven females; mean age 59.8 ± 9.6 years) were enrolled in the study. Patients were treated with pars plana vitrectomy followed by ERM and ILM peeling. Subjects were evaluated at baseline and at the week-1 and month-1 follow-up visits. At each visit, patients were evaluated with a complete ophthalmologic evaluation, which included imaging with optical coherence tomography angiography. RESULTS Overall, the SCP vessel density was 43.0 ± 3.0% at baseline and was stable throughout the follow-up (40.0 ± 4.0% at week-1 and 41.0 ± 4.0% at month-1 follow-up visits; p = 0.087 and p = 0.426, respectively). Nevertheless, the SCP vessel density was reduced at week-1 visit in both the superior and inferior sectors. In these sectors, the superficial vessel density was still reduced at the month-1 follow-up visit. CONCLUSIONS We observed a reduction in the SCP vessel density occurring after pars plana vitrectomy with ILM peeling. The reduction is referred to those areas where other changes (e.g., swelling of the arcuate nerve fiber layer) have been already described. In theory, superficial vessel density modifications may be due to the direct surgical trauma to the inner retina, where the superficial plexus is contained, during the ILM grasping.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Enrico Borrelli
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy.
| | - Paolo Carpineto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Luca Di Antonio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Peter A Mattei
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
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Bandello F, Sacconi R, Querques L, Corbelli E, Cicinelli MV, Querques G. Recent advances in the management of dry age-related macular degeneration: A review. F1000Res 2017; 6:245. [PMID: 28529701 PMCID: PMC5428517 DOI: 10.12688/f1000research.10664.1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 12/13/2022] Open
Abstract
Age-related macular degeneration (AMD), the most important cause of vision loss in elderly people, is a degenerative disorder of the central retina with a multifactorial etiopathology. AMD is classified in dry AMD (d-AMD) or neovascular AMD depending on the presence of choroidal neovascularization. Currently, no therapy is approved for geographic atrophy, the late form of d-AMD, because no treatment can restore the damage of retinal pigment epithelium (RPE) or photoreceptors. For this reason, all treatment approaches in d-AMD are only likely to prevent and slow down the progression of existing atrophy. This review focuses on the management of d-AMD and especially on current data about potential targets for therapies evaluated in clinical trials. Numerous examinations are available in clinics to monitor morphological changes in the retina, RPE and choroid of d-AMD patients. Fundus autofluorescence and optical coherence tomography (OCT) are considered the most useful tools in the diagnosis and follow-up of d-AMD alterations, including the monitoring of atrophy area progression. Instead, OCT-angiography is a novel imaging tool that may add further information in patients affected by d-AMD. Several pathways, including oxidative stress, deposits of lipofuscin, chronic inflammation and choroidal blood flow insufficiency, seem to play an important role in the pathogenesis of d-AMD and represent possible targets for new therapies. A great number of treatments for d-AMD are under investigation with promising results in preliminary studies. However, only few of these drugs will enter the market, offering a therapeutic chance to patients affected by the dry form of AMD and help them to preserve a good visual acuity. Further studies with a long-term follow-up would be important to test the real safety and efficacy of drugs under investigation.
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Affiliation(s)
- Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Ophthalmology, University of Verona, University hospital of Verona, Verona, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eleonora Corbelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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