Age-dependent Changes in the Macular Choriocapillaris of Normal Eyes Imaged With Swept-Source Optical Coherence Tomography Angiography

Zheng, Fang; Zhang, Qinqin; Shi, Yingying; Russell, Jonathan F.; Motulsky, Elie; Banta, James T.; Chu, Zhongdi; Zhou, Hao; Patel, Nimesh A.; Sisternes, Luís de; Durbin, Mary K; Feuer, William J.; Gregori, Giovanni; Wang, Ke; Rosenfeld, Philip J.

doi:10.1016/j.ajo.2018.12.025

Cited by 124 publications

(110 citation statements)

References 55 publications

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“…28 Moreover, we quantitated and compared the CC FDs in different macular regions since the CC FDs presented regional distributions in the macula. 44,45 We observed significantly increased FD% and enlarged average size of FDs in CC in diabetic eyes compared with controls within all quantified regions.…”

Section: Meanmentioning

confidence: 65%

“…Furthermore, although the NPA was reported to be less age dependent, 40 we nevertheless selected age-matched individuals as controls in this study since prior investigations have shown that vascular density, [41][42][43] FAZ size, 41,43 and CC FDs tended to be influenced by age. 44,45 Several groups also investigated CC perfusion in diabetic eyes. Using an investigational SS-OCT system, Choi et al 46 described focal or diffuse CC flow impairment in diabetic eyes without quantitative assessments.…”

Section: Meanmentioning

confidence: 99%

“…Instead of quantifying the CC vasculature directly, many researchers have chosen flow deficits to analyze CC perfusion. 12,44,45 The CC FD represents the area where there is a lack of CC flow or CC flow below the detectable threshold of the OCT system. To improve the robust assessment of the CC FDs, we segmented FDs with a size larger than normal intercapillary spacing (24 μm in diameter) for quantification, which is within the capability of the OCT system to resolve.…”

Section: Meanmentioning

confidence: 99%

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Microvascular Changes in the Choriocapillaris of Diabetic Patients Without Retinopathy Investigated by Swept-Source OCT Angiography

Dai

Zhou

Chu

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Purpose To investigate the microvascular changes in macular retina and choriocapillaris (CC) in diabetic eyes without retinopathy using swept-source optical coherence tomography angiography (SS-OCTA). Methods A commercial SS-OCTA system was used to collect 6 × 6-mm macular scans from patients. Three depth-resolved retinal slabs and a CC slab were segmented by a validated semiautomated algorithm. Retinal vessel area density, vessel skeleton density, and nonperfusion area were calculated on segmented retinal slabs. Foveal avascular zone was automatically measured based on en face image of the whole retinal layer. For CC quantification, the percentage of flow deficits (FD%) and the flow deficit (FD) sizes were measured. Results Sixteen eyes from 16 diabetic patients without clinically detectable retinopathy and 16 eyes from 16 age-matched nondiabetic controls were included. There was no significant difference between the two groups in all retinal vessel quantitative parameters (all P > 0.05). However, the mean FD% and mean FD sizes were significantly increased in CC in the central 1.0-mm disk ( P = 0.011 and P = 0.017, respectively), the central 1.5-mm rim ( P = 0.003 and P = 0.009, respectively), the central 2.5-mm rim ( P = 0.018 and P = 0.020, respectively), and the entire 5.0-mm disk ( P = 0.009 and P = 0.008, respectively) in diabetic eyes compared with controls. Conclusions CC perfusion in the macula is decreased in diabetic patients without retinopathy as compared to age-matched normal controls. Decreased CC perfusion in the macula may be an early indicator of otherwise clinically undetectable diabetic vasculopathy.

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Section: Meanmentioning

confidence: 65%

Section: Meanmentioning

confidence: 99%

Section: Meanmentioning

confidence: 99%

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Microvascular Changes in the Choriocapillaris of Diabetic Patients Without Retinopathy Investigated by Swept-Source OCT Angiography

Dai

Zhou

Chu

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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“…For instance, the percent of CC area without flow (called flow deficit percentage) in the choriocapillaris has been shown to be significantly affected by age [16,17]. Specifically, CC flow voids increase with age and the association rises with proximity to the central fovea, with more deficits in the central region [18,19]. Qualitatively, it has also been shown that CC flow impairment is present in early stages of diabetes sometime even before the appearance of DR on clinical exam, and that longstanding diabetes is correlated with CC drop-out on histology [13,20].…”

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confidence: 99%

Topographic analysis of macular choriocapillaris flow deficits in diabetic retinopathy using swept–source optical coherence tomography angiography

et al. 2020

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Background: The purpose of this study was to investigate the association between diabetic retinopathy (DR) severity and macular choriocapillaris (CC) flow deficit percentage (FD %) in different macular regions using swept-source optical coherence tomography angiography (SS-OCTA). Methods: Diabetic patients with SS-OCTA images were graded by severity and retrospectively assessed. CC FD % was calculated in four different regions of the OCTA image: inner, middle, outer, and full-field region. The generalized estimating equations (GEE) approach for clustered eye data was used to determine effect size and significance of age and disease severity on FD % for each region. Results: 160 eyes from 90 total diabetic patients met inclusion criteria. Out of 90 patients, 33 had no DR, 17 had mild nonproliferative DR (NPDR), 8 had moderate NPDR, 10 had severe NPDR and 22 had proliferative DR. Age and DR severity had a significant positive association with FD % for each region studied with a greater effect in the two centermost regions. The increase in flow deficit percentage per year of age by region was: inner 0.12 (p < 0.001), middle 0.09 (p < 0.001), outer 0.05 (p < 0.001, full-field 0.06 (p < 0.001). The increase in flow deficit percentage per increase in diabetic retinopathy severity stage by region was: inner 0.65 (p < 0.0087), middle 0.56 (p < 0.0012), outer 0.33 (p < 0.045), full-field 0.36 (p < 0.018). Conclusions: Topographic analysis of the CC FD % in diabetic eyes suggests that CC flow impairment corresponds to DR severity, with all studied regions of the CC significantly affected. There was greater regional impairment due to age and disease severity in the inner and middle regions.

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“…The larger FPL found in old controls compared to young controls is in agreement with a recent report showing increased choriocapillaris flow deficits with age, measured with swept-source OCTA. 22 In terms of capillary density, the AMD group showed a significantly smaller value than the age-matched (p < 0.01) and the young (p < 0.01) healthy control groups (Table 1). Capillary density of the young control group was also larger than the age-matched control group (p < 0.01).…”

Section: Resultsmentioning

confidence: 87%

Detecting and measuring areas of choriocapillaris low perfusion in intermediate, non-neovascular age-related macular degeneration

et al. 2019

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Age-related macular degeneration (AMD) is a vision-threatening disease that affects the outer retina and choroid of elderly adults. Because photoreceptors are found in the outer retina and rely primarily on the trophic support of the underlying choriocapillaris, imaging of flow or lack thereof in choriocapillaris by optical coherence tomography angiography (OCTA) has great clinical potential in AMD assessment. We introduce a metric using OCTA, named "focal perfusion loss" (FPL) to describe the effects of age and non-neovascular AMD on choriocapillaris flow. Because OCTA imaging of choriocapillaris is vulnerable to artifacts-namely motion, projections, segmentation errors, and shadows-they are removed by postprocessing software. The shadow detection software is a machine learning algorithm recently developed for the evaluation of the retinal circulation and here adapted for choriocapillaris analysis. It aims to exclude areas with unreliable flow signal due to blocking of the OCT beam by objects anterior to the choriocapillaris (e.g., drusen, retinal vessels, vitreous floaters, and iris). We found that both the FPL and the capillary density were able to detect changes in the choriocapillaris of AMD and healthy age-matched subjects with respect to young controls. The dominant cause of shadowing in AMD is drusen, and the shadow exclusion algorithm helps determine which areas under drusen retain sufficient signal for perfusion evaluation and which areas must be excluded. Such analysis allowed us to determine unambiguously that choriocapillaris density under drusen is indeed reduced. © The Authors. Published by SPIE under a Creative Commons Attribution 4.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Age-dependent Changes in the Macular Choriocapillaris of Normal Eyes Imaged With Swept-Source Optical Coherence Tomography Angiography

Cited by 124 publications

References 55 publications

Microvascular Changes in the Choriocapillaris of Diabetic Patients Without Retinopathy Investigated by Swept-Source OCT Angiography

Microvascular Changes in the Choriocapillaris of Diabetic Patients Without Retinopathy Investigated by Swept-Source OCT Angiography

Topographic analysis of macular choriocapillaris flow deficits in diabetic retinopathy using swept–source optical coherence tomography angiography

Detecting and measuring areas of choriocapillaris low perfusion in intermediate, non-neovascular age-related macular degeneration

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