Linking Retinal Microvasculature Features With Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography

Bhanushali, Devanshi; Anegondi, Neha; Gadde, Santosh Gopi Krishna; Srinivasan, Priya; Chidambara, Lavanya; Yadav, Naresh Kumar; Roy, Abhijit Sinha

doi:10.1167/iovs.15-18901

Cited by 159 publications

(230 citation statements)

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“…Vascular parameters, such as vessel density, regions with no or minimal vascular features, and regions surrounding small vessels, have been quantified. 16,17 The method is not device specific and not limited to just OCTA images. 16,17 In this study, global and regional differences in vascular parameters around the ONH were evaluated in normal, preperimetric, and glaucomatous eyes.…”

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“…16,17 The method is not device specific and not limited to just OCTA images. 16,17 In this study, global and regional differences in vascular parameters around the ONH were evaluated in normal, preperimetric, and glaucomatous eyes. Further, the study attempted to determine the discriminant capacity of the vascular parameters, on the basis of disease severity, and compared it with the discriminant capacity of VFs, retinal nerve fiber layer thickness (RNFLT), and ganglion cell complex (GCC) thickness.…”

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Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma

Kumar

Anegondi

Chandapura

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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Citation: Kumar RS, Anegondi N, Chandapura RS, et al. Discriminant function of optical coherence tomography angiography to determine disease severity in glaucoma. Invest Ophthalmol Vis Sci. 2016;57:6079-6088. DOI:10.1167/iovs.16-19984 PURPOSE. To determine the discriminant function of optical coherence tomography angiography (OCTA) by disease severity in glaucoma.METHODS. In this prospective, observational cross-sectional study, all subjects underwent visual fields, retinal nerve fiber layer (RNFL) measurements, and OCTA imaging. Local fractal analysis was applied to OCTA images (radial peripapillary capillaries [RPC] layer). Vessel density en face and inside the disc and spacing between large and small vessels were quantified. Stepwise logistic regression was performed and a glaucoma severity score (range, 0-1: 0, normal; 1, severe glaucoma) was developed by using global and regional (superotemporal [ST], inferotemporal [IT], temporal, superonasal [SN], inferonasal, and nasal) vascular parameters. Glaucoma severity score was compared with visual field and RNFL indices. RESULTS.One hundred ninety-nine eyes (112 subjects) with glaucoma (28 eyes preperimetric; 83 early, 43 moderate, and 45 severe glaucoma) and 74 normal (54 subjects) eyes were enrolled. Preperimetric and glaucomatous eyes had significantly altered (P < 0.001) global vascular parameters as compared to normal; regionally, ST, then SN and IT sectors (in that order) showed more change in glaucomatous eyes. Vascular parameters showed better discriminant ability (area under the curve [AUC], sensitivity, and specificity of 0.70, 69.2%, and 72.9%, respectively) than structural parameters between normal and preperimetric glaucomatous eyes. Vascular parameters had comparable AUC (P > 0.05) to visual fields for perimetric glaucoma. Glaucoma severity score identified preperimetric glaucoma and early glaucoma better than did visual fields.CONCLUSIONS. Vascular parameters could be a useful adjunct tool to evaluate/diagnose glaucoma. Longitudinal studies are needed to determine their use in early detection and prognostication.Keywords: optical coherence tomography, glaucoma, visual field, angiography G laucoma is the leading cause of irreversible blindness worldwide.1,2 It is characterized by progressive degeneration of the optic nerve and loss of retinal ganglion cells, with corresponding visual field (VF) defects on standard automated perimetry.1,2 While raised intraocular pressure (IOP) is currently the only known modifiable risk factor for glaucoma, there is evidence that vascular insufficiency in the optic nerve head (ONH) also plays an important role in the pathogenesis of glaucoma.3-5 Currently, a number of methods are available for measuring ONH perfusion.6-11 Fluorescein angiography is invasive. It provides only superficial ONH perfusion and not deep perfusion.6 Noninvasive methods such as laser Doppler flowmetry and laser speckle flowgraphy have demonstrated decreased ONH perfusion in glaucomatous eyes, but have moderate repeatability.8,10 Doppler O...

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Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma

Kumar

Anegondi

Chandapura

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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“…Moreover, the recent adjunction of quantitative tools to OCTA provides access to retinal microcirculatory metrics, such as foveal avascular zone (FAZ) dimensions, 5,6 capillary density, 7,8 and capillary network fractal dimension, 9 at the level of both plexuses. Fractal dimension is a promising endpoint to measure vascular network disorganization in OCTA images, which has been used successfully in diabetic retinopathy [10][11][12] and posterior uveitis. 13 Ocular irradiation by I-125 plaque brachytherapy induces microvascular changes detected by OCTA.…”

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Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Matet

Daruich

Zografos

2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To analyze microvascular and structural changes in radiation maculopathy and their influence on visual acuity (VA), using optical coherence tomography (OCT) and OCT angiography (OCTA).METHODS. This was a retrospective analysis of consecutive patients with radiation maculopathy, 12 months or more after proton-beam irradiation for uveal melanoma, imaged with fluorescein angiography, OCT, and OCTA. Clinical parameters potentially affecting VA were recorded, including OCTA-derived metrics: foveal avascular zone (FAZ) area, vascular density, and local fractal dimension of the superficial (SCP) and deep capillary plexuses (DCP). Nonirradiated fellow eyes served as controls. RESULTS.Ninety-three patients were included. FAZ was larger, while SCP/DCP capillary density and local fractal dimension were lower in the 35 irradiated than in the 35 fellow eyes (P < 0.0001). Microvascular alterations graded on fluorescein angiography (minimally damaged/ disrupted/disorganized) were correlated to FAZ area and SCP/DCP density on OCTA (P < 0.01). By univariate analysis, worse VA was associated to macular detachment at presentation (P ¼ 0.024), total macular irradiation (P ¼ 0.0008), higher central macular thickness (CMT) (P ¼ 0.019), higher absolute CMT variation (P < 0.0001), cystoid edema (P ¼ 0.030), ellipsoid zone disruption (P ¼ 0.002), larger FAZ (P < 0.0001), lower SCP (P ¼ 0.001) and DCP capillary density (P < 0.0001), and lower SCP (P ¼ 0.009) and DCP local fractal dimension (P < 0.0001). Two multivariate models with either capillary density or fractal dimension as covariate showed that younger age (P ¼ 0.014/0.017), ellipsoid zone disruption (P ¼ 0.034/0.019), larger FAZ (P ¼ 0.0006/0.002), and lower DCP density (P ¼ 0.008) or DCP fractal dimension (P ¼ 0.012), respectively, were associated with worse VA.CONCLUSIONS. VA of eyes with radiation maculopathy is influenced by structural and microvascular factors identified with OCTA, including FAZ area and DCP integrity.

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“…Our center reviewed literature regarding the OCTA applications in diabetics which is going to be published soon. Available reports are few, but interesting facts regarding the FAZ is published [7][8][9][10][11][12][13][14][15][16][17][18]. The FAZ in normal individual was described in the OCTA as an intact well-demarcated round or oval area of reduced capillary density with a border without gaps, holes or interruption of the capillary network in both superficial and deep plexuses.…”

Section: Introductionmentioning

confidence: 99%

“…This finding may also add to our knowledge regarding pathophysiology behind the ischemic changes in DR. The OCTA has increased feasibility of qualitative FAZ assessment; but the most impressing are regarding the quantitative FAZ assessments the FAZ size increased significantly by progression of retinopathy grade in almost all reports [9][10][11][12][13][14][15][16][17]. (Table 1) has summarized current available range of the mean FAZ size values in different grades of disease.…”

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confidence: 99%

Can Foveal Avascular Zone (FAZ) Assessment By OCT Angiography, Used For Grading Of Diabetic Retinopathy?

Khadamy¹

2016

AOVS

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OpinionDiabetic retinopathy (DR) not only is common among diabetics, but also is leading cause of new onset blindness in developed countries. Fortunately, visual loss is preventable by early detection and treatment of DR. Current screening guidelines suggest yearly to monthly full dilated fundus exam by ophthalmologist, based on DR grade. The World Health Organization (WHO) estimated that the number of individuals with diabetes mellitus (DM) to rise to 360 million by the year 2030 [1]. This number of affected individuals will be a burden on eye care health system which calls for computerized and digitalized screening and grading of patients. Wider field imaging systems have shown to be comparative to clinical examinations [2]. But still grading of these images is qualitative and needed to be reviewed by specialists.

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Linking Retinal Microvasculature Features With Severity of Diabetic Retinopathy Using Optical Coherence Tomography Angiography

Abstract: Spacing between the large vessels in the superficial and deep retinal layers had superior diagnostic performance than overall vessel density.

Cited by 159 publications

References 31 publications

Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma

Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma

Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Can Foveal Avascular Zone (FAZ) Assessment By OCT Angiography, Used For Grading Of Diabetic Retinopathy?

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