Widefield En Face Optical Coherence Tomography Imaging of Subretinal Drusenoid Deposits

Schaal, Karen B.; Legarreta, Andrew D.; Gregori, Giovanni; Legarreta, John E.; Cheng, Qianqian Ellie; Stetson, Paul F.; Cai, Ming; Laron, Michal; Durbin, Mary K; Rosenfeld, Philip J.

doi:10.3928/23258160-20150521-06

Cited by 24 publications

(13 citation statements)

References 45 publications

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“…Subretinal drusenoid deposits beyond the arcades and ONH is outside the typical scan volumes of current SD-OCT, and in the future, detection will be facilitated by wide-field imaging. 82 As in all studies of this nature, we do not have histology of graded eyes, but we did have access to histology demonstrating the existence of sparse lesions. We relied on grader learning and intra-grader reliability in the absence of direct histologic validation, a strategy used by early epidemiology studies based on CFP.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging

et al. 2016

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Purpose To assess the prevalence of subretinal drusenoid deposits (SDD) in older adults with healthy maculas and early and intermediate age-related macular degeneration (AMD) using multimodal imaging. Design Cross-sectional study. Participants A total of 651 subjects aged ≥60 years enrolled in the Alabama Study of Early Age-Related Macular Degeneration from primary care ophthalmology clinics. Methods Subjects were imaged using spectral domain optical coherence tomography (SD-OCT) of the macula and optic nerve head (ONH), infrared reflectance, fundus autofluorescence, and color fundus photographs (CFP). Eyes were assessed for AMD presence and severity using the AREDS 9-step scale. Criteria for SDD presence were identification on ≥1 en-face modality plus SD-OCT or on ≥2 en-face modalities if absent on SD-OCT. SDD were considered present at the person-level if present in 1 or both eyes. Main outcomes measures Prevalence of SDD in participants with and without AMD. Results Overall prevalence of SDD was 32% (197/611), with 62% (122/197) affected in both eyes. Persons with SDD were older than those without SDD (70.6 vs. 68.7 years, p =0.0002). Prevalence of SDD was 23% in subjects without AMD and 52% in subjects with AMD (p<0.0001). Among those with early and intermediate AMD, SDD prevalence was 49% and 79%, respectively. After age adjustment, those with SDD were 3.4x more likely to have AMD than those without SDD (95% CI 2.3–4.9). By using CFP only for SDD detection per the AREDS protocol, prevalence of SDD was 2% (12/610). Of persons with SDD detected by SD-OCT and confirmed by at least one en-face modality 47% (89/190) were detected exclusively on the ONH SD-OCT volume. Conclusion SDD are present in approximately one quarter of older adults with healthy maculae and in more than half of persons with early to intermediate AMD, even by stringent criteria. The prevalence of SDD is strongly associated with AMD presence and severity and increases with age, and its retinal topography including peripapillary involvement resembles that of rod photoreceptors. Consensus on SDD detection methods is recommended to advance our knowledge of this lesion and its clinical and biologic significance.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging

et al. 2016

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“…Between August 2013 and August 2014, patients with the diagnosis of nonexudative AMD were included in a prospective OCT study 30 at the Bascom Palmer Eye Institute. The study sought to analyze the performance of OCT as a tool to establish the presence of RPD.…”

Section: Methodsmentioning

confidence: 99%

“…Eyes were partitioned into two groups based on a consensus assessment of whether RPD were present or absent based on standard multimodal fundus images, which included color, AF, and IR reflectance images, and en face OCT images generated using slabs with boundaries from 35 to 55 μm above the RPE as described previously by Schaal et al 30 The original sample contained 88 nonexudative AMD eyes without RPD and 72 nonexudative AMD eyes with RPD. For the purposes of the current study, we reanalyzed a subset of the original dataset large enough to show a significant effect.…”

Section: Methodsmentioning

confidence: 99%

Choroidal Thickness and Choroidal Vessel Density in Nonexudative Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Imaging

Zheng

Gregori

Schaal

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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PurposeTo analyze the relationship between choroidal thickness and the distribution of choroidal blood vessels in eyes with nonexudative AMD.MethodsEyes with a diagnosis of nonexudative AMD were imaged using a prototype 100-kHz swept-source (SS) optical coherence tomography (OCT) instrument (Carl Zeiss Meditec, Dublin, CA, USA) with a central wavelength of 1050 nm. We used an OCT cube scan pattern consisting of 512 × 512 A-scans over a 12 × 12 mm retinal area. The eyes were partitioned into two groups based on the presence or absence of reticular pseudodrusen (RPD). All scans were segmented using an automated algorithm. In addition, five eyes from each of the two groups were randomly chosen for manual segmentation. Binary choroidal vessels maps were generated from suitable OCT choroidal slabs, and the relationship between the density of large choroidal vessels and choroidal thickness was analyzed using an Early Treatment Diabetic Retinopathy Study–like target centered on the fovea.ResultsTwenty-five eyes were enrolled in each group. The automated algorithm produced accurate choroidal thickness maps with an average difference between the manual and automated segmentations of 13.7 μm. There was a significant and stable correlation between choroidal thickness and choroidal vessel density across the two groups. Both average choroidal thickness and vessel density were significantly lower in eyes with RPD.ConclusionsOur fully automated choroidal segmentation algorithm was able to capture the different patterns of choroidal thickness over a wide area. Choroidal thickness has a clear relationship with the density of large choroid vessels in our sample, irrespective of the presence or absence of RPD.

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“…13 The consensus seems to be that subretinal drusenoid deposits are most reliably identified using two en-face imaging modalities: preferably SD-OCT and infrared reflectance imaging. 14 Recently, however, Schaal et al 15 proposed wide-field en-face slab imaging with SD-OCT and swept-source OCT as a new imaging standard in detecting subretinal drusenoid deposits with the potential to replace multimodal imaging. Similar to drusen, subretinal drusenoid deposits have been shown to be dynamic structures, changing in appearance, stage and volume.…”

Section: Eyementioning

confidence: 99%

A view of the current and future role of optical coherence tomography in the management of age-related macular degeneration

Schmidt‐Erfurth

Klimscha

Waldstein

et al. 2016

Eye

136

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Optical coherence tomography (OCT) has become an established diagnostic technology in the clinical management of age-related macular degeneration (AMD). OCT is being used for primary diagnosis, evaluation of therapeutic efficacy, and long-term monitoring. Computer-based advances in image analysis provide complementary imaging tools such as OCT angiography, further novel automated analysis methods as well as feature detection and prediction of prognosis in disease and therapy by machine learning. In early AMD, pathognomonic features such as drusen, pseudodrusen, and abnormalities of the retinal pigment epithelium (RPE) can be imaged in a qualitative and quantitative way to identify early signs of disease activity and define the risk of progression. In advanced AMD, disease activity can be monitored clearly by qualitative and quantified analyses of fluid pooling, such as intraretinal cystoid fluid, subretinal fluid, and pigment epithelial detachment (PED). Moreover, machine learning methods detect a large spectrum of new biomarkers. Evaluation of treatment efficacy and definition of optimal therapeutic regimens are an important aim in managing neovascular AMD. In atrophic AMD hallmarked by geographic atrophy (GA), advanced spectral domain (SD)-OCT imaging largely replaces conventional fundus autofluorescence (FAF) as it adds insight into the condition of the neurosensory layers and associated alterations at the level of the RPE and choroid. Exploration of imaging features by computerized methods has just begun but has already opened relevant and reliable horizons for the optimal use of OCT imaging for individualized and population-based management of AMD-the leading retinal epidemic of modern times.

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Widefield En Face Optical Coherence Tomography Imaging of Subretinal Drusenoid Deposits

Abstract: Widefield en face slab imaging with SD-OCT and SS-OCT can detect SDD and could replace multimodal imaging for the diagnosis of RPD in the future.

Cited by 24 publications

References 45 publications

Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging

Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging

Choroidal Thickness and Choroidal Vessel Density in Nonexudative Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Imaging

A view of the current and future role of optical coherence tomography in the management of age-related macular degeneration

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