IMPORTANCE Wide-field optical coherence tomographic angiography (OCTA) may provide insights to peripheral capillary dropout in eyes with diabetic retinopathy (DR).OBJECTIVE To describe the diagnostic performance of wide-field OCTA with and without large vessel removal for assessment of DR in persons with diabetes. DESIGN, SETTING, AND PARTICIPANTSThis case-control study was performed from April 26, 2018, to April 8, 2019, at a single tertiary eye center in Singapore. Case patients were those with type 2 diabetes for more than 5 years and bilateral DR diagnosed by fundus imaging; control participants included those with no self-reported history of diabetes, a fasting glucose level within the normal range in the past year, and no ocular pathologic findings. A wide-field (12 × 12-mm 2 ) fovea-centered scan was performed using a prototype swept source OCTA system. Retinal microvasculature was examined by separating the angiograms into large vessels, capillaries, and capillary dropout regions. MAIN OUTCOMES AND MEASURES Area under the receiver operating characteristic curve (AUC)for DR severity discrimination using wide-field vascular metrics. Retinal perfusion density (RPD), capillary perfusion density (CPD), large vessel density (LVD), and capillary dropout density (CDD) were calculated. Low-contrast regions were excluded from the calculation. RESULTSA total of 49 eyes in 27 control participants (17 male [63.0%]; mean [SD] age, 59.96 [7.63] years; age range, 44-79 years) and 76 eyes in 47 patients with diabetes (29 male [61.7%]; mean [SD] age, 64.36 [8.08] years; range, 41-79 years) were included. Among eyes in patients with diabetes, 23 were in those with diabetes but no DR, 25 in those with mild nonproliferative DR, and 28 in those with moderate to severe nonproliferative DR. There was no difference in RPD, CPD, LVD, and CDD between the control group and the group with diabetes and no DR. There was a stepwise decrease in RPD, CPD, and CDD in the diabetes with no DR, mild nonproliferative DR, and moderate to severe nonproliferative DR groups, whereas LVD was not associated with DR staging. The nonproliferative DR group had decreased RPD, CPD, and CDD compared with the control group. The CPD had higher AUCs than RPD for discriminating diabetes with nonproliferative DR (combined mild and moderate to severe nonproliferative DR) vs no DM (AUC, 0.92 [95% CI, 0.87-0.98] vs 0.89 [95% CI, 0.83-0.95], P = .01), diabetes with no DR vs mild nonproliferative DR (AUC, 0.81 [95% CI, 0.68-0.94] vs 0.77 [95% CI, 0.64-0.91], P = .18), and mild nonproliferative DR vs moderate to severe nonproliferative DR (AUC, 0.82 [95% CI, 0.71-0.94] vs 0.78 [95% CI, 0.65-0.91], P = .01) but similar AUCs for no DM vs diabetes with no DR. The total perfusion density and CPD in wide-field OCTA had better discriminative power than the central 6 × 6-mm 2 field (CPD, 0.89 [95% CI, 0.83-0.95] vs 0.84 [95% CI, 0.77-0.92], P = .06; total perfusion density, 0.93 [95% CI, 0.87-0.98] vs 0.90 [95% CI, 0.83-0.96], P = .06).(continued) Key Points Question Wha...

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Purpose To assess the repeatability of retinal vascular metrics using different postprocessing methods as obtained from the swept‐source optical coherence tomography angiography ( SS ‐ OCTA ). Methods Thirty‐two participants (63% males; mean [ SD ] age, 70 [7] years) underwent SS ‐ OCTA imaging ( PLEX ® Elite 9000, Carl Zeiss Meditec, Inc., Dublin, USA ). Each participant underwent 2 repeated scans of 2 scan protocols: a macular‐centred 3 × 3‐mm 2 and a widefield 12 × 12‐mm 2 for a total of 4 acquisitions. Images of superficial vascular plexuses ( SVP ) and deep vascular plexuses ( DVP ) were processed using different filters to generate the perfusion density ( PD ) and vessel density ( VD ). Vessel enhancement filters ranged from vessel targeted (Hessian and Gabor filters), classical denoising (Gaussian filter), to a scale‐selective adaption (modified Bayesian residual transform [ MBRT ]). Intra‐session repeatability of the different filters and their correlation with the original data set were calculated with the intraclass correlation coefficient ( ICC ) and Pearson's r . Results Of the 32 eyes, 17 and 15 were right and left eyes, respectively. For 3 × 3‐mm 2 scans, both MBRT and Gabor filters yielded very good repeatable PD and VD (both ICC s > 0.87) values. Gabor filter was the most correlated with the original data set for the OCTA metrics ( r = 0.95–0.97). For 12 × 12‐mm 2 scans, MBRT filter produced good‐to‐moderate ICC values for SVP ( ICC >0.89) and DVP ( ICC >0.73) metrics. Both the MBRT and Gabor filters were highly correlated with the original 12 × 12‐mm 2 scan data set ( r = 0.96–0.98). The ICC s for the agreement between 3 × 3‐mm 2 and cropped 12 × 12‐mm 2 were high only for the PD values at the SVP layer and were poor for the VD at SVP and DVP measurements ( ICC < 0.50). ...

We evaluated the impact of diurnal variation on choroidal and retinal microvasculature and structural measurements using a swept-source optical coherence tomography angiography machine (SS-OCTA; PLEX Elite 9,000, Carl Zeiss Meditec, Inc., Dublin, USA). Fourteen participants who were without ocular diseases underwent SS-OCTA imaging using 3 × 3-mm 2 macular scan pattern on two separate days at five time points. Choriocapillaris flow voids were generated to determine its density (percentage), size (μm) and numbers. Perfusion densities of the large superficial vessels, as well as capillaries on superficial and deep vascular plexuses were generated from retinal angiograms. Subfoveal choroidal and retinal thicknesses were manually measured. Repeated-measures ANOVA was used to investigate the impact of diurnal variation on choroidal and retinal measurements. There was no observable diurnal pattern for any of the flow void features, in terms of the density, size and numbers. There was a significant diurnal pattern observed in the choroidal thickness, where it decreased progressively during the day (P < 0.005). As opposed to sub-foveal choroidal thickness, there does not appear to be significant diurnal variation in choriocapillaris flow voids in normal individuals. This suggests that alterations of choriocapillaris flow deficit seen in pathological eyes will not be confounded by the diurnal fluctuation.

The choriocapillaris is a unique vascular plexus located posterior to the retinal pigment epithelium. In recent years, there is an increasing interest in the examination of the interrelationship between the choriocapillaris and eye diseases. We used several techniques to study choroidal perfusion, including laser Doppler flowmetry, laser speckle flowgraphy, and optical coherence tomography angiography (OCTA), but with the latter no standardized algorithm for quantitative analysis has been provided. We analyzed different algorithms to quantify flow voids in non-human primates that can be easily implemented into clinical research. In-vivo, high-resolution images of the non-human primate choriocapillaris were acquired with a swept-source OCTA (SS-OCTA) system with 100kHz A-scan/s rate, over regions of 3 × 3 mm 2 and 12 × 12 mm 2. The areas of non-perfusion, also called flow voids, were segmented with a structural, intensity adjusted, uneven illuminance-compensated algorithm and the new technique was compared to previously published methods. The new algorithm shows improved reproducibility and may have applications in a wide array of eye diseases including age-related macular degeneration (AMD).

To evaluate the change of retinal thickness and ocular microvasculature in a rat model of retinitis pigmentosa using swept source optical coherence tomography angiography (SS-OCTA) METHODS. Three-weeks-old Royal College of Surgeons (RCS) rats (n = 8) and age-matched control rats (n = 14) were imaged by a prototype SS-OCTA system. Follow-up measurements occurred every three weeks on six RCS rats until week 18, and cross-sectional measurements were conducted on control rats. Thicknesses of different retinal layers and the total retina were measured. The enface angiograms from superficial vascular plexiform (SVP) and deep capillary plexiform (DCP) were analyzed, and the image sharpness was also extracted from the choroidal angiograms. Immunohistochemical analysis was done in the RCS rats after week 18, as well as in three-week-old RCS rats and age-matched controls. RESULTS. In RCS rats, the thicknesses of the ganglion cell complex, the nuclear layer, the debris/photoreceptor layer and the total retina decreased over the weeks (P < 0.001). The SVP metrics remained unchanged whereas the DCP metrics decreased significantly over the weeks (P < 0.001). The immunohistochemical analysis confirmed our OCTA findings of capillary dropout in the DCP. The choroidal plexus appeared indistinct initially due to scattering of light at the intact retinal pigment epithelium (RPE) and became more visible after week nine probably due to RPE degeneration. Loss of choriocapillaris was visualized at week 18. In control rats, no vascular change was detected, but nuclear layers, photoreceptor layers and total retina showed slight thinning with age (P < 0.001). CONCLUSIONS. Photoreceptor degeneration in RCS rats was associated with the loss of capillaries in DCP, but not in SVP. The OCTA imaging allows for the characterization of structural and angiographic changes in rodent models.

Fundus fluorescein angiography revealed bilateral window defects, corresponding to the areas of mottled RPE atrophy, and punctate spots of late hyperfluorescence (Fig. 1). The small RPE detachment in the left eye became hyperfluorescent in a sharply demarcated manner. A flash electroretinogram and electro-oculogram were normal.The patient's healthy 28-year-old daughter worked as a business executive in a "stressful" environment. A year earlier, she had noticed distortion and blurred vision in the right eye, with best-corrected visual acuities of 20/40 in the right eye and 20/25 in the left (refractive error not recorded). In the right macula was a serous retinal detachment with subretinal yellow dots. The left macula was normal. Fundus fluorescein angiography demonstrated, in the right eye, several areas of window defect and a focal leak two disc diameters temporal to the foveal center; the left eye was normal. Persistence of the symptomatic serous detachment for 10 months led to treatment of the focal leak with laser, leading to resolution. Family 2An asymptomatic 72-year-old retired physician, a former department chairman at a university medical center, presented to UCSF for routine eye examination. Best-corrected visual acuity was 20/40 in the right eye and 20/30 in the left with a low hyperopic correction. With the exception of bilateral, mild nuclear sclerosis, the anterior segments were normal. Bilateral, eccentric, mottled atrophy of the macular RPE associated with a few intraretinal exudates was present. No drusen, cystic retinal change, hemorrhage, or subretinal fluid was evident. Choroidal folds were present in the left macula. Fundus fluorescein angiography revealed bilateral mottled window defects and multiple punctate spots of late hyperfluorescence (Fig. 2). Upon being given the diagnosis of Dear Editor:We read with great interest the article by Oosterhuis reporting 11 cases of familial central serous chorioretinopathy (CSC) [6]. Sixteen families exhibiting familial CSC have now been reported [1,2,[4][5][6][7], 13 of which involve sibships. The occurrence of CSC in a parent and child appears to be uncommon. Here, we report two families with CSC affecting a parent and child. Family 1An asymptomatic 54-year-old woman was referred to UCSF for evaluation for a possible macular dystrophy. She was employed as a labor relations representative and described her job as "extremely stressful". With the exception of mild hypertension, she was otherwise healthy. Her daughter was known to have a "macular problem". This emmetropic patient had visual acuities of 20/20 in the right eye and 20/40 in the left. The anterior segments were normal. Bilateral, asymmetric, eccentric mottled atrophy of the macular retinal pigment epithelium (RPE) was present in each eye. A small, serous RPE detachment was also present inferotemporal to the left macula.