Choroidal Vascularity Index Quantification in Geographic Atrophy Using Binarization of Enhanced-Depth Imaging Optical Coherence Tomographic Scans

Giannaccare, Giuseppe; Pellegrini, Marco; Sebastiani, Stefano; Bernabei, Federico; Moscardelli, Fabiana; Iovino, Claudio; Napoli, Pietro Emanuele; Campos, Emilio C.

doi:10.1097/iae.0000000000002459

Cited by 54 publications

(38 citation statements)

References 30 publications

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“…A recent study reported a decrease in the choriocapillaris vascular density during long-term anti-VEGF therapy for nAMD [36]. Therefore, excessive choroidal thinning and decreased vascularity after anti-VEGF therapy may be an undesired effect leading to deterioration in the choriocapillaris-RPE complex and development of geographic atrophy [37,38]. In the present study, we could not identify any association between choroidal changes and anatomical and visual outcomes.…”

Section: Discussioncontrasting

confidence: 75%

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Pellegrini

Bernabei

Mercanti

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Introduction The purpose of this study was to evaluate choroidal vascular changes in patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept injection over a 3-month period. Methods Enhanced depth imaging optical coherence tomography scans of 60 eyes with treatment-naïve nAMD and 60 unaffected fellow eyes were retrospectively analyzed. Data was collected at baseline and after 3 monthly intravitreal injections of aflibercept. The ImageJ software was used to binarize OCT scans and measure total choroid area (TCA), luminal area (LA), and stromal area (SA). Choroidal vascularity index (CVI) was defined as the ratio of LA to TCA. Results After treatment, subfoveal choroidal thickness (CT) in nAMD eyes significantly decreased from 210. 6 ± 61.6 to 194.6 ± 58.7 μm (P < 0.001), TCA from 1.620 ± 0.502 to 1.500 ± 0.451 mm2 (P < 0.001), LA from 1.075 ± 0.335 to 0.985 ± 0.307 mm2 (P < 0.001), SA from 0.545 ± 0.176 to 0.516 ± 0.153 mm2 (P = 0.005), and CVI from 66.36 ± 2.89 to 65.46 ± 2.87% (P = 0.009). The decrease of CVI after treatment was significantly correlated with baseline CVI (Rs = 0.466, P < 0.001), but not with the change in BCVA and presence of dry macula after treatment (always P > 0.05). Conclusion Choroidal thickness and vascularity significantly decreased after treatment with aflibercept in nAMD eyes. Besides the pharmacologic effect on the neovascular lesion, aflibercept may induce vascular changes also on the underlying choroid.

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Section: Discussioncontrasting

confidence: 75%

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Pellegrini

Bernabei

Mercanti

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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“…CVI was also investigated in eyes with geographic atrophy (GA) [59]. In the latter study, 34 patients with GA and 32 control subjects were retrospectively analyzed.…”

Section: In Age-related Macular Degenerationmentioning

confidence: 99%

“…The CVI was found to be reduced in patients with GA and it continued to reduce during the follow-up period (Figure 4). These results may suggest a stromal replacement of the choroidal vessels occurring in the setting of GA [59]. Invernizzi and colleagues performed a longitudinal analysis to correlate changes in CT and CVI with disease activity in eyes with neovascular AMD [60].…”

Section: In Age-related Macular Degenerationmentioning

confidence: 99%

Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter

Iovino

Pellegrini

Bernabei

et al. 2020

JCM

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Remarkable improvements in optical coherence tomography (OCT) technology have resulted in highly sophisticated, noninvasive machines allowing detailed and advanced morphological evaluation of all retinal and choroidal layers. Postproduction semiautomated imaging analysis with dedicated public-domain software allows precise quantitative analysis of binarized OCT images. In this regard, the choroidal vascularity index (CVI) is emerging as a new imaging tool for the measurement and analysis of the choroidal vascular system by quantifying both luminal and stromal choroidal components. Numerous reports have been published so far regarding CVI and its potential applications in healthy eyes as well as in the evaluation and management of several chorioretinal diseases. Current literature suggests that CVI has a lesser variability and is influenced by fewer physiologic factors as compared to choroidal thickness. It can be considered a relatively stable parameter for evaluating the changes in the choroidal vasculature. In this review, the principles and the applications of this advanced imaging modality for studying and understanding the contributing role of choroid in retinal and optic nerve diseases are discussed. Potential advances that may allow the widespread adoption of this tool in the routine clinical practice are also presented.

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“…Although SD-OCT was initially conceived for retina imaging [15,16], it was later adapted to visualize the anterior segment of the eye through the addition of a positive lens system [17]. For example, the Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA, USA) adopted a 60-diopter aspheric lens for anterior segment.…”

Section: Introductionmentioning

confidence: 99%

Fourier-Domain OCT Imaging of the Ocular Surface and Tear Film Dynamics: A Review of the State of the Art and an Integrative Model of the Tear Behavior during the Inter-Blink Period and Visual Fixation

Napoli

Nioi

Mangoni

et al. 2020

JCM

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In the last few decades, the ocular surface and the tear film have been noninvasively investigated in vivo, in a three-dimensional, high resolution, and real-time mode, by optical coherence tomography (OCT). Recently, OCT technology has made great strides in improving the acquisition speed and image resolution, thus increasing its impact in daily clinical practice and in the research setting. All these results have been achieved because of a transition from traditional time-domain (TD) to Fourier-domain (FD) technology. FD-OCT devices include a spectrometer in the receiver that analyzes the spectrum of reflected light on the retina or ocular surface and transforms it into information about the depth of the structures according to the Fourier principle. In this review, we summarize and provide the state-of-the-art in FD-OCT imaging of the ocular surface system, addressing specific aspects such as tear film dynamics and epithelial changes under physiologic and pathologic conditions. A theory on the dynamic nature of the tear film has been developed to explain the variations within the individual compartments. Moreover, an integrative model of tear film behavior during the inter-blink period and visual fixation is proposed.

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Choroidal Vascularity Index Quantification in Geographic Atrophy Using Binarization of Enhanced-Depth Imaging Optical Coherence Tomographic Scans

Cited by 54 publications

References 30 publications

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Short-term choroidal vascular changes after aflibercept therapy for neovascular age-related macular degeneration

Choroidal Vascularity Index: An In-Depth Analysis of This Novel Optical Coherence Tomography Parameter

Fourier-Domain OCT Imaging of the Ocular Surface and Tear Film Dynamics: A Review of the State of the Art and an Integrative Model of the Tear Behavior during the Inter-Blink Period and Visual Fixation

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