Distinctive Analysis of Macular Superficial Capillaries and Large Vessels Using Optical Coherence Tomographic Angiography in Healthy and Diabetic Eyes

Lei, Jianqin; Yi, Enhui; Sai, Yan; Chen, Cheng; Xu, Xiayu; Ding, Wenxiang; Abdelfattah, Nizar Saleh; Fan, Xiaojuan; Lü, Hongyan

doi:10.1167/iovs.17-23676

Cited by 33 publications

(24 citation statements)

References 22 publications

(26 reference statements)

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“…Moreover, SCP is considered more easily evaluated for differentiating healthy eyes from eyes with DR as previously reported. 46,47 The present data are in agreement with previously published data evaluating VD in the macular region and reporting a significant decrease in patients with DR versus healthy controls. 35,48 Some authors have described a decrease in VD even in patients with DM without DR versus control.…”

Section: Discussionsupporting

confidence: 93%

“…35,48 Some authors have described a decrease in VD even in patients with DM without DR versus control. 34,47 Lei et al 47 evaluated only superficial capillaries on images having very different signal strength among groups, that might have influenced the analyses, as reported by the same authors. Dimitrova et al 34 described a significant difference in macular VD between patients with DM without DR and healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

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Peripapillary Microvascular and Neural Changes in Diabetes Mellitus: An OCT-Angiography Study

Vujosevic

Muraca

Gatti

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To evaluate peripapillary vessel density and morphology in patients with diabetes mellitus (DM) without clinical signs of diabetic retinopathy (DR) and with mild, nonproliferative DR and to correlate with peripapillary nerve fiber layer (NFL) thickness. METHODS. One hundred seventeen eyes (34 healthy controls, 54 patients with DM without DR [noDR group] and 24 patients with mild DR [DR group]) were prospectively evaluated. All subjects underwent peripapillary and macular optical coherence tomography angiography (OCT-A). Peripapillary NFL thickness was also recorded. OCT-A slab of radial peripapillary plexus (RPC) and macular superficial capillary plexus (SCP) were analysed in order to calculate perfusion density (PD) and vessel density (VD). Further an image analysis of RPC slab was performed to identify number of branches (NoB) and total branches length (tBL). RESULTS. In peripapillary area there was a significant decrease in VD (P ¼ 0.003), NoB (P < 0.001), and tBL (P < 0.001) in noDR group versus controls; PD values were not different among groups (P ¼ 0.126); there was a significant decrease in average NFL thickness in DR versus controls (P ¼ 0.008) and in the inferior quadrant in noDR group versus controls (P ¼ 0.03); there was a significant correlation between OCT-A and NFL thickness values (q ranging from 0.19-0.57). In macular region PD and VD were decreased only in DR group (P < 0.05). CONCLUSIONS. There are early changes in the peripapillary vessel morphology and VD of the RPC in patients with DM without DR that correlate to NFL thinning. Earlier changes in superficial vessel density are documented in the peripapillary than in the macular region. These data may confirm a coexistence of an early neuronal and microvascular damage in patients with DM without clinical signs of DR.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Peripapillary Microvascular and Neural Changes in Diabetes Mellitus: An OCT-Angiography Study

Vujosevic

Muraca

Gatti

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…Numerous quantitative OCTA measures of either flow areas (i.e., vessel density and perfusion density) or nonflow area (i.e., nonperfused areas), have agreed closely with the grading of DR based on clinical features and worsening of visual acuity [104][105][106][107][108][109][110]. They reported that the FAZ area increased and retinal vessel density decreased significantly in all plexuses with worsening levels of DR [104][105][106][107]109,110].…”

Section: Quantitative Measurements Are Correlated With Severity Of DImentioning

confidence: 67%

“…A reduction in retinal vessel density in both the superficial and deep plexuses has been correlated to visual acuity in diabetic patients [108]. Changes in OCTA measures are correlated significantly with disease severity in eyes with DR, thereby suggesting a promising role for OCTA as an objective technique for monitoring disease progression in DR [104][105][106][107][108][109][110].…”

Section: Quantitative Measurements Are Correlated With Severity Of DImentioning

confidence: 99%

Optical Coherence Tomography Angiography in Diabetes and Diabetic Retinopathy

Chua

Sim

Tan

et al. 2020

JCM

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Diabetic retinopathy (DR) is a common complication of diabetes mellitus that disrupts the retinal microvasculature and is a leading cause of vision loss globally. Recently, optical coherence tomography angiography (OCTA) has been developed to image the retinal microvasculature, by generating 3-dimensional images based on the motion contrast of circulating blood cells. OCTA offers numerous benefits over traditional fluorescein angiography in visualizing the retinal vasculature in that it is non-invasive and safer; while its depth-resolved ability makes it possible to visualize the finer capillaries of the retinal capillary plexuses and choriocapillaris. High-quality OCTA images have also enabled the visualization of features associated with DR, including microaneurysms and neovascularization and the quantification of alterations in retinal capillary and choriocapillaris, thereby suggesting a promising role for OCTA as an objective technology for accurate DR classification. Of interest is the potential of OCTA to examine the effect of DR on individual retinal layers, and to detect DR even before it is clinically detectable on fundus examination. We will focus the review on the clinical applicability of OCTA derived quantitative metrics that appear to be clinically relevant to the diagnosis, classification, and management of patients with diabetes or DR. Future studies with longitudinal design of multiethnic multicenter populations, as well as the inclusion of pertinent systemic information that may affect vascular changes, will improve our understanding on the benefit of OCTA biomarkers in the detection and progression of DR.

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“…The three most common solutions are manual binarization methods, automated binarization methods using open source software and automated binarization using commercial software. [3][4][5][6][7][8][9] Manual and semi-automated methods often gain a threshold for binarization based on the signal within the vesselfree foveal avascular zone (FAZ). Automated algorithms use e.g.…”

Section: Introductionmentioning

confidence: 99%

Automated thresholding algorithms outperform manual thresholding in macular optical coherence tomography angiography image analysis

et al. 2020

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Data Availability Statement: The data proving the main findings of the study are contained within the manuscript. The Optical Coherence Tomography Angiography images of all participants cannot be made publicly available as public availability of the data might compromise participant privacy. All participants consented to scientific analysis of the data by the researchers involved but not to public data sharing (according to the consent form approved by the Ethics committee, University of Bonn). As subjects might be identifiable by the higher for the Mean algorithm compared to the manual approach with respect to the superficial retinal layer. Conclusions Automated thresholding algorithms yield a higher reproducibility of OCTA parameters and allow for a more sensitive diagnosis of macular pathology. However, different algorithms are not interchangeable nor results readily comparable. Especially the Mean algorithm should be investigated in further detail. Automated thresholding algorithms are preferable but more standardization is needed for clinical use.

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Distinctive Analysis of Macular Superficial Capillaries and Large Vessels Using Optical Coherence Tomographic Angiography in Healthy and Diabetic Eyes

Abstract: Retinal capillaries and large vessels responded differently in the context of diabetes. VLD of capillary is a potentially reliable metric in diabetic retinopathy staging.

Cited by 33 publications

References 22 publications

Peripapillary Microvascular and Neural Changes in Diabetes Mellitus: An OCT-Angiography Study

Peripapillary Microvascular and Neural Changes in Diabetes Mellitus: An OCT-Angiography Study

Optical Coherence Tomography Angiography in Diabetes and Diabetic Retinopathy

Automated thresholding algorithms outperform manual thresholding in macular optical coherence tomography angiography image analysis

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