Optimizing the Repeatability of Choriocapillaris Flow Deficit Measurement From Optical Coherence Tomography Angiography

Byon, Ik Soo; Alagorie, Ahmed Roshdy; Ji, Yong‐Sok; Su, Li

doi:10.1016/j.ajo.2020.05.027

Cited by 30 publications

(29 citation statements)

References 33 publications

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“…This variability has a profound impact on the consistency of studies in the literature, as quantitative choriocapillaris measurements may be significantly influenced by small differences in slab selection [18]. Byon et al [19] found that the use of a Max projection with a slab positioned 21-31 µm below the RPE band centerline produced the most repeatable flow deficit measurements in normal eyes. More superficial slabs showed a hypointense region caused by inadvertent inclusion of the RPE band in the slab, while deeper slabs showed inadvertent inclusion of the choroidal stroma.…”

Section: Quantification Of the Choriocapillarismentioning

confidence: 99%

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Scharf

Corradetti

Corvi

et al. 2021

JCM

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The advent of optical coherence tomography angiography (OCTA) has allowed for remarkable advancements in our understanding of the role of the choriocapillaris in age-related macular degeneration (AMD). As a relatively new imaging modality, techniques to analyze and quantify choriocapillaris images are still evolving. Quantification of the choriocapillaris requires careful consideration of many factors, including the type of OCTA device, segmentation of the choriocapillaris slab, image processing techniques, and thresholding method. OCTA imaging shows that the choriocapillaris is impaired in intermediate non-neovascular AMD, and the severity of impairment may predict the advancement of disease. In advanced atrophic AMD, the choriocapillaris is severely impaired underneath the area of geographic atrophy, and the level of impairment surrounding the lesion predicts the rate of atrophy enlargement. Macular neovascularization can be readily identified and classified using OCTA, but it is still unclear if neovascularization features with OCTA can predict the lesion’s level of activity. The choriocapillaris surrounding macular neovascularization is impaired while the more peripheral choriocapillaris is spared, implying that choriocapillaris disruption may drive neovascularization growth. With continued innovation in OCTA image acquisition and analysis methods, advancement in clinical applications and pathophysiologic discoveries in AMD are set to follow.

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Section: Quantification Of the Choriocapillarismentioning

confidence: 99%

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Scharf

Corradetti

Corvi

et al. 2021

JCM

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“…In a different study, Byon et al . reported that the most consistent measurements of CC flow deficits are obtained from images generated by using a 21–31 μm slab below the RPE segmentation line 22 . Furthermore, the authors elaborate that 21–31 μm slab is better referred to as the “inner choroidal” slab, as the CC image from this slab may also contain other choroidal structures 22 .…”

Section: Discussionmentioning

confidence: 99%

Stage-dependent choriocapillaris impairment in Best vitelliform macular dystrophy characterized by optical coherence tomography angiography

Jauregui

Parmann

Nuzbrokh

et al. 2021

Sci Rep

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Characterization of vascular impairment in Best vitelliform macular dystrophy (BVMD) is essential for the development of treatment modalities and therapy trials. As such, we seek to characterize the choriocapillaris (CC) at each stage of the disease process in 22 patients (44 eyes) with a diagnosis of BVMD confirmed by genetic sequencing. We utilize optical coherence tomography angiography (OCTA) images to characterize the CC and correlate our findings to the status of the retinal pigment epithelium (RPE) as observed on short-wavelength fundus autofluorescence (SW-AF) images. We observed that in the vitelliruptive stage, the CC appeared as bright and granular in the area where the vitelliform lesion was present. In the atrophic stage, varying degrees of CC atrophy were observed within the lesion area, with the regions of CC atrophy appearing as hypoautofluorescent on SW-AF images. Our results suggest that the CC impairment observed in the vitelliruptive stage of BVMD progressively culminates in the CC atrophy observed at the atrophic stage. As such, OCTA imaging can be used to characterize CC impairment in BVMD patients as part of diagnosis and tracking of disease progression. Our findings suggest that the best window of opportunity for therapeutic approaches is before the atrophic stage, as it is during this stage that CC atrophy is observed.

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“…Yet, the Phansalkar method has been shown to be more reproducible in the choriocapillaris than other binarization methods. 40,41 Differences in the magnitude of the FD results produced by each method can be appreciated in Figure 5. We were reassured that our findings were consistent, because both methods showed a lower FD count with increases in any of the three CNV complexity parameters (highest CNV flow signal, number of CNV flow layers, and CNV flow layer thickness) in the area outside of CNV and outside the annulus.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Relationship Between Multilayered Choroidal Neovascularization and Choriocapillaris Flow Deficits in AMD

Nesper

Ong

Fawzi

2021

Invest. Ophthalmol. Vis. Sci.

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We used optical coherence tomography angiography to test the hypothesis that more complex, multilayered choroidal neovascular (CNV) membranes in AMD are associated with worse flow deficits (FD) in the choriocapillaris. METHODS. Retrospective, cross-sectional study including 29 eyes of 29 subjects with neovascular AMD. En face choriocapillaris images were compensated for signal attenuation using the structural OCT slab and signal normalization based on a cohort of healthy subjects. We binarized the choriocapillaris using both local Phansalkar and global MinError(I) methods and quantified FD count, FD density, and mean FD size in the entire area outside the CNV, in the 200-μm annulus surrounding the CNV, and in the area outside the annulus. We used projection-resolved optical coherence tomography angiography to quantify CNV complexity, including highest CNV flow height, number of flow layers, and flow layer thickness. We explored the relationship between CNV complexity and choriocapillaris FD using Spearman correlations. RESULTS. The highest CNV flow signal significantly correlated with lower FD count (P < 0.01), higher FD density (P < 0.05), and higher mean FD size (P < 0.05) in the area outside the annulus and the entire area outside the CNV using both Phansalkar and MinError(I). Within the annulus, CNV complexity was not consistently correlated with choriocapillaris defects. CONCLUSIONS. CNV vascular complexity is correlated with choriocapillaris FD outside the CNV area, providing evidence for the importance of choriocapillaris dysfunction in neovascular AMD, as well as the potential role of choroidal ischemia in the pathogenesis of complex CNV membranes.

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Optimizing the Repeatability of Choriocapillaris Flow Deficit Measurement From Optical Coherence Tomography Angiography

Cited by 30 publications

References 33 publications

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Optical Coherence Tomography Angiography of the Choriocapillaris in Age-Related Macular Degeneration

Stage-dependent choriocapillaris impairment in Best vitelliform macular dystrophy characterized by optical coherence tomography angiography

Exploring the Relationship Between Multilayered Choroidal Neovascularization and Choriocapillaris Flow Deficits in AMD

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