Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Glaucoma Using Optical Coherence Tomography–Based Microangiography

Chen, Chieh Li; Zhang, Anqi; Bojikian, Karine D.; Wen, Joanne C; Zhang, Qinqin; Chen, Xin; Mudumbai, Raghu C.; Johnstone, Murray; Chen, Philip; Wang, Ke

doi:10.1167/iovs.15-18909

Cited by 125 publications

(127 citation statements)

References 40 publications

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“…Akagi et al 5 suggested that the superficial vessel density is a better indicator of nerve damage than the vasculature of the entire disc in high myopia. Recently, Chen et al 18 reported that a superficial blood flux index is more susceptible to glaucomatous damage than vessel density. Even though vascular insufficiency might occur in the prelaminar area of glaucomatous eyes, a complex interaction among the ocular perfusion pressure, oxygen tension, vasoactive substances, extracellular matrix, and IOP might minimize ischemia and mask impaired blood flow in the prelaminar area of the glaucomatous optic disc.…”

Section: Discussionmentioning

confidence: 99%

Discriminatory Power of Superficial Vessel Density and Prelaminar Vascular Flow Index in Eyes With Glaucoma and Ocular Hypertension and Normal Eyes

Chihara¹,

Dimitrova

Amano³

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. We evaluate the ability of optical coherence tomography angiography parameters, such as the peripapillary vessel density of the superficial retina and prelaminar flow index of the optic disc (PLFI), to differentiate primary open-angle glaucoma (POAG) and ocular hypertension (OH) from normal eyes. METHODS.The vessel density, PLFI, mean deviation of the visual field, circumpapillary retinal nerve fiber layer thickness (cpNFLT), and global loss volume of the ganglion cell complex were evaluated in one eye of 105 subjects with POAG and OH and normal eyes. The discriminatory powers of these parameters were evaluated based on the area under the curve (AUC) of the receiver operation characteristic curve and multiple comparisons.RESULTS. The vessel density (P < 0.001) and PLFI/unit area (PLFI/UA; P ¼ 0.020) in eyes with POAG were significantly less than in normal eyes. The vessel density in eyes with OH was significantly (P ¼ 0.018) reduced, whereas the PLFI/UA, global loss volume and cpNFLT were unaffected. The AUCs of the vessel density to discriminate glaucoma and OH from normal eyes were 0.832 and 0.724, respectively, and were significantly better than the PLFI/UA, in which the AUCs were 0.662 (P ¼ 0.002) and 0.569 (P ¼ 0.038), respectively. The powers of the vessel density and PLFI/UA to discriminate POAG from normal eyes were inferior to the global loss volume (P ¼ 0.006 and <0.0001) and cpNFLT (P ¼ 0.055 and P < 0.0001, respectively). CONCLUSIONS.The vessel density and PLFI/UA decreased significantly in glaucomatous eyes. The vessel density was more efficient than the PLFI/UA for differentiating glaucoma and OH from normal eyes.

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Section: Discussionmentioning

confidence: 99%

Discriminatory Power of Superficial Vessel Density and Prelaminar Vascular Flow Index in Eyes With Glaucoma and Ocular Hypertension and Normal Eyes

Chihara¹,

Dimitrova

Amano³

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…The decreased microvascular density was more severe in the inferior region in eyes with more superior visual field (VF) defect and vice versa. Similarly, Yarmohammadi et al 22 and Chen et al 23 reported that the vessel density within the RNFL was lower in eyes with primary open-angle glaucoma (POAG) than in glaucoma suspects and healthy eyes. Akagi et al 24 showed that the parapapillary retinal vessel density was reduced in the corresponding hemi-field in POAG eyes with hemi-field VF defect.…”

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confidence: 94%

OCT Angiography of the Peripapillary Retina in Primary Open-Angle Glaucoma

Lee

et al. 2016

Invest. Ophthalmol. Vis. Sci.

147

107

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PURPOSE. The purpose of this study was to investigate the topographic relationship between the decreased parapapillary retinal microvasculature as assessed by optical coherence tomography angiography (OCTA) and retinal nerve fiber layer (RNFL) defect in eyes with primary open-angle glaucoma (POAG) and a localized RNFL defect.METHODS. The peripapillary retinal circulation was evaluated using the OCTA centered on the optic nerve head in 98 POAG eyes having a localized RNFL defect and 45 healthy control eyes. A vascular impairment (VI) was identified in OCTA by the presence of a sign indicating decreased microvasculature. The frequencies of VI were compared between the POAG and control groups, and the topographic correlation between the VI and the RNFL defect identified in red-free fundus photographs was determined in the POAG group.RESULTS. The VI was observed as an area of decreased density of the microvascular network of the retina in 100% of the POAG eyes. The VI exactly coincided with the RNFL defect evident in red-free fundus photographs in terms of both the location and extent (Pearson's correlation coefficient ¼ 0.997 and 0.988, respectively, all P < 0.001). None of the control eyes exhibited VI in OCTA.CONCLUSIONS. Decreased parapapillary microvasculature of the retina determined by OCTA was found at the location of RNFL defect in POAG patients. This finding suggests that the decreased retinal microvasculature is likely secondary loss or closure of capillaries at the area of glaucomatous RNFL atrophy.Keywords: primary open-angle glaucoma, optical coherence tomography angiography, retinal microvasculature S tudies have shown that peripapillary retinal blood flow 1,2 and retinal vessel caliber 3,4 are reduced in glaucoma patients compared with healthy subjects, using laser Doppler flowmetry, 1 Doppler optical coherence tomography (OCT), 2 and measurements of retinal vessel caliber. [3][4][5][6] Decreased retinal perfusion has also been demonstrated angiographically in glaucoma patients using fluorescein angiography.7-10 These findings has raised the interest in the potential role of decreased ocular perfusion as an etiopathogenic factor for the glaucomatous optic neuropathy (GON), together with epidemiologic or clinical data that demonstrated the association of low blood pressure [11][12][13] or nocturnal blood pressure dips 14-16 with glaucoma. In contrast, Quigley et al. 17 demonstrated that the density of capillaries remained constant across a wide range of neural tissue losses within the optic nerve head (ONH) in both experimental and human glaucoma eyes. In addition, Cull et al. 18 showed that the ONH blood flow measured by laser speckle flowgraphy increased during the earliest stage of glaucoma followed by a linear decline that was strongly correlated with thickness reduction of the retinal nerve fiber layer (RNFL) thickness. These findings suggest that the reduced retinal perfusion could simply result from ONH degeneration and a consequently diminished metabolic demand.1,2,4-6 It therefore remains unc...

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“…There are a number of approaches one could use to contrast vasculature, each with its own advantages, but of interest here is a complex-signal based method because it provides more sensitive measurement to slow blood flow, such as in the functional capillary vessels (41,42). One such method whose high sensitivity has already been shown to be successful in the visualization of functional vasculatures in small animal models and human tissues, such as skin and eye (43)(44)(45) is optical microangiography (OMAG) (39,(46)(47)(48). The recent development of OMAG for imaging dynamic blood perfusion within tissue beds was heralded as one of the most significant extensions of conventional OCT, and has been successfully translated to clinical ophthalmic imaging (45,(49)(50)(51).…”

Section: Introductionmentioning

confidence: 99%

“…One such method whose high sensitivity has already been shown to be successful in the visualization of functional vasculatures in small animal models and human tissues, such as skin and eye (43)(44)(45) is optical microangiography (OMAG) (39,(46)(47)(48). The recent development of OMAG for imaging dynamic blood perfusion within tissue beds was heralded as one of the most significant extensions of conventional OCT, and has been successfully translated to clinical ophthalmic imaging (45,(49)(50)(51). Here, we present a clinical prototype OMAG system that was specially designed for dermatological applications for high resolution monitoring of the microcirculatory and structural features underlying the processes of wound healing in otherwise healthy skin.…”

Section: Introductionmentioning

confidence: 99%

Optical coherence tomography angiography monitors human cutaneous wound healing over time

Deegan¹,

Men²,

Li³

et al. 2018

Quant. Imaging Med. Surg.

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Background: In vivo imaging of the complex cascade of events known to be pivotal elements in the healing of cutaneous wounds is a difficult but essential task. Current techniques are highly invasive, or lack the level of vascular and structural detail required for accurate evaluation, monitoring and treatment. We aimed to use an advanced optical coherence tomography (OCT)-based angiography (OCTA) technique for the noninvasive, high resolution imaging of cutaneous wound healing.Methods: We used a clinical prototype OCTA to image, identify and track key vascular and structural adaptations known to occur throughout the healing process. Specific vascular parameters, such as diameter and density, were measured to aid our interpretations under a spatiotemporal framework.Results: We identified multiple distinct, yet overlapping stages, hemostasis, inflammation, proliferation, and remodeling, and demonstrated the detailed vascularization and anatomical attributes underlying the multifactorial processes of dermatologic wound healing.Conclusions: OCTA provides an opportunity to both qualitatively and quantitatively assess the vascular response to acute cutaneous damage and in the future, may help to ascertain wound severity and possible healing outcomes; thus, enabling more effective treatment options.

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Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Glaucoma Using Optical Coherence Tomography–Based Microangiography

Cited by 125 publications

References 40 publications

Discriminatory Power of Superficial Vessel Density and Prelaminar Vascular Flow Index in Eyes With Glaucoma and Ocular Hypertension and Normal Eyes

Discriminatory Power of Superficial Vessel Density and Prelaminar Vascular Flow Index in Eyes With Glaucoma and Ocular Hypertension and Normal Eyes

OCT Angiography of the Peripapillary Retina in Primary Open-Angle Glaucoma

Optical coherence tomography angiography monitors human cutaneous wound healing over time

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