Predicting the Progression of Geographic Atrophy in Age-Related Macular Degeneration With SD-OCT En Face Imaging of the Outer Retina

Nunes, Renata Portella; Gregori, Giovanni; Yehoshua, Zohar; Stetson, Paul F.; Feuer, William J.; Moshfeghi, Andrew A; Rosenfeld, Philip J.

doi:10.3928/23258160-20130715-06

Cited by 86 publications

(64 citation statements)

References 41 publications

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“…The later occurs in 20% of patients with preexisting clinical hallmarks of this degenerative disease [2,5]. The characteristic appearance of GA results from the loss of the photoreceptor layer, retinal pigment epithelium (RPE), and choriocapillaris [7,8]. In most cases, GA first appears in the parafoveal location and progresses around the fovea and then through the fovea with concomitant loss of central visual acuity [9,10].…”

Section: Introductionmentioning

confidence: 99%

Automated geographic atrophy segmentation for SD-OCT images using region-based C-V model via local similarity factor

Niu¹,

Sisternes²,

Chen³

et al. 2016

Biomed. Opt. Express

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Age-related macular degeneration (AMD) is the leading cause of blindness among elderly individuals. Geographic atrophy (GA) is a phenotypic manifestation of the advanced stages of non-exudative AMD. Determination of GA extent in SD-OCT scans allows the quantification of GA-related features, such as radius or area, which could be of important value to monitor AMD progression and possibly identify regions of future GA involvement. The purpose of this work is to develop an automated algorithm to segment GA regions in SD-OCT images. An en face GA fundus image is generated by averaging the axial intensity within an automatically detected sub-volume of the three dimensional SD-OCT data, where an initial coarse GA region is estimated by an iterative threshold segmentation method and an intensity profile set, and subsequently refined by a region-based Chan-Vese model with a local similarity factor. Two image data sets, consisting on 55 SD-OCT scans from twelve eyes in eight patients with GA and 56 SD-OCT scans from 56 eyes in 56 patients with GA, respectively, were utilized to quantitatively evaluate the automated segmentation algorithm. We compared results obtained by the proposed algorithm, manual segmentation by graders, a previously proposed method, and experimental commercial software. When compared to a manually determined gold standard, our algorithm presented a mean overlap ratio (OR) of 81.86% and 70% for the first and second data sets, respectively, while the previously proposed method OR was 72.60% and 65.88% for the first and second data sets, respectively, and the experimental commercial software OR was 62.40% for the second data set.

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Section: Introductionmentioning

confidence: 99%

Automated geographic atrophy segmentation for SD-OCT images using region-based C-V model via local similarity factor

Niu¹,

Sisternes²,

Chen³

et al. 2016

Biomed. Opt. Express

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“…3 More recently, Spectral-Domain OCT technology with advanced alignment algorithm have adjusted sections to a reference curve, which has allowed layer-by-layer retinal imaging and provided a new investigation tool for a range of retinal disorders. [4][5][6][7][8][9] The foveal microstructure is formed by a dense compaction of cone photoreceptors and their projected axons, which are intertwined with retinal glial Müller cells and follow a centrifugal course towards the inner layers at the edges of the fovea. Retinal glial Müller cells are critical for retinal homeostasis, providing metabolic support to neighboring neural cells, delivering neuroactive substances and retinoids to cones, and recycling waste compounds.…”

Section: Introductionmentioning

confidence: 99%

En Face Optical Coherence Tomography of Foveal Microstructure in Full-Thickness Macular Hole: A Model to Study Perifoveal Müller Cells

Matet¹,

Savastano²,

Rispoli³

et al. 2015

American Journal of Ophthalmology

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INTRODUCTIONEn-face optical coherence tomography (OCT) is an emerging imaging modality that facilitates the assessment of retinal structures transversely.1,2 Available since 2006 on certain OCT devices, the first retinal transverse scans were difficult to analyze interpret as only plane sections of the concave retina were available. 3 More recently, Spectral-Domain OCT technology with advanced alignment algorithm have adjusted sections to a reference curve, which has allowed layer-by-layer retinal imaging and provided a new investigation tool for a range of retinal disorders. 4-9The foveal microstructure is formed by a dense compaction of cone photoreceptors and their projected axons, which are intertwined with retinal glial Müller cells and follow a centrifugal course towards the inner layers at the edges of the fovea. Retinal glial Müller cells are critical for retinal homeostasis, providing metabolic support to neighboring neural cells, delivering neuroactive substances and retinoids to cones, and recycling waste compounds. 10,11 Müller cells are 5 times more abundant in the macula than in the peripheral retina.12 The "Z-shape" morphology of perifoveal Müller cells has been observed on histological sections in both animal and human models, where the cells adopt three consecutive orientations (Figure 1). 13,14 From the internal limiting membrane, perifoveal Müller cells run vertically to the inner nuclear layer, then turn inwards towards the foveal center across the outer plexiform layer and the Henle's fiber layer where their course is oblique and almost horizontal in the internal portion of the foveal pit. Then, at the junction with the outer nuclear layer, they take a vertical orientation again to reach the external limiting membrane (Figure 1). At the external limiting membrane of the primate retina, Omri et al. have previously shown that Müller cells and photoreceptors are bound by tight-like junctions, where the proteins occludin and zonula occludens-1 are expressed. 15Intraretinal fluid accumulation disrupts the foveal architecture, presenting an opportunity to examine its components in better detail. In full-thickness macular hole (MH), intraretinal cysts are frequently observed on OCT around the edges of the hole. On fluorescein angiography, no vascular leakage or filling of the cysts is usually observed. 16 This suggests that they originate from a metabolic dysfunction and supports the hypothesis of Müller cells implication in the pathogenesis of fullthickness MH. [17][18][19] In this study, we use en face OCT to characterize and quantify layer by layer, the perifoveal cystic cavities occurring around full-thickness MHs. To support the OCT findings, we used human and non-human primate macular flat-mounts and sections to visualize Müller cells stained with a glial marker. METHODS SubjectsThis observational case series adhered to the tenets of the Declaration of Helsinki, and the need of approval was waived by the Institutional Review Board of the Nuovo Regina Margherita Hospital, due to its retrospect...

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“…To perform such analyses in future en face SD-OCT images, derived from slabs encompassing the outer retinal bands will be helpful. Approaches for slab generation may be parallel to those used by Nunes et al 21 and Niu et al 25 The latter study presented a predictive model for local GA progression that was based on the thicknesses of various retinal layers and local reflectivity values. Remarkably, in that model-though developed only on a limited number of eyesthe thickness of the RPE-BM complex was one important predictor for atrophy progressions.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] The border zone of atrophy represents the area where pathologic processes promote atrophy progression and has, therefore, recently received major attention. [16][17][18][19][20][21] Brar et al 19 originally identified two distinct types of atrophy border: type 1 (also termed 'regular' according to Fleckenstein et al, 18 Fig. 1A) shows smooth margins and no alterations of the outer retina while type 2 (also termed 'irregular', 18 Fig.…”

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confidence: 99%

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Local Progression Kinetics of Geographic Atrophy in Age-Related Macular Degeneration Are Associated With Atrophy Border Morphology

Lindner

Kosanetzky

Pfau

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To assess the impact of distinct atrophy border characteristics based on spectraldomain optical coherence tomography (SD-OCT) imaging on local atrophy progression. METHODS.Patients with geographic atrophy (GA) secondary to AMD were recruited in the context of the Longitudinal Fundus Autofluorescence in Age-related Macular Degeneration and Directional Spread in Geographic Atrophy studies (NCT00393692, NCT02051998). Horizontal and vertical SD-OCT scans were acquired at sequential visits using a device allowing for anatomically accurate registration of follow-up to baseline scans. For quantification of local atrophy progression, the lateral spread of GA (LSGA) was measured. Further, border types were independently graded. Comparison of LSGA between the different border types was performed using linear mixed-effects models. RESULTS. Seventy-two eyes of 49 patients (27 female) aged 74.0 years (Inter quartile range[IQR], 68.1-79.0) were included into this analysis. A total of 258 border sections were analyzed longitudinally over a median period of 1.2 years (IQR, 0.9-1.6). At baseline, 17.1% borders were classified as 'regular', 47.7% as 'irregular', and 35.3% as 'splitting'. Sixty-two percent of the eyes exhibited more than one border type. LSGA was slowest in 'regular' borders (62.85 6 25.29 lm/y), followed by 'irregular' borders (91.15 6 15.05 lm/y) and fastest in 'splitting' borders (183.15 6 18.17 lm/y). Differences between the 'splitting' and each other border type were statistically significant (P < 0.001). CONCLUSIONS.The results indicate that SD-OCT-based assessment of local GA border morphology can serve as a predictor for local atrophy progression. These observations help to better understand the natural history and potential pathogenetic factors of GA development and progression.

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Predicting the Progression of Geographic Atrophy in Age-Related Macular Degeneration With SD-OCT En Face Imaging of the Outer Retina

Cited by 86 publications

References 41 publications

Automated geographic atrophy segmentation for SD-OCT images using region-based C-V model via local similarity factor

Automated geographic atrophy segmentation for SD-OCT images using region-based C-V model via local similarity factor

En Face Optical Coherence Tomography of Foveal Microstructure in Full-Thickness Macular Hole: A Model to Study Perifoveal Müller Cells

Local Progression Kinetics of Geographic Atrophy in Age-Related Macular Degeneration Are Associated With Atrophy Border Morphology

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