Repeatability and reproducibility of vessel density measurements on optical coherence tomography angiography in diabetic retinopathy

Levine, Emily S.; Arya, Malvika; Chaudhari, Juhi; Greig, Eugenia Custo; Alibhai, A. Yasin; Baumal, Caroline R.; Witkin, André J.; Duker, Jay S.; Waheed, Nadia K.

doi:10.1007/s00417-020-04716-6

Cited by 19 publications

(16 citation statements)

References 19 publications

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“…For example, when macular vessel density, including both macular vessel area and skeletonized vessel density, has been calculated using three different types of OCTA devices, RTVue XR Avanti, Cirrus HD-OCT 5000 and Plex Elite 9000, significant variability in the calculations was found across the devices suggesting that the values of vessel density cannot be easily compared in research studies if the same OCTA device is not used. 21 , 36 , 39 In addition to these fully automated algorithms by devices, other studies have found similar results with custom semiautomated algorithms. 40 …”

Section: Methods To Calculate Macular Vessel Densitymentioning

confidence: 52%

“… 50–54 , 76 Additionally, many different OCTA devices exist and macular vessel density values from different devices are not comparable. 21 , 22 , 39 Therefore, it is generally recommended that the same type of device be used for longitudinal follow-up of vessel density in the same patient. Also, since not all clinical sites have the same machine, this calculation has not yet seen widespread adoption as a metric in clinical trials and thus for clinical use.…”

Section: Limitations and Future Directions Of Macular Vessel Density Measurements In Diabetic Retinopathymentioning

confidence: 99%

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Macular Vessel Density in Diabetic Retinopathy Patients: How Can We Accurately Measure and What Can It Tell Us?

Pramil¹,

Levine²,

Waheed³

2021

OPTH

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Diabetic retinopathy is one of the leading causes of blindness worldwide. Optical coherence tomography angiography (OCTA) is a non-invasive technology that provides depth-resolved images of the chorioretinal vasculature and allows for the understanding of the changes in vasculature with diabetic retinopathy. Not only can it provide qualitative information, but OCTA can also provide quantitative information about the vasculature in patients with diabetic retinopathy. Macular vessel density is one of the quantitative metrics that can be obtained from OCTA images. This is a repeatable and non-subjective measurement that can provide valuable insight into the pathophysiology of diabetic retinopathy. In this non-systematic review, the measurement of macular vessel density in diabetic retinopathy and the reasons for its importance in the diagnosis and management of patients with diabetes and varying severities of diabetic retinopathy is discussed.

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Section: Methods To Calculate Macular Vessel Densitymentioning

confidence: 52%

Section: Limitations and Future Directions Of Macular Vessel Density Measurements In Diabetic Retinopathymentioning

confidence: 99%

Macular Vessel Density in Diabetic Retinopathy Patients: How Can We Accurately Measure and What Can It Tell Us?

Pramil¹,

Levine²,

Waheed³

2021

OPTH

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“…First, only normal eyes were examined. Our group has initially assessed the repeatability of OCTA measurements in diabetic eyes in one published separate study 48 —in future, it would be valuable to complete similar analysis with manual quantification using a range of binarization techniques. In addition, three devices were used in this study.…”

Section: Discussionmentioning

confidence: 99%

Repeatability of binarization thresholding methods for optical coherence tomography angiography image quantification

Mehta

Braun

Gendelman

et al. 2020

Sci Rep

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Binarization is a critical step in analysis of retinal optical coherence tomography angiography (OCTA) images, but the repeatability of metrics produced from various binarization methods has not been fully assessed. This study set out to examine the repeatability of OCTA quantification metrics produced using different binarization thresholding methods, all of which have been applied in previous studies, across multiple devices and plexuses. Successive 3 × 3 mm foveal OCTA images of 13 healthy eyes were obtained on three different devices. For each image, contrast adjustments, 3 image processing techniques (linear registration, histogram normalization, and contrast-limited adaptive histogram equalization), and 11 binarization thresholding methods were independently applied. Vessel area density (VAD) and vessel length were calculated for retinal vascular images. Choriocapillaris (CC) images were quantified for VAD and flow deficit metrics. Repeatability, measured using the intra-class correlation coefficient, was inconsistent and generally not high (ICC < 0.8) across binarization thresholds, devices, and plexuses. In retinal vascular images, local thresholds tended to incorrectly binarize the foveal avascular zone as white (i.e., wrongly indicating flow). No image processing technique analyzed consistently resulted in highly repeatable metrics. Across contrast changes, retinal vascular images showed the lowest repeatability and CC images showed the highest.

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“…This study has a few limitations. The cohort size was small and of healthy and young individuals, which may not be generalisable to older patients and individuals with diseased eyes, where reduced reproducibility has been reported for 3 × 3 OCTA scans 38 . Widefield 15 × 9-mm 2 scanning protocol was introduced recently and the repeatability study in older patients free from eye diseases is ongoing.…”

Section: Analysis Of Choriocapillaris Flow Void Repeatability the Repeatability Of Choriocapillaris Flow Voidsmentioning

confidence: 99%

Effect of vessel enhancement filters on the repeatability of measurements obtained from widefield swept-source optical coherence tomography angiography

Hong

Tan

et al. 2020

Sci Rep

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We assessed the inter-visit repeatability of 15 × 9-mm2 swept-source OCTA (SS-OCTA; PLEX Elite 9000, Carl Zeiss Meditec) metrics in 14 healthy participants. We analysed the perfusion density (PD) of large vessels, superficial capillary plexus (SCP), and deep capillary plexus (DCP) as well as choriocapillaris flow voids in 2 different regions: the macular region and peripheral region. Also, retinal plexus metrics were processed further using different filters (Hessian, Gabor and Bayesian) while choriocapillaris flow voids were calculated with 1 and 1.25 standard deviation (SD) thresholding algorithms. We found excellent repeatability in the perfusion densities of large vessels (ICC > 0.96). Perfusion densities varied with different filters in the macular region (SCP: 24.12–38.57% and DCP: 25.16–38.50%) and peripheral (SCP: 30.52–39.84% and DCP: 34.19–41.60%) regions. The ICCs were lower in the macular region compared to the peripheral region and lower for DCP than for SCP. For choriocapillaris flow voids, the 1.25 SD threshold resulted in fewer flow voids, while a good ICC (ICC > 0.81) was achieved using either threshold settings for flow void features in both regions. Our results suggest good repeatability of widefield SS-OCTA for the measurements of retinal perfusion density and choriocapillaris flow voids, but measurements from different filters should not be interchanged.

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Repeatability and reproducibility of vessel density measurements on optical coherence tomography angiography in diabetic retinopathy

Cited by 19 publications

References 19 publications

Macular Vessel Density in Diabetic Retinopathy Patients: How Can We Accurately Measure and What Can It Tell Us?

Macular Vessel Density in Diabetic Retinopathy Patients: How Can We Accurately Measure and What Can It Tell Us?

Repeatability of binarization thresholding methods for optical coherence tomography angiography image quantification

Effect of vessel enhancement filters on the repeatability of measurements obtained from widefield swept-source optical coherence tomography angiography

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