An Approach to the Quantitative Assessment of Retinal Layer Distortions and Subretinal Fluid in SD-OCT Images

A modern tool for age-related macular degeneration (AMD) investigation is Optical Coherence Tomography (OCT), which can produce high resolution cross-sectional images of retinal layers. AMD is one of the most frequent reasons for blindness in economically developed countries. AMD means degeneration of the macula, which is responsible for central vision. Since AMD affects only this specific part of the retina, untreated patients lose their fine shape- and face recognition, reading ability, and central vision. Here, we deal with the automatic localization of subretinal fluid areas and also analyze retinal layers, since layer information can help to localize fluid regions. We present an algorithm that automatically delineates the two extremal retinal layers, successfully localizes subretinal fluid regions, and computes their extent. We present our results using a set of SD-OCT images. The quantitative information can also be visualized in an anatomical context for visual assessment.

Download Full-text

ORCA study: real-world versus reading centre assessment of disease activity of neovascular age-related macular degeneration (nAMD)

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315717 ◽

2020 ◽

pp. bjophthalmol-2019-315717 ◽

Cited By ~ 2

Author(s):

Sandra Liakopoulos ◽

Georg Spital ◽

Christian K Brinkmann ◽

Tina Schick ◽

Focke Ziemssen ◽

...

Keyword(s):

Macular Degeneration ◽

Image Interpretation ◽

Subretinal Fluid ◽

Treatment Decisions ◽

Age Related Macular Degeneration ◽

Correct Identification ◽

Age Related ◽

Ocean Study ◽

The Impact ◽

Sd Oct

Background/aimsThe prospective, non-interventional ORCA module of the OCEAN study (Observation of Treatment Patterns with Lucentis in Approved Indications) evaluated the qualiy of spectral domain-optical coherence tomography (SD-OCT) image interpretation and treatment decisions by clinicians in Germany and the impact on visual outcomes over 24 months in patients with neovascular age-related macular degeneration (nAMD).Methods2286 SD-OCT scans of 205 eyes were independently evaluated by clinicians and reading centres (RCs) regarding signs of choroidal neovascularisation (CNV) activity, including presence of intraretinal fluid, subretinal fluid, and/or increase in pigment epithelial detachments. Agreement between clinicians and RCs was calculated. Treatment decisions by clinicians and the impact on treatment outcomes were evaluated.ResultsCNV activity was detected by RCs on 1578 scans (69.0%) and by clinicians on 1392 scans (60.9%), with agreement in 74.9% of cases. Of the 1578 scans with RC detected CNV activity, anti-vascular endothelial growth factor injections were performed by clinicians in only 35.5% (560/1578). In 19.7% of cases (311/1578), lack of treatment was justified by patients request, termination criteria or chronic cystoid spaces without other signs for CNV activity. In 44.8% of cases (707/1578) with RC detected CNV activity, clinicians claimed no treatment was necessary despite having correctly detected CNV activity in about 2/3 of these cases. In 34% of cases with presumed undertreatment, visual acuity declined in the following visit.ConclusionAlthough broad agreement on CNV activity parameters was observed between clinicians and RCs, correct identification of CNV activity did not always lead to the initiation of (re-)treatment. To preserve vision over time, correct interpretation of SD-OCT scans and careful retreatment decisions are required.Trial registration numberNCT02194803.

Download Full-text

Association between central retinal thickness and low luminance visual acuity in early age-related macular degeneration

European Journal of Ophthalmology ◽

10.1177/1120672120968740 ◽

2020 ◽

pp. 112067212096874

Author(s):

María Cinta Puell ◽

Francisco Javier Hurtado-Ceña ◽

María Jesús Pérez-Carrasco ◽

Inés Contreras

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Retinal Thickness ◽

Central Area ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Cross Sectional ◽

Age Related ◽

Low Luminance ◽

Sd Oct

Purpose/Aim: To examine whether central retinal thickness (CRT) is related to mesopic visual acuity (VA) and low luminance deficit (LLD, difference between photopic and mesopic VA) in eyes with early and intermediate age-related macular degeneration (AMD). Materials and Methods: In a cross-sectional study, 50 pseudophakic subjects older than 63 years were divided into three groups (no AMD, early AMD and intermediate AMD). Spectral domain optical coherence tomography (SD-OCT) was used to measure CRT in the 1 mm-central-area. Best-corrected distance VA was measured under photopic or mesopic luminance conditions and LLD calculated. Subjects were stratified by VA impairment to compare CRTs across these groups. Relationships were examined by stepwise multiple linear regression. Results: No significant differences in mean CRT, photopic and mesopic VA or LLD were detected between the groups no AMD, early AMD and intermediate AMD. However, mean CRTs were 20 microns and 18 microns thicker in the eyes with impaired mesopic VA (> 0.3 logMAR) and impaired LLD (⩾ 0.3 logMAR) compared to the eyes with non-impaired VA or LLD respectively (both p < 0.01). CRT and mesopic pupil size were independent predictors of mesopic VA ( p = 0.001). CRT emerged as the only independent predictor of LLD ( p = 0.004). Conclusions: Increased CRT was linked to worse retinal function when measured under mesopic conditions in eyes without AMD and eyes with early to intermediate AMD. SD-OCT imaging combined with VA measurements under low luminance conditions could be a useful tool to detect early AMD.

Download Full-text

Optical coherence tomography identifies outer retina thinning in frontotemporal degeneration

Neurology ◽

10.1212/wnl.0000000000004500 ◽

2017 ◽

Vol 89 (15) ◽

pp. 1604-1611 ◽

Cited By ~ 12

Author(s):

Benjamin J. Kim ◽

David J. Irwin ◽

Delu Song ◽

Ebenezer Daniel ◽

Jennifer D. Leveque ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Outer Nuclear Layer ◽

Retinal Layer ◽

Optical Coherence ◽

Outer Retina ◽

Frontotemporal Degeneration ◽

Cross Sectional ◽

Clinical Criteria ◽

Retinal Layers ◽

Sd Oct

Objective:Whereas Alzheimer disease (AD) is associated with inner retina thinning visualized by spectral-domain optical coherence tomography (SD-OCT), we sought to determine if the retina has a distinguishing biomarker for frontotemporal degeneration (FTD).Methods:Using a cross-sectional design, we examined retinal structure in 38 consecutively enrolled patients with FTD and 44 controls using a standard SD-OCT protocol. Retinal layers were segmented with the Iowa Reference Algorithm. Subgroups of highly predictive molecular pathology (tauopathy, TAR DNA–binding protein 43, unknown) were determined by clinical criteria, genetic markers, and a CSF biomarker (total tau: β-amyloid) to exclude presumed AD. We excluded eyes with poor image quality or confounding diseases. SD-OCT measures of patients (n = 46 eyes) and controls (n = 69 eyes) were compared using a generalized linear model accounting for intereye correlation, and correlations between retinal layer thicknesses and Mini-Mental State Examination (MMSE) were evaluated.Results:Adjusting for age, sex, and race, patients with FTD had a thinner outer retina than controls (132 vs 142 μm, p = 0.004). Patients with FTD also had a thinner outer nuclear layer (ONL) (88.5 vs 97.9 μm, p = 0.003) and ellipsoid zone (EZ) (14.5 vs 15.1 μm, p = 0.009) than controls, but had similar thicknesses for inner retinal layers. The outer retina thickness of patients correlated with MMSE (Spearman r = 0.44, p = 0.03). The highly predictive tauopathy subgroup (n = 31 eyes) also had a thinner ONL (88.7 vs 97.4 μm, p = 0.01) and EZ (14.4 vs 15.1 μm, p = 0.01) than controls.Conclusions:FTD is associated with outer retina thinning, and this thinning correlates with disease severity.

Download Full-text

Plexus-specific retinal capillary avascular area in exudative age-related macular degeneration with projection-resolved OCT angiography

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317562 ◽

2020 ◽

pp. bjophthalmol-2020-317562

Author(s):

Liqin Gao ◽

Jie Wang ◽

Qisheng You ◽

Yukun Guo ◽

Christina J Flaxel ◽

...

Keyword(s):

Macular Degeneration ◽

Three Dimensional ◽

Age Related Macular Degeneration ◽

Retinal Layer ◽

Cross Sectional ◽

Avascular Area ◽

Age Related ◽

Significant Difference ◽

Retinal Capillary ◽

Capillary Plexus

ObjectiveTo detect the plexus-specific retinal capillary avascular area in exudative age-related macular degeneration (EAMD) with projection-resolved optical coherence tomography angiography (PR-OCTA).Methods and analysisIn this prospective cross-sectional single centre study, eyes with treatment-naïve EAMD underwent macular 3×3 mm OCTA with AngioVue system. OCTA scans were analysed and processed including three-dimensional projection artefact removal, retinal layer semi-automated segmentation and en face angiogram generation. Automated quantification of extrafoveal (excluding the central 1 mm circle) avascular area (EAA) were calculated on projection-resolved superficial vascular complex (SVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP), respectively.ResultsNineteen eyes with EAMD and 19 age-matched healthy control eyes were included. There was no significant difference between the EAMD and control eyes in terms of age, sex, axial length and mean ocular perfusion pressure (all p>0.05). Compared with control eyes, EAMD eyes had significantly larger EAA in SVC (median 0.125 vs 0.059 mm2, p=0.006), ICP (0.016 vs 0.000 mm2, p=0.004) and DCP (0.033 vs 0.000 mm2, p＜0.001).ConclusionPR-OCTA showed that EAMD is associated with focal avascular area in all the three retinal vascular plexuses.

Download Full-text

Green emission fluorophores in eyes with atrophic age-related macular degeneration: a colour fundus autofluorescence pilot study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310881 ◽

2017 ◽

Vol 102 (6) ◽

pp. 827-832 ◽

Cited By ~ 10

Author(s):

Enrico Borrelli ◽

Jianqin Lei ◽

Siva Balasubramanian ◽

Akihito Uji ◽

Mariano Cozzi ◽

...

Keyword(s):

Macular Degeneration ◽

Fundus Autofluorescence ◽

Case Series ◽

Green Emission ◽

Short Wave ◽

Age Related Macular Degeneration ◽

Excitation Wavelength ◽

Cross Sectional ◽

Age Related ◽

Sd Oct

Background/AimsTo investigate the presence of short-wave fluorophores within regions of age-related macular degeneration (AMD)-associated macular atrophy (MA) area.MethodsThis is a prospective, observational, cross-sectional case series. 25 eyes (18 patients) with late AMD and clinically identified MA were enrolled. Eyes were imaged using a confocal light-emitting diode blue-light fundus autofluorescence (FAF) device (EIDON, CenterVue, Padua, Italy) with 450 nm excitation wavelength and the capability for ‘colour’ FAF imaging, including both the individual red and green components of the emission spectrum. To produce images with a high contrast for isolating the green component, the red component was subtracted from the total FAF image. The main outcome measure was the presence of green emission fluorescence component (GEFC) within the MA area. Volume spectral domain optical coherence tomography (SD-OCT) scans were obtained through the macula and the OCT was correlated with the MA lesions identified on the FAF images, including regions of increased GEFC.ResultsOf the investigated eyes, 11 out of 25 (44.0 %) showed the absence of GEFC in the MA area, whereas 14 eyes (56.0%) were characterised by GEFC within the MA area. The presence and distribution of GEFC in the MA area correlated with the presence of hyper-reflective material over Bruch’s membrane on the corresponding SD-OCT scans.ConclusionShort-wave fluorophores, which contribute to the GEFC, are present in the MA area and appear to correspond to residual debris or drusenoid material. Short-wavelength fluorophores revealed by colour FAF imaging may warrant further study.

Download Full-text

High frequency SD-OCT follow-up leading to up to biweekly intravitreal ranibizumab treatment in neovascular age-related macular degeneration

Scientific Reports ◽

10.1038/s41598-021-86348-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Cengiz Tuerksever ◽

Christian Pruente ◽

Katja Hatz

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

High Frequency ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Intravitreal Ranibizumab ◽

Age Related ◽

Ranibizumab Treatment ◽

Sd Oct

AbstractA remarkable proportion of neovascular age-related macular degeneration (nAMD) patients respond rather poorly to ranibizumab treatment, in spite of the minimum 4-week follow-up and treatment interval. Usually, retreatments are based on nAMD activity as evaluated by Spectral-domain Optical coherence Tomography (SD-OCT), biomicroscopic fundus examination and visual acuity changes. In this prospective pilot study, we aimed to study SD-OCT changes in a high-frequent follow-up manner (weekly (month 0–6), biweekly (month 7–12)) throughout the first year, which consequently led to intravitreal ranibizumab being administered up to biweekly. Best corrected visual acuity (BCVA) was already significantly improved at week 2. Central retinal thickness (CRT), intraretinal and subretinal fluid (SRF) were significantly improved from week 1 onwards. Half of the patients showed nAMD activity at week 2 or 3 and received the first retreatment earlier than 4 weeks after baseline injection. In total, 46% of retreatments were already applied 2 or 3 weeks after the previous treatment. Greater range of CRT and SRF fluctuation during follow-up was associated with lower final BCVA. Lower baseline BCVA and better SRF improvement at week 2 was associated with greater BCVA improvement. In conclusion, high-frequency SD-OCT follow-up provided a good option for adapting treatment in nAMD individually.

Download Full-text

Anti-VEGF-resistant subretinal fluid is associated with better vision and reduced risk of macular atrophy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318688 ◽

2021 ◽

pp. bjophthalmol-2020-318688

Author(s):

Marco A Zarbin ◽

Lauren Hill ◽

Andreas Maunz ◽

Martin Gliem ◽

Ivaylo Stoilov

Keyword(s):

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Treatment Resistant ◽

Corrected Visual Acuity ◽

Macular Atrophy ◽

Age Related ◽

Fundus Photographs ◽

Post Hoc ◽

Baseline Screening ◽

Sd Oct

Background/aimTo evaluate relationships between subretinal fluid (SRF), macular atrophy (MA) and visual outcomes in ranibizumab-treated neovascular age-related macular degeneration (nAMD).MethodsThis post hoc HARBOR trial (NCT00891735) analysis included ranibizumab-treated (0.5 or 2.0 mg, monthly or as-needed, all treatment arms pooled) eyes with nAMD and baseline (screening, baseline and week 1) SRF. SRF presence, SRF thickness (0, >0–50, >50–100 and >100 µm) and subretinal fluid volume (SRFV) were determined by spectral domain optical coherence tomography (SD-OCT). Best-corrected visual acuity (BCVA) was assessed. MA was identified using fluorescein angiograms and colour fundus photographs, as well as SD-OCT.ResultsSeven hundred eighty-five of 1097 eyes met analysis criteria. In eyes without baseline MA, residual versus no SRF at month (M) 3 was associated with lower MA rates at M12 (5.1% vs 22.1%) and M24 (13.3% vs 31.2%) (both p<0.0001); MA percentages at M12/M24 were similar among patients with residual SRF at M6. Higher baseline SRFV was associated with a lower MA rate. Greater mean BCVA was observed with residual SRF of any thickness (>0–50 µm, 71.2 letters; >50–100 µm, 71.3 letters; >100 µm, 69.2 letters) versus no SRF (63.6 letters), but the change in BCVA from baseline to M12 or M24 was the same for eyes with or without treatment-resistant subretinal fluid (TR-SRF) at M3 or M6.ConclusionTR-SRF was not detrimental to vision outcomes over 2 years, regardless of thickness. MA rates were significantly higher without TR-SRF.

Download Full-text

Hyperautofluorescence in Outer Retinal Layers Thinning

BioMed Research International ◽

10.1155/2014/741538 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Marina Bertolotto ◽

Luigi Borgia ◽

Michele Iester

Keyword(s):

Retinal Thickness ◽

Pigment Epithelium ◽

Fundus Autofluorescence ◽

Retinal Pigment ◽

Age Related Macular Degeneration ◽

Retinal Layer ◽

Autofluorescence Imaging ◽

Cross Sectional ◽

Age Related ◽

Window Effect

Purpose. To evaluate if paracentral hyperautofluorescence (HAF) retinal regions, which can be occasionally found and analyzed by optical coherence tomography (OCT), were related to retinal layer changes and to detect which layer was involved.Methods. This is a cross-sectional and retrospective study. 648 OCT files were revised. OCTs that showed a paracentral HAF area by using the fundus autofluorescence imaging in Heidelberg Spectralis (Heidelberg Engineering, Germany) were selected. Then retinal layer morphology was analyzed observing OCT scans and a retinal thickness was measured.Results. 31 patients were selected: 20 patients had chronic serous epitheliopathy (CSE), 8 patients had resolved central serous chorioretinopathy (CSC), and 3 patients wet age related macular degeneration (ARMD). The HAF zones corresponded to areas of thickness reduction of the external hyporeflective band. In all these areas the retinal pigment epithelium was not atrophic and the neuroepithelium was more or less dystrophic. In particular the retinal thickness was 264 um, 232 um, and 243 um in wet ARMD, CSE, and CSC, respectively; the reduction was significant (P<0.01) compared to the same area of the other eye.Discussion. The presence of HAF imaging might be mostly due to a “window effect” rather than an accumulation of lipofuscin.

Download Full-text

Percentage of Foveal vs Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-Related Macular Degeneration

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419859454 ◽

2019 ◽

Vol 3 (5) ◽

pp. 278-282 ◽

Cited By ~ 4

Author(s):

Saghar Bagheri ◽

Ines Lains ◽

Rebecca F. Silverman ◽

Ivana Kim ◽

Dean Eliott ◽

...

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Fundus Autofluorescence ◽

Cross Sectional Study ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

Cross Sectional ◽

Age Related ◽

The Impact ◽

Sd Oct

Purpose: This article investigates the relationship between visual acuity (VA), total area of geographic atrophy (GA), and percentage of foveal GA. Methods: A multicenter, retrospective, cross-sectional study was conducted of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (SD-OCT) images were collected. Using FAF images aided by SD-OCT, fovea-sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area—within a 1.5-mm-diameter circle centered on the fovea centralis—were assessed. Univariable and multiple linear regression analyses were performed. Results: Fifty-four eyes (mean age, 78.7 ±7.7 years [SD], 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logarithm of the minimum angle of resolution (Snellen equivalent 20/126 ± 20/80), mean total GA 8.8 ± 6.7 mm2, and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n = 10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß = 0.41, P = .004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß = 0.010, P = .440). Conclusions: Percentage of foveal GA was significantly associated with VA impairment, although the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.

Download Full-text