Deep Capillary Macular Perfusion Indices Obtained with OCT Angiography Correlate with Degree of Nonproliferative Diabetic Retinopathy

2017 ◽  
Vol 27 (6) ◽  
pp. 716-729 ◽  
Author(s):  
Kumar Sambhav ◽  
Khaled K. Abu-Amero ◽  
Kakarla V. Chalam
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Optical Coherence Tomography Angiography ◽  
Inverse Correlation ◽  
Normal Subjects ◽  
Vessel Density ◽  
Perfusion Index ◽  
Flow Index ◽  
Optical Coherence ◽  
Nonproliferative Diabetic Retinopathy

Purpose To evaluate the integrity of macular and temporomacular vasculature in nonproliferative diabetic retinopathy (NPDR) with noninvasive optical coherence tomography angiography (OCTA) and correlate perfusion indices with degree of NPDR. Methods In this prospective observational cross-sectional study, 102 eyes with newly diagnosed NPDR (mild NPDR, 36; moderate NPDR, 21; severe NPDR, 13; NPDR with diabetic macular edema [DME], 32) underwent OCTA. Sixty eyes of normal subjects served as control. Degree of NPDR (based on Early Treatment Diabetic Retinopathy Study criteria) was confirmed with fluorescein angiography. Automated OCTA/split-spectrum amplitude decorrelation angiography software generated perfusion indices (vessel density and flow index) from images of the retina. The perfusion index of superficial and deep retinal plexuses was obtained in both perifoveal (central 1-3 mm) and parafoveal (3-6 mm) areas. Results Deep plexus parafoveal vessel density was 25.23% (±6.1) in mild NPDR, 20.16% (±6.16) in moderate NPDR, 11.16% (±4.16) in severe NPDR, and 17.91% (±4.42) in NPDR + DME compared to normal subjects (36.93% [±8.1]; (p<0.01). Spearman correlation coefficient (rs) between vessel density and level of NPDR severity in the parafoveal region showed inverse correlation for both superficial (rs -0.87; p = 0.083) and deep (rs -0.96; p = 0.017) plexus. Similarly, when vessel density of the perifoveal region was compared with level of NPDR severity, inverse correlation was noted in both superficial (rs -0.85; p = 0.08) and deep (rs -0.98; p = 0.011) plexus. Conclusions Optical coherence tomography angiography clearly delineated the retinal microcirculation and allowed quantification of vascular perfusion of each layer. As diabetic retinopathy progressed, a decrease in perfusion index is more pronounced in the deep retinal plexus and precedes changes in superficial plexus.

Optical coherence tomography angiography in diabetic patients without diabetic retinopathy

2019 ◽  
Vol 30 (6) ◽  
pp. 1418-1423 ◽  
Author(s):  
Claudio Furino ◽  
Grazia Montrone ◽  
Maria Vittoria Cicinelli ◽  
Stefania Balestra ◽  
Maria Oliva Grassi ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Optical Coherence Tomography Angiography ◽  
Vessel Density ◽  
Foveal Avascular Zone ◽  
Diabetic Patients ◽  
Optical Coherence ◽  
Avascular Zone ◽  
Capillary Plexus ◽  
Superficial Capillary Plexus

Purpose: To investigate a subset of diabetic patients without diabetic retinopathy with optical coherence tomography angiography, assessing the differences in macular perfusion between diseased eyes and healthy controls. Methods: Monocentric cross-sectional study, including 86 eyes from 43 diabetic patients with no clinical signs of diabetic retinopathy and 78 eyes from 39 controls. Patients underwent 3.0 × 3.0 mm and 4.5 × 4.5 mm swept-source optical coherence tomography angiography. Vessel density (%), foveal avascular zone area (mm2), and avascular density (%) were provided for the superficial capillary plexus and the deep capillary plexus. Results: The foveal avascular zone area at the superficial capillary plexus was larger in the study group compared to controls, irrespective of the area of the slab considered. A meaningful difference was found in the vessel density at the deep capillary plexus of the 3.0 × 3.0 mm slab (p = 0.03). Almost all the variables considered in the study showed a significant within-subject effect. Age significantly correlated with vessel density of superficial capillary plexus on 4.5 × 4.5 mm in both control and diabetic eyes. Conclusion: Diabetic patients with subclinical diabetic retinopathy feature a larger foveal avascular zone at the superficial capillary plexus compared with controls, as well as relative reduction of the vessel density at the deep capillary plexus. These findings might serve as the basis for screening between normal and diabetic subjects.

scholarly journals Quantitative Evaluation of Vascular Density in Diabetic Retinopathy Subtypes using Optical Coherence Tomography Angiography

2020 ◽  
Author(s):  
Fariba Ghassemi ◽  
Kaveh Fadakar ◽  
Sahar Berijani ◽  
Ameneh Babeli ◽  
Alireza Gholizadeh ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Optical Coherence Tomography Angiography ◽  
Normal Subjects ◽  
Vascular Density ◽  
Diabetic Patients ◽  
Multivariate Linear Regression Analysis ◽  
Optical Coherence ◽  
Potential Biomarker ◽  
Capillary Plexus

Abstract Background: To determine the discrepancy between quantitative measurement of retinal and choriocapillaris (CC) vascular density (VD) in diabetic retinopathy (DR) stages using spectral domain optical coherence tomography angiography (SD OCTA) and compare it with normal subjects.Methods: 188 eyes of 97 participants were recruited in this cross-sectional study. Macular OCTA (3x3mm) scan was performed and VD at the level of superficial capillary plexus (SCP), deep capillary plexus (DCP) and CC were measured with the device software.Results: In normal subjects, VD in SCP, DCP, and CC were higher in all subsegments. In retinal VD, all calculated parameters were reduced in the more extreme stages of DR, except for foveal VD of SCP. There was a constant pattern of decrease in VD of CC from normal cases to cases of NDR and NPDR and then a slight increase happened in the PDR stage but never touching the normal quantities. Age, fasting blood sugar, and years of diabetes mellitus were correlated with reduced VD in different segments. Multivariate linear regression analysis showed that best-corrected visual acuity (BCVA) was positively correlated with parafoveal VD at SCP and VD of foveal area at CC. VD of all subfields of macular area except foveal DCP VD showed reduced levels in diabetic macular edema (DME) patients compared to those without DME.Conclusions: The findings of the study endorse retina VD changes as a potential biomarker for DR development before retinopathy becomes clinically evident. It seems that parafoveal VD of SCP and foveal VD of CC are good biomarkers to predict VA in the diabetic patients.

scholarly journals Reversed Neurovascular Coupling on Optical Coherence Tomography Angiography Is the Earliest Detectable Abnormality before Clinical Diabetic Retinopathy

2020 ◽  
Vol 9 (11) ◽  
pp. 3523
Author(s):  
Yi Stephanie Zhang ◽  
Ilda Mucollari ◽  
Changyow C. Kwan ◽  
Gianna Dingillo ◽  
Jaspreet Amar ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Dark Adaptation ◽  
Optical Coherence Tomography Angiography ◽  
Neurovascular Coupling ◽  
Flow Index ◽  
Optical Coherence ◽  
Significant Difference ◽  
Capillary Plexus ◽  
Healthy Eyes

Diabetic retinopathy (DR) has traditionally been viewed as either a microvasculopathy or a neuropathy, though neurovascular coupling deficits have also been reported and could potentially be the earliest derangement in DR. To better understand neurovascular coupling in the diabetic retina, we investigated retinal hemodynamics by optical coherence tomography angiography (OCTA) in individuals with diabetes mellitus (DM) but without DR (DM no DR) and mild non-proliferative DR (mild NPDR) compared to healthy eyes. Using an experimental design to monitor the capillary responses during transition from dark adaptation to light, we examined 19 healthy, 14 DM no DR and 11 mild NPDR individuals. We found that the only structural vascular abnormality in the DM no DR group was increased superficial capillary plexus (SCP) vessel density (VD) compared to healthy eyes, while mild NPDR eyes showed significant vessel loss in the SCP at baseline. There was no significant difference in inner retinal thickness between the groups. During dark adaptation, the deep capillary plexus (DCP) VD was lower in mild NPDR individuals compared to the other two groups, which may leave the photoreceptors more susceptible to ischemia in the dark. When transitioning from dark to ambient light, both diabetic groups showed a qualitative reversal of VD trends in the SCP and middle capillary plexus (MCP), with significantly decreased SCP at 5 min and increased MCP VD at 50 s compared to healthy eyes, which may impede metabolic supply to the inner retina during light adaptation. Mild NPDR eyes also demonstrated DCP dilation at 50 s and 5 min and decreased adjusted flow index at 5 min in light. Our results show altered neurovascular responses in all three macular vascular plexuses in diabetic subjects in the absence of structural neuronal changes on high resolution imaging, suggesting that neurovascular uncoupling may be a key mechanism in the early pathogenesis of DR, well before the clinical appearance of vascular or neuronal loss.

scholarly journals Quantifying the pattern of retinal vascular orientation in diabetic retinopathy using optical coherence tomography angiography

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yanhui Ma ◽  
Matthew P. Ohr ◽  
Xueliang Pan ◽  
Cynthia J. Roberts
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Optical Coherence Tomography Angiography ◽  
Preferred Orientation ◽  
Vessel Density ◽  
Optical Coherence ◽  
Vessel Area ◽  
Retinal Microvasculature ◽  
Significant Difference ◽  
Orientation Pattern

AbstractQuantitative imaging using optical coherence tomography angiography (OCTA) could provide objective tools for the detection and characterization of diabetic retinopathy (DR). In this study, an operator combining the second derivative and Gaussian multiscale convolution is applied to identify the retinal orientation at each pixel in the OCTA image. We quantified the pattern of retinal vascular orientation and developed three novel quantitative metrics including vessel preferred orientation, vessel anisotropy, and vessel area. Each of eight 45º sectors of the circular disk centered at the macular region was defined as the region of interest. Significant sectoral differences were observed in the preferred orientation (p < 0.0001) and vessel area (p < 0.0001) in the 34 healthy subjects, whereas vessel anisotropy did not demonstrate a significant difference among the eight sectors (p = 0.054). Differential retinal microvascular orientation patterns were observed between healthy controls (n = 34) and the DR subjects (n = 7). The vessel area characterized from the vascular orientation pattern was shown to be strongly correlated with the traditionally reported vessel density (Pearson R > 0.97, p < 0.0001). With three metrics calculated from the vascular orientation pattern simultaneously and sectorally, our quantitative assessment for retinal microvasculature provides more information than vessel density alone and thereby may enhance the detection of DR. These preliminary results suggest the feasibility and advantage of our vessel orientation-based quantitative approach using OCTA to characterize DR-associated changes in retinal microvasculature.

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