TY - JOUR
T1 - Automated quantification of capillary nonperfusion using optical coherence tomography angiography in diabetic retinopathy
AU - Hwang, Thomas S.
AU - Gao, Simon S.
AU - Liu, Liang
AU - Lauer, Andreas K.
AU - Bailey, Steven T.
AU - Flaxel, Christina J.
AU - Wilson, David J.
AU - Huang, David
AU - Jia, Yali
N1 - Funding Information:
This work was supported by grants DP3 DK104397, R01-EY024544, R01-EY023285, and P30-EY010572 from the National Institutes of Health; Oregon Health &Science University Clinical and Translational Science Award grant UL1TR000128; and an unrestricted grant from Research to Prevent Blindness.
Publisher Copyright:
© 2016 American Medical Association. All rights reserved.
PY - 2016/4
Y1 - 2016/4
N2 - Importance Macular ischemia is a key feature of diabetic retinopathy (DR). Quantification of macular ischemia has potential as a biomarker for DR. OBJECTIVE To assess the feasibility of automated quantification of capillary nonperfusion as a potential sign of macular ischemia using optical coherence tomography (OCT) angiography. DESIGN, SETTING, AND PARTICIPANTS An observational study conducted in a tertiary, subspecialty, academic practice evaluated macular nonperfusion with 6 ∼ 6-mm OCT angiography obtained with commercially available 70-kHz OCT and fluorescein angiography (FA). The study was conducted from January 22 to September 18, 2014. Data analysis was performed from October 1, 2014, to April 7, 2015. Participants included 12 individuals with normal vision serving as controls and 12 patients with various levels of DR. MAIN OUTCOMES AND MEASURES Preplanned primary measureswere parafoveal and perifoveal vessel density, total avascular area, and foveal avascular zone as detected with 6 ∼ 6-mm OCT angiography and analyzed using an automated algorithm. Secondary measures included the agreement of the avascular area between the OCT angiogram and FA. RESULTS Compared with the 12 healthy controls (11 women; mean [SD] age, 54.2 [14.2] years), the 12 participants with DR (4 women; mean [SD] age, 55.1 [12.1] years) had reduced parafoveal and perifoveal vessel density by 12.6%(95%CI, 7.7%-17.5%; P <.001) and 10.4% (95%CI, 6.8%-14.1%; P <.001), respectively. Total avascular area and foveal avascular zone area were greater in eyes with DR by 0.82mm2 (95%CI, 0.65-0.99mm2; P =.02) and 0.16 mm2 (95%CI, 0.05-0.28mm2; P <.001). The agreement between the vascular areas in the OCT angiogram and FA had a value of 0.45 (95%CI, 0.21-0.70; P <.001). Total avascular area in the central 5.5-mm-diameter area distinguished eyes with DR from control eyes with 100% sensitivity and specificity. CONCLUSIONS AND RELEVANCE Avascular area analysis with an automated algorithm using OCT angiography, although not equivalent to FA, detected DR reliably in this small pilot study. Further study is necessary to determine the usefulness of the automated quantification in clinical practice.
AB - Importance Macular ischemia is a key feature of diabetic retinopathy (DR). Quantification of macular ischemia has potential as a biomarker for DR. OBJECTIVE To assess the feasibility of automated quantification of capillary nonperfusion as a potential sign of macular ischemia using optical coherence tomography (OCT) angiography. DESIGN, SETTING, AND PARTICIPANTS An observational study conducted in a tertiary, subspecialty, academic practice evaluated macular nonperfusion with 6 ∼ 6-mm OCT angiography obtained with commercially available 70-kHz OCT and fluorescein angiography (FA). The study was conducted from January 22 to September 18, 2014. Data analysis was performed from October 1, 2014, to April 7, 2015. Participants included 12 individuals with normal vision serving as controls and 12 patients with various levels of DR. MAIN OUTCOMES AND MEASURES Preplanned primary measureswere parafoveal and perifoveal vessel density, total avascular area, and foveal avascular zone as detected with 6 ∼ 6-mm OCT angiography and analyzed using an automated algorithm. Secondary measures included the agreement of the avascular area between the OCT angiogram and FA. RESULTS Compared with the 12 healthy controls (11 women; mean [SD] age, 54.2 [14.2] years), the 12 participants with DR (4 women; mean [SD] age, 55.1 [12.1] years) had reduced parafoveal and perifoveal vessel density by 12.6%(95%CI, 7.7%-17.5%; P <.001) and 10.4% (95%CI, 6.8%-14.1%; P <.001), respectively. Total avascular area and foveal avascular zone area were greater in eyes with DR by 0.82mm2 (95%CI, 0.65-0.99mm2; P =.02) and 0.16 mm2 (95%CI, 0.05-0.28mm2; P <.001). The agreement between the vascular areas in the OCT angiogram and FA had a value of 0.45 (95%CI, 0.21-0.70; P <.001). Total avascular area in the central 5.5-mm-diameter area distinguished eyes with DR from control eyes with 100% sensitivity and specificity. CONCLUSIONS AND RELEVANCE Avascular area analysis with an automated algorithm using OCT angiography, although not equivalent to FA, detected DR reliably in this small pilot study. Further study is necessary to determine the usefulness of the automated quantification in clinical practice.
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U2 - 10.1001/jamaophthalmol.2015.5658
DO - 10.1001/jamaophthalmol.2015.5658
M3 - Article
C2 - 26795548
AN - SCOPUS:84963507420
SN - 2168-6165
VL - 134
SP - 367
EP - 373
JO - JAMA Ophthalmology
JF - JAMA Ophthalmology
IS - 4
ER -