TY - JOUR
T1 - Classification of choroidal neovascularization using projection-resolved optical coherence tomographic angiography
AU - Patel, Rachel
AU - Wang, Jie
AU - Campbell, J. Peter
AU - Kiang, Lee
AU - Lauer, Andreas
AU - Flaxel, Christina
AU - Hwang, Thomas
AU - Lujan, Brandon
AU - Huang, David
AU - Bailey, Steven T.
AU - Jia, Yali
N1 - Funding Information:
Supported by National Institutes of Health (Bethesda, MD, USA) Grants R01 EY024544, R01 EY027833, and P30 EY010572; unrestricted departmental funding; the William & Mary Greve Special Scholar Award from Research to Prevent Blindness (New York, NY, USA); and the Alpha Omega Alpha Carolyn L. Kuckein Student Research Fellowship. The authors alone are responsible for the content and writing of the paper.
Publisher Copyright:
© 2018 The Authors.
PY - 2018/8
Y1 - 2018/8
N2 - PURPOSE. To evaluate if projection-resolved optical coherence tomographic angiography (PR-OCTA) reduces projection artifact with less attenuation of choroidal neovascularization (CNV) flow signal compared to conventional OCTA with slab subtraction. METHODS. In this retrospective cross-sectional study, participants with subfoveal treatment-naïve CNV secondary to age-related macular degeneration underwent OCTA. Scans were exported for custom processing including manual segmentation as necessary, application of slab subtraction and PR-OCTA algorithm, and calculation of CNV vascular area and connectivity. CNV was classified as type 1, minimally type 2, or predominantly type 2 based on fluorescein angiography (FA) and OCT. Two masked retina specialists independently classified CNV using cross-sectional conventional OCTA and PR-OCTA. RESULTS. A total of 17 eyes were enrolled in this study. Mean CNV vessel area (mm 2 ) was 0.67 ± 0.51 for PR-OCTA and 0.53 ± 0.41 for slab subtraction (P = 0.018). Mean vascular connectivity was 96.80 ± 1.28 for PR-OCTA and 90.90 ± 4.42 (P = 0.018) for slab subtraction. Within-visit repeatability (coefficient of variation) of PR-OCTA was 0.044 for CNV vessel area and 0.012 for vascular connectivity, compared to 0.093 and 0.028 by slab subtraction. PR-OCTA classification agreement with FA/OCT was 88.2% and 76.5% for the two graders, while conventional OCTA agreement was 58.8% and 70.6% (grader 1, P = 0.025; grader 2, P = 0.56). Moreover, PR-OCTA enabled the individual quantification of type 1 and type 2 components of a CNV. CONCLUSIONS. PR-OCTA had greater CNV vessel area and vascular connectivity, as well as better repeatability, compared to slab subtraction, suggesting PR-OCTA is a superior technique for imaging CNV. Furthermore, PR-OCTA removes projection artifact on cross-sectional OCTA, improving the ability to classify and quantify CNV components.
AB - PURPOSE. To evaluate if projection-resolved optical coherence tomographic angiography (PR-OCTA) reduces projection artifact with less attenuation of choroidal neovascularization (CNV) flow signal compared to conventional OCTA with slab subtraction. METHODS. In this retrospective cross-sectional study, participants with subfoveal treatment-naïve CNV secondary to age-related macular degeneration underwent OCTA. Scans were exported for custom processing including manual segmentation as necessary, application of slab subtraction and PR-OCTA algorithm, and calculation of CNV vascular area and connectivity. CNV was classified as type 1, minimally type 2, or predominantly type 2 based on fluorescein angiography (FA) and OCT. Two masked retina specialists independently classified CNV using cross-sectional conventional OCTA and PR-OCTA. RESULTS. A total of 17 eyes were enrolled in this study. Mean CNV vessel area (mm 2 ) was 0.67 ± 0.51 for PR-OCTA and 0.53 ± 0.41 for slab subtraction (P = 0.018). Mean vascular connectivity was 96.80 ± 1.28 for PR-OCTA and 90.90 ± 4.42 (P = 0.018) for slab subtraction. Within-visit repeatability (coefficient of variation) of PR-OCTA was 0.044 for CNV vessel area and 0.012 for vascular connectivity, compared to 0.093 and 0.028 by slab subtraction. PR-OCTA classification agreement with FA/OCT was 88.2% and 76.5% for the two graders, while conventional OCTA agreement was 58.8% and 70.6% (grader 1, P = 0.025; grader 2, P = 0.56). Moreover, PR-OCTA enabled the individual quantification of type 1 and type 2 components of a CNV. CONCLUSIONS. PR-OCTA had greater CNV vessel area and vascular connectivity, as well as better repeatability, compared to slab subtraction, suggesting PR-OCTA is a superior technique for imaging CNV. Furthermore, PR-OCTA removes projection artifact on cross-sectional OCTA, improving the ability to classify and quantify CNV components.
KW - Age-related macular degeneration
KW - Choroidal neovascularization
KW - OCTA
KW - Projection-resolved optical coherence tomographic angiography
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U2 - 10.1167/iovs.18-24624
DO - 10.1167/iovs.18-24624
M3 - Article
C2 - 30372757
AN - SCOPUS:85052691104
SN - 0146-0404
VL - 59
SP - 4285
EP - 4291
JO - Investigative Ophthalmology and Visual Science
JF - Investigative Ophthalmology and Visual Science
IS - 10
ER -