Elsevier

Ophthalmology Retina

Volume 4, Issue 11, November 2020, Pages 1069-1082
Ophthalmology Retina

Original Article
Correlation of Quantitative Measurements with Diabetic Disease Severity Using Multiple En Face OCT Angiography Image Averaging

Presented at: American Academy of Ophthalmology Annual Meeting, October 2019, San Francisco, California.
https://doi.org/10.1016/j.oret.2020.04.029Get rights and content

Purpose

To evaluate the effect of averaging en face OCT angiography (OCTA) images on quantitative measurements of the retinal microvasculature and their correlation to diabetic retinopathy (DR) disease severity.

Design

Cross-sectional cohort study.

Participants

One hundred five eyes (65 patients) comprising 28 eyes from 19 healthy, aged-matched control participants, 14 eyes from 9 diabetics without DR, and 63 eyes from 37 diabetics with varying levels of DR.

Methods

Spectral-domain CIRRUS 5000 (Carl Zeiss Meditec, Dublin, CA) OCTA images with no macular edema or significant motion artifact were acquired 5 times with the 3 × 3-mm scan pattern. En face images of the superficial retinal layer (SRL) and deep retinal layer were registered and averaged. Vessel length density (VLD), perfusion density (PD), and foveal avascular zone (FAZ) parameters were measured on averaged versus single OCTA images.

Main Outcome Measures

Univariate and multivariate linear regression correlated quantitative metrics to DR severity and best-corrected visual acuity (BCVA).

Results

Eighty-four eyes (55 patients) met the inclusion criteria. Almost uniformly, lower VLD and PD parameters were associated significantly with worse DR severity and BCVA. Multivariate linear regression for DR severity resulted in an R2 value of 0.82 and 0.77 for single and averaged groups, respectively. No variables remained associated significantly with DR severity in multivariate analysis with single images, but in averaged images, increased superior SRL PD significantly predicted worse DR severity (coefficient, 52.7; P = 0.026). Multivariate linear regression for BCVA had an R2 value of 0.42 and 0.47 for single and averaged groups, respectively. Foveal avascular zone size was not associated with DR severity when single OCTA images (P = 0.98) were considered, but was highly associated when using averaged images (coefficient, 6.18; P < 0.001). Foveal avascular zone size was predictive for logarithm of the minimum angle of resolution BCVA with averaged images (0.21; P = 0.004), but not with single images (P = 0.31).

Conclusions

Averaging of en face OCTA images improves the visualization of capillaries, particularly increasing the clarity of the FAZ borders, and therefore improves the correlation of vessel density and FAZ-specific parameters to DR severity and BCVA.

Section snippets

Methods

This retrospective, cross-sectional cohort study received institutional review board approval from Salus IRB (Austin, TX). This study complied with the Health Insurance Portability and Accountability Act of 1996 and followed the tenets of the Declaration of Helsinki. All individuals signed a written informed consent before participating in the study.

Demographics

Eighty-four eyes of 55 patients, including normal control participants and those with varying levels of DR, met the inclusion criteria. Twenty-eight eyes (19 patients) were from healthy, age-matched controls, 11 eyes (8 patients) were from diabetics without DR, 9 eyes (7 patients) had mild DR, 10 eyes (7 patients) had moderate DR, 5 eyes (3 patients) had severe DR, and 21 eyes (15 patients) had proliferative DR. The average hemoglobin A1C of the DR cohort was 7.0±1.8%. Baseline characteristics

Discussion

We previously demonstrated that image averaging in RVO eyes showed improved visualization of angiographic en face images. In this study, we evaluated the correlation between quantitative microvascular changes on spectral-domain OCTA with BCVA and severity of DR. Univariate analysis demonstrated that the correlation with BCVA was statistically significant for all quantitative variables except for FAZ size in the single images and for the SRL inferior PD, SRL nasal PD, SRL temporal PD, and DRL

References (48)

  • C. Balaratnasingam et al.

    Visual acuity is correlated with the area of the foveal avascular zone in diabetic retinopathy and retinal vein occlusion

    Ophthalmology

    (2016)
  • R. Tzekov et al.

    The electroretinogram in diabetic retinopathy

    Surv Ophthalmol

    (1999)
  • A. Couturier et al.

    Widefield OCT-angiography and fluorescein angiography assessments of nonperfusion in diabetic retinopathy and edema treated with anti-vascular endothelial growth factor

    Ophthalmology

    (2019)
  • M.M. Nentwich et al.

    Diabetic retinopathy—ocular complications of diabetes mellitus

    World J Diabetes

    (2015)
  • R. Lee et al.

    Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss

    Eye Vis (Lond)

    (2015)
  • Fluorescein angiographic risk factors for progression of diabetic retinopathy. ETDRS report number 13

    Ophthalmology

    (1991)
  • R.F. Spaide et al.

    Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography

    JAMA Ophthalmol

    (2015)
  • U. Karhunen et al.

    Adverse reactions to fluorescein angiography

    Acta Ophthalmol (Copenh)

    (1986)
  • J. Lei et al.

    Repeatability and reproducibility of superficial macular retinal vessel density measurements using optical coherence tomography angiography en face images

    JAMA Ophthalmol

    (2017)
  • B. Dupas et al.

    Association between vessel density and visual acuity in patients with diabetic retinopathy and poorly controlled type 1 diabetes

    JAMA Ophthalmol

    (2018)
  • D.S.W. Ting et al.

    Optical coherence tomographic angiography in type 2 diabetes and diabetic retinopathy

    JAMA Ophthalmol

    (2017)
  • M.K. Durbin et al.

    Quantification of retinal microvascular density in optical coherence tomographic angiography images in diabetic retinopathy

    JAMA Ophthalmol

    (2017)
  • A.Y. Kim et al.

    Quantifying microvascular density and morphology in diabetic retinopathy using spectral-domain optical coherence tomography angiography

    Invest Ophthalmol Vis Sci

    (2016)
  • A.Y. Alibhai et al.

    Quantification of retinal capillary nonperfusion in diabetics using wide-field optical coherence tomography angiography

    Retina

    (2020)
  • Cited by (9)

    View all citing articles on Scopus

    Financial Disclosure(s): The author(s) have made the following disclosure(s): J.J.J.: Consultant – Carl Zeiss Meditec, Inc, Alimera Sciences, Allergan, Google.

    D.J.G.Y.: Financial support – Johnson and Johnson Vision Care.

    M.H.C.: Employee – Topcon Medical Systems, Inc.

    S.R.S.: Consultant – Optos, Heidelberg, Centervue, Allergan, Amgen, Roche/Genentech, Novartis, Regeneron, 4DMT, Carl Zeiss Meditec, Inc; Financial support – Carl Zeiss Meditec, Inc.

    Q.V.H.: Financial support – Johnson and Johnson Vision Care

    HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at Salus IRB approved the study. All research complied with the Health Insurance Portability and Accountability (HIPAA) Act of 1996 and adhered to the tenets of the Declaration of Helsinki. All participants provided informed consent.

    No animal subjects were included in this study.

    Author Contributions:

    Conception and design: Jung, Shi, Nassisi, Marion, Sadda, Hoang

    Analysis and interpretation: Jung, Yu, Zeng, Chen, Shi, Nassisi, Marion, Sadda, Hoang

    Data collection: Jung, Yu, Zeng, Chen, Hoang

    Obtained funding: Supported in part by Research to Prevent Blindness, New York, New York (unrestricted grant and Career Development Award [Q.V.H.]); and the National Eye Institute/National Institutes of Health, Bethesda, Maryland (grant no.: 1 K08 EY023595 [Q.V.H.]). The sponsor or funding organization had no role in the design or conduct of this research.

    Overall responsibility: Jung, Yu, Zeng, Chen, Shi, Nassisi, Marion, Sadda, Hoang

    View full text