Projection-Resolved Optical Coherence Tomography Angiography of Macular Retinal Circulation in Glaucoma

Hana Takusagawa, Liang Liu, Kelly N. Ma, Jia Yali, Simon S. Gao, Miao Zhang, Lorna (Beth) Edmunds, Mansi Parikh, Shandiz Tehrani, John Morrison, David Huang

Research output: Contribution to journalArticle

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Abstract

Purpose: To detect macular perfusion defects in glaucoma using projection-resolved optical coherence tomography (OCT) angiography. Design: Prospective observation study. Participants: A total of 30 perimetric glaucoma and 30 age-matched normal participants were included. Methods: One eye of each participant was imaged using 6 × 6-mm macular OCT angiography (OCTA) scan pattern by 70-kHz 840-nm spectral-domain OCT. Flow signal was calculated by the split-spectrum amplitude-decorrelation angiography algorithm. A projection-resolved OCTA (PR-OCTA) algorithm was used to remove flow projection artifacts. Four en face OCTA slabs were analyzed: the superficial vascular complex (SVC), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and all-plexus retina (SVC + ICP + DCP). The vessel density (VD), defined as the percentage area occupied by flow pixels, was calculated from en face OCTA. A novel algorithm was used to adjust the vessel density to compensate for local variations in OCT signal strength. Main Outcome Measures: Macular retinal VD, ganglion cell complex (GCC) thickness, and visual field (VF) sensitivity. Results: Focal capillary dropout could be visualized in the SVC, but not the ICP and DVP, in glaucomatous eyes. In the glaucoma group, the SVC and all-plexus retinal VD (mean ± standard deviation: 47.2%±7.1% and 73.5%±6.6%) were lower than in the normal group (60.5%±4.0% and 83.2%±4.2%, both P < 0.001, t test). The ICP and DCP VD were not significantly lower in the glaucoma group. Among the overall macular VD parameters, the SVC VD had the best diagnostic accuracy as measured by the area under the receiver operating characteristic curve (AROC). The accuracy was even better when the worse hemisphere (inferior or superior) was used, achieving an AROC of 0.983 and a sensitivity of 96.7% at a specificity of 95%. Among the glaucoma participants, the hemispheric SVC VD values were highly correlated with the corresponding GCC thickness and VF sensitivity (P < 0.003). The reflectance compensation step in VD calculation significantly improved repeatability, normal population variation, and correlation with VF and GCC thickness. Conclusions: On the basis of PR-OCTA, glaucoma preferentially affects perfusion in the SVC in the macula more than the deeper plexuses. Reflectance-compensated SVC VD measurement by PR-OCTA detected glaucoma with high accuracy and could be useful in the clinical evaluation of glaucoma.

Original languageEnglish (US)
JournalOphthalmology
DOIs
StateAccepted/In press - 2017

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Optical Coherence Tomography
Glaucoma
Blood Vessels
Angiography
Visual Fields
Ganglia
Retinal Vessels
ROC Curve
Perfusion
Artifacts
Retina
Cell Count
Observation
Outcome Assessment (Health Care)
Prospective Studies
Population

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Projection-Resolved Optical Coherence Tomography Angiography of Macular Retinal Circulation in Glaucoma. / Takusagawa, Hana; Liu, Liang; Ma, Kelly N.; Yali, Jia; Gao, Simon S.; Zhang, Miao; Edmunds, Lorna (Beth); Parikh, Mansi; Tehrani, Shandiz; Morrison, John; Huang, David.

In: Ophthalmology, 2017.

Research output: Contribution to journalArticle

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title = "Projection-Resolved Optical Coherence Tomography Angiography of Macular Retinal Circulation in Glaucoma",
abstract = "Purpose: To detect macular perfusion defects in glaucoma using projection-resolved optical coherence tomography (OCT) angiography. Design: Prospective observation study. Participants: A total of 30 perimetric glaucoma and 30 age-matched normal participants were included. Methods: One eye of each participant was imaged using 6 × 6-mm macular OCT angiography (OCTA) scan pattern by 70-kHz 840-nm spectral-domain OCT. Flow signal was calculated by the split-spectrum amplitude-decorrelation angiography algorithm. A projection-resolved OCTA (PR-OCTA) algorithm was used to remove flow projection artifacts. Four en face OCTA slabs were analyzed: the superficial vascular complex (SVC), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and all-plexus retina (SVC + ICP + DCP). The vessel density (VD), defined as the percentage area occupied by flow pixels, was calculated from en face OCTA. A novel algorithm was used to adjust the vessel density to compensate for local variations in OCT signal strength. Main Outcome Measures: Macular retinal VD, ganglion cell complex (GCC) thickness, and visual field (VF) sensitivity. Results: Focal capillary dropout could be visualized in the SVC, but not the ICP and DVP, in glaucomatous eyes. In the glaucoma group, the SVC and all-plexus retinal VD (mean ± standard deviation: 47.2{\%}±7.1{\%} and 73.5{\%}±6.6{\%}) were lower than in the normal group (60.5{\%}±4.0{\%} and 83.2{\%}±4.2{\%}, both P < 0.001, t test). The ICP and DCP VD were not significantly lower in the glaucoma group. Among the overall macular VD parameters, the SVC VD had the best diagnostic accuracy as measured by the area under the receiver operating characteristic curve (AROC). The accuracy was even better when the worse hemisphere (inferior or superior) was used, achieving an AROC of 0.983 and a sensitivity of 96.7{\%} at a specificity of 95{\%}. Among the glaucoma participants, the hemispheric SVC VD values were highly correlated with the corresponding GCC thickness and VF sensitivity (P < 0.003). The reflectance compensation step in VD calculation significantly improved repeatability, normal population variation, and correlation with VF and GCC thickness. Conclusions: On the basis of PR-OCTA, glaucoma preferentially affects perfusion in the SVC in the macula more than the deeper plexuses. Reflectance-compensated SVC VD measurement by PR-OCTA detected glaucoma with high accuracy and could be useful in the clinical evaluation of glaucoma.",
author = "Hana Takusagawa and Liang Liu and Ma, {Kelly N.} and Jia Yali and Gao, {Simon S.} and Miao Zhang and Edmunds, {Lorna (Beth)} and Mansi Parikh and Shandiz Tehrani and John Morrison and David Huang",
year = "2017",
doi = "10.1016/j.ophtha.2017.06.002",
language = "English (US)",
journal = "Ophthalmology",
issn = "0161-6420",
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T1 - Projection-Resolved Optical Coherence Tomography Angiography of Macular Retinal Circulation in Glaucoma

AU - Takusagawa, Hana

AU - Liu, Liang

AU - Ma, Kelly N.

AU - Yali, Jia

AU - Gao, Simon S.

AU - Zhang, Miao

AU - Edmunds, Lorna (Beth)

AU - Parikh, Mansi

AU - Tehrani, Shandiz

AU - Morrison, John

AU - Huang, David

PY - 2017

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N2 - Purpose: To detect macular perfusion defects in glaucoma using projection-resolved optical coherence tomography (OCT) angiography. Design: Prospective observation study. Participants: A total of 30 perimetric glaucoma and 30 age-matched normal participants were included. Methods: One eye of each participant was imaged using 6 × 6-mm macular OCT angiography (OCTA) scan pattern by 70-kHz 840-nm spectral-domain OCT. Flow signal was calculated by the split-spectrum amplitude-decorrelation angiography algorithm. A projection-resolved OCTA (PR-OCTA) algorithm was used to remove flow projection artifacts. Four en face OCTA slabs were analyzed: the superficial vascular complex (SVC), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and all-plexus retina (SVC + ICP + DCP). The vessel density (VD), defined as the percentage area occupied by flow pixels, was calculated from en face OCTA. A novel algorithm was used to adjust the vessel density to compensate for local variations in OCT signal strength. Main Outcome Measures: Macular retinal VD, ganglion cell complex (GCC) thickness, and visual field (VF) sensitivity. Results: Focal capillary dropout could be visualized in the SVC, but not the ICP and DVP, in glaucomatous eyes. In the glaucoma group, the SVC and all-plexus retinal VD (mean ± standard deviation: 47.2%±7.1% and 73.5%±6.6%) were lower than in the normal group (60.5%±4.0% and 83.2%±4.2%, both P < 0.001, t test). The ICP and DCP VD were not significantly lower in the glaucoma group. Among the overall macular VD parameters, the SVC VD had the best diagnostic accuracy as measured by the area under the receiver operating characteristic curve (AROC). The accuracy was even better when the worse hemisphere (inferior or superior) was used, achieving an AROC of 0.983 and a sensitivity of 96.7% at a specificity of 95%. Among the glaucoma participants, the hemispheric SVC VD values were highly correlated with the corresponding GCC thickness and VF sensitivity (P < 0.003). The reflectance compensation step in VD calculation significantly improved repeatability, normal population variation, and correlation with VF and GCC thickness. Conclusions: On the basis of PR-OCTA, glaucoma preferentially affects perfusion in the SVC in the macula more than the deeper plexuses. Reflectance-compensated SVC VD measurement by PR-OCTA detected glaucoma with high accuracy and could be useful in the clinical evaluation of glaucoma.

AB - Purpose: To detect macular perfusion defects in glaucoma using projection-resolved optical coherence tomography (OCT) angiography. Design: Prospective observation study. Participants: A total of 30 perimetric glaucoma and 30 age-matched normal participants were included. Methods: One eye of each participant was imaged using 6 × 6-mm macular OCT angiography (OCTA) scan pattern by 70-kHz 840-nm spectral-domain OCT. Flow signal was calculated by the split-spectrum amplitude-decorrelation angiography algorithm. A projection-resolved OCTA (PR-OCTA) algorithm was used to remove flow projection artifacts. Four en face OCTA slabs were analyzed: the superficial vascular complex (SVC), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and all-plexus retina (SVC + ICP + DCP). The vessel density (VD), defined as the percentage area occupied by flow pixels, was calculated from en face OCTA. A novel algorithm was used to adjust the vessel density to compensate for local variations in OCT signal strength. Main Outcome Measures: Macular retinal VD, ganglion cell complex (GCC) thickness, and visual field (VF) sensitivity. Results: Focal capillary dropout could be visualized in the SVC, but not the ICP and DVP, in glaucomatous eyes. In the glaucoma group, the SVC and all-plexus retinal VD (mean ± standard deviation: 47.2%±7.1% and 73.5%±6.6%) were lower than in the normal group (60.5%±4.0% and 83.2%±4.2%, both P < 0.001, t test). The ICP and DCP VD were not significantly lower in the glaucoma group. Among the overall macular VD parameters, the SVC VD had the best diagnostic accuracy as measured by the area under the receiver operating characteristic curve (AROC). The accuracy was even better when the worse hemisphere (inferior or superior) was used, achieving an AROC of 0.983 and a sensitivity of 96.7% at a specificity of 95%. Among the glaucoma participants, the hemispheric SVC VD values were highly correlated with the corresponding GCC thickness and VF sensitivity (P < 0.003). The reflectance compensation step in VD calculation significantly improved repeatability, normal population variation, and correlation with VF and GCC thickness. Conclusions: On the basis of PR-OCTA, glaucoma preferentially affects perfusion in the SVC in the macula more than the deeper plexuses. Reflectance-compensated SVC VD measurement by PR-OCTA detected glaucoma with high accuracy and could be useful in the clinical evaluation of glaucoma.

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