Effect of Signal Strength in the Analysis of Normal Macular Microvascular Density Using Optical Coherence Tomography Angiography
Yanjiao Huo, Yan Guo, Wei Zhang, Lei Li, Ningli Wang
Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
Abstract: Objective: To report the effects of signal strength (SS) on the normal macular microvascular density acquired from optical coherence tomography angiography (OCTA). Methods: This was a case series study. Normal subjects (right eyes) were recruited from September 2020 to December 2020 in the Beijing Tongren Hospital. All subjects underwent 6 mm×6 mm high-definition (HD)-OCT/OCTA. Macular ganglion cell-inner plexiform layer (mGCIPL) thickness and macular microvascular density were analyzed using the Cirrus OCTA system (Angio Plexversion 10.0). Subjects were grouped according to the signal strength (SS) (8, 9, 10): SS8, SS9 and SS10. Vessel density (VD), perfusion density (PD) and foveal avascular zone (FAZ) parameters of the superficial capillary plexus were calculated. One-way analysis of variance and a nonparametric test were conducted to compare macular VD, PD and FAZ among the three groups. Spearman correlation was used to determine the relationship between macular VD and PD. Multiple regression analysis determined the association between macular vascular parameters and SS, age, gender, spherical equivalent (SE) and mGCIPL thickness. Results: Seventy-five subjects (75 eyes) were included. SS8 group was 20 eyes, SS9 group was 20 eyes and SS10 group was 35 eyes. There were significant differences between SS8, SS9 and SS10 (Hc=19.86, P<0.001). There were significant differences between the SS8, SS9 and SS10 groups in the total area of the macular PD (Hc=25.51, P<0.001). There were no significant differences among the three groups in FAZ parameters. The Spearman test showed that the total area of VD was significantly correlated with PD (r=0.978, P<0.001). The total area of VD was associated with mGCIPL and SS; the total area of PD was associated with mGCIPL and SS. Both VD and PD were not associated with age, gender or SE. Conclusions: In normal subjects, macular VD and PD show significant differences in different SS groups, but the FAZ parameters show no significant differences among the SS groups above 8. This may suggest the impact of SS should be considered carefully when interpreting perifoveal vessel parameters.
霍妍佼 郭彦 张微 李蕾 王宁利. 扫描信号强度对OCTA测量正常人黄斑浅层血流的影响[J]. 中华眼视光学与视觉科学杂志, 2021, 23(7): 515-521.
Yanjiao Huo, Yan Guo, Wei Zhang, Lei Li, Ningli Wang. Effect of Signal Strength in the Analysis of Normal Macular Microvascular Density Using Optical Coherence Tomography Angiography. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(7): 515-521. DOI: 10.3760/cma.j.cn115909-20210107-00006
Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: A review. JAMA, 2014, 311(18): 1901- 1911. DOI: 10.1001/jama.2014.3192.
[2]
The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): The relationship between control of intraocular pressure and visual field deterioration. The AGIS investigators. Am J Ophthalmol, 2000, 130(4): 429-440. DOI: 10.1016/s0002- 9394(00)00538-9.
[3]
Grunwald JE, Piltz J, Hariprasad SM, et al. Optic nerve and choroidal circulation in glaucoma. Invest Ophthalmol Vis Sci,1998, 39(12): 2329-2336.
[4]
Galassi F, Sodi A, Ucci F, et al. Ocular hemodynamics and glaucoma prognosis: a color Doppler imaging study. Arch Ophthalmol, 2003, 121(12): 1711-1715. DOI: 10.1001/ archopht.121.12.1711.
[5]
Lei J, Durbin MK, Shi Y, et al. Repeatability and reproducibility of superficial macular retinal vessel density measurements using optical coherence tomography angiography en face images. JAMA Ophthalmol, 2017, 135(10): 1092-1098. DOI: 10.1001/ jamaophthalmol.2017.3431.
[6]
Quaranta-EI Maftouhi M, EI Maftouhi A, Eandi CM. Chronic central serous chorioretinopathy imaged by optical coherencetomographic angiography. Am J Ophthalmol, 2015, 160(3): 581-587. DOI: 10.1016/j.ajo.2015.06.016.
[7]
Jia Y, Bailey ST, Wilson DJ, et al. Quantitative optical coherence tomography angiography of choroidal neovascularization in agerelated macular degeneration. Ophthalmology, 2014, 121(7): 1435-1444. DOI: 10.1016/j.ophtha.2014.01.034.
[8]
Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherencetomography angiography in diabetic retinopathy: A prospectivepilot study. Am J Ophthalmol, 2015, 160(1): 35-44. e1. DOI: 10.1016/j.ajo.2015.04.021.
[9]
Wang X, Jiang C, Ko T, et al. Correlation between optic disc perfusion and glaucomatous severity in patients with open-angle glaucoma: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol, 2015, 253(9): 1557-1564. DOI: 10.1007/s00417-015-3095-y.
[10]
Yarmohammadi A, Zangwill LM, Diniz-Filho A, et al. Relationship between optical coherence tomography angiography vessel density and severity of visual field loss in glaucoma. Ophthalmology, 2016, 123(12): 2498-508. DOI: 10.1016/ j.ophtha.2016.08.041.
[11]
Chen HS, Liu CH, Wu WC, et al. Optical coherence tomography angiography of the superficial microvasculature in the macular and peripapillary areas in glaucomatous and healthy eyes. Invest Ophthalmol Vis Sci, 2017, 58(9): 3637-3645. DOI: 10.1167/ iovs.17-21846.
[12]
Brücher VC, Storp JJ, Eter N, et al. Optical coherence tomography angiography-derived flow density: A review of the influencing factors. Graefes Arch Clin Exp Ophthalmol, 2020, 258(4): 701- 710. DOI: 10.1007/s00417-019-04553-2.
[13]
Lim HB, Kim YW, Nam KY, et al. Signal strength as an important factor in the analysis of peripapillary microvascular density using optical coherence tomography angiography. Sci Rep, 2019, 9(1): 16299. DOI: 10.1038/s41598-019-52818-x.
[14]
Yu JJ, Camino A, Liu L, et al. Signal strength reduction effects in OCT angiography. Ophthalmol Retina, 2019, 3(10): 835-842. DOI: 10.1016/j.oret.2019.04.029.
[15]
You QS, Chan J, Ng A, et al. Macular vessel density measured with optical coherence tomography angiography and its associations in a large population-based study. Invest Ophthalmol Vis Sci, 2019, 60(14): 4830-4837. DOI: 10.1167/iovs.19-28137.
[16]
American academy of ophthalmology. Basic and clinical science course. Italy: FSC, 2014: 46-47.
Richter GM, Madi I, Chu Z, et al. Structural and functional associations of macular microcirculation in the ganglion cellinner plexiform layer in glaucoma using optical coherence tomography angiography. J Glaucoma, 2018, 27(3): 281-290. DOI: 10.1097/IJG.0000000000000888.
[19]
Shoji T, Zangwill LM, Akagi T, et al. Progressive macula vessel density loss in primary open-angle glaucoma: Alongitudinalstudy. Am J Ophthalmol, 2017, 182: 107-117. DOI: 10.1016/j.ajo.2017. 07.011.
[20]
Kwon J, Choi J, Shin JW, et al. Alterations of the foveal avascular zone measured by optical coherence tomography angiography in glaucoma patients with central visual field defects. Invest Ophthalmol Vis Sci, 2017, 58(3): 1637-1645. DOI: 10.1167/ iovs.16-21079.
[21]
Park SH, Cho H, Hwang SJ, et al. Changes in the retinal microvasculature measured using optical coherence tomography angiography according to age. J Clin Med, 2020, 9(3): 883. DOI: 10.3390/jcm9030883.
[22]
Yu J, Gu R, Zong Y, et al. Relationship between retinal perfusion and retinal thickness in healthy subjects: An optical coherence tomography angiography study. Invest Ophthalmol Vis Sci, 2016, 57(9): 204-210. DOI: 10.1167/iovs.15-18630.
[23]
Zhang Z, Huang X, Meng X, et al. In vivo assessment of macular in eyes of healthy children 8 to 16 years old using optical coherence tomography angiography. Sci Rep, 2017, 7(1): 8936. DOI: 10.1038/s41598-017-08174-9.
[24]
Coscas F, Sellam A, Glacet-Bernard A, et al. Normative data for vascular density in superficial and deep capillary plexuses of healthy adults assessed by optical coherence tomography angiography. Invest Opthalmol Vis Sci, 2016, 57(9): 211-223. DOI: 10.1167/iovs.15-18793.
[25]
Rao HL, Pradhan ZS, Weinreb RN, et al. Determinants of peripapillary and macular vessel densities measured by optical coherence tomography angiography in normal eyes. J Glaucoma, 2017, 26(5): 491-497. DOI: 10.1097/IJG.0000000000000655.
[26]
Lim HB, Lee MW, Park JH, et al. Changes in ganglion cellinner plexiform layer thickness and retinal microvasculature in hypertension: an optical coherence tomography angiography study. Am J Ophthalmol, 2019, 199(13): 167-176. DOI: 10.1016/j.ajo.2018.11.016.
[27]
Köse HC, Tekeli O. Optical coherence tomography angiography of the peripapillary region and macula in normal, primary open angle glaucoma, pseudoexfoliation glaucoma and ocular hypertension eyes. Int J Ophthalmol, 2020, 13(5): 744-754. DOI: 10.18240/ijo.2020.05.08.