Publications by authors named "Emily D Cole"

22 Publications

  • Page 1 of 1

Deep Learning for the Diagnosis of Stage in Retinopathy of Prematurity: Accuracy and Generalizability across Populations and Cameras.

Ophthalmol Retina 2021 10 6;5(10):1027-1035. Epub 2021 Feb 6.

Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. Electronic address:

Purpose: Stage is an important feature to identify in retinal images of infants at risk of retinopathy of prematurity (ROP). The purpose of this study was to implement a convolutional neural network (CNN) for binary detection of stages 1, 2, and 3 in ROP and to evaluate its generalizability across different populations and camera systems.

Design: Diagnostic validation study of CNN for stage detection.

Participants: Retinal fundus images obtained from preterm infants during routine ROP screenings.

Methods: Two datasets were used: 5943 fundus images obtained by RetCam camera (Natus Medical, Pleasanton, CA) from 9 North American institutions and 5049 images obtained by 3nethra camera (Forus Health Incorporated, Bengaluru, India) from 4 hospitals in Nepal. Images were labeled based on the presence of stage by 1 to 3 expert graders. Three CNN models were trained using 5-fold cross-validation on datasets from North America alone, Nepal alone, and a combined dataset and were evaluated on 2 held-out test sets consisting of 708 and 247 images from the Nepali and North American datasets, respectively.

Main Outcome Measures: Convolutional neural network performance was evaluated using area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), sensitivity, and specificity.

Results: Both the North American- and Nepali-trained models demonstrated high performance on a test set from the same population: AUROC, 0.99; AUPRC, 0.98; sensitivity, 94%; and AUROC, 0.97; AUPRC, 0.91; and sensitivity, 73%; respectively. However, the performance of each model decreased to AUROC of 0.96 and AUPRC of 0.88 (sensitivity, 52%) and AUROC of 0.62 and AUPRC of 0.36 (sensitivity, 44%) when evaluated on a test set from the other population. Compared with the models trained on individual datasets, the model trained on a combined dataset achieved improved performance on each respective test set: sensitivity improved from 94% to 98% on the North American test set and from 73% to 82% on the Nepali test set.

Conclusions: A CNN can identify accurately the presence of ROP stage in retinal images, but performance depends on the similarity between training and testing populations. We demonstrated that internal and external performance can be improved by increasing the heterogeneity of the training dataset features of the training dataset, in this case by combining images from different populations and cameras.
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http://dx.doi.org/10.1016/j.oret.2020.12.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8364291PMC
October 2021

Development of Screening Criteria for Retinopathy of Prematurity in Ulaanbaatar, Mongolia, Using a Web-based Data Management System.

J Pediatr Ophthalmol Strabismus 2020 Sep;57(5):333-339

Purpose: To describe a process for identifying birth weight (BW) and gestational age (GA) screening guidelines in Mongolia.

Methods: This was a prospective cohort study in a tertiary care hospital in Ulaanbataar, Mongolia, of 193 premature infants with GA of 36 weeks or younger and/or BW of 2,000 g or less) with regression analysis to determine associations between BW and GA and the development of retinopathy of prematurity (ROP).

Results: As BW and GA decreased, the relative risk of developing ROP increased. The relative risk of developing any stage of ROP in infants born at 29 weeks or younger was 2.91 (95% CI: 1.55 to 5.44; P < .001] compared to older infants. The relative risk of developing any type of ROP in infants with BW of less than 1,200 g was 2.41 (95% CI: 1.35 to 4.29; P = .003] and developing type 2 or worse ROP was 2.05 (95% CI: 0.99 to 4.25; P = .05).

Conclusions: Infants in Mongolia with heavier BW and older GA who fall outside of current United States screening guidelines of GA of 30 weeks or younger and/or BW of 1,500 g or less developed clinically relevant ROP. [J Pediatr Ophthalmol Strabismus. 2020;57(5):333-339.].
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http://dx.doi.org/10.3928/01913913-20200804-01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880618PMC
September 2020

VISUALIZATION OF CHOROIDAL NEOVASCULARIZATION USING TWO COMMERCIALLY AVAILABLE SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY DEVICES.

Retina 2019 Sep;39(9):1682-1692

New England Eye Center, Tufts Medical Center, Boston, Massachusetts.

Purpose: To compare the sensitivity of detection and the measured size of choroidal neovascularization (CNV) on two commercially available spectral domain optical coherence tomography angiography (OCTA) devices, the Optovue RTVue XR Avanti with AngioVue and the Zeiss Cirrus HD-OCT with AngioPlex.

Methods: Patients with CNV lesions were imaged consecutively on both OCTA devices on the same day of their visit. 3 × 3 mm and 6 × 6 mm scans centered at the fovea were obtained. Two independent masked readers evaluated the OCTA images for CNV identification and its area measurements.

Results: No significant differences were observed between the 2 OCTA devices in CNV area measurements on their 3 × 3 mm and 6 × 6 mm scans. However, there was suboptimal performance of their automated segmentation algorithms as compared to manually adjusted segmentation for visualizing CNV lesions.

Conclusion: There was no significant difference in the size of the CNV lesion as measured on either commercially available spectral domain OCTA device. Both devices were comparable in their detection of CNV lesions on manual adjustment of segmentation lines. However, their automated segmentation algorithms need improvement to allow for accurate measurement of CNV lesions for routine clinical application.
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http://dx.doi.org/10.1097/IAE.0000000000002241DOI Listing
September 2019

Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis Syndrome Presenting With Branch Retinal Artery Occlusion.

Ophthalmic Surg Lasers Imaging Retina 2017 11;48(11):948-951

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) is a rare syndrome affecting the retinal and optic disc vasculature. Diffuse retinal ischemia, macular edema, and neovascularization may lead to bilateral vision loss. The authors report a case of a 36-year-old woman presenting with branch retinal artery occlusion (BRAO) in her right eye who was subsequently diagnosed with IRVAN syndrome. She was treated with panretinal photocoagulation for peripheral retinal ischemia and pars plana vitrectomy for vitreous hemorrhage. She later developed a BRAO in her left eye. This case demonstrates that BRAO may be a presenting feature of IRVAN syndrome. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:948-951.].
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http://dx.doi.org/10.3928/23258160-20171030-13DOI Listing
November 2017

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY TO DETECT MACULAR CAPILLARY ISCHEMIA IN PATIENTS WITH INNER RETINAL CHANGES AFTER RESOLVED DIABETIC MACULAR EDEMA.

Retina 2018 Dec;38(12):2277-2284

New England Eye Center, Tufts Medical Center, Boston, Massachusetts.

Purpose: To compare foveal vascular anatomy between patients with and without disorganization of retinal inner layers (DRILs) after resolved diabetic macular edema using optical coherence tomography angiography (OCTA).

Methods: Twenty-four eyes of 21 age- and sex-matched patients with resolved diabetic macular edema were included in this retrospective, cross-sectional study. All eyes were imaged with enhanced high-definition line or cross-line structural B scans and 3 × 3-mm OCTA scans. Optical coherence tomography B scans were analyzed for the presence of DRIL, and based on this, eyes were classified as either DRIL present or DRIL absent. The foveal avascular zone area on OCTA was compared between patients with and without DRIL. The foveal avascular zone area was correlated with visual acuity.

Results: Nine eyes with DRIL and resolved diabetic macular edema were compared with 15 control eyes without DRIL and resolved diabetic macular edema. Area of ischemia on OCTA scans corresponded to the area of DRIL as determined on OCT B scans. The foveal avascular zone area in full retina as well as superficial and deep retinal plexuses OCTA slabs were significantly larger in patients with DRIL as compared to those without DRIL (P = 0.005, P < 0.001, and P = 0.004, respectively). The larger foveal avascular zone in full retinal segmentation (r = 0.72, P = 0.03) and superficial plexus (r = 0.74, P = 0.02) were positively correlated with lower visual acuity.

Conclusion: Optical coherence tomography angiography can visualize retinal ischemia in patients with and without DRIL. Correspondence of impaired blood flow with DRIL suggests that retinal ischemia and loss of normal vasculature contributes to DRIL.
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http://dx.doi.org/10.1097/IAE.0000000000001902DOI Listing
December 2018

The Definition, Rationale, and Effects of Thresholding in OCT Angiography.

Ophthalmol Retina 2017 Sep-Oct;1(5):435-447. Epub 2017 Apr 5.

New England Eye Center, Tufts Medical Center, Boston, Massachusetts.

Purpose: To examine the definition, rationale, and effects of thresholding in OCT angiography (OCTA).

Design: A theoretical description of OCTA thresholding in combination with qualitative and quantitative analysis of the effects of OCTA thresholding in eyes from a retrospective case series.

Participants: Four eyes were qualitatively examined: 1 from a 27-year-old control, 1 from a 78-year-old exudative age-related macular degeneration (AMD) patient, 1 from a 58-year-old myopic patient, and 1 from a 77-year-old nonexudative AMD patient with geographic atrophy (GA). One eye from a 75-year-old nonexudative AMD patient with GA was quantitatively analyzed.

Main Outcome Measures: A theoretical thresholding model and a qualitative and quantitative description of the dependency of OCTA on thresholding level.

Results: Due to the presence of system noise, OCTA thresholding is a necessary step in forming OCTA images; however, thresholding can complicate the relationship between blood flow and OCTA signal.

Conclusions: Thresholding in OCTA can cause significant artifacts, which should be considered when interpreting and quantifying OCTA images.
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http://dx.doi.org/10.1016/j.oret.2017.01.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640169PMC
April 2017

Diagnosing Choroidal Neovascularization in Asymptomatic Individuals Using Optical Coherence Tomography Angiography.

Ophthalmic Surg Lasers Imaging Retina 2017 07;48(7):596-598

Optical coherence tomography angiography (OCTA) is a noninvasive, rapid imaging technique that generates angiographic images without intravenous dye injections. Cross-sectional studies have described the presence of asymptomatic choroidal neovascularization (CNV) in patients with intermediate age-related macular degeneration (AMD). This case report describes the OCT features on longitudinal follow-up of a patient who started with unilateral asymptomatic CNV and eventually developed symptomatic exudative AMD. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:596-598.].
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http://dx.doi.org/10.3928/23258160-20170630-13DOI Listing
July 2017

Visualization of changes in the foveal avascular zone in both observed and treated diabetic macular edema using optical coherence tomography angiography.

Int J Retina Vitreous 2017 19;3:19. Epub 2017 Jun 19.

New England Eye Center, Tufts Medical Center, Tufts University, 800 Washington Street, Box 450, Boston, MA 02111 USA.

Background: Central vision loss in diabetic retinopathy is commonly related to diabetic macular edema (DME). The objective of this study was to describe changes between consecutive visits on optical coherence tomography angiography (OCTA) of the foveal avascular zone (FAZ) in eyes with DME.

Methods: 20 eyes from 14 patients with DME were imaged on 2 successive clinic visits separated by at least 1 month. The mean interval between visits was 3.2 months. The only intervention used was intravitreal anti-VEGF in 11 eyes; the others were observed over time without treatment. Two different readers measured FAZ area using a pseudo-automated tool in comparison to a manual tracing tool. Qualitative changes in the appearance of the vasculature surrounding the FAZ were also recorded. The retinal capillary plexus was segmented into deep and superficial plexuses, and FAZ measurements were done on the superficial, deep, and summated plexuses.

Results: Pseudo-automated and manual measurements of FAZ area decreased significantly ( < 0.05) between visits in the deep, superficial, and summated plexuses. Qualitative analysis of vasculature surrounding the FAZ showed that most of the vascular changes (65%) over time were visible in the deep plexus, compared to 30 and 20% in the superficial and summated plexuses, respectively.

Conclusions: The most significant differences in FAZ size over time were in the summated plexus ( < 0.001), while changes in FAZ appearance were most prominent in the deep plexus. Absolute decrease in FAZ size over visits was largest in the deep plexus. Our results demonstrate that OCTA can effectively be used to measure FAZ area in patients with DME, visualize qualitative changes in retinal vasculature, and visualize the segmentation levels at which these changes can be best appreciated. However, larger studies are needed to evaluate the reproducibility of manual and pseudo-automated measuring techniques.
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http://dx.doi.org/10.1186/s40942-017-0074-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474852PMC
June 2017

Optical Coherence Tomography Angiography in Nonarteritic Anterior Ischemic Optic Neuropathy.

J Neuroophthalmol 2017 12;37(4):358-364

New England Eye Center (EWM, EDC, SD, EAN, LV, CM-S, JSD, TRH), Tufts Medical Center, Boston, Massachusetts; and Universidade Federal de São Paulo (EAN), Escola Paulista de Medicina, São Paulo, Brazil.

Background: Optical coherence tomography angiography (OCTA) has demonstrated good utility in qualitative analysis of retinal and choroidal vasculature and therefore may be relevant in the diagnostic and treatment efforts surrounding nonarteritic anterior ischemic optic neuropathy (NAION).

Methods: Retrospective, cross-sectional study of 10 eyes of 9 patients with a previous or new diagnosis of NAION that received imaging with OCTA between November 2015 and February 2016. Two independent readers qualitatively analyzed the retinal peripapillary capillaries (RPC) and peripapillary choriocapillaris (PCC) for flow impairment. Findings were compared with automated visual field and structural optical coherence tomography (OCT) studies.

Results: Flow impairment seen on OCTA in the RPC corresponded to structural OCT deficits of the retinal nerve fiber layer (RNFL) and ganglion cell layer complex (GCC) in 80% and 100% of eyes, respectively, and to automated visual field deficits in 90% of eyes. Flow impairment seen on OCTA in the PCC corresponded to structural OCT deficits of the RNFL and GCC in 70% and 80% of eyes, respectively, and to visual field deficits in 60%-80% of eyes.

Conclusions: OCTA can noninvasively visualize microvascular flow impairment in patients with NAION.
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http://dx.doi.org/10.1097/WNO.0000000000000493DOI Listing
December 2017

En Face Doppler Optical Coherence Tomography Measurement of Total Retinal Blood Flow in Diabetic Retinopathy and Diabetic Macular Edema.

JAMA Ophthalmol 2017 Mar;135(3):244-251

Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge2Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge.

Importance: Alterations in ocular blood flow play an important role in the pathogenesis and progression of diabetic retinopathy (DR). However, the measurement of retinal blood flow in clinical studies has been challenging. En face Doppler optical coherence tomography (OCT) provides an effective method for measuring total retinal blood flow (TRBF) in the clinic.

Objective: To investigate TRBF in eyes with DR of varying severity, with or without diabetic macular edema (DME), using en face Doppler OCT.

Design, Setting, And Participants: This was a cross-sectional study conducted from May 23, 2014, to January 11, 2016, which analyzed 41 eyes with DR from 31 diabetic patients, 20 eyes without DR from 11 diabetic patients, and 16 eyes from 12 healthy age-matched controls, all at the New England Eye Center in Boston, Massachusetts.

Main Outcomes And Measures: Participants were imaged with a high-speed, swept-source OCT prototype at 1050-nm wavelength using repeated en face Doppler OCT raster scans, comprising 600 × 80 axial scans and covering a 1.5 × 2-mm2 area centered at the optic disc. The TRBF was automatically calculated using custom Matlab software.

Results: This study included 41 eyes with DR from 31 diabetic patients (mean [SD] age, 62.8 [13.4] years; 12 were female patients), 20 eyes without DR from 11 diabetic patients (mean [SD] age, 58.8 [10.1] years; 5 were female patients), and 16 eyes from 12 healthy age-matched controls (mean [SD] age, 57.9 [8.1] years; 8 were female participants). The mean (SD) TRBF was 28.0 (8.5) µL/min in the eyes with DME, 48.8 (13.4) µL/min in the eyes with DR but without DME, 40.1 (7.7) µL/min in the diabetic eyes without retinopathy, and 44.4 (8.3) µL/min in age-matched healthy eyes. A difference in TRBF between the eyes with DME that were treated and the eyes with DME that were not treated was not identified. The TRBF was consistently low in the eyes with DME regardless of DR severity. The eyes with moderate nonproliferative DR but without DME exhibited a wide range of TRBF from 31.1 to 75.0 µL/min, with the distribution being highly skewed.

Conclusions And Relevance: High-speed en face Doppler OCT can measure TRBF in healthy and diabetic eyes. Diabetic eyes with DME exhibited lower TRBF than healthy eyes (P ≤ .001). Further longitudinal studies of TRBF in eyes with DR would be helpful to determine whether reduced TRBF is a risk factor for DME.
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http://dx.doi.org/10.1001/jamaophthalmol.2016.5774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784830PMC
March 2017

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AFTER PHOTOCOAGULATION OF TYPE 2 NEOVASCULARIZATION.

Retin Cases Brief Rep 2018 Fall;12(4):275-278

New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts.

Purpose: To illustrate errors in the automated segmentation image analysis of optical coherence tomography angiography after laser photocoagulation therapy for Type 2 neovascularization.

Methods: This case report describes a patient with extrafoveal Type 2 neovascularization treated with argon laser photocoagulation evaluated before and after treatment by optical coherence tomography angiography.

Results: Disrupted retinal layers after laser photocoagulation therapy lead to segmentation errors.

Conclusion: Images of optical coherence tomography angiography are prone to degradation by artifacts in cases in which there is disruption of the retinal layers. Clinicians must be aware of these errors because they can be misinterpreted as active Type 2 neovascularization. Improvement in optical coherence tomography angiography image analysis to minimize automated segmentation errors needs to be further explored.
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http://dx.doi.org/10.1097/ICB.0000000000000511DOI Listing
September 2018

TOWARD QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY: Visualizing Blood Flow Speeds in Ocular Pathology Using Variable Interscan Time Analysis.

Retina 2016 Dec;36 Suppl 1:S118-S126

*Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts; †Department of Computer Science, Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; ‡New England Eye Center, Tufts Medical Center, Boston, Massachusetts; §Department of Ophthalmology, Federal University of São Paulo, School of Medicine, São Paulo, Brazil; ¶Praevium Research Inc, Santa Barbara, California; **Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; and ††Erlangen Graduate School in Advanced Optical Technologies (SAOT), Erlangen, Germany.

Purpose: Currently available optical coherence tomography angiography systems provide information about blood flux but only limited information about blood flow speed. The authors develop a method for mapping the previously proposed variable interscan time analysis (VISTA) algorithm into a color display that encodes relative blood flow speed.

Methods: Optical coherence tomography angiography was performed with a 1,050 nm, 400 kHz A-scan rate, swept source optical coherence tomography system using a 5 repeated B-scan protocol. Variable interscan time analysis was used to compute the optical coherence tomography angiography signal from B-scan pairs having 1.5 millisecond and 3.0 milliseconds interscan times. The resulting VISTA data were then mapped to a color space for display.

Results: The authors evaluated the VISTA visualization algorithm in normal eyes (n = 2), nonproliferative diabetic retinopathy eyes (n = 6), proliferative diabetic retinopathy eyes (n = 3), geographic atrophy eyes (n = 4), and exudative age-related macular degeneration eyes (n = 2). All eyes showed blood flow speed variations, and all eyes with pathology showed abnormal blood flow speeds compared with controls.

Conclusion: The authors developed a novel method for mapping VISTA into a color display, allowing visualization of relative blood flow speeds. The method was found useful, in a small case series, for visualizing blood flow speeds in a variety of ocular diseases and serves as a step toward quantitative optical coherence tomography angiography.
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http://dx.doi.org/10.1097/IAE.0000000000001328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193243PMC
December 2016

CLINICAL TRIAL ENDPOINTS FOR OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

Retina 2016 Dec;36 Suppl 1:S83-S92

*New England Eye Center, Tufts Medical Center, Boston, Massachusetts; †Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts; ‡Federal University of Goiás, Goiânia, Brazil; and §School of Medicine, Federal University of São Paulo, São Paulo, Brazil.

Purpose: To describe qualitative and quantitative optical coherence tomography (OCT) angiography (OCTA) parameters for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and their applicability as potential clinical trial endpoints.

Methods: A review of current literature related to the topic of OCTA and AMD.

Results: There are a number of promising OCTA parameters that can be used to diagnose the presence of CNV and to monitor the activity and progression of the lesion, pre- and post-treatment morphological characteristics, CNV dimensions, and automated quantitative parameters such as vessel density.

Conclusion: The OCTA parameters described in this review have promise for the future development of clinical trial endpoints, but require further validation before they can be widely used.
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http://dx.doi.org/10.1097/IAE.0000000000001338DOI Listing
December 2016

SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY REVEALS CHORIOCAPILLARIS ALTERATIONS IN EYES WITH NASCENT GEOGRAPHIC ATROPHY AND DRUSEN-ASSOCIATED GEOGRAPHIC ATROPHY.

Retina 2016 Dec;36 Suppl 1:S2-S11

*Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts; †New England Eye Center, Tufts Medical Center, Boston, Massachusetts; ‡Department of Ophthalmology, Federal University of São Paulo, School of Medicine, São Paulo, Brazil; §Department of Computer Science, Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; ¶Department of Ophthalmology, Federal University of Goiás, Goiânia, Brazil; and **Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Purpose: To investigate choriocapillaris (CC) alteration in patients with nascent geographic atrophy (nGA) and/or drusen-associated geographic atrophy (DAGA) using swept-source optical coherence tomography angiography (OCTA).

Methods: A 1,050-nm wavelength, 400 kHz A-scan rate swept-source optical coherence tomography prototype was used to perform volumetric swept-source optical coherence tomography angiography over 6 mm × 6 mm fields of view in patients with nGA and/or DAGA. The resulting optical coherence tomography (OCT) and OCTA data were analyzed using a combination of en face and cross-sectional techniques. Variable interscan time analysis (VISTA) was used to differentiate CC flow impairment from complete CC atrophy.

Results: A total of 7 eyes from 6 patients (mean age: 73.8 ± 5.7 years) were scanned. Seven areas of nGA and three areas of DAGA were identified. Analysis of cross-sectional OCT and OCTA images identified focal alterations of the CC underlying all seven areas of nGA and all three areas of DAGA. En face OCTA analysis of the CC revealed diffuse CC alterations in all eyes. Variable interscan time analysis processing suggested that the observed CC flow alterations predominantly corresponded to flow impairment rather than complete CC atrophy.

Conclusion: The OCTA imaging of the CC revealed focal CC flow impairment associated with areas of nGA and DAGA, as well as diffuse CC flow impairment throughout the imaged field. En face OCT analysis should prove useful for understanding the pathogenesis of nGA and DAGA and for identifying the formation of nGA and DAGA as endpoints in therapeutic trials.
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http://dx.doi.org/10.1097/IAE.0000000000001287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193240PMC
December 2016

Choroidal thickness in older patients with central serous chorioretinopathy.

Int J Retina Vitreous 2016 15;2:22. Epub 2016 Sep 15.

New England Eye Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111 USA.

Background: To investigate the choroidal thickness in older patients with central serous chorioretinopathy (CSCR) compared to age-matched normal subjects.

Methods: Fifteen patients (30 eyes) with CSCR, all aged ≥60 years, and 21 age-matched normal subjects (21 eyes) underwent high-definition raster scanning using SD-OCT. Both eyes from CSCR patients were included in the analysis. The eyes in patients with CSCR were divided into two groups: active CSCR (17 eyes) if there was foveal-involving subretinal fluid and inactive contralateral eye group (13 eyes). Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroidal-scleral junction at 500 µm intervals up to 2500 µm temporal and nasal to the fovea (11 locations).

Results: The mean age of the patients with CSCR was 68.87 ± 6.83 years (mean ± standard deviation). Reliable measurements of choroidal thickness were obtainable in 70.6 % of eyes examined. The choroid was statistically significantly thicker in eyes with both active CSCR ( < 0.001) and inactive contralateral eyes ( < 0.01) when compared to normal age-matched eyes. The subfoveal choroid was 95 µm ( < 0.01) thicker in eyes with active CSCR (338.05 ± 31.42 µm) compared with normal eyes (243.05 ± 13.39 µm). The subfoveal choroid thickness in the inactive contralateral eyes was numerically greater than normal, and it was not statistically significantly thicker compared to the normal eyes (difference-55.68 µm,  > 0.05).

Conclusion: Choroid in older patients with active CSCR was thicker than the choroid in age-matched normal eyes. It is important to consider CSCR as a differential diagnosis of serous retinal detachment in elderly patients with thickened choroid and to consider SD-OCT as an imaging modality by which to evaluate the choroidal thickness.
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http://dx.doi.org/10.1186/s40942-016-0046-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088461PMC
September 2016

Comparison of Optical Coherence Tomography Angiography and Fluorescein Angiography for the Identification of Retinal Vascular Changes in Eyes With Diabetic Macular Edema.

Ophthalmic Surg Lasers Imaging Retina 2016 11;47(11):1013-1019

Background And Objective: To compare the visualization of microaneurysms (MA) and the foveal avascular zone (FAZ) area using optical coherence tomography angiography (OCTA) versus fluorescein angiography (FA) in patients with diabetic macular edema (DME).

Patients And Methods: Patients were prospectively recruited for same-day imaging on spectral-domain OCTA and FA. OCTA images were automatically segmented into superficial (sOCTA) and deep (dOCTA) capillary plexuses. The number of visible MAs and the FAZ area were compared between the two imaging modalities.

Results: Nineteen eyes of 10 patients were included. There was a statistically significant difference between MA counts for FA, sOCTA, and dOCTA (P = .002), and median MA counts were 14.5 (range: 2-43), 9.75 (range: 0-37.5), and 22.5 (range: 5.5-46.5), respectively. dOCTA showed significantly more MAs than sOCTA (P < .001). Although not significant statistically, dOCTA revealed more MAs than FA (P = .06). There was a statistically significant difference between FAZ area for FA, sOCTA, and dOCTA (P = .046), and median FAZ areas were 0.444 (range: 0.1-0.689), 0.224 (range: 0.335-0.806), and 0.345 (range: 0.106-0.881), respectively. FA showed a significantly larger FAZ area than sOCTA (P = .04).

Conclusions: Deep plexus OCTA can better identify microaneurysms compared to either sOCTA or FA. The FAZ area appears larger on FA in contrast to OCTA of both plexuses. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1013-1019.].
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http://dx.doi.org/10.3928/23258160-20161031-05DOI Listing
November 2016

Optical Coherence Tomography Angiography of Chorioretinal Diseases.

Ophthalmic Surg Lasers Imaging Retina 2016 09;47(9):848-61

Fluorescein angiography (FA) and indocyanine green angiography (ICGA) have been the gold standard for the evaluation of retinal and choroidal vasculature in the last three decades and have revolutionized the diagnosis of retinal and choroidal vascular diseases. The advantage of these imaging modalities lies in their ability to document retinal and choroidal vasculature through the dynamic assessment of contrast transit over time in the intravascular and extravascular spaces. However, disadvantages include the absence of depth resolution, blurring of details by contrast leakage, and the inability to selectively evaluate different levels of the retinal and choroidal microvasculature. In addition, these angiographic methods require intravenous dye, which may cause adverse reactions such as nausea, vomiting, and rarely, anaphylaxis. Optical coherence tomography angiography (OCTA) is a noninvasive imaging technique that, in contrast to dye-based angiography, is faster and depth-resolved, allowing in some cases for more precise evaluation of the vascular plexuses of the retina and choroid. The method has been demonstrated in the assessment of various vascular diseases such as venous occlusions, diabetic retinopathy, macular neovascularization, and others. Limitations of this imaging modality include a small registered field of view and the inability to visualize leakage and dye transit over time. It is also subject to a variety of artifacts, including those generated by blinking and eye movement during image acquisition. However, more than an alternative for FA and ICGA, OCTA is bringing new insights to our understanding of retinal and choroidal vascular structure and is changing fundamental paradigms in the clinical management of pathologic conditions. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:848-861.].
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http://dx.doi.org/10.3928/23258160-20160901-09DOI Listing
September 2016

Visualizing the Choriocapillaris Under Drusen: Comparing 1050-nm Swept-Source Versus 840-nm Spectral-Domain Optical Coherence Tomography Angiography.

Invest Ophthalmol Vis Sci 2016 07;57(9):OCT585-90

New England Eye Center Tufts Medical Center, Boston, Massachusetts, United States.

Purpose: To investigate the appearance of choriocapillaris (CC) flow under drusen by comparing long-wavelength (1050 nm) swept-source optical coherence tomography (SS-OCT) angiography with shorter-wavelength (840 nm) spectral-domain (SD) OCT angiography.

Methods: Patients with drusen imaged on both devices on the same day were selected and graded. Ambiguous OCT angiography (OCTA) signal loss was defined as low OCTA signal on the en face OCTA CC image that also had low OCT signal in the corresponding area on the en face OCT CC image and OCT B-scans. Unambiguous OCTA signal loss was defined as low OCTA signal on the en face OCTA CC image that did not have low OCT signal in the corresponding area on the en face OCT CC image and OCT B-scans. False-positive flow impairment on SS-OCTA was defined as ambiguous OCTA signal loss on SS-OCTA but no OCTA signal loss on SD-OCTA. False-positive flow impairment on SD-OCTA was defined as ambiguous OCTA signal loss on SD-OCTA but no OCTA signal loss on SS-OCTA.

Results: Nine eyes from seven patients were enrolled, 23 drusen were analyzed. On 840-nm SD-OCTA, 17 drusen (73.9%) exhibited OCTA signal loss. Fourteen (82.4%) were classified as ambiguous, and three (17.6%) were classified as unambiguous; 10 (58.8%) were classified as having false-positive flow impairment. On 1050-nm SS-OCTA, seven drusen (30.4%) exhibited OCTA signal loss and were classified as unambiguous; none were classified as having false-positive flow impairment.

Conclusions: Results showed that 1050-nm SS-OCTA appears less prone to producing areas of false-positive flow impairment under drusen.
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http://dx.doi.org/10.1167/iovs.15-18915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995042PMC
July 2016

Effect of intravitreal anti-VEGF on choroidal thickness in patients with diabetic macular edema using spectral domain OCT.

Arq Bras Oftalmol 2016 May-Jun;79(3):155-8

Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Purpose: To evaluate choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT) imaging at baseline and 6 months after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular edema (DME).

Methods: A retrospective chart review was performed to identify patients with DME who underwent intravitreal injection of anti-VEGF (bevacizumab or ranibizumab) in a pro re nata (PRN) regimen. Subfoveal choroidal thickness was compared between values obtained at baseline and at 6-month follow-up visits.

Results: Thirty-nine eyes (15 females, 24 males) from 39 patients were enrolled (mean age, 62.43 ± 8.7 years; range, 44-79 years). Twenty-three and 16 eyes were treated with ranibizumab and bevacizumab respectively. The mean number of anti-VEGF injections was 2.28 ± 1.27 (range, 1-5). Mean nasal, subfoveal, and temporal choroidal thickness (CT) measurements at baseline were 234.10 ± 8.63 µm, 246.89 ± 8.94 µm, and 238.12 ± 8.20 µm, respectively, and those at 6 months post-treatment were 210.46 ± 8.00 µm, 215.66 ± 8.29 µm, and 212.43 ± 8.14 µm, respectively. Significant differences in CT were observed between baseline and the 6-month follow-up at all measured points (p=0.0327).

Conclusions: Over a 6-month period, the use of intravitreal anti-VEGF was associated with significant thinning of the choroid in patients with DME. The clinical significance of a thinner choroid in DME is currently unknown; however, it may contribute to long-term adverse effects on choroidal and retinal function, representing an area requiring future investigation.
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http://dx.doi.org/10.5935/0004-2749.20160047DOI Listing
April 2017

Visualization of Changes in the Choriocapillaris, Choroidal Vessels, and Retinal Morphology After Focal Laser Photocoagulation Using OCT Angiography.

Invest Ophthalmol Vis Sci 2016 07;57(9):OCT356-61

New England Eye Center Tufts University School of Medicine, Boston, Massachusetts, United States.

Purpose: To utilize optical coherence tomography (OCT) and OCT angiography (OCTA) to describe alterations in the retinal and choriocapillaris vasculature following remote laser photocoagulation. Lesions are classified on the basis of choriocapillaris alteration as evaluated on en face OCTA.

Methods: This was a retrospective, cross-sectional study analyzing 28 laser photocoagulation scars from 8 patients treated for diabetic macular edema. All eyes were analyzed using a combination of OCTA, en face and cross-sectional OCT, and fundus photography. Two masked readers scored images for alterations at the level of the retinal pigment epithelium (RPE), choroid, and choriocapillaris. Laser photocoagulation lesions were classified as deep if choriocapillaris alteration was present on OCTA; lesions were classified as superficial if no choriocapillaris alteration was present on OCTA.

Results: Optical coherence tomography angiography was found to be useful for evaluation of choriocapillaris alteration underlying regions of laser scarring. Of the 28 analyzed laser scars, 13 were classified as superficial and 15 were classified as deep.

Conclusions: Optical coherence tomography angiography can be used to visualize choriocapillaris alterations associated with focal laser photocoagulation treatment.
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http://dx.doi.org/10.1167/iovs.15-18473DOI Listing
July 2016

Choroidal Neovascularization Analyzed on Ultrahigh-Speed Swept-Source Optical Coherence Tomography Angiography Compared to Spectral-Domain Optical Coherence Tomography Angiography.

Am J Ophthalmol 2016 Apr 4;164:80-8. Epub 2016 Feb 4.

New England Eye Center, Tufts Medical Center, Boston, Massachusetts. Electronic address:

Purpose: To compare visualization of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) using an ultrahigh-speed swept-source (SS) optical coherence tomography angiography (OCTA) prototype vs a spectral-domain (SD) OCTA device.

Design: Comparative analysis of diagnostic instruments.

Methods: Patients were prospectively recruited to be imaged on SD OCT and SS OCT devices on the same day. The SD OCT device employed is the RTVue Avanti (Optovue, Inc, Fremont, California, USA), which operates at ∼840 nm wavelength and 70 000 A-scans/second. The SS OCT device used is an ultrahigh-speed long-wavelength prototype that operates at ∼1050 nm wavelength and 400 000 A-scans/second. Two observers independently measured the CNV area on OCTA en face images from the 2 devices. The nonparametric Wilcoxon signed rank test was used to compare area measurements and P values of <.05 were considered statistically significant.

Results: Fourteen eyes from 13 patients were enrolled. The CNV in 11 eyes (78.6%) were classified as type 1, 2 eyes (14.3%) as type 2, and 1 eye (7.1%) as mixed type. Total CNV area measured using SS OCT and SD OCT 3 mm × 3 mm OCTA were 0.949 ± 1.168 mm(2) and 0.340 ± 0.301 mm(2), respectively (P = .001). For the 6 mm × 6 mm OCTA the total CNV area using SS OCT and SD OCT were 1.218 ± 1.284 mm(2) and 0.604 ± 0.597 mm(2), respectively (P = .0019). The field of view did not significantly affect the measured CNV area (P = .19 and P = .18 for SS OCT and SD OCT, respectively).

Conclusion: SS OCTA yielded significantly larger CNV areas than SD OCTA. It is possible that SS OCTA is better able to demarcate the full extent of CNV vasculature.
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http://dx.doi.org/10.1016/j.ajo.2016.01.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811690PMC
April 2016
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