Abstract
Purpose
Optical coherence tomography angiography (OCT-A) is a novel imaging modality for the diagnosis of chorioretinal diseases. A number of FDA-approved OCT-A devices are currently commercially available, each with unique algorithms and scanning protocols. Although several published studies have compared different combinations of OCT-A machines, there is a lack of agreement on the consistency of measurements across OCT-A devices. Therefore, we conducted a prospective quantitative comparison of four available OCT-A platforms.
Methods
Subjects were scanned on four devices: Optovue RTVue-XR, Heidelberg Spectralis OCT2 module, Zeiss Plex Elite 9000 Swept-Source OCT, and Topcon DRI-OCT Triton Swept-Source OCT. 3 mm × 3 mm images were utilized for analysis. Foveal avascular zone (FAZ) area was separately and independently measured by two investigators. Fractal dimension (FD), superficial capillary plexus (SCP), and deep capillary plexus (DCP) vessel densities (VD) were calculated from binarized images using the Fiji image processing software. SCP and DCP VD were further calculated after images were skeletonized. Repeated measures ANOVA, post hoc tests, and interclass correlation coefficient (ICC) were performed for statistical analysis.
Results
Sixteen healthy eyes from sixteen patients were scanned on the four devices. Images of five eyes from the Triton device were excluded due to poor image quality; thus, the authors performed two sets comparisons, one with and one without the Triton machine. FAZ area showed no significant difference across devices with an ICC of > 95%. However, there were statistically significant differences for SCP and DCP VD both before and after skeletonization (p < 0.05). Fractal analysis revealed no significant difference of FD at the SCP; however, a statistically significant difference was found for FD at the DCP layer (p < 0.05).
Conclusions
The results showed that FAZ measurements were consistent across all four devices, while significant differences in VD and FD measurements existed. Therefore, we suggest that for both clinical follow-up and research studies, FAZ area is a useful parameter for OCT-A image analysis when measurements are made on different machines, while VD and FD show significant variability when measured across devices.
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References
Khalid H, Schwartz R, Nicholson L et al (2020) Widefield optical coherence tomography angiography for early detection and objective evaluation of proliferative diabetic retinopathy. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2019-315365
Cui Y, Zhu Y, Wang JC et al (2019) Imaging artifacts and segmentation errors with wide-field swept-source optical coherence tomography angiography in diabetic retinopathy. Transl Vis Sci Technol. https://doi.org/10.1167/tvst.8.6.18
Choi M, Kim S-W, Yun C, Oh J (2020) OCT angiography features of neovascularization as predictive factors for frequent recurrence in age-related macular degeneration. Am J Ophthalmol. https://doi.org/10.1016/j.ajo.2020.01.012
Zhu Y, Cui Y, Wang JC et al (2020) Different scan protocols affect the detection rates of diabetic retinopathy lesions by wide-field swept-source optical coherence tomography angiography. Am J Ophthalmology. https://doi.org/10.1016/j.ajo.2020.03.004
Kashani AH, Lee SY, Moshfeghi A, Durbin MK, Puliafeto CA (2015) Optical coherence tomography angiography of retinal venous occlusion. Retina 35(11):2323–2331. https://doi.org/10.1097/IAE.0000000000000811
Wang JC, Lu Y, Sobrin L, Husain D (2020) Multimodal imaging in acute retinal necrosis presenting with macular involvement. Retin Cases Brief Rep. https://doi.org/10.1097/ICB.0000000000000978
Naseripour M, Ghasemi Falavarjani K, Mirshahi R, Sedaghat A (2020) Optical coherence tomography angiography (OCTA) applications in ocular oncology. Eye Lond Engl. https://doi.org/10.1038/s41433-020-0819-y
Kashani AH, Chen C-L, Gahm JK et al (2017) Optical coherence tomography angiography: a comprehensive review of current methods and clinical applications. Prog Retin Eye Res 60:66–100
Zhang A, Zhang Q, Chen CL, Wang RK (2015) Methods and algorithms for optical coherence tomography-based angiography: a review and comparison. J Biomed Opt 20(10):100901. https://doi.org/10.1117/1.JBO.20.10.100901
Li XX, Wu W, Zhou H et al (2018) A quantitative comparison of five optical coherence tomography angiography systems in clinical performance. Int J Ophthalmol 11(11):1784–1795. https://doi.org/10.18240/ijo.2018.11.09
Corvi F, Pellegrini M, Erba S, Cozzi M, Staurenghi G, Giani A (2018) Reproducibility of vessel density, fractal dimension, and foveal avascular zone using 7 different optical coherence tomography angiography devices. Am J Ophthalmol 186:25–31. https://doi.org/10.1016/j.ajo.2017.11.011
Lu Y, Wang JC, Zeng R et al (2019) Quantitative comparison of microvascular metrics on three optical coherence tomography angiography devices in chorioretinal disease. Clin Ophthalmol Auckl NZ 13:2063–2069. https://doi.org/10.2147/OPTH.S215322
Munk MR, Giannakaki-Zimmermann H, Berger L et al (2017) OCT-angiography: a qualitative and quantitative comparison of 4 OCT-A devices. PLoS One 12(5):e0177059. https://doi.org/10.1371/journal.pone.0177059
Al-Sheikh M, Falavarjani KG, Tepelus TC et al (2017) Quantitative comparison of swept-source and spectral-domain OCT angiography in healthy eyes. Ophthalmic Surg Lasers Imaging Retina 48(5):385–391
Falavarjani KG, Shenazandi H, Naseri D et al (2018) Foveal avascular zone and vessel density in healthy subjects: an optical coherence tomography angiography study. J Ophthalmic Vis Res 13(3):260–265
Rocholz R, Teussink MM, Dolz-Marco R, Holzhey C, Dechent JF, Tafreshi A, Schulz S (2018) SPECTRALIS optical coherence tomography angiography (OCTA): principles and clinical applications. Heidelberg Engineering Academy. https://www.heidelbergengineering.com/media/e-learning/Totara/Dateien/pdf-tutorials/210111-001_SPECTRALIS%20OCTA%20-%20Principles%20and%20Clinical%20Applications_EN.pdf
Yarmohammadi A, Zangwill LM, Diniz-Filho A et al (2016) Relationship between optical coherence tomography angiography vessel density and severity of visual field loss in glaucoma. Ophthalmology 123(12):2498–2508
Mihailovic N, Brand C, Lahme L et al (2018) Repeatability, reproducibility and agreement of foveal avascular zone measurements using three different optical coherence tomography angiography devices. PLoS One 13(10):e0206045. Published 2018 Oct 18. https://doi.org/10.1371/journal.pone.0206045
Shoji T, Yoshikawa Y, Kanno J et al (2018) Reproducibility of macular vessel density calculations via imaging with two different swept-source optical coherence tomography angiography systems. Transl Vis Sci Technol 7(6):31. Published 2018 Dec 21. https://doi.org/10.1167/tvst.7.6.31
Ohayon A, Sacconi R, Semoun O et al (2020) Choroidal neovascular area and vessel density comparison between two swept-source optical coherence tomography angiography devices. Retina. 40(3):521–528. https://doi.org/10.1097/IAE.0000000000002430
Chen Q, Ma Q, Wu C et al (2017) Macular vascular fractal dimension in the deep capillary layer as an early indicator of microvascular loss for retinopathy in type 2 diabetic patients. Invest Ophthalmol Vis Sci 58(9):3785–3794. https://doi.org/10.1167/iovs.17-21461
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Lu, Y., Wang, J.C., Cui, Y. et al. A quantitative comparison of four optical coherence tomography angiography devices in healthy eyes. Graefes Arch Clin Exp Ophthalmol 259, 1493–1501 (2021). https://doi.org/10.1007/s00417-020-04945-9
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DOI: https://doi.org/10.1007/s00417-020-04945-9