Choriocapillaris Vascular Density Changes in Patients with Drusen: Cross-Sectional Study Based on Optical Coherence Tomography Angiography Findings

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Abstract

Introduction

The purpose of this study was to investigate the extent and morphology of the choriocapillaris’ density defect in patients with drusen in non-neovascular age-related macular degeneration (AMD).

Methods

Participants in this study were 36 patients with non-neovascular AMD and drusen. All patients underwent best-corrected visual acuity, slit-lamp examination, spectral domain-optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA).

Results

In all studied cases, the presence of drusen was associated with choriocapillaris’ reduced blood flow signal of different extent and severity. Three types of choriocapillaris’ non-perfusion were observed, along with an association between the size of drusen and the morphology of choriocapillaris’ density defect. Moreover, the extent of choriocapillaris’ density change has been related to ellipsoid zone disruption and therefore to visual impairment.

Conclusions

Our study showed that in patients with drusen due to non-neovascular AMD, there is choriocapillaris’ impairment of different morphology in OCTA, which is mainly related to the size and location of the drusen.

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Most cited references 16

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A review of optical coherence tomography angiography (OCTA)

Talisa de Carlo, André Romano, Nadia K. Waheed … (2015)

Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging technique that generates volumetric angiography images in a matter of seconds. This is a nascent technology with a potential wide applicability for retinal vascular disease. At present, level 1 evidence of the technology’s clinical applications doesn’t exist. In this paper, we introduce the technology, review the available English language publications regarding OCTA, and compare it with the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA). Finally we summarize its potential application to retinal vascular diseases. OCTA is quick and non-invasive, and provides volumetric data with the clinical capability of specifically localizing and delineating pathology along with the ability to show both structural and blood flow information in tandem. Its current limitations include a relatively small field of view, inability to show leakage, and proclivity for image artifact due to patient movement/blinking. Published studies hint at OCTA’s potential efficacy in the evaluation of common ophthalmologic diseases such age related macular degeneration (AMD), diabetic retinopathy, artery and vein occlusions, and glaucoma. OCTA can detect changes in choroidal blood vessel flow and can elucidate the presence of choroidal neovascularization (CNV) in a variety of conditions but especially in AMD. It provides a highly detailed view of the retinal vasculature, which allows for accurate delineation of the foveal avascular zone (FAZ) in diabetic eyes and detection of subtle microvascular abnormalities in diabetic and vascular occlusive eyes. Optic disc perfusion in glaucomatous eyes is notable as well on OCTA. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.

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The Age-Related Eye Disease Study severity scale for age-related macular degeneration: AREDS Report No. 17.

Angenee C. Milton, Mao-Yin Lee, Ronald Klein … (2005)

To develop a fundus photographic severity scale for age-related macular degeneration (AMD). In the Age-Related Eye Disease Study, stereoscopic color fundus photographs were taken at baseline, at the 2-year follow-up visit, and annually thereafter. Photographs were graded for drusen characteristics (size, type, area), pigmentary abnormalities (increased pigment, depigmentation, geographic atrophy), and presence of abnormalities characteristic of neovascular AMD (retinal pigment epithelial detachment, serous or hemorrhagic sensory retinal detachment, subretinal or sub-retinal pigment epithelial hemorrhage, subretinal fibrous tissue). Advanced AMD was defined as presence of 1 or more neovascular AMD abnormalities, photocoagulation for AMD, or geographic atrophy involving the center of the macula. We explored associations among right eyes of 3212 participants between severity of drusen characteristics and pigmentary abnormalities at baseline and development of advanced AMD within 5 years of follow-up. A 9-step severity scale that combines a 6-step drusen area scale with a 5-step pigmentary abnormality scale was developed, on which the 5-year risk of advanced AMD increased progressively from less than 1% in step 1 to about 50% in step 9. Among the 334 eyes that had at least a 3-step progression on the scale between the baseline and 5-year visits, almost half showed stepwise progression through intervening severity levels at intervening visits. Replicate gradings showed agreement within 1 step on the scale in 87% of eyes. The scale provides convenient risk categories and has acceptable reproducibility. Progression along it may prove to be useful as a surrogate for progression to advanced AMD.

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Prevalence of age-related macular degeneration in the US population.

Xinzhi Zhang, Dai-Fang Chou, Jinan B Saaddine … (2010)

To examine the prevalence of age-related macular degeneration (AMD) in non-Hispanic white, non-Hispanic black, Mexican American, and other racial/ethnic groups. A US nationally representative, population-based, cross-sectional study involving a total of 5553 persons aged 40 years and older from the 2005-2008 National Health and Nutrition Examination Survey. The main outcome measure was AMD determined by the grading of 45° digital images from both eyes using a standardized protocol. In the civilian, noninstitutionalized, US population aged 40 years and older, the estimated prevalence of any AMD was 6.5% (95% confidence interval, 5.5-7.6) and the estimated prevalence of late AMD was 0.8% (95% confidence interval, 0.5-1.3). Non-Hispanic black persons aged 60 years and older had a statistically significantly lower prevalence of any AMD than non-Hispanic white persons aged 60 years and older (odds ratio = 0.37; 95% confidence interval, 0.21-0.67). Overall, the prevalence of any AMD in the 2005-2008 National Health and Nutrition Examination Survey was 6.5%, which is lower than the 9.4% prevalence reported in the 1988-1994 Third National Health and Nutrition Examination Survey. While this finding might be explained in part by possible methodological differences, these estimates are consistent with a decreasing incidence of AMD and suggest important public health care implications.

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Author and article information

Contributors

Irini Chatziralli: eirchat@yahoo.gr

Journal

Journal ID (nlm-ta): Ophthalmol Ther

Journal ID (iso-abbrev): Ophthalmol Ther

Title: Ophthalmology and Therapy

Publisher: Springer Healthcare (Cheshire )

ISSN (Print): 2193-8245

ISSN (Electronic): 2193-6528

Publication date (Electronic): 30 January 2018

Publication date PMC-release: 30 January 2018

Publication date (Print): June 2018

Volume: 7

Issue: 1

Pages: 101-107

Affiliations

[1 ]ISNI 0000 0001 2155 0800, GRID grid.5216.0, 2nd Department of Ophthalmology, , University of Athens, ; Athens, Greece

[2 ]Macula Center, Athens, Greece

Article

Publisher ID: 119

DOI: 10.1007/s40123-018-0119-9

PMC ID: 5997591

PubMed ID: 29383674

SO-VID: 4c1c4914-92f0-4a43-9b49-6021a5078fa7

History

Date received : 20 November 2017

Choriocapillaris Vascular Density Changes in Patients with Drusen: Cross-Sectional Study Based on Optical Coherence Tomography Angiography Findings

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Abstract

Introduction

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Conclusions

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Communication Through Coherence

Most cited references 16

A review of optical coherence tomography angiography (OCTA)

The Age-Related Eye Disease Study severity scale for age-related macular degeneration: AREDS Report No. 17.

Prevalence of age-related macular degeneration in the US population.

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