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      Repeatability, reproducibility and agreement of foveal avascular zone measurements using three different optical coherence tomography angiography devices

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          Abstract

          Purpose

          To evaluate the repeatability, the reproducibility and the agreement of foveal avascular zone (FAZ) measurements using three different optical coherence tomography angiography (OCT-A) devices.

          Procedures

          This prospective study included 24 eyes of 24 healthy volunteers. OCT-A imaging was performed using RTVue XR Avanti, Canon OCT-HS100 and Spectralis OCT-A. Repeated measurements were performed under the same conditions on two separate days, and the area of the FAZ was determined and analyzed using the above devices.

          Results

          All three devices showed a high ICC and there was no significant difference between the ICCs (pairwise comparison) of the three devices (Optovue–Canon (p = 0.66); Canon–Heidelberg (p = 0.21); Heidelberg–Optovue (p = 0.37). Agreement analysis of the three devices revealed a significant elevation of FAZ area values with the Heidelberg device and a slight underestimation of the FAZ area with the Canon device. Nevertheless, overall we found a high level of agreement between all of the three devices (ICC ≥ 0.958 (0.905–0.982)).

          Conclusions

          Good reproducibility and repeatability were observed for all three devices. However, the agreement analysis revealed slight, but significant differences, which might limit alternating use of these devices for clinical research and follow-up examinations.

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          Most cited references18

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          A review of optical coherence tomography angiography (OCTA)

          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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            CORRELATION OF FOVEAL AVASCULAR ZONE SIZE WITH FOVEAL MORPHOLOGY IN NORMAL EYES USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

            To analyze the foveal avascular zone (FAZ) in normal eyes using optical coherence tomography angiography.
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              Visual Acuity Is Correlated with the Area of the Foveal Avascular Zone in Diabetic Retinopathy and Retinal Vein Occlusion.

              To determine if the area of the foveal avascular zone (FAZ) is correlated with visual acuity (VA) in diabetic retinopathy (DR) and retinal vein occlusion (RVO).
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: ConceptualizationRole: Data curation
                Role: Formal analysisRole: MethodologyRole: Software
                Role: ConceptualizationRole: SupervisionRole: Validation
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: Project administrationRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 October 2018
                2018
                : 13
                : 10
                : e0206045
                Affiliations
                [1 ] Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
                [2 ] Institute of Reproductive and Regenerative Biology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
                [3 ] Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany, Muenster, Germany
                Save Sight Institute, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-6747-4751
                Article
                PONE-D-18-08162
                10.1371/journal.pone.0206045
                6193722
                30335839
                56c81681-1923-4cc4-8a44-d2f3509fd167
                © 2018 Mihailovic et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 March 2018
                : 5 October 2018
                Page count
                Figures: 3, Tables: 3, Pages: 10
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Biology and Life Sciences
                Anatomy
                Head
                Eyes
                Medicine and Health Sciences
                Anatomy
                Head
                Eyes
                Biology and Life Sciences
                Anatomy
                Ocular System
                Eyes
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Eyes
                Biology and Life Sciences
                Bioengineering
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                Engineering and Technology
                Bioengineering
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                Medical Devices and Equipment
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                Medical Devices and Equipment
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                Cardiovascular Medicine
                Cardiovascular Imaging
                Angiography
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Cardiovascular Imaging
                Angiography
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Cardiovascular Imaging
                Angiography
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Cardiovascular Imaging
                Angiography
                Medicine and Health Sciences
                Diagnostic Medicine
                Diagnostic Radiology
                Tomography
                Research and Analysis Methods
                Imaging Techniques
                Diagnostic Radiology
                Tomography
                Medicine and Health Sciences
                Radiology and Imaging
                Diagnostic Radiology
                Tomography
                Medicine and Health Sciences
                Ophthalmology
                Retinal Disorders
                Retinopathy
                Diabetic Retinopathy
                Medicine and Health Sciences
                Ophthalmology
                Eye Diseases
                Medicine and Health Sciences
                Ophthalmology
                Retinal Disorders
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