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Toward quantitative and reproducible clinical use of OCT-Angiography

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      Abstract

      Optical coherence tomography angiography (OCT-A) is an ophthalmic imaging technique which has recently been introduced to clinical use. OCT-A provides visualization of the retinal vascularization in three dimensions, without injection of contrast agents. OCT-A could thus replace the current standard of opthalmic imaging, which is 2D only and requires contrast agents. However, quantitative studies remain to be carried out to assess the full potential of OCT-A. In this context, the present work proposes a methodology to perform OCT-A in a more reproducible and precise way. We introduce a procedure to automatically extract the area of interest in avascular regions, which we demonstrate on various avascular areas with a focus on the optic nerve extracted in 2-dimensional images for a selected depth. We then study the repeatability of OCT-A with our segmentation technique when implemented on various clinical devices. For illustration, we apply this segmentation to healthy control group and to patients presenting different stages of glaucoma, a disease of clinical interest. The variability observed between these two cohorts compares favorably to the variability due to instrumental limitations or the segmentation algorithm. Our results thus constitute a significant step toward a more quantitative use of OCT-A in a clinical context.

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      Optical coherence tomography angiography of optic disc perfusion in glaucoma.

      To compare optic disc perfusion between normal subjects and subjects with glaucoma using optical coherence tomography (OCT) angiography and to detect optic disc perfusion changes in glaucoma.
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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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          Quantitative optical coherence tomography angiography of vascular abnormalities in the living human eye.

          Retinal vascular diseases are important causes of vision loss. A detailed evaluation of the vascular abnormalities facilitates diagnosis and treatment in these diseases. Optical coherence tomography (OCT) angiography using the highly efficient split-spectrum amplitude decorrelation angiography algorithm offers an alternative to conventional dye-based retinal angiography. OCT angiography has several advantages, including 3D visualization of retinal and choroidal circulations (including the choriocapillaris) and avoidance of dye injection-related complications. Results from six illustrative cases are reported. In diabetic retinopathy, OCT angiography can detect neovascularization and quantify ischemia. In age-related macular degeneration, choroidal neovascularization can be observed without the obscuration of details caused by dye leakage in conventional angiography. Choriocapillaris dysfunction can be detected in the nonneovascular form of the disease, furthering our understanding of pathogenesis. In choroideremia, OCT's ability to show choroidal and retinal vascular dysfunction separately may be valuable in predicting progression and assessing treatment response. OCT angiography shows promise as a noninvasive alternative to dye-based angiography for highly detailed, in vivo, 3D, quantitative evaluation of retinal vascular abnormalities.
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            Author and article information

            Affiliations
            [1 ] LARIS, UMR INRA IRHS, Université d’Angers, 62 Avenue Notre Dame du Lac, 49000 Angers, France
            [2 ] Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
            Charite Universitatsmedizin Berlin, GERMANY
            Author notes

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

            Contributors
            Role: Data curation, Role: Investigation, Role: Methodology, Role: Resources, Role: Validation, Role: Writing – original draft
            ORCID: http://orcid.org/0000-0002-7935-1609, Role: Conceptualization, Role: Formal analysis, Role: Investigation, Role: Methodology, Role: Resources, Role: Software, Role: Supervision, Role: Validation, Role: Visualization, Role: Writing – original draft, Role: Writing – review & editing
            Role: Conceptualization, Role: Data curation
            Role: Data curation, Role: Funding acquisition, Role: Project administration, Role: Supervision
            Role: Data curation, Role: Funding acquisition, Role: Project administration, Role: Supervision
            Role: Editor
            Journal
            PLoS One
            PLoS ONE
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, CA USA )
            1932-6203
            2018
            6 July 2018
            : 13
            : 7
            29979719 6034792 PONE-D-17-28470 10.1371/journal.pone.0197588
            © 2018 Douma 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.

            Counts
            Figures: 4, Tables: 5, Pages: 13
            Product
            Funding
            The author(s) received no specific funding for this work.
            Categories
            Research Article
            Biology and Life Sciences
            Anatomy
            Ocular System
            Optic Nerve
            Medicine and Health Sciences
            Anatomy
            Ocular System
            Optic Nerve
            Medicine and Health Sciences
            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
            Ophthalmology
            Eye Diseases
            Glaucoma
            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
            Research and Analysis Methods
            Imaging Techniques
            Biology and Life Sciences
            Anatomy
            Cardiovascular Anatomy
            Blood Vessels
            Retinal Vessels
            Medicine and Health Sciences
            Anatomy
            Cardiovascular Anatomy
            Blood Vessels
            Retinal Vessels
            Biology and Life Sciences
            Anatomy
            Ocular System
            Ocular Anatomy
            Retinal Vessels
            Medicine and Health Sciences
            Anatomy
            Ocular System
            Ocular Anatomy
            Retinal Vessels
            Biology and Life Sciences
            Anatomy
            Ocular System
            Ocular Anatomy
            Retina
            Medicine and Health Sciences
            Anatomy
            Ocular System
            Ocular Anatomy
            Retina
            Medicine and Health Sciences
            Surgical and Invasive Medical Procedures
            Ophthalmic Procedures
            Cataract Surgery
            Custom metadata
            All relevant data are available in the manuscript and Supporting Information files. The MACRO is also available at: https://doi.org/10.6084/m9.figshare.6281498.v1 The images are also available at: https://doi.org/10.6084/m9.figshare.6281525.v1.

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