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      Age- and refraction-related changes in anterior segment anatomical structures measured by swept-source anterior segment OCT

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          Abstract

          Purpose

          To assess the effects of age and refractive status on anterior segment anatomical structures, including the ciliary body, using a new swept-source anterior segment optical coherence tomography (AS-OCT) device.

          Methods

          This prospective observational study included 63 healthy volunteers (mean age: 44.2 years). Images of the anterior segment were obtained using a new swept-source AS-OCT (ANTERION, Heidelberg Engineering GmbH, Heidelberg, Germany) with tracking and image averaging from the right eye of all participants. Repeatability as well as inter- and intra-observer reliability of biometric measurements were evaluated. The impact of image tracking and averaging on ciliary muscle measurements was tested. Univariate and multivariable statistical models were developed to evaluate the relationship of age and refractive status on anterior segment biometric measurements.

          Results

          For all test-retest repeatability and inter- and intra-observer reproducibility of swept-source AS-OCT measurements, high intraclass correlation (ICC) was noted (0.88–1.00). The nasal maximum ciliary muscle thickness (CMTMAX) and distance between scleral spur to the thickest point of the ciliary muscle (SSMAX) were larger than those on the temporal side ( p<0.001 and p = 0.006, respectively). Nasal and temporal CMTMAX ( p = 0.004 and p<0.001, respectively) and lens thickness ( p<0.01) increased with age. Nasal and temporal SSMAX decreased with older age and increasing hyperopia ( p = 0.01 and p<0.001, respectively). Image averaging resulted in improved ciliary muscle measurements ( p = 0.008 to 0.02). Lens vault increased with older age and increased hyperopia ( p<0.01). OCT measurements of the angle decreased with older age and increased hyperopia ( p<0.001 to 0.03). Aqueous depth decreased with older age and increased hyperopia ( p<0.01). Pupil diameter decreased with older age ( p<0.01).

          Conclusions

          Repeatability and reproducibility of biometric measurements using the ANTERION AS-OCT were excellent. Image averaging improved the accuracy of ciliary muscle measurements. The device produced measurements of biometric parameters that described superficial and deep structures including the ciliary body and full lens thickness from a single image.

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          Most cited references46

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          STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT

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            Optical coherence tomography

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              Optical coherence tomography--current and future applications.

              Optical coherence tomography (OCT) has revolutionized the clinical practice of ophthalmology. It is a noninvasive imaging technique that provides high-resolution, cross-sectional images of the retina, retinal nerve fiber layer and the optic nerve head. This review discusses the present applications of the commercially available spectral-domain OCT (SD-OCT) systems in the diagnosis and management of retinal diseases, with particular emphasis on choroidal imaging. Future directions of OCT technology and their potential clinical uses are discussed. Analysis of the choroidal thickness in healthy eyes and disease states such as age-related macular degeneration, central serous chorioretinopathy, diabetic retinopathy and inherited retinal dystrophies has been successfully achieved using SD-OCT devices with software improvements. Future OCT innovations such as longer-wavelength OCT systems including the swept-source technology, along with Doppler OCT and en-face imaging, may improve the detection of subtle microstructural changes in chorioretinal diseases by improving imaging of the choroid. Advances in OCT technology provide for better understanding of pathogenesis, improved monitoring of progression and assistance in quantifying response to treatment modalities in diseases of the posterior segment of the eye. Further improvements in both hardware and software technologies should further advance the clinician's ability to assess and manage chorioretinal diseases.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Validation
                Role: Data curationRole: InvestigationRole: Validation
                Role: MethodologyRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: ResourcesRole: Software
                Role: InvestigationRole: MethodologyRole: Software
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: 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
                23 October 2020
                2020
                : 15
                : 10
                : e0240110
                Affiliations
                [1 ] Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, China
                [2 ] Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
                [3 ] Roski Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, California, United States of America
                [4 ] Department of Ophthalmology, College of Medicine, Gil Medical Center, Gachon University, Incheon, Korea
                Bascom Palmer Eye Institute, UNITED STATES
                Author notes

                Competing Interests: 1) Alex Huang: I have read the journal's policy and the authors of this manuscript have the following competing interests: Heidelberg Engineering provided this device for research; Glaukos Corporation (consultant); Santen (consultant); Allergan (consultant); Gore (consultant); Diagnosys (research support); Aerie (consultant). 2) Ben Xu: I have read the journal's policy and the authors of this manuscript have the following competing interests: Heidelberg Engineering provided this device for research 3)Vas Sadda: I have read the journal's policy and the authors of this manuscript have the following competing interests: Heidelberg Engineering (consultant and research support), Amgen (consultant), Allergan (consultant), Genentech/Roche (consultant), Oxurion (consultant), Novartis (consultant), Regeneron (consultant), Bayer (consultant), 4DMT (consultant), Centervue (consultant), Optos (consultant and research support), Zeiss (research support). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0001-6874-8339
                https://orcid.org/0000-0001-5629-5117
                Article
                PONE-D-20-16290
                10.1371/journal.pone.0240110
                7584205
                33095821
                c1b756be-97a8-4541-89bd-7550baf54efe
                © 2020 Xie 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
                : 31 May 2020
                : 18 September 2020
                Page count
                Figures: 3, Tables: 7, Pages: 18
                Funding
                Funded by: China Scholarship Council Grant (CN)
                Award ID: 201808110001
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100007826, American Glaucoma Society;
                Award ID: MAPS
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000053, National Eye Institute;
                Award ID: K23EY029763
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000053, National Eye Institute;
                Award ID: R01EY030501
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100001818, Research to Prevent Blindness;
                Award ID: Career Development Award
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100001818, Research to Prevent Blindness;
                Award ID: Unrestricted Award to UCLA
                Award Recipient :
                This study was supported by China Scholarship Council Grant (#201808110001), Capital Characteristic Clinic Project of Beijing (Z18110000171808) [XX]. AGS MAPS Award (BX); NIH NEI K23EY029763 [BX]; R01EY030501 [ASH]; Research to Prevent Blindness Career Development Award 2016 [ASH]; an unrestricted grant from Research to Prevent Blindness [UCLA and USC]. The sponsor or funding organization had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Eye Lens
                Medicine and Health Sciences
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                Ocular System
                Ocular Anatomy
                Eye Lens
                Biology and Life Sciences
                Anatomy
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