1. Articles from Jay S. Duker

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    1. Repeatability and reproducibility of vessel density measurements on optical coherence tomography angiography in diabetic retinopathy

      Repeatability and reproducibility of vessel density measurements on optical coherence tomography angiography in diabetic retinopathy

      Purpose Understanding the precision of measurements on and across optical coherence tomography angiography (OCTA) devices is critical for tracking meaningful change in disease. The purpose of this study is to investigate the repeatability and reproducibility of vessel area density and vessel skeleton density measurements from various commercial OCTA devices in diabetic eyes. Methods Patients were imaged three consecutive times each on three different OCTA devices. En face OCTA images of the superficial capillary plexus, deep capillary plexus, and full retinal layer were exported for analysis. Vessel area density and vessel skeleton density were calculated. The coefficient of repeatability (CoR) was ...

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    2. Topographic analysis of macular choriocapillaris flow deficits in diabetic retinopathy using swept–source optical coherence tomography angiography

      Topographic analysis of macular choriocapillaris flow deficits in diabetic retinopathy using swept–source optical coherence tomography angiography

      Background The purpose of this study was to investigate the association between diabetic retinopathy (DR) severity and macular choriocapillaris (CC) flow deficit percentage (FD %) in different macular regions using swept-source optical coherence tomography angiography (SS-OCTA). Methods Diabetic patients with SS-OCTA images were graded by severity and retrospectively assessed. CC FD % was calculated in four different regions of the OCTA image: inner, middle, outer, and full-field region. The generalized estimating equations (GEE) approach for clustered eye data was used to determine effect size and significance of age and disease severity on FD % for each region. Results 160 eyes from 90 total ...

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    3. SPATIAL DISTRIBUTION OF CHORIOCAPILLARIS IMPAIRMENT IN EYES WITH CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION: A Quantitative OCT Angiography Study

      SPATIAL DISTRIBUTION OF CHORIOCAPILLARIS IMPAIRMENT IN EYES WITH CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION: A Quantitative OCT Angiography Study

      Purpose: To develop an optical coherence tomography angiography ( OCTA )-based framework for quantitatively analyzing the spatial distribution of choriocapillaris (CC) impairment around choroidal neovascularization ( CNV ) secondary to age-related macular degeneration. Methods: In a retrospective, cross-sectional study, 400-kHz swept-source OCTA images from 7 eyes of 6 patients with CNV secondary to age-related macular degeneration were quantitatively analyzed using custom software. A lesion-centered zonal OCTA analysis technique—which portioned the field-of-view into zones relative to CNV boundaries—was developed to quantify the spatial dependence of CC flow deficits. Results: Quantitative, lesion-centered zonal analysis of CC OCTA images revealed highest flow-deficit percentages near ...

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    4. How SD-OCT is enhancing our management of DR

      How SD-OCT is enhancing our management of DR

      Laser therapy was a major breakthrough in diabetic retinopathy treatment, with its efficacy validated by a number of clinical studies in the last three decades of the 20th century. However, it relied on fundus photography and fluorescein angiography to diagnose clinically significant macular edema. Since then, optical coherence tomography has revolutionized the clinical management of diabetic macular edema because of its widespread availability, ease of use, and ability to quantify DME noninvasively. This tool has become even more powerful coupled with the emergence of pharmacotherapies to treat the disease. Here, we review how OCT has changed the way retina specialists ...

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    5. A Framework for Multiscale Quantitation of Relationships Between Choriocapillaris Flow Impairment and Geographic Atrophy Growth

      A Framework for Multiscale Quantitation of Relationships Between Choriocapillaris Flow Impairment and Geographic Atrophy Growth

      Purpose To develop a multiscale analysis framework for investigating the relationships between geographic atrophy (GA) growth rate and choriocapillaris (CC) blood flow impairment using optical coherence tomography (OCT) and OCT angiography (OCTA). Design Retrospective case series. Methods We developed an OCT/OCTA analysis framework that quantitatively measures GA growth rates at global and local scales, and CC impairment at global, zonal, and local scales. A geometric GA growth model was used to measure local GA growth rates. The utility of the framework was demonstrated on 7 eyes with GA imaged at two time points using a prototype 400 kHz, 1050 ...

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    6. Global Analysis of Macular Choriocapillaris Perfusion in Dry Age-Related Macular Degeneration using Swept-Source Optical Coherence Tomography Angiography

      Global Analysis of Macular Choriocapillaris Perfusion in Dry Age-Related Macular Degeneration using Swept-Source Optical Coherence Tomography Angiography

      Purpose : Swept-source optical coherence tomography angiography (SS-OCTA) was used to investigate if the clinical stage of dry age-related macular degeneration (AMD) was correlated with global and regional macular choriocapillaris (CC) perfusion. Methods : In this retrospective, cross-sectional study, 6 × 6-mm SS-OCTA images from eyes with early, intermediate, and advanced dry AMD (56 eyes, 41 patients) were analyzed using algorithms described in the literature to assess regional flow deficit percentage (FD%) and average flow deficit size. Regions were defined by concentric areas centered on the fovea: a 1-mm-diameter area, 3-mm-diameter ring, 5-mm-diameter area, 5-mm-diameter ring, and 6 × 6-mm whole image. Data were ...

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    7. Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy

      Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy

      Purpose : To evaluate whether retinal capillary nonperfusion is found predominantly adjacent to arteries or veins in eyes with diabetic retinopathy (DR). Methods : Sixty-three eyes from 44 patients with proliferative DR (PDR) or non-PDR (NPDR) were included. Images (12 × 12-mm) foveal-centered optical coherence tomography (OCT) angiography (OCTA) images were taken using the Zeiss Plex Elite 9000. In 37 eyes, widefield montages with five fixation points were also obtained. A semiautomatic algorithm that detects nonperfusion in full-retina OCT slabs was developed, and the percentages of capillary nonperfusion within the total image area were calculated. Retinal arteries and veins were manually traced. Based ...

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    8. Controlling for Artifacts in Widefield Optical Coherence Tomography Angiography Measurements of Non-Perfusion Area

      Controlling for Artifacts in Widefield Optical Coherence Tomography Angiography Measurements of Non-Perfusion Area

      The recent clinical adoption of optical coherence tomography (OCT) angiography (OCTA) has enabled non-invasive, volumetric visualization of ocular vasculature at micron-scale resolutions. Initially limited to 3 mm × 3 mm and 6 mm × 6 mm fields-of-view (FOV), commercial OCTA systems now offer 12 mm × 12 mm, or larger, imaging fields. While larger FOVs promise a more complete visualization of retinal disease, they also introduce new challenges to the accurate and reliable interpretation of OCTA data. In particular, because of vignetting, wide-field imaging increases occurrence of low-OCT-signal artifacts, which leads to thresholding and/or segmentation artifacts, complicating OCTA analysis. This study presents ...

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    9. Impact of Binarization Thresholding and Brightness/Contrast Adjustment Methodology on Optical Coherence Tomography Angiography Image Quantification

      Impact of Binarization Thresholding and Brightness/Contrast Adjustment Methodology on Optical Coherence Tomography Angiography Image Quantification

      Purpose Binarization is a critical technique in OCTA image analysis, but there is no consistency in the method used in published OCTA studies. This study assessed whether differences in OCTA binarization and brightness/contrast adjustments affect quantification metrics. Design Prospective cross-sectional validity study Methods This was a single-center study examining 21 eyes of 11 healthy individuals. All eyes were imaged using the Carl Zeiss PLEX Elite 9000 swept source-OCTA, and quantitative metrics resulting from five binarization thresholding and five brightness/contrast adjustment methodologies were compared. All metrics were calculated for the superficial plexus and choriocapillaris (CC), as well as unaveraged ...

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    10. Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects

      Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects

      Background/Aims Hydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing. Methods Data from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal ...

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    11. QUANTIFICATION OF RETINAL CAPILLARY NONPERFUSION IN DIABETICS USING WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

      QUANTIFICATION OF RETINAL CAPILLARY NONPERFUSION IN DIABETICS USING WIDE-FIELD OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

      Purpose: To combine advances in high-speed, wide-field optical coherence tomography angiography ( OCTA ) with image processing methods for semiautomatic quantitative analysis of capillary nonperfusion in patients with diabetic retinopathy (DR). Methods: Sixty-eight diabetic patients (73 eyes), either without retinopathy or with different degrees of retinopathy, were prospectively recruited for volumetric swept-source OCTA imaging using 12 mm × 12 mm fields centered at the fovea. A custom, semiautomatic software algorithm was used to quantify areas of capillary nonperfusion . Results: The mean percentage of nonperfused area was 0.1% (95% confidence interval: 0.0–0.4) in the eyes without DR; 2.1% (95 ...

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    12. Microscope-Integrated Intraoperative Ultrahigh-Speed Swept-Source Optical Coherence Tomography for Widefield Retinal and Anterior Segment Imaging

      Microscope-Integrated Intraoperative Ultrahigh-Speed Swept-Source Optical Coherence Tomography for Widefield Retinal and Anterior Segment Imaging

      BACKGROUND AND OBJECTIVE: To demonstrate the feasibility of retinal and anterior segment intraoperative widefield imaging using an ultrahigh-speed, swept-source optical coherence tomography (SS-OCT) surgical microscope attachment. PATIENTS AND METHODS: A prototype post-objective SS-OCT using a 1,050-nm wavelength, 400 kHz A-scan rate, vertical cavity surface-emitting laser (VCSEL) light source was integrated to a commercial ophthalmic surgical microscope after the objective. Each widefield OCT data set was acquired in 3 seconds (1,000 × 1,000 A-scans, 12 × 12 mm 2 for retina and 10 × 10 mm 2 for anterior segment). RESULTS: Intraoperative SS-OCT was performed in 20 eyes of 20 patients ...

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    13. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY TO DETECT MACULAR CAPILLARY ISCHEMIA IN PATIENTS WITH INNER RETINAL CHANGES AFTER RESOLVED DIABETIC MACULAR EDEMA

      OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY TO DETECT MACULAR CAPILLARY ISCHEMIA IN PATIENTS WITH INNER RETINAL CHANGES AFTER RESOLVED DIABETIC MACULAR EDEMA

      To compare foveal vascular anatomy between patients with and without disorganization of retinal inner layers (DRILs) after resolved diabetic macular edema using optical coherence tomography angiography (OCTA). Methods: Twenty-four eyes of 21 age- and sex-matched patients with resolved diabetic macular edema were included in this retrospective, cross-sectional study. All eyes were imaged with enhanced high-definition line or cross-line structural B scans and 3 × 3-mm OCTA scans. Optical coherence tomography B scans were analyzed for the presence of DRIL, and based on this, eyes were classified as either DRIL present or DRIL absent. The foveal avascular zone area on OCTA was ...

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    14. Polypoidal Choroidal Vasculopathy on Swept-Source Optical Coherence Tomography Angiography with Variable Interscan Time Analysis

      Polypoidal Choroidal Vasculopathy on Swept-Source Optical Coherence Tomography Angiography with Variable Interscan Time Analysis

      Purpose : To use a novel optical coherence tomography angiography (OCTA) algorithm termed variable interscan time analysis (VISTA) to evaluate relative blood flow speeds in polypoidal choroidal vasculopathy (PCV). Methods : Prospective cross-sectional study enrolling patients with confirmed diagnosis of PCV. OCTA of the retina and choroid was obtained with a prototype swept-source OCT system. The acquired OCT volumes were centered on the branching vascular network (BVN) and polyps as determined by indocyanine-green angiography (ICGA). The relative blood flow speeds were characterized on VISTA-OCTA. Results : Seven eyes from seven patients were evaluated. Swept-source OCTA enabled detailed enface visualization of the BVN and ...

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    15. Image Averaging, a Powerful Tool in Optical Coherence Tomography and OCT Angiography

      Image Averaging, a Powerful Tool in Optical Coherence Tomography and OCT Angiography

      In an elegantly conducted study, Uji et al 1 describe the association of averaging multiple en face images with the quality of the optical coherence tomography angiography (OCTA) images of the choroidal microvasculature. They demonstrate that the resulting vascular images approximate much more closely the structure of the choriocapillaris as visualized histopathologically. This is an interesting and potentially important advance in the ability of OCTA to image the choriocapillaris in vivo.

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    16. Diagnosing Choroidal Neovascularization in Asymptomatic Individuals Using Optical Coherence Tomography Angiography

      Diagnosing Choroidal Neovascularization in Asymptomatic Individuals Using Optical Coherence Tomography Angiography

      Optical coherence tomography angiography (OCTA) is a noninvasive, rapid imaging technique that generates angiographic images without intravenous dye injections. Cross-sectional studies have described the presence of asymptomatic choroidal neovascularization (CNV) in patients with intermediate age-related macular degeneration (AMD). This case report describes the OCT features on longitudinal follow-up of a patient who started with unilateral asymptomatic CNV and eventually developed symptomatic exudative AMD.

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    17. Visualization of changes in the foveal avascular zone in both observed and treated diabetic macular edema using optical coherence tomography angiography

      Visualization of changes in the foveal avascular zone in both observed and treated diabetic macular edema using optical coherence tomography angiography

      Background Central vision loss in diabetic retinopathy is commonly related to diabetic macular edema (DME). The objective of this study was to describe changes between consecutive visits on optical coherence tomography angiography (OCTA) of the foveal avascular zone (FAZ) in eyes with DME. Methods 20 eyes from 14 patients with DME were imaged on 2 successive clinic visits separated by at least 1 month. The mean interval between visits was 3.2 months. The only intervention used was intravitreal anti-VEGF in 11 eyes; the others were observed over time without treatment. Two different readers measured FAZ area using a pseudo-automated ...

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    18. Analysis Of AGE-RELATED Choroidal Layers Thinning In Healthy Eyes Using SWEPT-SOURCE Optical Coherence Tomography

      Analysis Of AGE-RELATED Choroidal Layers Thinning In Healthy Eyes Using SWEPT-SOURCE Optical Coherence Tomography

      Purpose: To study the changes in the choroidal layers thickness with age in a healthy population using swept-source optical coherence tomography. Methods: Retrospective data analysis of a subgroup of eyes from a previous single-center, prospective, cross-sectional, noninterventional study. One hundred and sixty-nine healthy eyes were evaluated using swept-source optical coherence tomography. Inclusion criteria were best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, and no systemic or ocular diseases. Two independent investigators determined the macular horizontal choroidal thickness (CT) and the Haller's layer thickness across a 9 mm line centered at the fovea. Subjects ...

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    19. OCT Technology: Will We Be “Swept” Away?

      OCT Technology: Will We Be “Swept” Away?

      A look at the differences between spectral-domain and swept-source OCT, and the potential clinical benefits of swept-source. As is sometimes the case with technology, just when we get comfortable using a device and begin to understand its secrets, limitations and how to best put it to use in our practices, a shiny new instrument arrives and demands our attention. Though this imaging modality has been around for some time, swept-source optical coherence tomography is one such example. It captures your attention, and though you may already use a spectral-domain device, you’re left wondering if it’s the next big ...

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    20. Optical coherence tomography angiography artifacts in retinal pigment epithelial detachment

      Optical coherence tomography angiography artifacts in retinal pigment epithelial detachment

      Objective To describe optical coherence tomography angiography (OCTA) reflectance artifacts secondary to retinal pigment epithelial detachment (RPED). Design Retrospective review. Methods Four eyes from 4 subjects were included. Three presented with RPED and 1 eye was a normal control. Two eyes diagnosed with RPED and the normal eye were evaluated using en face OCTA centred at the fovea acquired using the RTVue XR Avanti (Optovue Inc). In the third eye with RPED, OCTA imaging was performed using a CIRRUS 5000 prototype modified to do OCTA imaging on a spectral domain OCT platform provided by Carl Zeiss Meditec, Inc. The segmented ...

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    21. Optical Coherence Tomography Angiography in Nonarteritic Anterior Ischemic Optic Neuropathy

      Optical Coherence Tomography Angiography in Nonarteritic Anterior Ischemic Optic Neuropathy

      Background: Optical coherence tomography angiography (OCTA) has demonstrated good utility in qualitative analysis of retinal and choroidal vasculature and therefore may be relevant in the diagnostic and treatment efforts surrounding nonarteritic anterior ischemic optic neuropathy (NAION). Methods: Retrospective, cross-sectional study of 10 eyes of 9 patients with a previous or new diagnosis of NAION that received imaging with OCTA between November 2015 and February 2016. Two independent readers qualitatively analyzed the retinal peripapillary capillaries (RPC) and peripapillary choriocapillaris (PCC) for flow impairment. Findings were compared with automated visual field and structural optical coherence tomography (OCT) studies. Results: Flow impairment seen ...

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    22. Choroidal Vessel Diameters in Pseudoexfoliation and Pseudoexfoliation Glaucoma Analyzed Using Spectral-Domain Optical Coherence Tomography

      Choroidal Vessel Diameters in Pseudoexfoliation and Pseudoexfoliation Glaucoma Analyzed Using Spectral-Domain Optical Coherence Tomography

      Abstract Purpose of the Study: The purpose of the study was to analyze choroidal vessel diameters in pseudoexfoliation (PXF) and pseudoexfoliation glaucoma (PXFG) using spectral-domain optical coherence tomography (SD-OCT). Materials and Methods: Fifty patients (100 eyes) with PXF and PXFG who underwent high-definition 1-line raster SD-OCT imaging at New England Eye Center, Boston, were retrospectively identified and divided into unilateral PXFG (26 patients, 52 eyes), unilateral PXF (4 patients, 8 eyes), bilateral PXFG (4 patients, 8 eyes), and bilateral PXF (16 patients, 32 eyes). Eyes with concomitant chorioretinal pathology, history of shunting/filtering for glaucoma, and significant anisometropia were excluded ...

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    23. Comparison of Optical Coherence Tomography Angiography and Fluorescein Angiography for the Identification of Retinal Vascular Changes in Eyes With Diabetic Macular Edema

      Comparison of Optical Coherence Tomography Angiography and Fluorescein Angiography for the Identification of Retinal Vascular Changes in Eyes With Diabetic Macular Edema

      BACKGROUND AND OBJECTIVE: To compare the visualization of microaneurysms (MA) and the foveal avascular zone (FAZ) area using optical coherence tomography angiography (OCTA) versus fluorescein angiography (FA) in patients with diabetic macular edema (DME). PATIENTS AND METHODS: Patients were prospectively recruited for same-day imaging on spectral-domain OCTA and FA. OCTA images were automatically segmented into superficial (sOCTA) and deep (dOCTA) capillary plexuses. The number of visible MAs and the FAZ area were compared between the two imaging modalities. RESULTS: Nineteen eyes of 10 patients were included. There was a statistically significant difference between MA counts for FA, sOCTA, and dOCTA ...

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    24. Use of Retinal Optical Coherence Tomography to Detect Congenital Zika Syndrome

      Use of Retinal Optical Coherence Tomography to Detect Congenital Zika Syndrome

      First identified in rhesus monkeys in Uganda in 1947, the Zika virus (ZIKV), a flavirus spread most commonly by the Aedes aegypti and Aedes albopictus mosquitos, 1 was not implicated in human disease until 1953, when it was recognized in Nigeria to produce a mild, febrile illness. The virus, related to the pathogens that cause yellow fever, dengue, and the West Nile virus, 1 has emerged recently as a serious health care threat resulting in widespread panic across the globe, particularly in the Pacific and the Americas. The recent outbreak began in Brazil in 2015, with over 1 million people ...

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    1. (148 articles) Jay S. Duker
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