1. Articles from philip j. rosenfeld

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    1. Mitigating the effects of choroidal hyper- and hypo-transmission defects on choroidal vascularity index assessments using optical coherence tomography

      Mitigating the effects of choroidal hyper- and hypo-transmission defects on choroidal vascularity index assessments using optical coherence tomography

      Background: Changes in choroidal vascularity index (CVI) are associated with multiple choroid-related ocular diseases. CVI is calculated as the area/volume ratio of vessels in the choroid, which could be affected by alterations in regional signal intensities due to hypo-transmission defects (hypoTDs) caused by drusen and retinal pigment epithelium (RPE) detachments, and hyper-transmission defects (hyperTDs) caused by the absence of RPE. To develop a simulation model to verify the CVI assessments in eyes with hyper/hypoTDs and demonstrate that accurate CVIs can be achieved after attenuation correction on swept-source optical coherence tomography (SS-OCT). Methods: A simulation model was developed on ...

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    2. Swept-Source Optical Coherence Tomography Detection of Bruch’s Membrane and Choriocapillaris Abnormalities in Sorsby Macular Dystrophy

      Swept-Source Optical Coherence Tomography Detection of Bruch’s Membrane and Choriocapillaris Abnormalities in Sorsby Macular Dystrophy

      Purpose: Swept-source optical coherence tomography angiography (SS-OCTA) was used to analyze Bruch's membrane (BM) and choriocapillaris (CC) abnormalities in undiagnosed family members with Sorsby macular dystrophy (SMD). Methods: In a family with SMD (TIMP3 Tyr191Cys), SS-OCTA imaging was performed using the 6X6mm scan patter and previously validated algorithms to detect abnormalities in BM and the CC, as well as the presence of reticular pseudodrusen (RPD) and macular neovascularization (MNV). Genetic analyses were performed for TIMP3 mutations. Results: Of eight family members, two were previously diagnosed with SMD and six were asymptomatic. SS-OCTA imaging of the 33-year-old proband revealed type ...

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    3. Automatic geographic atrophy segmentation using optical attenuation in OCT scans with deep learning

      Automatic geographic atrophy segmentation using optical attenuation in OCT scans with deep learning

      A deep learning algorithm was developed to automatically identify, segment, and quantify geographic atrophy (GA) based on optical attenuation coefficients (OACs) calculated from optical coherence tomography (OCT) datasets. Normal eyes and eyes with GA secondary to age-related macular degeneration were imaged with swept-source OCT using 6 × 6 mm scanning patterns. OACs calculated from OCT scans were used to generate customized composite en face OAC images. GA lesions were identified and measured using customized en face sub-retinal pigment epithelium (subRPE) OCT images. Two deep learning models with the same U-Net architecture were trained using OAC images and subRPE OCT images. Model ...

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    4. Advanced retinal imaging and applications for clinical practice: A consensus review

      Advanced retinal imaging and applications for clinical practice: A consensus review

      Imaging is an integral part of the evaluation and management of retinal disorders. Each imaging modality has its own unique capabilities and can show a different aspect or perspective of disease. Multimodal retinal imaging provides a wealth of substantive and insightful information; however, the integration of all this complex data can be overwhelming. We discuss the applications and the strengths and limitations of the many different retinal imaging tools that are approved for clinical use. These modalities include color fundus photography, widefield imaging, fundus autofluorescence, near infrared reflectance, optical coherence tomography angiography, and en face optical coherence tomography. We also ...

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    5. Diagnosing Persistent Hyper-Transmission Defects on En Face OCT Imaging of Age-Related Macular Degeneration

      Diagnosing Persistent Hyper-Transmission Defects on En Face OCT Imaging of Age-Related Macular Degeneration

      Purpose: A training exercise was performed to study the ability of graders to reliably identify precursor lesions to geographic atrophy (GA), known as persistent choroidal hyper-transmission defects (hyperTDs), using en face optical coherence tomography (OCT) images from eyes with non-exudative age-related macular degeneration (AMD). Design: Intergrader agreement study PARTICIPANTS: Eleven graders participated in this exercise. Methods: Formal training on how to identify persistent hyperTDs on en face OCT images was provided to the graders. Persistent hyperTDs were defined as bright lesions having a greatest linear dimension (GLD) of at least 250 μm. Training consisted of a tutorial session followed by ...

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    6. Laser-induced choroidal neovascularization detected on optical coherence tomography angiography in patients with diabetic retinopathy

      Laser-induced choroidal neovascularization detected on optical coherence tomography angiography in patients with diabetic retinopathy

      Purpose To report two cases of laser-induced choroidal neovascularization (CNV) using swept source optical coherence tomography (SS-OCTA) imaging in patients with proliferative diabetic retinopathy. Observations Two patients developed CNV adjacent to laser scars, and these neovascular lesions were detected on SS-OCTA imaging. Historically, both patients had subretinal fluid associated with these lesions. Visual acuity for both patients was 20/25 in the affected eyes. Both patients were observed over multiple years with stable CNV and visual acuity. Conclusions and importance SS-OCTA was able to detect laser-induced CNV in a rapid and non-invasive manner. When there is no foveal involvement and ...

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    7. Interocular asymmetry of choroidal thickness and vascularity index measurements in normal eyes assessed by swept-source optical coherence tomography

      Interocular asymmetry of choroidal thickness and vascularity index measurements in normal eyes assessed by swept-source optical coherence tomography

      Background: To investigate the symmetry of interocular choroidal thickness and vascularity index measurements in normal eyes using swept-source optical coherence tomography (SS-OCT). Cross-sectional and observational study. This study included 244 eyes of 122 normal adults with ages uniformly distributed from 19 to 89 years. Methods: SS-OCT imaging was performed using a scanning pattern of 12×12 mm. Mean choroidal thickness (MCT) and choroidal vascularity index (CVI) measurements in the entire scanning region were obtained using a validated and published automatic method. The correlation and differences (including signed and absolute differences) between bilateral MCT and CVI measurements were analyzed at the ...

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    8. Widefield Swept-Source Optical Coherence Tomography Angiography of a "Polypoidal-Like" Retinal Arteriovenous Anastomosis in Proliferative Diabetic Retinopathy

      Widefield Swept-Source Optical Coherence Tomography Angiography of a "Polypoidal-Like" Retinal Arteriovenous Anastomosis in Proliferative Diabetic Retinopathy

      A 69-year-old man with a history of proliferative diabetic retinopathy in both eyes presented with retinal hemorrhages and a whitish boundary demarcating the arterioles ( Figure , A, yellow arrowheads, right eye shown). His visual acuity was 20/400 OU. The right eye received several anti–vascular endothelial growth factor injections. En face widefield swept-source optical coherence tomography angiography (SS-OCTA; 15 × 15 mm) of the total retina showed extensive retinal capillary and arteriolar nonperfusion ( Figure , B, yellow segmentation lines). The en face OCTA image revealed a tangled-vessel structure surrounded by retinal capillary and arteriolar nonperfusion ( Figure , B, blue box). The “polypoidal-like” lesion ...

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    9. Analysis of correlations between local geographic atrophy growth rates and local OCT angiography-measured choriocapillaris flow deficits

      Analysis of correlations between local geographic atrophy growth rates and local OCT angiography-measured choriocapillaris flow deficits

      The purpose of this study is to quantitatively assess correlations between local geographic atrophy (GA) growth rates and local optical coherence tomography angiography (OCTA)-measured choriocapillaris (CC) flow deficits. Thirty-eight eyes from 27 patients with GA secondary to age-related macular degeneration (AMD) were imaged with a commercial 1050 nm swept-source OCTA instrument at 3 visits, each separated by ∼6 months. Pearson correlations were computed between local GA growth rates, estimated using a biophysical GA growth model, and local OCTA CC flow deficit percentages measured along the GA margins of the baseline visits. The p-values associated with the null hypothesis of ...

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    10. WIDE-FIELD SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF DIABETIC TRACTIONAL RETINAL DETACHMENTS BEFORE AND AFTER SURGICAL REPAIR

      WIDE-FIELD SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF DIABETIC TRACTIONAL RETINAL DETACHMENTS BEFORE AND AFTER SURGICAL REPAIR

      Purpose: Wide-field (WF) swept-source (SS) optical coherence tomography angiography (SS-OCTA) was used to image diabetic tractional retinal detachments (TRDs) before and after pars plana vitrectomy. The clinical utility of SS-OCTA was assessed. Methods: Patients with diabetic TRDs were imaged prospectively with SS-OCTA. Ultrawide-field imaging was obtained when possible. Postoperative WF SS-OCTA imaging was performed. Results: From January 2018 through December 2019, 31 eyes of 21 patients with diabetic TRDs were imaged. Wide-field SS-OCTA en-face images captured all areas of TRD and fibrovascular proliferation within the posterior pole that were visualized on ultrawide-field imaging. Optical coherence tomography angiography B-scans revealed the ...

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    11. Swept-Source OCT En Face Imaging of Paravascular Inner Retinal Defects

      Swept-Source OCT En Face Imaging of Paravascular Inner Retinal Defects

      Widefield swept-source optical coherence tomography angiography (SS-OCTA) was performed on eyes with paravascular inner retinal defects (PIRDs) and the morphological alterations of PIRDs were described. Patients with PIRDs were imaged using 12 mm × 12 mm SS-OCTA scans. En face structural and angiographic images of the superficial retinal layers were reviewed along with retinal thickness maps. SS-OCTA en face structural images identified dark, scalloped regions along major retinal veins that corresponded to PIRDs on B-scans. The authors concluded that imaging with both structural and angiographic en face OCT was useful for the diagnosis and monitoring of patients with PIRDs.

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    12. Can there be smoke without fire? Optical coherence tomography angiography has the answer

      Can there be smoke without fire? Optical coherence tomography angiography has the answer

      Macular edema is typically seen on optical coherence tomography (OCT) as fluid-filled cystic alterations that cause increased retinal thickness. The increased OCT reflectivity within these intraretinal spaces in the outer avascular retina can exhibit flow-like properties when imaged using OCT angiography (OCTA). The motion signal arising from within these intraretinal cavities corresponds to a feature of exudation known as suspended scattering particles in motion (SSPiM). We present multimodal imaging of a patient with SSPiM who underwent partial resolution of this OCTA finding.

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    13. Widefield SS-OCTA for Localization of Retinal Nematode in Diffuse Unilateral Subacute Neuroretinitis

      Widefield SS-OCTA for Localization of Retinal Nematode in Diffuse Unilateral Subacute Neuroretinitis

      Diffuse unilateral subacute neuroretinitis (DUSN) is a rare form of chorioretinitis caused by retinal infestation by nematode larvae. Definitive diagnosis requires visualization of a motile nematode, but this can be challenging because the nematode is small, translucent, and usually motionless with overlying media opacity from cellular inflammation. The authors describe a case of DUSN in which widefield swept-source optical coherence tomography angiography was used to localize a midperipheral intraretinal nematode facilitating subsequent clinical observation of movement. Inflammation resolved after focal laser photocoagulation of the nematode with recovery of visual acuity to 20/20.

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    14. Swept-Source OCT Angiographic Characteristics of Treatment-Naïve Nonexudative Macular Neovascularization in AMD Prior to Exudation

      Swept-Source OCT Angiographic Characteristics of Treatment-Naïve Nonexudative Macular Neovascularization in AMD Prior to Exudation

      Purpose: To investigate the characteristics of treatment-naïve nonexudative macular neovascularization (MNV) in age-related macular degeneration before the onset of exudation using swept-source optical coherence tomography angiography. Methods: MNV area, choriocapillaris (CC) flow deficits (FDs), vessel area density (VAD), vessel skeleton density (VSD), retinal pigment epithelial detachment (PED) volume, mean choroidal thickness (MCT), and choroid vascularity index (CVI) measurements were assessed at two visits prior to exudation. We compared measurements made at the second visit and the rate of change between visits in eyes with and without exudation. The differences in these parameters between eyes with and without subsequent exudation ...

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    15. Validation of a Novel Automated Algorithm to Measure Drusen Volume and Area Using Swept Source Optical Coherence Tomography Angiography

      Validation of a Novel Automated Algorithm to Measure Drusen Volume and Area Using Swept Source Optical Coherence Tomography Angiography

      Purpose : The purpose of this study was to validate a novel automated swept source optical coherence tomography angiography (SS-OCTA) algorithm to measure elevations of the retinal pigment epithelium (RPE) in eyes with nonexudative age-related macular degeneration (neAMD). Methods : Patients with drusen were enrolled in a prospective optical coherence tomography (OCT) study and underwent both spectral domain OCT (SD-OCT) and SS-OCTA imaging at the same visit using the 6 × 6 mm scan patterns. The RPE elevation measurements (square root area and cube root volume) from the SS-OCTA algorithm were compared with the automated validated SD-OCT algorithm on the instrument. Standard deviations ...

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    16. Replacement of polyps with type 1 macular neovascularization in polypoidal choroidal vasculopathy imaged with swept source OCT angiography

      Replacement of polyps with type 1 macular neovascularization in polypoidal choroidal vasculopathy imaged with swept source OCT angiography

      Purpose: To investigate the morphological changes of polyps in eyes with polypoidal choroidal vasculopathy (PCV) after treatment with vascular endothelial growth factor (VEGF) inhibitors using swept source optical coherence tomography angiography (SS-OCTA). Observations: Following anti-VEGF therapy, polyps were found to evolve into typical type 1 macular neovascularization (MNV) in five eyes. In all of these five eyes, a polypoidal lesion was detected adjacent to a serous or hemorrhagic retinal pigment epithelial detachment (PED). Conclusions and importance: Polypoidal lesions in PCV can evolve into typical type 1 MNV. This morphological evolution suggests that these polyps are clusters of tangled vessels that ...

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    17. Deliberations of an International Panel of Experts on OCTA Nomenclature of nAMD

      Deliberations of an International Panel of Experts on OCTA Nomenclature of nAMD

      A panel of imaging experts was assembled to review neovascular age-related macular degeneration optical coherence tomography angiography descriptors published to date, and test agreement on use of these terms, which was found to be low. Optical coherence tomography angiography (OCTA) has been used to identify and characterize macular neovascularization (MNV) secondary to age-related macular degeneration (AMD). 1-4 Many studies have explored OCTA morphological features of MNV that might serve as biomarkers to assess disease activity and response to treatment. 1-6 The proliferation of studies however has resulted in an OCTA terminology that has been variable and inconsistent. To address inconsistency ...

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    18. Correlations Between Choriocapillaris and Choroidal Measurements and the Growth of Geographic Atrophy using Swept Source OCT Imaging

      Correlations Between Choriocapillaris and Choroidal Measurements and the Growth of Geographic Atrophy using Swept Source OCT Imaging

      Purpose The correlations between enlargement rates (ERs) of geographic atrophy (GA) and choriocapillaris (CC) flow deficits (FDs), mean choroidal thickness (MCT), and choroidal vascularity index (CVI) were investigated using swept source optical coherence tomography (SS-OCT) in age-related macular degeneration (AMD). Design Retrospective review of prospective, observational case series. Methods Eyes with GA from AMD were imaged with SS-OCT (PLEX® Elite 9000; Carl Zeiss Meditec, Inc, Dublin, CA) using 6x6 mm scan pattern. GA lesions were identified and measured using custom en face structural images and annual square root ERs of GA were calculated. At baseline, CC FDs from different regions ...

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    19. Comparison Between Graders in Detection of Diabetic Neovascularization with Swept Source OCT Angiography and Fluorescein Angiography

      Comparison Between Graders in Detection of Diabetic Neovascularization with Swept Source OCT Angiography and Fluorescein Angiography

      Purpose To compare the ability of ophthalmologists to identify neovascularization (NV) in patients with proliferative diabetic retinopathy (PDR) using swept source optical coherence tomography angiography (SS-OCTA) and fluorescein angiography (FA). Design Retrospective study comparing diagnostic instruments. Methods Eyes with PDR or severe non-proliferative diabetic retinopathy and a high suspicion of NV based on clinical examination were imaged using SS-OCTA and FA at the same visit. Two separate grading sets consisting of scrambled, anonymized SS-OCTA and FA images were created. The ground truth for presence of NV was established by consensus of two graders with OCTA experience who did not participate ...

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    20. A Comparison Study of Polypoidal Choroidal Vasculopathy Imaged with Indocyanine Green Angiography and Swept Source OCT Angiography

      A Comparison Study of Polypoidal Choroidal Vasculopathy Imaged with Indocyanine Green Angiography and Swept Source OCT Angiography

      Purpose Indocyanine green angiography (ICGA) was compared with swept source optical coherence tomography angiography (SS-OCTA) for the detection of polypoidal choroidal vasculopathy (PCV). Design Retrospective, cross-sectional. Methods Patients with treatment-naïve PCV based on ICGA imaging underwent same day SS-OCTA imaging at Kyung Hee University Medical Center between April 2017 to November 2018. ICGA and SS-OCTA images were graded independently. SS-OCTA images were graded using both flow and structural information. Images were graded for the number of polypoidal lesions and the total lesion area, which included both the polypoidal lesions and the branching vascular networks (BVNs). Results A total of ...

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    21. Longitudinal Swept Source OCT Angiography of Juxtapapillary Retinal Capillary Hemangioblastoma

      Longitudinal Swept Source OCT Angiography of Juxtapapillary Retinal Capillary Hemangioblastoma

      In this case report, SS-OCTA identified the key diagnostic features of JRCH seen with multimodal imaging. Serial SS-OCTA imaging showed transient decreases in vascular congestion and exudation after intravitreal anti-VEGF injections. SS-OCTA may be the sole imaging modality needed for the diagnosis of JRCH, an important entity that is commonly misdiagnosed as disc edema or choroidal neovascularization. Transient responses to anti-VEGF therapy suggests that higher dose or sustained-release anti-VEGF therapy may be effective for retinal capillary hemangioblastomas.

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    22. Correlations between Different Choriocapillaris Flow Deficit Parameters in Normal Eyes using Swept Source OCT Angiography

      Correlations between Different Choriocapillaris Flow Deficit Parameters in Normal Eyes using Swept Source OCT Angiography

      Purpose Choriocapillaris (CC) imaging of normal eyes with swept-source optical coherence tomography SS-OCTA was performed, and the percentage of CC flow deficits (FD%) and the average area of CC flow deficits (FDa) were compared within given macular regions. Design A prospective, cross-sectional study. Methods Subjects with normal eyes ranging in age from their 20s through their 80s were imaged with SS-OCTA (PLEX Elite 9000, Carl Zeiss Meditec, Dublin, CA) using both 3x3 mm and 6x6 mm macular scan patterns. The CC images were generated using a previously published and validated algorithm. In both 3x3 mm and 6x6 mm scans, the ...

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    23. Are Dilated Fundus Exams Needed for Optical Coherence Tomography–Guided Re-treatment of Exudative Age-Related Macular Degeneration?

      Are Dilated Fundus Exams Needed for Optical Coherence Tomography–Guided Re-treatment of Exudative Age-Related Macular Degeneration?

      Purpose To determine whether presence of macular hemorrhage on dilated fundus exam (DFE) or fundus photography influences vision outcomes with optical coherence tomography (OCT)-guided pro re nata (PRN) ranibizumab (RBZ) re-treatment in patients with neovascular age-related macular degeneration (nAMD), we investigated whether hemorrhage without OCT-detectable fluid impacted vision outcomes. Design Post hoc analysis of prospectively collected data from the 24-month phase III HARBOR trial (NCT00891735). Participants This post hoc analysis examined 1097 patients from the intention-to-treat population of HARBOR. Methods DFE and fundus photography were evaluated for hemorrhage, and spectral domain (SD)-OCT images from HARBOR participants were analyzed ...

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    24. Two-Year Risk of Exudation in Eyes with Nonexudative Age-Related Macular Degeneration and Subclinical Neovascularization Detected with Swept Source Optical Coherence Tomography Angiography

      Two-Year Risk of Exudation in Eyes with Nonexudative Age-Related Macular Degeneration and Subclinical Neovascularization Detected with Swept Source Optical Coherence Tomography Angiography

      Purpose Swept source optical coherence tomography angiography (SS-OCTA) was used to study the prevalence, incidence, and natural history of subclinical macular neovascularization (MNV) in eyes with unilateral nonexudative age-related macular degeneration. Design Prospective cohort study. Methods Patients were imaged using 3- × 3-mm and 6- × 6-mm SS-OCTA scan patterns. MNV was detected using the outer retina to choriocapillaris en face slab. Prevalence and incidence of subclinical MNV, Kaplan–Meier cumulative estimates for the overall risk of exudation, and the association between neovascular lesion size and the risk of exudation were assessed through 2 years. Results From August 2014 through March 2018 ...

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