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Artigo IPEN-doc 26892 Quantification of retinal capillary nonperfusion in diabetics using wide-field optical coherence tomography angiography2020 - ALIBHAI, A.Y.; PRETTO, LUCAS R. de; MOULT, ERIC M.; OR, CHRIS; ARYA, MALVIKA; MCGOWAN, MITCHELL; CARRASCO-ZEVALLOS, OSCAR; LEE, BYUNGKUN; CHEN, SIYU; BAUMAL, CAROLINE R.; WITKIN, ANDRE J.; REICHEL, ELIAS; FREITAS, ANDERSON Z. de; DUKER, JAY S.; FUJIMOTO, JAMES G.; WAHEED, NADIA K.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% confidence interval: 1.2–3.7) in the nonproliferative DR eyes (mild, moderate, and severe), and 8.5% (95% confidence interval: 5.0–14.3) in the proliferative DR eyes. The percentage of nonperfused area increased in a statistically significant manner from eyes without DR, to eyes with nonproliferative DR, to eyes with proliferative DR. Conclusion: Capillary nonperfusion area in the posterior retina increases with increasing DR severity as measured by swept-source OCTA. Quantitative analysis of retinal nonperfusion on wide-field OCTA may be useful for early detection and monitoring of disease in patients with diabetes and DR.Artigo IPEN-doc 26682 Retinal nonperfusion relationship to arteries or veins observed on widefield optical coherence tomography angiography in diabetic retinopathy2019 - ISHIBAZAWA, AKIHIRO; PRETTO, LUCAS R. de; ALIBHAI, A. YASIN; MOULT, ERIC M.; ARYA, MALVIKA; SOROUR, OSAMA; MEHTA, NIHAAL; BAUMAL, CAROLINE R.; WITKIN, ANDRE J.; YOSHIDA, AKITOSHI; DUKER, JAY S.; FUJIMOTO, JAMES G.; WAHEED, NADIA K.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 3 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 on the shortest distance, nonperfusion pixels were labeled as either arterial-side or venous-side. Arterial-adjacent and venous-adjacent nonperfusion and the A/V ratio (arterial-adjacent nonperfusion divided by venous-adjacent nonperfusion) were quantified. RESULTS. Twenty-two eyes with moderate NPDR, 16 eyes with severe NPDR, and 25 eyes with PDR were scanned. Total nonperfusion area in PDR (median: 8.93%) was greater than in moderate NPDR (3.49%, P < 0.01). Arterial-adjacent nonperfusion was greater than venousadjacent nonperfusion for all stages of DR (P < 0.001). The median A/V ratios were 1.93 in moderate NPDR, 1.84 in severe NPDR, and 1.78 in PDR. The A/V ratio was negatively correlated with the total nonperfusion area (r ¼ 0.600, P < 0.0001). The results from the widefield montages showed similar patterns. CONCLUSIONS. OCTA images with arteries and veins traced allowed us to estimate the nonperfusion distribution. In DR, smaller nonperfusion tends to be arterial-adjacent, while larger nonperfusion tends toward veins.Artigo IPEN-doc 26419 Controlling for artifacts in widefield optical coherence tomography angiography measurements of non-perfusion area2019 - PRETTO, LUCAS R. de; MOULT, ERIC M.; ALIBHAI, A.Y.; CARRASCO-ZEVALLOS, OSCAR M.; CHEN, SIYU; LEE, BYUNGKUN; WITKIN, ANDRE J.; BAUMAL, CAROLINE R.; REICHEL, ELIAS; FREITAS, ANDERSON Z. de; DUKER, JAY S.; WAHEED, NADIA K.; FUJIMOTO, JAMES G.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 theoretical and case-based descriptions of the causes and effects of low-OCTsignal artifacts. Through these descriptions, we demonstrate that OCTA data interpretation can be ambiguous if performed without consulting corresponding OCT data. Furthermore, using wide-field non-perfusion analysis in diabetic retinopathy as a model widefield OCTA usage-case, we show how qualitative and quantitative analysis can be confounded by low-OCT-signal artifacts. Based on these results, we suggest methods and best-practices for preventing and managing low-OCT-signal artifacts, thereby reducing errors in OCTA quantitative analysis of non-perfusion and improving reproducibility. These methods promise to be especially important for longitudinal studies detecting progression and response to therapy.Resumo IPEN-doc 25645 Quantitative analysis of capillary non-perfusion in diabetic retinopathy using widefield OCT-angiography2018 - ALIBHAI, A.Y.; PRETTO, LUCAS R. de; MOULT, ERIC; SCHOTTENHAMML, JULIA; OR, CHRIS; ARYA, MALVIKA; MCGOWAN, MITCHELL; BAUMAL, CAROLINE; WITKIN, ANDRE J.; DUKER, JAY S.; FUJIMOTO, JAMES G.; WAHEED, NADIA K.Purpose : Several OCT angiography (OCTA) studies suggest an association between capillary non-perfusion, a surrogate for retinal ischemia, and diabetic retinopathy (DR) severity. However, due to technical limitations, these studies focused on either 3x3mm or 6x6mm fields of view centered on the macula. In contrast, widefield fluorescein angiography (FA) studies suggest that the majority of capillary non-perfusion in early DR occurs outside of the macular region. The recent development of high-speed, widefield OCTA systems, has for the first time allowed non-invasive visualization of retinal vasculature over wider fields of view—a functionality that, in light of previous widefield FA studies, may be promising for early detection and monitoring of DR. This study aims to couple the recent technological advances in high-speed, widefield OCTA with image processing methods to allow for semi-automatic quantitative analysis of capillary non-perfusion of widefield OCTA images of diabetic eyes. Methods : A semi-automatic, texture-based algorithm that detects areas of non-perfusion on 12x12mm SS-OCTA images from the Zeiss PlexElite™ system was developed. We tested the algorithm on a series of patients with diabetes without DR (28 eyes, 21 subjects; 54.8 ± 10.9 y/o), eyes with non-proliferative DR (NPDR) (24 eyes, 16 subjects; 62.1 ± 13.2 y/o) and eyes with proliferative DR (PDR) (21 eyes, 14 subjects; 52.2 ± 12.7 y/o). Results : There was a general trend of increasing capillary non-perfusion with increasing DR severity; however, there was significant overlap between patients having different DR severities (Fig. 1). Conclusions : Quantitative analysis of widefield OCTA images may be useful for early detection and monitoring for diabetic retinopathy progression in diabetics. Additional work is needed to determine the added value of widefield OCTA.