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Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Optical Diagnostics".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 24894

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Dr. Daniela Bacherini

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Department of Neurosciences, Psychology, Drug Research and Child Health Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy
Interests: retinal imaging; medical retina; OCT; OCT angiography
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Prof. Dr. Stanislao Rizzo

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1. Ophthalmology Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
2. Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy
Interests: surgical retina
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Prof. Dr. Fabrizio Giansanti

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Department of Neurosciences, Psychology, Drug Research, and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy
Interests: surgical retina; medical retina
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

On behalf of the Diagnostics Editorial Team, I am delighted to present a Special Issue on the topic of Optical Coherence Tomography Angiography (OCTA) as a new diagnostic tool in clinical disease.

Currently we are assisting in an evolution and revolution of retinal diagnostic imaging. Optical Coherence Tomography Angiography (OCTA) is increasingly becoming a popular tool for retinal imaging in many retinal diseases, where it provides new and useful insights. It allows a rapid, non-invasive, and detailed evaluation of the retinal and choroidal vascular networks allowing the evaluation of the retina-choroidal flow layer by layer, with a separated evaluation of the different retinochoroidal plexi that may be involved individually or separately in various pathological diseases. OCTA can provide a qualitative and quantitative assessment of the retinal and choroidal microvascularization. There is growing interest in the potential role of OCTA in providing early diagnostic or prognostic biomarkers. This is why an increased interest in this new retinal imaging tool is also emerging in the field of systemic non-ocular pathologies.

This Special Issue aims to evaluate the use of OCTA as a new diagnostic tool in ocular and systemic pathologies in order to evaluate the possibility of obtaining new potential diagnostic biomarkers and to create a multidisciplinary integration between clinical medicine and the field of retinal imaging.

After all, the retina is a window on our central nervous system and vascularization; it would be interesting if we could also let our non-ophthalmologist colleagues look into this window.

The accepted papers will describe new applications in these areas. This Special Issue accepts high-quality articles containing original research results and case reports, as well as review articles.

Dr. Daniela Bacherini
Prof. Dr. Stanislao Rizzo
Prof. Dr. Fabrizio Giansanti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Optical Coherence Tomography Angiography
non-invasive retinal imaging
biomarkers

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Published Papers (10 papers)

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Research

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9 pages, 1469 KiB

Open AccessArticle

Assessment of Retinal Capillary Dropout after Transcatheter Aortic Valve Implantation by Optical Coherence Tomography Angiography

by Jeanne Martine Gunzinger, Burbuqe Ibrahimi, Joel Baur, Maximilian Robert Justus Wiest, Marco Piccirelli, Athina Pangalu, Dominik Straumann, Fabian Nietlispach, Igal Moarof and Sandrine Anne Zweifel

Diagnostics 2021, 11(12), 2399; https://doi.org/10.3390/diagnostics11122399 - 20 Dec 2021

Cited by 6 | Viewed by 2195

Abstract

Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis, which is often the treatment of choice in elderly and frail patients. It carries a risk of embolic complications in the whole cerebral vascular bed, which includes the retinal vasculature. The main objective was the evaluation of retinal emboli visible on optical coherence tomography angiography (OCTA) following TAVI. This is a prospective, single center, observational study enrolling consecutive patients over two years. Patients were assessed pre- and post-TAVI. Twenty-eight patients were included in the final analysis, 82.1% were male, median age was 79.5 (range 52–88), median BCVA was 82.5 letters (range 75–93). Eight patients (28.6%) presented new capillary dropout lesions in their post-TAVI OCTA scans. There was no statistically significant change in BCVA. Quantitative analysis of macular or peripapillary OCTA parameters did not show any statistically significant difference in pre- and post-intervention. In conclusion, capillary dropout lesions could frequently be found in patients after TAVI. Quantitative measurements of macular and peripapillary flow remained stable, possibly indicating effective ocular blood flow regulation within the range of left ventricular ejection fraction in our cohort. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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13 pages, 13572 KiB

Open AccessArticle

Choriocapillaris Vascular Density Changes: Healthy vs. Advanced Exudative Age-Related Macular Degeneration Previously Treated with Multiple Anti-VEGF Intravitreal Injections

by Maria Cristina Savastano, Clara Rizzo, Gloria Gambini, Alfonso Savastano, Benedetto Falsini, Daniela Bacherini, Carmela Grazia Caputo, Raphael Kilian, Francesco Faraldi, Umberto De Vico and Stanislao Rizzo

Diagnostics 2021, 11(11), 1958; https://doi.org/10.3390/diagnostics11111958 - 22 Oct 2021

Cited by 3 | Viewed by 1960

Abstract

Purpose: To assess choriocapillaris vascular density (VD) in healthy and advanced exudative age-related macular degeneration (ae-AMD) patients by new full-range optical coherence tomography angiography (OCT-A). Method: In this observational, cross-sectional study, 21 healthy and 21 ae-AMD eyes, already treated with anti-VEGF, were enrolled. Angio-View retina patterns centered on fovea (6.4 × 6.4 mm) were acquired for all participants using Solix full-range OCT (Optovue Inc., Freemont, CA, USA). The main outcome was to compare choriocapillaris VD between healthy and ae-AMD eyes. Automated measurements of whole image choriocapillaris VD (%) and fovea grid-based (%) were collected for the analysis. Angio-View patterns were used to assess the flow area (mm²) of macular neovascularization (MNV) by contour flow measure algorithm. Best-corrected visual acuity (BCVA) of both groups was also used for the statistical analysis. Results: The mean age was 60.9 (±8.3) in healthy and 73.33 (±15.05) in ae-AMD eyes. The mean BCVA (ETDRS letters) was 98.47 (±1.50) in healthy and 7.04 (±5.96) in ae-AMD eyes. The Mann–Whitney test comparing choriocapillaries VD for whole and fovea healthy and ae-AMD eyes showed statistical significance (p < 0.0001 (t = 4.91; df = 40) and p < 0.0001 (t = 6.84; df = 40), respectively). Regarding, the correlation between MNV and VD of choriocapillaries, neither whole nor fovea areas were statistically significant (F = 0.38 (R² = 0.01) and 1.68 (R² = 0.08), respectively). Conclusions: Choriocapillaris VD showed a statistically significant reduction in comparison to healthy eyes in ae-AMD eyes. Choriocapillaris impairment can be seen in the early phase of MNV pathogenesis. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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12 pages, 1653 KiB

Open AccessArticle

OCT-Angiography Findings in Patients with Amblyopia: Comparison between Healthy Controls, Treatment-Responsive, and Treatment-Unresponsive Amblyopic Patients

by Annabella Salerni, Gloria Gambini, Chiara Fedeli, Ludovica Paris, Emanuele Crincoli, Gustavo Savino, Maria Cristina Savastano, Daniela Bacherini, Umberto De Vico, Clara Rizzo, Raphael Killian and Stanislao Rizzo

Diagnostics 2021, 11(10), 1751; https://doi.org/10.3390/diagnostics11101751 - 24 Sep 2021

Cited by 8 | Viewed by 2103

Abstract

There is no consensus on whether amblyopia affects the retinal vascular plexus and morphology. Previous studies focused on the differences between amblyopic patients and normal controls without evaluating amblyopic eyes after patching. To evaluate differences in the superficial vascular density of amblyopic eyes, normal eyes, and amblyopic eyes reaching normal BCVA after patch therapy, OCTA was used. All patients underwent a comprehensive ophthalmological examination, including visual acuity, refraction, ocular motility tests, and anterior and posterior segment examination. OCTA was performed by an expert physician using the Zeiss Cirrus 5000-HD-OCT Angioplex (Carl Zeiss, Meditec, Inc., Dublin, OH, USA). OCTA scans were performed using a 3 × 3 mm² and 6 × 6 mm² fovea-centered image setting. The mean outer macular vessel density in the previously amblyopic group was 19.15 ± 0.51%. This was statistically significantly higher than in both the amblyopic group (18.70 ± 1.14%) and the normal controls (18.18 ± 1.40%) (p = 0.014). The previously amblyopic group also significantly differed from both normal controls and amblyopic eyes with regards to the inner (p = 0.011), outer (p = 0.006), and full (p = 0.003) macular perfusion. Finally, linear regression analysis revealed that BCVA was linearly correlated to outer perfusion in amblyopic (p = 0.003) and ex amblyopic eyes (p < 0.001). Considering the cross-sectional nature of our study, from our results, we can only hypothesize a possible correlation between light stimulation and retinal vasculature development. However, further longitudinal studies are needed to support this hypothesis. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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9 pages, 1654 KiB

Open AccessArticle

Macular Microvascular Modifications in Progressive Lamellar Macular Holes

by Fiammetta Catania, Davide Allegrini, Alessandra Nembri, Filippo Confalonieri, Piero Zollet, Emanuele Crincoli and Mario R Romano

Diagnostics 2021, 11(9), 1717; https://doi.org/10.3390/diagnostics11091717 - 19 Sep 2021

Cited by 8 | Viewed by 1807

Abstract

Lamellar macular holes (LMHs) may show morphological and functional deterioration over time, yet no definite prognostic factor for progression has been identified. Since neurovascular retinal unit impairment may take part in neurodegeneration, we compare progressive LMHs to stable ones in optical coherence tomography (OCT) angiography parameters. Methods: OCT B scans of eyes with LMH were analyzed to detect the presence of tissue loss (TL) over time, allowing us to identify a TL group and a stable (ST) group (14 patients each). The best corrected visual acuity (BCVA) at each considered imaging time point was collected. Lastly, patients underwent macular OCT angiography. Results: BCVA at last follow up was significantly reduced in the TL group compared to both the ST group and TL group baseline assessment. SCP foveal vessel density (VD), SCP and deep capillary plexus (DCP) perfusion density (PD) and parafoveal PD were lower in the TL group. Linear correlations between quantitative TL over time and parafoveal PD in SCP and between the speed of TL and BCVA variation during follow up were also detected. Conclusions: TL in LMHs is associated with both OCT angiography modifications and BCVA deterioration over time. We suggest these findings to be a manifestation of foveal Muller cell impairment in progressive LMHs. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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13 pages, 1151 KiB

Open AccessArticle

Stability of OCT and OCTA in the Intensive Therapy Unit Setting

by Ella F. Courtie, Aditya U. Kale, Benjamin T. K. Hui, Xiaoxuan Liu, Nicholas I. Capewell, Jonathan R. B. Bishop, Tony Whitehouse, Tonny Veenith, Ann Logan, Alastair K. Denniston and Richard J. Blanch

Diagnostics 2021, 11(8), 1516; https://doi.org/10.3390/diagnostics11081516 - 23 Aug 2021

Cited by 4 | Viewed by 2031

Abstract

To assess the stability of retinal structure and blood flow measures over time and in different clinical settings using portable optical coherence tomography angiography (OCTA) as a potential biomarker of central perfusion in critical illness, 18 oesophagectomy patients completed retinal structure and blood flow measurements by portable OCT and OCTA in the eye clinic and intensive therapy unit (ITU) across three timepoints: (1) pre-operation in a clinic setting; (2) 24–48 h post-operation during ITU admission; and (3) seven days post-operation, if the patient was still admitted. Blood flow and macular structural measures were stable between the examination settings, with no consistent variation between pre- and post-operation scans, while retinal nerve fibre layer thickness increased in the post-operative scans (+2.31 µm, p = 0.001). Foveal avascular zone (FAZ) measurements were the most stable, with an intraclass correlation coefficient of up to 0.92 for right eye FAZ area. Blood flow and structural measures were lower in left eyes than right eyes. Retinal blood flow assessed in patients before and during an ITU stay using portable OCTA showed no systematic differences between the clinical settings. The stability of retinal blood flow measures suggests the potential for portable OCTA to provide clinically useful measures in ITU patients. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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12 pages, 9093 KiB

Open AccessArticle

High-Resolution Optical Coherence Tomography Angiography Characteristics of Limbal Stem Cell Deficiency

by Shobhit Varma, Swapna S. Shanbhag, Pragnya Rao Donthineni, Dilip Kumar Mishra, Vivek Singh and Sayan Basu

Diagnostics 2021, 11(6), 1130; https://doi.org/10.3390/diagnostics11061130 - 21 Jun 2021

Cited by 12 | Viewed by 2857

Abstract

This study aimed to identify the anterior segment high-resolution optical coherence tomography (HR-OCT) and HR-OCT angiography (HR-OCTA) features suggestive of limbal stem cell deficiency (LSCD) as confirmed by both impression cytology (IC) and in vivo confocal microscopy (IVCM). This was a single-centre prospective cross-sectional study including 24 eyes of 22 patients with clinical suspicion of LSCD based on peripheral superficial corneal vascularisation and scarring. On IC and IVCM, performed and interpreted by blinded observers, 12 eyes each were diagnosed with and without LSCD. Additionally, 10 eyes of 5 healthy volunteers with no ocular pathology were also imaged. The 136 HR-OCT/A images of these 34 eyes were analysed with respect to 12 imaging parameters; the parameters most suggestive of LSCD were identified and the sensitivity and specificity were calculated. In the LSCD group, the most common aetiology was ocular chemical burns (83%), whereas in the non-LSCD group, the most common aetiology was viral keratitis (67%). Multiple logistic regression analysis revealed that mean epithelial reflectivity, mean stromal reflectivity, and mean superficial vascular density were the parameters that were diagnostic of LSCD on HR-OCT/A (p < 0.0001). A ratio of the mean epithelial reflectivity to stromal reflectivity of >1.29 corresponded with a high sensitivity (91.7%) and specificity (98.75%); while a mean superficial vascular density score of >0.38 corresponded with a sensitivity of 97.9% and specificity of 73.8%. In conclusion, HR-OCT/A as a non-invasive imaging modality could prove to be a useful tool for confirming the diagnosis of LSCD, with potential clinical and research applications. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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15 pages, 6869 KiB

Open AccessArticle

Phenotypic Differences in a PRPH2 Mutation in Members of the Same Family Assessed with OCT and OCTA

by Henar Albertos-Arranz, Xavier Sánchez-Sáez, Natalia Martínez-Gil, Isabel Pinilla, Rosa M. Coco-Martin, Jesús Delgado and Nicolás Cuenca

Diagnostics 2021, 11(5), 777; https://doi.org/10.3390/diagnostics11050777 - 26 Apr 2021

Cited by 6 | Viewed by 1780

Abstract

Choroidal dystrophies comprise a group of chorioretinal degenerations. However, the different findings observed among these patients make it difficult to establish a correct clinical diagnosis. The objective of this study was to characterize new clinical findings by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in these patients. Four family members with a PRPH2 gene mutation (p.Arg195Leu) were included. OCT was performed at the macula, and the thickness of the outer and inner retina, total retina, and choroid was measured. The features of the vascular network were analyzed by OCTA. Patients showed a decreased outer nuclear layer in the avascular area compared with the controls. Two patients presented greater foveal and parafoveal degeneration of the outer retina, whereas the most degenerated area in the rest was the perifovea. Disruption of the third outer band at the foveola is one of the first-altered outer bands. Slow blood flow areas or capillary dropout were main signs in the deep capillary plexus. Microaneurysms were frequently observed in less degenerated retinas. Vascular loops and intraretinal microvascular abnormalities (IRMAs) were present in the superficial plexus. Extensive degeneration of the choriocapillaris was detected. Phenotypic differences were found between patients: two showed central areolar choroidal dystrophy and the rest had extensive chorioretinal atrophy. These signs observed in OCT and OCTA can help to more appropriately define the clinical disease in patients with choroidal dystrophies. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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Review

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15 pages, 12167 KiB

Open AccessReview

Role of Anterior Segment-Optical Coherence Tomography Angiography in Acute Ocular Burns

by Anahita Kate and Sayan Basu

Diagnostics 2022, 12(3), 607; https://doi.org/10.3390/diagnostics12030607 - 28 Feb 2022

Cited by 5 | Viewed by 2980

Abstract

Acute ocular burns have varied manifestations which require prompt diagnosis and management to prevent chronic sequelae. Of these, the detection of limbal ischemia poses a challenge because of the subjective nature of its clinical signs. Anterior segment optical coherence tomography angiography (AS-OCTA) offers an objective method of assessing ischemia in these eyes. This review provides an overview of the technology of AS-OCTA and its applications in acute burns. AS-OCTA generates images by isolating the movement of erythrocytes within blood vessels from sequentially obtained b-scans. Limbal ischemia manifests in these scans as absent vasculature and the extent of ischemia can be quantified using different vessel-related parameters. Of these, the density of vessels is most commonly used and correlates with the severity of the injury. Incorporation of the degree of ischemia in the classification of acute burns has been attempted in animal studies and its extension to human trials may provide an added dimension in determining the final prognosis of these eyes. Thus, AS-OCTA is a promising device that can objectively evaluate limbal ischemia. This will facilitate the identification of patients who will benefit from revascularization therapies and stem cell transplants in acute and chronic ocular burns, respectively. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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17 pages, 10119 KiB

Open AccessReview

The Value of Optical Coherence Tomography Angiography (OCT-A) in Neurological Diseases

by Albert J. Augustin and Jenny Atorf

Diagnostics 2022, 12(2), 468; https://doi.org/10.3390/diagnostics12020468 - 11 Feb 2022

Cited by 11 | Viewed by 2695

Abstract

Optical coherence tomography angiography (OCT-A) was commercially introduced in 2014. OCT-A allows a fast, non-invasive, three-dimensional analysis of the retinal vasculature from the vitreoretinal interface to the choriocapillaris. The results can be evaluated separately in automated or custom-defined retinal layers. Since its introduction, OCT-A has also been used in patients with neurological diseases in order to find and characterize retinal biomarkers. Many neurological diseases have retinal manifestations, often preceding the key symptoms of the neurological disease. Anatomically and developmentally, the retina is a part of the brain. In contrast to the brain, the retina is easily accessible for imaging methods; moreover, retinal imaging is more cost-effective than brain imaging. In this review, the current knowledge about OCT-A findings and possible OCT-A biomarkers in neurological diseases is summarized and discussed regarding the value of OCT-A as a diagnostic tool in neurological diseases. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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15 pages, 6475 KiB

Open AccessReview

Update on Optical Coherence Tomography and Optical Coherence Tomography Angiography Imaging in Proliferative Diabetic Retinopathy

by Sara Vaz-Pereira, Tiago Morais-Sarmento and Michael Engelbert

Diagnostics 2021, 11(10), 1869; https://doi.org/10.3390/diagnostics11101869 - 11 Oct 2021

Cited by 5 | Viewed by 2387

Abstract

Proliferative diabetic retinopathy (PDR) is a major cause of blindness in diabetic individuals. Optical coherence tomography (OCT) and OCT-angiography (OCTA) are noninvasive imaging techniques useful for the diagnosis and assessment of PDR. We aim to review several recent developments using OCT and discuss their present and potential future applications in the clinical setting. An electronic database search was performed so as to include all studies assessing OCT and/or OCTA findings in PDR patients published from 1 January 2020 to 31 May 2021. Thirty studies were included, and the most recently published data essentially focused on the higher detection rate of neovascularization obtained with widefield-OCT and/or OCTA (WF-OCT/OCTA) and on the increasing quality of retinal imaging with quality levels non-inferior to widefield-fluorescein angiography (WF-FA). There were also significant developments in the study of retinal nonperfusion areas (NPAs) using these techniques and research on the impact of PDR treatment on NPAs and on vascular density. It is becoming increasingly clear that it is critical to use adequate imaging protocols focused on optimized segmentation and maximized imaged retinal area, with ongoing technological development through artificial intelligence and deep learning. These latest findings emphasize the growing applicability and role of noninvasive imaging in managing PDR with the added benefit of avoiding the repetition of invasive conventional FA. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases)

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