Repeatability and Reproducibility of Superficial Macular Retinal Vessel Density Measurements Using Optical Coherence Tomography Angiography En Face Images

Importance The repeatability and reproducibility of quantitative metrics from optical coherence tomographic angiography (OCTA) must be assessed before these data can be confidently interpreted in clinical research and practice. Objective To evaluate the repeatability and reproducibility of OCTA-derived retinal vascular quantitative metrics. Design, Setting and Participants In this cross-sectional study, 21 healthy volunteers (42 eyes) and 22 patients with retinal disease (22 eyes), including 14 with age-related macular degeneration, 3 with epiretinal membrane, 2 with diabetic retinopathy, 2 with myopic macular degeneration, and 1 with retinal vein occlusion, were enrolled. Participants were recruited from September 1 through November 31, 2016. Each eye underwent 3 repeated scans with 3 instruments for a total of 9 acquisitions. Eyes were randomly assigned to scanning with a 3 × 3-mm or 6 × 6-mm pattern. Eyes were excluded from subsequent analysis if any acquisition had a signal strength of less than 7. Repeatability (defined as the agreement in measurements within a device) and reproducibility (defined as the agreement between devices of the same type) were assessed by intraclass correlation coefficient (ICC) and coefficient of variation. Exposures All eyes underwent scanning using 3 separate devices. Main Outcomes and Measures Vessel length density (VLD) and perfusion density (PD) of the superficial retinal vasculature. Results A total of 21 healthy volunteers (8 men and 13 women; mean [SD] age, 36 [6] years) and 22 patients with retinal disease (15 men and 7 women; mean [SD] age, 79 [9] years) underwent evaluation. Of these, 40 of 42 normal eyes and 15 of 22 eyes with retinal disease met signal strength criteria and were included in this analysis. The ICC among the 3 consecutive scans ranged from 0.82 to 0.98 for VLD and from 0.83 to 0.95 for PD. The coefficient of variation (CV) ranged from 2.2% to 5.9% for VLD and from 2.4% to 5.9% for PD. For reproducibility, the ICC ranged from 0.62 to 0.95 and the CV was less than 6% in all groups. The agreement was highest for the 3 × 3-mm pattern in the inner ring (ICC range, 0.92 [95% CI, 0.85-0.96] to 0.96 [95% CI, 0.93-0.98]) and 6 × 6-mm pattern in the outer ring (ICC range, 0.93 [95% CI, 0.86-0.97] to 0.96 [95% CI, 0.92-0.98]). Conclusions and Relevance Vessel length density and PD of the superficial retinal vasculature can be obtained from OCTA images with high levels of repeatability and reproducibility but can vary with scan pattern and location.

[1]  G. Staurenghi,et al.  REPEATABILITY AND REPRODUCIBILITY OF RETINAL THICKNESS MEASUREMENTS WITH SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY USING DIFFERENT SCAN PARAMETERS , 2012, Retina.

[2]  Carmen A. Puliafito,et al.  Quantifying Microvascular Density and Morphology in Diabetic Retinopathy Using Spectral-Domain Optical Coherence Tomography Angiography , 2016, Investigative ophthalmology & visual science.

[3]  C. Cheung,et al.  Relationship between retinal nerve fiber layer measurement and signal strength in optical coherence tomography. , 2008, Ophthalmology.

[4]  Mayss Al-Sheikh,et al.  Repeatability of automated vessel density measurements using optical coherence tomography angiography , 2016, British Journal of Ophthalmology.

[5]  Nathan D. Shemonski,et al.  Quantification of Retinal Microvascular Density in Optical Coherence Tomographic Angiography Images in Diabetic Retinopathy , 2017, JAMA ophthalmology.

[6]  A. Ho,et al.  In Vivo Assessment of Macular Vascular Density in Healthy Human Eyes Using Optical Coherence Tomography Angiography. , 2016, American journal of ophthalmology.

[7]  Qienyuan Zhou,et al.  RETINAL VASCULAR PERFUSION DENSITY MAPPING USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN NORMALS AND DIABETIC RETINOPATHY PATIENTS , 2015, Retina.

[8]  Robert N Weinreb,et al.  REPRODUCIBILITY OF VESSEL DENSITY MEASUREMENT WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN EYES WITH AND WITHOUT RETINOPATHY , 2017, Retina.

[9]  Hiroshi Ishikawa,et al.  Histogram Matching Extends Acceptable Signal Strength Range on Optical Coherence Tomography Images. , 2015, Investigative ophthalmology & visual science.

[10]  Florence Coscas,et al.  Normative Data for Vascular Density in Superficial and Deep Capillary Plexuses of Healthy Adults Assessed by Optical Coherence Tomography Angiography. , 2016, Investigative ophthalmology & visual science.

[11]  Nan M. Laird,et al.  Using the General Linear Mixed Model to Analyse Unbalanced Repeated Measures and Longitudinal Data , 1997 .

[12]  R. Spaide,et al.  Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. , 2015, JAMA ophthalmology.

[13]  David Huang,et al.  Optical Coherence Tomography Angiography of Peripapillary Retinal Blood Flow Response to Hyperoxia. , 2015, Investigative ophthalmology & visual science.

[14]  Wolzt,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2003, The Journal of the American College of Dentists.

[15]  David Huang,et al.  Automated Quantification of Capillary Nonperfusion Using Optical Coherence Tomography Angiography in Diabetic Retinopathy. , 2016, JAMA ophthalmology.

[16]  Marco Rispoli,et al.  IN VIVO CHARACTERIZATION OF RETINAL VASCULARIZATION MORPHOLOGY USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY , 2015, Retina.

[17]  David Huang,et al.  Compensation for Reflectance Variation in Vessel Density Quantification by Optical Coherence Tomography Angiography , 2016, Investigative ophthalmology & visual science.