Optical coherence tomography angiography-derived flow density: a review of the influencing factors

Research interest in the possibility of quantifying macular and optic nerve head perfusion through optical coherence tomography angiography (OCTA) is rapidly advancing. Numerous scientific trials have furthered our understanding of the capabilities and the limitations of this novel technology, while applying OCTA to various ocular pathologies. In recent years, different parameters such as age, gender, intraocular pressure, spherical equivalent, physical activity, systemic diseases, and medication have been shown to have a significant impact on quantitative OCTA metrics. Since OCTA is likely to remain a “hot topic” in the near future, it is crucial to be aware of influencing factors in order to ensure correct interpretation of imaging results. This article reviews the factors currently known to influence flow density (FD) as measured by OCTA in healthy eyes.

[1]  A. Yoshida,et al.  Reperfusion of the choriocapillaris observed using optical coherence tomography angiography in hypertensive choroidopathy , 2018, International Ophthalmology.

[2]  H. Terasaki,et al.  Novel Classification of Early-stage Systemic Hypertensive Changes in Human Retina Based on OCTA Measurement of Choriocapillaris , 2018, Scientific Reports.

[3]  X. Kong,et al.  Retinal Vascular Autoregulation during Phase IV of the Valsalva Maneuver: An Optical Coherence Tomography Angiography Study in Healthy Chinese Adults , 2017, Front. Physiol..

[4]  G. Holló No Acute Effect of Smoking on Peripapillary and Macular Vessel Density in Healthy Middle-aged Smokers , 2019, Journal of glaucoma.

[5]  M. K. Erol,et al.  Optical coherence tomography angiography for screening of hydroxychloroquine-induced retinal alterations , 2018, Graefe's Archive for Clinical and Experimental Ophthalmology.

[6]  Tiago M. Rodrigues,et al.  OCT angiography findings in children with amblyopia. , 2018, Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

[7]  C W Whitney,et al.  Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. , 2001, American journal of respiratory and critical care medicine.

[8]  J. Lauermann,et al.  Evaluation of Ocular Perfusion in Alzheimer's Disease Using Optical Coherence Tomography Angiography. , 2018, Journal of Alzheimer's disease : JAD.

[9]  X. Kong,et al.  Microcirculatory Responses to Hyperoxia in Macular and Peripapillary Regions. , 2016, Investigative ophthalmology & visual science.

[10]  A. Carotenuto,et al.  Optical coherence tomography angiography retinal vascular network assessment in multiple sclerosis , 2018, Multiple sclerosis.

[11]  Jianqin Lei,et al.  Influence of Axial Length on Parafoveal and Peripapillary Metrics from Swept Source Optical Coherence Tomography Angiography , 2019, Current eye research.

[12]  M. Burns,et al.  Case-Control Study , 2020, Definitions.

[13]  K. Tekin,et al.  The Validity of Optical Coherence Tomography Angiography as a Screening Test for the Early Detection of Retinal Changes in Patients with Hydroxychloroquine Therapy , 2018, Current eye research.

[14]  D. Ladas,et al.  Multimodal imaging of hypertensive chorioretinopathy by swept-source optical coherence tomography and optical coherence tomography angiography , 2017, Medicine.

[15]  E. Chihara,et al.  Increase in the OCT angiographic peripapillary vessel density by ROCK inhibitor ripasudil instillation: a comparison with brimonidine , 2018, Graefe's Archive for Clinical and Experimental Ophthalmology.

[16]  Joachim Hornegger,et al.  Optical coherence tomography angiography of optic nerve head and parafovea in multiple sclerosis , 2014, British Journal of Ophthalmology.

[17]  C. Zimmer,et al.  Optical coherence tomography angiography indicates associations of the retinal vascular network and disease activity in multiple sclerosis , 2019, Multiple sclerosis.

[18]  C. Zheng,et al.  Evaluation of retinal vasculature before and after treatment of children with obstructive sleep apnea-hypopnea syndrome by optical coherence tomography angiography , 2018, Graefe's Archive for Clinical and Experimental Ophthalmology.

[19]  A. G. Bennett,et al.  Improvements on Littmann's method of determining the size of retinal features by fundus photography , 1994, Graefe's Archive for Clinical and Experimental Ophthalmology.

[20]  G. Bartsch,et al.  Molecular mechanisms of the effects of sildenafil (VIAGRA®) , 1999, Experimental Gerontology.

[21]  I. Yilmaz,et al.  Comparison of quantitative measurement of foveal avascular zone and macular vessel density in eyes of children with amblyopia and healthy controls: an optical coherence tomography angiography study. , 2017, Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

[22]  N. Eter,et al.  Optical coherence tomography (OCT) angiography findings in retinal arterial macroaneurysms , 2016, BMC Ophthalmology.

[23]  Jaeryung Oh,et al.  Inter-relationship between retinal and choroidal vasculatures using optical coherence tomography angiography in normal eyes , 2018, European journal of ophthalmology.

[24]  Reza Mirshahi,et al.  The Quantitative Measurements of Vascular Density and Flow Area of Optic Nerve Head Using Optical Coherence Tomography Angiography , 2017, Journal of glaucoma.

[25]  J. Nordmann,et al.  Parafoveal and optic disc vessel density in patients with obstructive sleep apnea syndrome: an optical coherence tomography angiography study , 2018, Graefe's Archive for Clinical and Experimental Ophthalmology.

[26]  Ruikang K. Wang,et al.  Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications , 2017, Progress in Retinal and Eye Research.

[27]  V. Morales-Canton,et al.  Changes in Retinal and Choroidal Vascular Blood Flow after Oral Sildenafil: An Optical Coherence Tomography Angiography Study , 2017, Journal of ophthalmology.

[28]  C. Cheung,et al.  Quantitative retinal microvasculature in children using swept-source optical coherence tomography: the Hong Kong Children Eye Study , 2018, British Journal of Ophthalmology.

[29]  Hong Jiang,et al.  Retinal Microvascular Network and Microcirculation Assessments in High Myopia. , 2017, American journal of ophthalmology.

[30]  R. Harwerth,et al.  The effects of graded intraocular pressure challenge on the optic nerve head , 2018, Experimental eye research.

[31]  In vivo assessment of macula in eyes of healthy children 8 to 16 years old using optical coherence tomography angiography , 2017, Scientific Reports.

[32]  M. Chimenti,et al.  Evaluation of retinal microvascular density in patients affected by systemic lupus erythematosus: an optical coherence tomography angiography study , 2018, Annals of the rheumatic diseases.

[33]  Ruikang K. Wang,et al.  Aging-associated changes in cerebral vasculature and blood flow as determined by quantitative optical coherence tomography angiography , 2018, Neurobiology of Aging.

[34]  David Huang,et al.  Relationship Between Retinal Perfusion and Retinal Thickness in Healthy Subjects: An Optical Coherence Tomography Angiography Study , 2016, Investigative ophthalmology & visual science.

[35]  S. Wolf,et al.  Cataract significantly influences quantitative measurements on swept-source optical coherence tomography angiography imaging , 2018, PloS one.

[36]  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.

[37]  Mehmet Bulut,et al.  Evaluation of optical coherence tomography angiographic findings in Alzheimer’s type dementia , 2017, British Journal of Ophthalmology.

[38]  K. Falavarjani,et al.  Effect of Age and Myopia on Retinal Microvasculature. , 2018, Ophthalmic surgery, lasers & imaging retina.

[39]  R. Spaide Choriocapillaris Flow Features Follow a Power Law Distribution: Implications for Characterization and Mechanisms of Disease Progression. , 2016, American journal of ophthalmology.

[40]  T. Wong,et al.  Impact of hypertension on retinal capillary microvasculature using optical coherence tomographic angiography , 2018, Journal of hypertension.

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

[42]  N. Choudhry,et al.  Swept-Source Optical Coherence Tomography Angiography and Vascular Perfusion Map Findings in Obstructive Sleep Apnea. , 2016, Ophthalmic surgery, lasers & imaging retina.

[43]  Lei Guo,et al.  In vivo optical imaging of amblyopia: Digital subtraction autofluorescence and split‐spectrum amplitude‐decorrelation angiography , 2016, Lasers in surgery and medicine.

[44]  P. Heiduschka,et al.  OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH RETINITIS PIGMENTOSA , 2017, Retina.

[45]  Daniel M. Schwartz,et al.  Optical imaging of the chorioretinal vasculature in the living human eye , 2013, Proceedings of the National Academy of Sciences.

[46]  N. Eter,et al.  Quantification of macular perfusion using optical coherence tomography angiography: repeatability and impact of an eye-tracking system , 2018, BMC Ophthalmology.

[47]  N. Eter,et al.  Changes in Flow Density Measured Using Optical Coherence Tomography Angiography after iStent Insertion in Combination with Phacoemulsification in Patients with Open-Angle Glaucoma , 2018, Journal of ophthalmology.

[48]  M. Kaya,et al.  Evaluation of Macular Perfusion in Healthy Smokers by Using Optical Coherence Tomography Angiography. , 2017, Ophthalmic surgery, lasers & imaging retina.

[49]  N. Eter,et al.  Effects of high-intensity interval training on optic nerve head and macular perfusion using optical coherence tomography angiography in healthy adults. , 2018, Atherosclerosis.

[50]  F. Velez,et al.  Increased choriocapillaris vessel density in amblyopic children: a case-control study. , 2018, Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

[51]  D. Han,et al.  [Application of optical coherence tomography angiography in evaluation of retinal microvascular changes in patients with obstructive sleep apnea syndrome]. , 2017, Zhonghua yi xue za zhi.

[52]  David Huang,et al.  Optical coherence tomography angiography enhances the detection of optic nerve damage in multiple sclerosis , 2017, British Journal of Ophthalmology.

[53]  Akitoshi Yoshida,et al.  Optical Coherence Tomography Angiography in Diabetic Retinopathy: A Prospective Pilot Study. , 2015, American journal of ophthalmology.

[54]  M. Lee,et al.  Changes in Ganglion Cell-Inner Plexiform Layer Thickness and Retinal Microvasculature in Hypertension: An Optical Coherence Tomography Angiography Study. , 2019, American journal of ophthalmology.

[55]  Robert J Zawadzki,et al.  Phase-variance optical coherence tomography: a technique for noninvasive angiography. , 2014, Ophthalmology.

[56]  G. Ravalico,et al.  Age-related ocular blood flow changes. , 1996, Investigative ophthalmology & visual science.

[57]  J. Demer,et al.  Spectral-Domain Optical Coherence Tomographic Angiography in Children With Amblyopia , 2017, JAMA ophthalmology.

[58]  N. Eter,et al.  Diurnal variations in flow density measured using optical coherence tomography angiography and the impact of heart rate, mean arterial pressure and intraocular pressure on flow density in primary open‐angle glaucoma patients , 2019, Acta ophthalmologica.

[59]  James G. Fujimoto,et al.  Optical coherence tomography angiography , 2017, Progress in Retinal and Eye Research.

[60]  L. Arnould,et al.  The EYE‐MI pilot study: a prospective acute coronary syndrome cohort evaluated with retinal optical coherence tomography angiography , 2018, Investigative ophthalmology & visual science.

[61]  E. Simjanoski,et al.  Retinal Macroaneurysm in Long-Standing Hypertension. , 2016, Ophthalmology.

[62]  Yong Woo Kim,et al.  The Importance of Signal Strength in Quantitative Assessment of Retinal Vessel Density Using Optical Coherence Tomography Angiography , 2018, Scientific Reports.

[63]  H. Lim,et al.  Repeatability of vessel density measurements using optical coherence tomography angiography in retinal diseases , 2018, British Journal of Ophthalmology.

[64]  Savleen Kaur,et al.  Comparison of quantitative measurement of foveal avascular zone and macular vessel density in eyes of children with amblyopia and healthy controls: an optical coherence tomography angiography study. , 2017, Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

[65]  N. Eter,et al.  OCT-Angiography reveals reduced vessel density in the deep retinal plexus of CADASIL patients , 2018, Scientific Reports.

[66]  A. Omma,et al.  The optical coherence tomography angiography findings of rheumatoid arthritis patients taking hydroxychloroquine , 2018, European journal of ophthalmology.

[67]  Jian Yu,et al.  Phenylephrine Affects Peripapillary Retinal Vasculature—an Optic Coherence Tomography Angiography Study , 2017, Front. Physiol..

[68]  Alexandra Miere,et al.  Clinical applications of optical coherence tomography angiography: What we have learnt in the first 3 years , 2018, European journal of ophthalmology.

[69]  Martin F. Kraus,et al.  Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration. , 2014, Ophthalmology.

[70]  Rosa Dolz-Marco,et al.  Quantitative OCT Angiography of the Retinal Microvasculature and the Choriocapillaris in Myopic Eyes. , 2017, Investigative ophthalmology & visual science.

[71]  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.

[72]  I. Selesnick,et al.  The avascular zone and neuronal remodeling of the fovea in Parkinson disease , 2015, Annals of clinical and translational neurology.

[73]  P. Heiduschka,et al.  OCT angiography in the mouse: A novel evaluation method for vascular pathologies of the mouse retina. , 2016, Experimental eye research.

[74]  D. Sarraf,et al.  Retinal Capillary Density and Foveal Avascular Zone Area Are Age-Dependent: Quantitative Analysis Using Optical Coherence Tomography Angiography. , 2016, Investigative ophthalmology & visual science.

[75]  Toco Y P Chui,et al.  Association of Myopia With Peripapillary Perfused Capillary Density in Patients With Glaucoma: An Optical Coherence Tomography Angiography Study , 2018, JAMA ophthalmology.

[76]  Jianhua Wang,et al.  Retinal Microvascular Impairment in the Early Stages of Parkinson's Disease. , 2018, Investigative ophthalmology & visual science.

[77]  S. Uzun,et al.  Vascular Density in Retina and Choriocapillaris as Measured by Optical Coherence Tomography Angiography. , 2016, American journal of ophthalmology.

[78]  G. Riemekasten,et al.  Evaluation of retinal microvascular perfusion in systemic sclerosis: a case–control study , 2019, Annals of the rheumatic diseases.

[79]  N. Eter,et al.  Changes in retinal flow density measured by optical coherence tomography angiography in patients with carotid artery stenosis after carotid endarterectomy , 2018, Scientific Reports.

[80]  David Huang,et al.  OCT Angiography Changes in the 3 Parafoveal Retinal Plexuses in Response to Hyperoxia. , 2017, Ophthalmology. Retina.

[81]  Giovanni Gregori,et al.  Age-Related Alterations in the Retinal Microvasculature, Microcirculation, and Microstructure , 2017, Investigative ophthalmology & visual science.

[82]  D. White Sleep-related breathing disorder.2. Pathophysiology of obstructive sleep apnoea. , 1995, Thorax.

[83]  Dawn A Sim,et al.  Evaluation of Nonperfused Retinal Vessels in Ischemic Retinopathy. , 2016, Investigative ophthalmology & visual science.

[84]  Chun Ding,et al.  Quantification of Vessel Density in Retinal Optical Coherence Tomography Angiography Images Using Local Fractal Dimension. , 2016, Investigative ophthalmology & visual science.

[85]  Ali Erginay,et al.  VESSEL DENSITY OF SUPERFICIAL, INTERMEDIATE, AND DEEP CAPILLARY PLEXUSES USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY , 2018, Retina.

[86]  N. Eter,et al.  Messung der Flussdichte mittels OCT-Angiographie , 2017, Der Ophthalmologe.

[87]  M. Treder,et al.  SHORT-TERM EFFECTS OF EXERCISE ON OPTIC NERVE AND MACULAR PERFUSION MEASURED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY , 2017, Retina.

[88]  Zhennan Zhao,et al.  Changes in macular vasculature after uncomplicated phacoemulsification surgery: Optical coherence tomography angiography study. , 2018, Journal of cataract and refractive surgery.

[89]  F. Kaya,et al.  Analysis of Macular Vessel Density and Foveal Avascular Zone Using Spectral-Domain Optical Coherence Tomography Angiography in Children With Amblyopia. , 2019, Journal of pediatric ophthalmology and strabismus.

[90]  T. Kusbeci,et al.  ACUTE EFFECT OF CAFFEINE ON MACULAR MICROCIRCULATION IN HEALTHY SUBJECTS: An Optical Coherence Tomography Angiography Study , 2018, Retina.

[91]  Srinivas R Sadda,et al.  Topographic distribution of choriocapillaris flow deficits in healthy eyes , 2018, PloS one.

[92]  Brian D. Krawitz,et al.  A method for age-matched OCT angiography deviation mapping in the assessment of disease- related changes to the radial peripapillary capillaries , 2018, PloS one.

[93]  L. Zangwill,et al.  Reproducibility of Optical Coherence Tomography Angiography Macular and Optic Nerve Head Vascular Density in Glaucoma and Healthy Eyes , 2017, Journal of glaucoma.

[94]  Xiaodong Sun,et al.  Determination of Topographic Variations in Inner Retinal Blood Flow Areas in Young Chinese Subjects Using Optical Coherence Tomography Angiography , 2017, Current eye research.

[95]  C. Lohmann,et al.  Eine junge Patientin mit vollem Visus, kleinen Gesichtsfelddefekten und normalem Fluoreszenzangiogramm , 2019, Der Ophthalmologe.

[96]  P. Heiduschka,et al.  Feasibility of optical coherence tomography angiography to assess changes in retinal microcirculation in ovine haemorrhagic shock , 2018, Critical Care.

[97]  A C S Tan,et al.  An overview of the clinical applications of optical coherence tomography angiography , 2018, Eye.

[98]  Yuh-Min Chen,et al.  Sleep apnea and risk of retinal vein occlusion: a nationwide population-based study of Taiwanese. , 2012, American journal of ophthalmology.

[99]  Bonnie K. Lind,et al.  Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study , 2000 .

[100]  Jian Yu,et al.  Reduced Retinal Vessel Density in Obstructive Sleep Apnea Syndrome Patients: An Optical Coherence Tomography Angiography Study. , 2017, Investigative ophthalmology & visual science.

[101]  Hongyu Chen,et al.  Effective use of latent semantic indexing and computational linguistics in biological and biomedical applications , 2012, Front. Physio..

[102]  G. Querques,et al.  Quantitative changes in the ageing choriocapillaris as measured by swept source optical coherence tomography angiography , 2018, British Journal of Ophthalmology.

[103]  Narendra K. Puttaiah,et al.  Determinants of Peripapillary and Macular Vessel Densities Measured by Optical Coherence Tomography Angiography in Normal Eyes , 2017, Journal of glaucoma.

[104]  Q. Nguyen,et al.  Evaluation of macular and peripapillary vessel flow density in eyes with no known pathology using optical coherence tomography angiography , 2016, International Journal of Retina and Vitreous.

[105]  M. Quaranta-El Maftouhi,et al.  Chronic central serous chorioretinopathy imaged by optical coherence tomographic angiography. , 2015, American journal of ophthalmology.

[106]  P. Heiduschka,et al.  Quantitative changes in flow density in patients with adult-onset foveomacular vitelliform dystrophy: an OCT angiography study , 2017, Graefe's Archive for Clinical and Experimental Ophthalmology.

[107]  Jost B Jonas,et al.  Optical Coherence Tomography Angiography Vessel Density Changes after Acute Intraocular Pressure Elevation , 2018, Scientific Reports.

[108]  Jian Yu,et al.  Macular perfusion in healthy Chinese: an optical coherence tomography angiogram study. , 2015, Investigative ophthalmology & visual science.

[109]  S. Yılmaz,et al.  Quantitative Analysis of Optical Coherence Tomography Angiography Features in Patients with Nonocular Behcet’s Disease , 2018, Current eye research.

[110]  Diurnal Variations of Peripapillary and Macular Vessel Density in Glaucomatous Eyes Using Optical Coherence Tomography Angiography , 2018, Journal of glaucoma.

[111]  P. Heiduschka,et al.  Aberrant ocular architecture and function in patients with Klinefelter syndrome , 2017, Scientific Reports.

[112]  J. Pépin,et al.  Non-arteritic anterior ischaemic optic neuropathy is nearly systematically associated with obstructive sleep apnoea , 2006, British Journal of Ophthalmology.

[113]  Giovanni Montesano,et al.  Vessel density, retinal thickness, and choriocapillaris vascular flow in myopic eyes on OCT angiography , 2018, Graefe's Archive for Clinical and Experimental Ophthalmology.

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

[115]  Aruj Khurana,et al.  Quantification of Vessel Density in Retinal Optical Coherence Tomography Angiography Images Using Local Fractal Dimension. , 2016, Investigative ophthalmology & visual science.

[116]  K. Falavarjani,et al.  Foveal Avascular Zone and Vessel Density in Healthy Subjects: An Optical Coherence Tomography Angiography Study , 2018, Journal of ophthalmic & vision research.

[117]  J. Jonas,et al.  Vascular Density in Retina and Choriocapillaris as Measured by Optical Coherence Tomography Angiography. , 2016, American journal of ophthalmology.

[118]  J. Forrester,et al.  Glucose-dependent regulation of DNA synthesis in bovine retinal endothelial cells. , 1998, Current eye research.

[119]  G. Holló Influence of Large Intraocular Pressure Reduction on Peripapillary OCT Vessel Density in Ocular Hypertensive and Glaucoma Eyes , 2017, Journal of glaucoma.