Ultrahigh-Speed, Swept-Source Optical Coherence Tomography Angiography in Nonexudative Age-Related Macular Degeneration with Geographic Atrophy.

PURPOSE To investigate ultrahigh-speed, swept-source optical coherence tomography (SSOCT) angiography for visualizing vascular changes in eyes with nonexudative age-related macular degeneration (AMD) with geographic atrophy (GA). DESIGN Observational, prospective, cross-sectional study. PARTICIPANTS A total of 63 eyes from 32 normal subjects and 12 eyes from 7 patients with nonexudative AMD with GA. METHODS A 1050-nm, 400-kHz A-scan rate SSOCT system was used to perform volumetric optical coherence tomography angiography (OCTA) of the retinal and choriocapillaris (CC) vasculatures in normal subjects and patients with nonexudative AMD with GA. Optical coherence tomography angiography using variable interscan time analysis (VISTA) was performed to assess CC alteration and differentiate varying degrees of CC flow impairment. MAIN OUTCOME MEASURES Qualitative comparison of retinal and CC vasculatures in normal subjects versus those in patients with a clinical diagnosis of nonexudative AMD with GA. RESULTS In all 12 eyes with GA, OCTA showed pronounced CC flow impairment within the region of GA. In 10 of the 12 eyes with GA, OCTA with VISTA showed milder CC flow impairment extending beyond the margin of GA. Of the 5 eyes exhibiting foveal-sparing GA, OCTA showed CC flow within the region of foveal sparing in 4 of the eyes. CONCLUSIONS The ability of ultrahigh-speed, swept-source OCTA to noninvasively visualize alterations in the retinal and CC vasculatures makes it a promising tool for assessing nonexudative AMD with GA. Optical coherence tomography angiography using VISTA can distinguish varying degrees of CC alteration and flow impairment and may be useful for elucidating disease pathogenesis, progression, and response to therapy.

[1]  R. Flower,et al.  Theoretical investigation of the role of choriocapillaris blood flow in treatment of subfoveal choroidal neovascularization associated with age-related macular degeneration. , 2001, American journal of ophthalmology.

[2]  Benjamin J Vakoc,et al.  Three-dimensional microscopy of the tumor microenvironment in vivo using optical frequency domain imaging , 2009, Nature Medicine.

[3]  Martin J. Leahy,et al.  Correlation mapping: rapid method for retrieving microcirculation morphology from optical coherence tomography intensity images , 2011, BiOS.

[4]  Sebastian Wolf,et al.  Morphologic changes in patients with geographic atrophy assessed with a novel spectral OCT-SLO combination. , 2008, Investigative ophthalmology & visual science.

[5]  R. Flower,et al.  Ten years experience with choroidal angiography using indocyanine green dye: a new routine examination or an epilogue? , 1985, Documenta Ophthalmologica.

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

[7]  W. Drexler,et al.  Three-dimensional optical coherence tomography at 1050 nm versus 800 nm in retinal pathologies: enhanced performance and choroidal penetration in cataract patients. , 2007, Journal of biomedical optics.

[8]  Adrian Mariampillai,et al.  Speckle variance detection of microvasculature using swept-source optical coherence tomography. , 2008, Optics letters.

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

[10]  M. Killingsworth,et al.  Evolution of geographic atrophy of the retinal pigment epithelium , 1988, Eye.

[11]  Eric M. Moult,et al.  Ultrahigh-speed swept-source OCT angiography in exudative AMD. , 2014, Ophthalmic surgery, lasers & imaging retina.

[12]  R. Mullins,et al.  Glycoconjugates of choroidal neovascular membranes in age-related macular degeneration. , 2005, Molecular vision.

[13]  J. Duker,et al.  Choriocapillaris and Choroidal Microvasculature Imaging with Ultrahigh Speed OCT Angiography , 2013, PloS one.

[14]  J S Sunness,et al.  The development of choroidal neovascularization in eyes with the geographic atrophy form of age-related macular degeneration. , 1999, Ophthalmology.

[15]  Robert F Mullins,et al.  Choriocapillaris vascular dropout related to density of drusen in human eyes with early age-related macular degeneration. , 2011, Investigative ophthalmology & visual science.

[16]  T. Yatagai,et al.  Optical coherence angiography. , 2006, Optics express.

[17]  W. Drexler,et al.  In vivo retinal optical coherence tomography at 1040 nm - enhanced penetration into the choroid. , 2005, Optics express.

[18]  Yuankai K. Tao,et al.  Single-pass volumetric bidirectional blood flow imaging spectral domain optical coherence tomography using a modified Hilbert transform. , 2008, Optics express.

[19]  Chen D. Lu,et al.  Retinal, anterior segment and full eye imaging using ultrahigh speed swept source OCT with vertical-cavity surface emitting lasers , 2012, Biomedical optics express.

[20]  Changhuei Yang,et al.  Mobility and transverse flow visualization using phase variance contrast with spectral domain optical coherence tomography. , 2007, Optics express.

[21]  Steffen Schmitz-Valckenberg,et al.  High-resolution spectral domain-OCT imaging in geographic atrophy associated with age-related macular degeneration. , 2008, Investigative ophthalmology & visual science.

[22]  I. Bhutto,et al.  Understanding age-related macular degeneration (AMD): relationships between the photoreceptor/retinal pigment epithelium/Bruch's membrane/choriocapillaris complex. , 2012, Molecular aspects of medicine.

[23]  Lingfeng Yu,et al.  Doppler variance imaging for three-dimensional retina and choroid angiography. , 2010, Journal of biomedical optics.

[24]  David Huang,et al.  Blood flow velocity quantification using split-spectrum amplitude-decorrelation angiography with optical coherence tomography. , 2013, Biomedical optics express.

[25]  Chen D. Lu,et al.  Phase-sensitive swept-source optical coherence tomography imaging of the human retina with a vertical cavity surface-emitting laser light source. , 2013, Optics letters.

[26]  J M Olver,et al.  Functional anatomy of the choroidal circulation: Methyl methacrylate casting of human choroid , 1990, Eye.

[27]  Takayuki Baba,et al.  Relationship between RPE and choriocapillaris in age-related macular degeneration. , 2009, Investigative ophthalmology & visual science.

[28]  P T de Jong,et al.  Morphometric analysis of Bruch's membrane, the choriocapillaris, and the choroid in aging. , 1994, Investigative ophthalmology & visual science.

[29]  Manuel Guizar-Sicairos,et al.  Efficient subpixel image registration algorithms. , 2008, Optics letters.

[30]  A. Bird,et al.  Geographic atrophy: a histopathological assessment. , 2014, JAMA ophthalmology.

[31]  R W Flower,et al.  Extraction of choriocapillaris hemodynamic data from ICG fluorescence angiograms. , 1993, Investigative ophthalmology & visual science.

[32]  Ajay E. Kuriyan,et al.  Optical coherence tomography measurements of choroidal thickness in healthy eyes: correlation with age and axial length. , 2015, Ophthalmic surgery, lasers & imaging retina.

[33]  R. Leitgeb,et al.  Ultrahigh-speed non-invasive widefield angiography. , 2012, Journal of biomedical optics.

[34]  U. Schraermeyer,et al.  Choriocapillaris breakdown precedes retinal degeneration in age-related macular degeneration , 2014, Neurobiology of Aging.

[35]  R W Flower,et al.  Feasibility of extracting velocity distribution in choriocapillaris in human eyes from ICG dye angiograms. , 2006, Journal of biomechanical engineering.

[36]  D. S. Mcleod,et al.  Quantifying changes in RPE and choroidal vasculature in eyes with age-related macular degeneration. , 2002, Investigative ophthalmology & visual science.

[37]  D. S. Mcleod,et al.  High-resolution histologic analysis of the human choroidal vasculature. , 1994, Investigative ophthalmology & visual science.

[38]  E. Stone,et al.  Is age-related macular degeneration a microvascular disease? , 2014, Advances in experimental medicine and biology.

[39]  Ruikang K. Wang,et al.  In vivo volumetric imaging of vascular perfusion within human retina and choroids with optical micro-angiography. , 2008, Optics express.

[40]  Shuichi Makita,et al.  Comprehensive in vivo micro-vascular imaging of the human eye by dual-beam-scan Doppler optical coherence angiography. , 2011, Optics express.