MACULAR VASCULAR DENSITY ANALYSIS USING ADOBE PHOTOSHOP SOFTWARE IN DIABETIC EYES: OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY STUDY
AbstractBackground: Optical Coherence Tomography Angiography (OCTA) is dye less microvascular visualizing technique. In study we binaries OCTA images of macular vessels in healthy and diabetic subjects without macular oedema using Adobe Photoshop CS3 extended version. Methods: Prospective, single centered, observational study total of 58 eyes of 108 Diabetic Retinopathy (DR) subjects and 20 eyes of 40 normal subjects with mean age of 58.3±10.5 range (40–82) were included in our study. Ten eyes with Non-Diabetic Retinopathy (NDR), twenty-nine eyes with Non-Proliferative Diabetic Retinopathy (NPDR) (mild-10, moderate-7 and severe-12) and nineteen eyes with Proliferative Diabetic Retinopathy (PDR)are studied with images obtained using OCTA between September 2016 to June 2017. Scan area of 6×6 mm was selected to find morphological changes in the superficial retinal layers and deep retinal layers. Captured OCTA images were binarized using automated thresholding algorithm. Macular Vessel Density (MVD) (%) and Foveal Avascular Zone area (mm2) measured for superficial and deep retinal vessel arcade. For comparison, analysis of variance and Kruskal–Wallis test are applied. Results: Diabetic eyes were grouped according to their severity level. MVD and FAZ are compared in all groups. Results are significantly lower in all groups except in controls and NDR. Significant decrease is observed in vascular density of most layers with progress in retinopathy. Conclusion: Adobe Photoshop CS3 extended version is an excellent tool for image binarization. Calculating FAZ area and MVD using OCTA images agreed closely with clinical grading system. Application of this method can be helpful in monitoring disease progression.
Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin Epidemiologic Study of Diabetic Retinopathy: III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984;102(4):527–32.
Stefansson E, Bek T, Porta M, Larsen N, Kristinsson JK, Agardh E. Screening and prevention of diabetic blindness. Acta Ophthalmol Scand 2000;78(4):374–85.
Prokofyeva E, Zrenner E. Epidemiology of major eye diseases leading to blindness in Europe: a literature review. Ophthalmic Res 2012;47(4):171–88.
Saaddine JB, Honeycutt AA, Narayan KV, Zhang X, Klein R, Boyle JP. Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus: United States, 2005-2050. Arch Ophthalmol 2008;126(12):1740–7.
Dimitrova G, Kato S, Yamashita H, Tamaki Y, Nagahara M, Fukushima H, et al. Relation between retrobulbar circulation and progression of diabetic retinopathy. Br J Ophthalmol 2003;87(5):622–5.
Arend O, Wolf S, Jung F, Bertram B, Postgens H, Toonen H, et al. Retinal microcirculation in patients with diabetes mellitus: dynamic and morphological analysis of perifoveal capillary network. Br J Ophthalmol 1991;75(9):514–8.
Cogan DG, Toussaint D, Kuwabara T. Retinal vascular patterns. IV. Diabetic retinopathy. Arch Ophthalmol 1961;66(3):366–78.
Klein R. Hyperglycemie and microvascular and macrovascular disease in diabetes. Diabetes care 1995;18(2):258–68.
Wu L, Fernandez-Loaiza P, Sauma J, Hernandez-Bogantes E, Masis M. Classification of diabetic retinopathy and diabetic macular edema. World J Diabetes 2013;4(6):290–4.
Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification: ETDRS report number 10. Early Teatment Diabetic Retionoparhy study research group. Ophthalmology 1991;98(5):786–806.
Wilkinson C, Ferris 3rd F, Klein RE, Lee PP, Agardh CD, Davis M, et al. Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003;110(9):1677–82.
Spaide RF, Klancnik JM Jr., Cooney MJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol 2015;133(1):45–50.
Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329(14):977–86.
Control D, Group CTR. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Diabetees control and complications trial research group. Ophthalmology 1995;102(4):647–61.
Ishibazawa A, Nagaoka T, Takahashi A, Omae T, Tani T, Sogawa K, et al. Optical Coherence Tomography Angiography in Diabetic Retinopathy: A Prospective Pilot Study. Am J Ophthalmol 2015;160(1):35–44.e1.
Jia Y, Bailey ST, Hwang TS, McClintic SM, Gao SS, Pennesi ME, et al. Quantitative optical coherence tomography angiography of vascular abnormalities in the living human eye. Proc Natl Acad Sci U S A 2015;112(18):E2395–402.
Jia Y, Bailey ST, Wilson DJ, Tan O, Klein ML, Flaxel CJ, et al. Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration. Ophthalmology 2014;121(7):1435–44.
Jia Y, Tan O, Tokayer J, Potsaid B, Wang Y, Liu JJ, et al. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography. Opt Express 2012;20(4):4710–25.
Gadde SG, Anegondi N, Bhanushali D, Chidambara L, Yadav NK, Khurana A, et al. Quantification of vessel density in retinal optical coherence tomography angiography images using local fractal dimension. Invest Ophthalmol Vis Sci 2016;57(1):246–52.
Takase N, Nozaki M, Kato A, Ozeki H, Yoshida M, Ogura Y. Enlargement of Foveal Avascular Zone in Diabetic Eyes Evaluated by En Face Optical Coherence Tomography Angiography. Retina 2015;35(11):2377–83.
Talisa E, Chin AT, Bonini Filho MA, Adhi M, Branchini L, Salz DA, et al. Detection of microvascular changes in eyes of patients with diabetes but not clinical diabetic retinopathy using optical coherence tomography angiography. Retina 2015;35(11):2364–70.
Bresnick GH, De Venecia G, Myers FL, Harris JA, Davis MD. Retinal ischemia in diabetic retinopathy. Arch Ophthalmol 1975;93(12):1300–10.
Agemy SA, Scripsema NK, Shah CM, Chui T, Garcia PM, Lee JG, et al. Retinal vascular perfusion density mapping using optical coherence tomography angiography in normals and diabetic retinopathy patients. Retina 2015;35(11):2353–63.
Kim AY, Chu Z, Shahidzadeh A, Wang RK, Puliafito CA, Kashani AH. Quantifying microvascular density and morphology in diabetic retinopathy using spectral-domain optical coherence tomography angiography. Invest Ophthalmol Vis Sci 2016;57(9):OCT362–70.
Chan G, Balaratnasingam C, Yu PK, Morgan WH, McAllister IL, Cringle SJ, et al. Quantitative morphometry of perifoveal capillary networks in the human retina. Invest Ophthalmol Vis Sci 2012;53(9):5502–14.
Craigie EH. The vascularity of the cerebral cortex of the albino rat. J Comp Neurol 1921;33(3):193–212.
Motti ED, Imhof HG, Yasargil MG. The terminal vascular bed in the superficial cortex of the rat. An SEM study of corrosion casts. J Neurosurg 1986;65(6):834–46.
Shahlaee A, Samara WA, Hsu J, Say EAT, Khan MA, Sridhar J, et al. In vivo assessment of macular vascular density in healthy human eyes using optical coherence tomography angiography. Am J Ophthalmol 2016;165:39–46.