Exploration of the Value of Optical Coherence Tomography (OCT) and OCT Angiography in Differentiating Between Major Depressive Disorder and Borderline Personality Disorder

BackgroundOptical coherence tomography (OCT) or OCT angiography (OCTA) has been investigated in few research studies of psychiatric disorders. No research has been done using OCT or OCTA in patients with borderline personality disorder (BPD).MethodsOCTA measured foveal avascular zone (FAZ), macular vessel density (MVD), and peripapillary vessel density (PVD). OCT measured the peripapillary retinal fiber layer (RNFL) and central retinal thickness (CRT). The study utilized the Ottawa Self‐Injury Inventory, Hamilton Anxiety Rating Scale (HAMA), and Global Assessment of Functioning (GAF) to assess the symptom characteristics of individuals with BPD.ResultsFifty‐nine eyes of BPD patients and 58 eyes of normal subjects were analyzed, MVD of the superficial retinal capillary plexus declined noticeably in most subfields (p < 0.05). Significant differences were observed in the whole inner ring and outer ring index between BPD and HC groups (p < 0.05). The patients with BPD exhibited lower RNFL and CRT, the difference was significant (p < 0.05). CRT indicated a significant negative correlation with the Ottawa Self‐Injury Inventory (p < 0.05). In addition, we observed that there was a negative correlation identified between the MVD of the inner ring and HAMA (p < 0.05). Meanwhile, the MVD of the outer ring was positively correlated with GAF (p < 0.05). The areas under the receiver operating characteristic curves (AUROCs) for distinguishing BPD and HC eyes in OCTA were the highest for fovea MVD (0.679), followed by outer ring MVD (0.669), inner ring MVD (0.641), FAZ (0.579). In OCT, CRT was highest for BPD (0.711), followed by RNFL (0.625).ConclusionThe OCT and OCTA can non‐invasively detect microvascular and morphology changes of the retina in BPD patients compared to healthy control subjects.

The retinal microvascular density changes have been identified in thyroid-associated ophthalmopathy (TAO) patients. Whereas a lack of research has been done on the diagnostic ability of optical coherence tomography (OCT) combined with optical coherence tomography angiography (OCTA) parameters. This study aims to evaluate the retina perfusion variations in eyes with active and stable TAO and its diagnostic abilities using OCT and OCTA. This is cohort longitudinal retrospective study. A total of 51 patients with TAO and 39 healthy controls (HCs) were recruited. The TAO eyes were divided into active and stable stage groups. The foveal avascular zone (FAZ), macular perfusion density (mPD), and peripapillary PD were measured by OCTA. The peripapillary retinal nerve fiber layer (RNFL), central retinal thickness (CRT), and whole macular volume (wMV) were measured by OCT. Visual evoked potential (VEP) and visual field (VF) were also assessed. The mPD of the superficial retinal capillary plexus (SRCP) was significantly different in all subfields among active, stable, and HC groups (p < 0.05) except for the temporal inner (p = 0.137), and the active group achieved the lowest PD. The FAZ size increased significantly in the active and stable groups compared with the HC group (p < 0.001). Significant difference was observed in mPD of deep retinal capillary plexus (DRCP) in all quadrants among three groups (p < 0.05). Moreover, PD parameters of optic nerve head (ONH) and radial peripapillary capillary plexus (RPCP) showed a different trend among three groups (p < 0.05). The r-value of visual field-mean deviation (VF-MD) of TAO with DRCP-whole PD (wPD) and RPCP-wPD was 0.421 and 0.299, respectively (p < 0.05). The DRCP-wPD in OCTA and RNFL in OCT were significantly higher in area under the receiver operating characteristic curve (AUC) than that of HC eyes. OCT and OCTA can noninvasively detect the peripapillary and macular changes in various stages of TAO patients, and it might be a high diagnostic value tool to monitor the TAO progression.

Optical coherence tomography angiography (OCTA) in differential diagnosis of aquaporin-4 antibody seronegative NMOSD and multiple sclerosis

The Promise of Optical Coherence Tomography Angiography in Glaucoma

Although early glaucoma detection is important to prevent visual loss due to disease progression, its clinical diagnosis in highly myopic eyes is still difficult. Many studies using optical coherence tomography (OCT) angiography (OCTA) reported decreased vessel density (VD) in glaucomatous eyes compared to normal eyes. We evaluated the diagnostic ability of peripapillary VD and macular VD measured by OCTA, comparing them with conventional valuables such as peripapillary retinal nerve fibre layer (RNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness measured by OCT. We also calculated the average VD ratio (VDR) (average outer macular VD/average inner macular VD), superior VDR (superior outer macular VD/average inner macular VD), and inferior VDR (inferior outer macular VD/average inner macular VD). Totally, 169 eyes from 169 subjects were enrolled. Among OCTA measurements, the best diagnostic parameters were average VDR (AUROC: 0.852 and 0.909) and inferior VDR (AUROC: 0.820 and 0.941) in nonhighly and highly myopic eyes, respectively. Inferior VDR showed better diagnostic ability than most of the other OCT measurements including peripapillary RNFL thickness and macular GCIPL thickness in highly myopic eyes. Accordingly, OCTA measurements can be useful for diagnosing glaucoma in highly myopic eyes, especially when using calculated indices such as average VDR or inferior VDR.

BackgroundA growing body of literature has shown a relationship between neurodegenerative diseases and ocular changes. Frontotemporal dementia (FTD) affects individuals under age 65. We use optical coherence tomography (OCT) and OCT angiography (OCTA) to characterize the retinal microvasculature and retinal and choroidal structure in patients with FTD vs normal cognition.MethodCross‐sectional comparison of patients with FTD to age‐ and sex‐matched controls with normal cognition. Exclusion criteria included diabetes, glaucoma, uncontrolled hypertension, and retinal or optic nerve pathology. Participants underwent OCT and OCTA imaging using the Zeiss Cirrus HD‐5000 Spectral‐Domain OCT with AngioPlex. Primary outcome measures included OCT parameters: subfoveal choroidal thickness, central subfield thickness, ganglion cell layer‐inner plexiform layer (GC‐IPL) thickness, and retinal nerve fiber layer (RNFL) thickness; and OCTA parameters: superficial capillary plexus foveal avascular zone area, 3×3mm and 6×6mm macular vessel density (VD) and perfusion density (PD), and 4.5×4.5mm peripapillary capillary perfusion density (CPD) and capillary flux index (CFI). Generalized estimating equations accounting for correlation between 2 eyes of the same subject were utilized for statistical analysis.ResultTwenty‐eight eyes of 17 participants with FTD and 85 eyes of 48 patients with normal cognition were analyzed. Individuals with FTD were matched to their normal cognition counterparts with regard to sex (64.7% vs 62.5% men, p = 0.871) and age (67.82 vs 68.98 years, p = 0.958). Compared to normal cognition participants, MMSE scores of FTD participants were significantly lower (p &lt; 0.001). In FTD, average 4.5×4.5‐mm CFI was decreased compared to controls (p = 0.032). There was no difference in average 4.5×4.5mm CPD between FTD and controls (p = 0.172).ConclusionIndividuals with FTD exhibited significantly reduced average CFI compared to controls. Retinal microvasculature changes may be useful as a biomarker for FTD diagnosis.

Although there is abundant evidence relating neuronal and vascular optical coherence tomography (OCT) and OCT angiography (OCTA) measures to retinal disease, data on the normative distribution of retinal features and their associations with visual function in a healthy, older, community-based population are sparse. To characterize the normative OCT and OCTA measures in older adults and describe their associations with visual function. This was a cross-sectional, observational study conducted from May 17, 2017, to May 31, 2019. The study included a community-based sample. Participants in the Atherosclerosis Risk in Communities study from Jackson, Mississippi (all self-reported Black participants), and Washington County, Maryland (all self-reported White participants), were recruited in the Eye Determinants of Cognition study (EyeDOC). Data analyses were conducted from June 14, 2020, to May 31, 2021. Retinal measurements, including retinal nerve fiber layer (RNFL) thickness, macular ganglion cell complex (GCC) thickness, macular vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), and foveal avascular zone (FAZ) area, were captured with spectral-domain OCT and OCTA. Visual function, including presenting distance vision, corrected distance vision, near visual acuity (VA), and contrast sensitivity (CS), was assessed. A total of 759 participants (mean [SD] age, 80 [4.2] years; 480 female participants [63%]; 352 Black participants [46%]) were included in the study. Mean (SD) GCC thickness (89.2 [9.3] μm vs 92.3 [8.5] μm) and mean (SD) FAZ (0.36 [0.16] mm2 vs 0.26 [0.12] mm2) differed between Jackson and Washington County participants, respectively. Mean (SD) RNFL thickness and mean (SD) VD in SCP and DCP were greater for participants 80 years or younger than for participants older than 80 years (RNFL: ≤80 years, 93.2 [10.5] μm; >80 years, 91.1 [11.6] μm; VD SCP, ≤80 years, 44.3% [3.5%]; >80 years, 43.5% [3.8%]; VD DCP, ≤80 years, 44.7% [4.9%]; >80 years, 43.7% [4.8%]). Linear regression showed each 10-μm increment in RNFL thickness and GCC thickness was positively associated with 0.016 higher logCS among all participants (RNFL: 95% CI, 0.005-0.027; P = .004; GCC: 95% CI, 0.003-0.029; P = .02), with stronger associations among Jackson participants. The associations of VA and structural measures were found only in Jackson participants, with coefficients per 10-μm increment of 0.012 logMAR VA (RNFL: 95% CI, 0.000-0.023; P = .049) and 0.020 logMAR VA (GCC: 95% CI, 0.004-0.034; P = .04). In this cross-sectional study, better CS was associated with greater RNFL thickness and GCC thickness, but no visual measures were associated with angiographic features overall. These findings suggest that clinical application of normative references for OCT- and OCTA-based measures should consider demographic and community features.

The prospects for early detection with optical coherence tomography (OCT) and OCT angiography in major depressive disorder

Purpose This study aimed to investigate the effect of nimodipine on peripapillary and macular capillary vessel density (VD) in patients with normal-tension glaucoma (NTG) using optical coherence tomography angiography (OCTA). Methods Sixty mg nimodipine was administered to 20 enrolled NTG patients for 3 months. Patients were treated with glaucoma medication simultaneously. The macular and peripapillary VD were measured automatically by OCTA at baseline, 1.5 h after administering nimodipine, and after 3 months of administering the drug. The retinal nerve fibre layer (RNFL), ganglion cell complex thickness, visual field (VF) testing, intraocular pressure (IOP), blood pressure and pulse rate in each subject were assessed during each follow-up. Results Compared with the baseline, the parafovea VD was higher (50.89 ± 4.26 versus 46.80 ± 5.40, P = .044) 1.5 h after administration of nimodipine. After administration of nimodipine for 3 months, the parafovea VD was obviously increased (51.14 ± 5.68 versus 46.80 ± 5.40, P = .039), while IOP, systolic blood pressure, mean arterial pressure and mean ocular perfusion pressure were decreased compared to baseline (all P < .05). No significant differences were found between the radial peripapillary capillary and disc VD. The parafovea VD was positively correlated with the administration of nimodipine (β = 0.39, P = .004), RNFL thickness (β = 0.49, P = .022), and VF mean deviation (β = 0.4, P = .040) in the multivariate analysis. Conclusions Nimodipine effectively increased superficial macular capillary VD, but did not affect peripapillary capillary VD in patients with NTG. This finding indicates that patients with NTG may benefit from the administration of nimodipine.

To evaluate the association between optical coherence tomography (OCT) angiography measurements and progressive retinal nerve fiber layer (RNFL) loss in eyes with mild to moderate open-angle glaucoma. In this prospective study, 111 quadrants of 59 eyes with mild-moderate open-angle glaucoma were longitudinally evaluated for a minimum of 2 years with at least 3 OCT scans performed. OCT angiography was performed at baseline and vessel densities in the peripapillary and parafoveal regions were determined quadrant-wise. Effect of demographic (age, sex, presence of diabetes and hypertension), clinical (mean and fluctuation of intraocular pressure, presence of pseudoexfoliation, presence of disc hemorrhages, central corneal thickness, baseline mean deviation on visual fields) and OCT angiography parameters (peripapillary and parafoveal vessel densities) on rate of RNFL change was determined using linear mixed models. Average baseline hemifield mean deviation and quadrant RNFL thickness was -3.5 ± 2.5dB and 97 ± 18µm respectively. The mean follow-up duration was 5.0 ± 1.8 years. The rate of change of quadrant RNFL thickness (RNFL slope) was -1.67 ± 0.2 µm/year. Multivariate mixed models showed that presence of pseudoexfoliation deposits (co-efficient -0.78 ± 0.34, p = 0.025) and optic disc hemorrhages (co-efficient -0.59 ± 0.28, p = 0.040) were associated with a faster rate of RNFL decline. None of the baseline OCT angiography parameters evaluated in this study showed any association with the RNFL slope. Presence of pseudoexfoliation and optic disc hemorrhages are significant risk factors for glaucoma progression in open-angle glaucoma. Baseline superficial vessel density, as measured on OCT angiography, was not associated with the rate of RNFL loss in mild-moderate open-angle glaucoma.

To asses changes in vessel density (VD) in children with optic disk drusen (ODD) using swept source optical coherence tomography angiography (OCTA). Cross-sectional study of 27 eyes with ODD compared with age-matched controls. Peripapillary and macular VD were measured in the superficial retinal capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC). The correlation between VD changes with alterations in retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and visual field (VF) was analyzed. Mean participant age was 12.5 ± 3.3 years (range, 7-18 years); 63% was females. In the patients vs. controls, median central peripapillary VD was 52.9% vs. 50.6% (p = 0.63) for SCP; 48.1% vs. 53.8% (p = 0.017) for DCP; and 17.0% vs. 28.2% (p = 0.0037) for CC, respectively. VD in the superior and nasal CC layers was significantly lower in the patients (36.3% vs. 56.2%; p < 0.001) and (60.4% vs. 70.3%, p < 0.001), respectively. No significant differences were observed for VD in the macular region. The RNFL was thinner in eyes with superficial drusen versus controls (87 vs. 111 μm; p < 0.001). No significant differences between were observed in GCL thickness (p = 0.13). Nasal SCP and nasal RNFL VD were moderately correlated (r = 0.54, p < 0.01), while mean VF deviation was strongly correlated with median SCP VD in patients with superficial drusen (r = 0.9, p = 0.03). Impaired VD was observed in the peripapillary nasal CC in patients with ODD; this impairment was associated with a decreased RNFL thickness. Nasal SCP VD and RNFL thickness were moderately correlated in patients with ODD.

Objective To determine the potential of optical coherence tomography (OCT) and OCT angiography (OCTA) to distinguish between glaucoma and pituitary macroadenoma by optic disc appearance. Methods This prospective case-control study comprised 31 patients: 23 with glaucoma (18 male, 5 female) and 8 with pituitary macroadenoma and chiasmatic compression (3 male, 5 female). The corresponding mean ages were 72.8 years (range 58–90) and 60.7 years (range 43–73). All participants underwent complete ophthalmological examination, spectral domain OCT and OCTA, and visual field testing. Clinical, imaging, and visual field results were compared between the groups. Results On OCT analysis, the glaucoma group had relatively lower peripapillary retinal nerve fiber layer (RNFL) thickness (65.79 ± 15.46, 86.0 ± 11.37, respectively, P = .002) and lower rim area (1.00 ± 0.22 mm2 and 1.2 ± 0.15 mm2, respectively, P = .005). On OCTA, peripapillary vessel density was significantly lower in all quadrants in the glaucoma group. The significance of these between-group differences was maintained when patients were stratified by visual field mean deviation. Conclusions This is the first comparative analysis of optic disc morphology between glaucoma and pituitary macroadenoma using combined OCT and OCTA. The results yielded lower peripapillary RNFL thickness, lower rim area, and lower peripapillary vessel density in the glaucoma group. These parameters may aid in the initial differentiation between these two optic neuropathies.

Glaucoma patients had a reduction in the inner annulus peripapillary choroidal microvascular density (PCMD) that became worse as the glaucoma severity progressed, which might provide new evidence supporting the vascular theory. To compare PCMD among normal tension glaucoma (NTG), primary open angle glaucoma (POAG), and healthy controls using optical coherence tomography (OCT) angiography (OCTA). The study included 40 POAG, 25 NTG, and 33 healthy controls. All subjects underwent OCT and OCTA testing. The inner annulus and outer annulus PCMD, as well as peripapillary vessel density (VD), were calculated. One-way analysis of variance was used to compare the vascular parameters of the 3 groups. Pearson correlation analysis or Spearman correlation test was used to evaluate the correlation between PCMD and glaucomatous severity factors. The spatial positional relationship between PCMD and corresponding peripapillary retinal nerve fiber layer (RNFL) thickness and visual field (VF) mean deviation (MD) was also assessed. The average and 4 quadrants of the inner annulus PCMD and peripapillary VD in the 2 glaucomatous groups were significantly lower than in normal eyes ( P <0.05). Strong correlations were found between inner annulus PCMD and VF MD, peripapillary VD, and RNFL in POAG patients. Similarly, the inner annulus PCMD in NTG patients was strongly correlated with peripapillary VD and RNFL (all r >0.5). Strong positional correlations were found between inner superior quadrantal PCMD and RNFL thickness in both POAG and NTG patients ( r =0.566 and 0.731, respectively). Likewise, inner inferior quadrantal PCMD exhibited a strong correlation with RNFL thickness in POAG patients ( r =0.608). Strong positional correlations were also found between inner superior PCMD and VF MD in both POAG and NTG patients ( r =0.589 and 0.622, respectively). Inner inferior PCMD exhibited a moderate correlation with VF MD in both POAG and NTG patients ( r =0.487 and 0.440, respectively). The study found that the inner annulus PCMD decreased to varying degrees in NTG and POAG patients. The inner annulus PCMD was closely related to the structural and visual function parameters of glaucoma in both NTG and POAG. Furthermore, inner PCMD demonstrated a spatial correlation with corresponding RNFL thickness and VF MD.

To evaluate the macular and peripapillary morpho-vascular changes in ADOA, using optical coherence tomography (OCT) and OCT angiography (OCTA). Prospectively defined, cross-sectional case-control study. Consecutive patients with a genetic or clinical diagnosis of ADOA along with age- and sex-matched controls were included. The radial peripapillary capillary (RPC) density and vessel density (VD) in the parafoveal superficial and deep capillary plexuses (SCP and DCP, respectively) were evaluated with OCTA. The ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thickness were determined using structural OCT. We applied a previously validated customized macro (Fiji, SciJava Consortium) to compute RPC density. The remaining parameters were calculated by the built-in software. Non-parametric methods were used for data analysis. The target α level was 0.05, which was adjusted through Bonferroni's correction when multiple outcomes were tested. Fifty-eight eyes (n = 29 control; n = 29 ADOA) from 30 subjects (mean age 42.43 ± 15.30years; 37.93% male) were included. Parafoveal SCP VD, GCC thickness, RPC VD in the temporal quadrant, as well as RNFL thickness in the nasal and temporal quadrants were decreased in ADOA eyes (all p < 0.001). When only patients with genetically confirmed diagnosis were included, capillary dropout in the circumpapillary superior and inferior quadrants also became evident (both p < 0.001). The GCC/parafoveal SCP ratio was increased in ADOA, relatively to matched controls. In contrast, none of the circumpapillary morpho-vascular ratios was significantly different in ADOA eyes. The microvascular and structural changes found in ADOA suggest that both the macular and peripapillary regions are involved, although the threshold for damage of the structural and vascular components may be different for each region. Larger series with longitudinal follow-up may validate OCTA biomarkers helpful for disease monitoring.

ObjectiveFrontotemporal dementia (FTD) is a progressive neurodegenerative disorder that affects the frontal and temporal lobes of the brain, leading to cognitive decline and personality changes. The objective of this cross-sectional study was to characterize angioarchitectural changes in the retina and choroid of individuals with FTD compared to cognitively normal controls using optical coherence tomography (OCT) and OCT angiography (OCTA).MethodsCross-sectional comparison of patients with FTD and controls with normal cognition. All participants underwent Mini-Mental State Examination (MMSE) at the time of imaging. Outcome measures included OCT parameters: retinal nerve fiber layer (RNFL) thickness, ganglion cell layer-inner plexiform layer (GC-IPL) thickness, central subfield thickness (CST), subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI); and OCTA superficial capillary plexus parameters: foveal avascular zone (FAZ) area, 3x3mm and 6x6mm macular perfusion density (PD) and vessel density (VD), 4.5x4.5mm peripapillary capillary perfusion density (CPD) and capillary flux index (CFI). Generalized estimating equation analysis was used to account for the inclusion of 2 eyes from the same participant.Results29 eyes of 19 patients with FTD and 85 eyes of 48 controls were analyzed. In FTD, 3x3mm macular PD (p = 0.02) and VD (p = 0.02) and CFI (p = 0.01) were reduced compared to controls. There was no difference in average 4.5x4.5mm CPD, RNFL thickness, GC-IPL thickness, CST, SFCT, CVI, FAZ, or 6x6mm VD or PD between FTD and controls (all p > 0.05); however, there was a trend toward lower macular 6x6mm PD and VD in patients with FTD.ConclusionDecline of peripapillary and macular OCT and OCTA parameters merit further investigation as potential biomarkers for FTD detection. Noninvasive retinal and choroidal imaging may hold promise for earlier detection, and future longitudinal studies will clarify their role in monitoring of FTD.