Abstract
PurposeTo investigate the impact of large choroidal vessels (LCV) on Choriocapillaris (CC) flow deficit (FD) analyses with swept-source optical coherence tomography angiography (SS-OCTA)DesignProspective, cross-sectional study.MethodsMacular 6x6mm SS-OCTA scans were obtained from intermediate age-related macular degeneration (iAMD) and healthy eyes. Images were captured and processed according to most common standards and analyzed for percentage of flow-deficits (FD%) within four 1x1mm squares at the corners of each image. Choroidal thickness (CT), iris color and refraction error were considered as potential influential factors for LCV visibility. A linear mixed model and logistic regression models were calculated for statistical evaluation.ResultsSixty-nine iAMD and 49 age-matched healthy eyes were enrolled. LCV were visible in at least one sector in 52% of iAMD and 47% of healthy eyes. Within the iAMD group FD% were significantly lower in areas containing LCV (p = 0.0029). Increasing CT resulted in an odds ratio decrease of LCV (OR: 0.94, p<0.0001). Below a CT value of ≤118μm LCV could be expected with a sensitivity of 86% and a specificity of 85%.ConclusionsLCV can significantly affect CC FD analyses of SS-OCTA images. Their visibility is negatively associated with CT. The impact of LCV should be taken into account when performing CC FD assessments, especially in patients where reduced CT is to be expected and inclusion of affected areas should be considered carefully.
Highlights
The choriocapillaris (CC) marks the capillary endpoint of the choroid and is located right below the Bruchs Membrane (BM)/retinal pigment epithelium (RPE) complex
Within the intermediate age-related macular degeneration (iAMD) group flow deficits (FD)% were significantly lower in areas containing large choroidal vessels (LCV) (p = 0.0029)
The impact of LCV should be taken into account when performing CC FD assessments, especially in patients where reduced Choroidal thickness (CT) is to be expected and inclusion of affected areas should be considered carefully
Summary
The choriocapillaris (CC) marks the capillary endpoint of the choroid and is located right below the Bruchs Membrane (BM)/retinal pigment epithelium (RPE) complex. The exclusion of areas below major retinal vessel branches was preferentially chosen for shadowing artifacts caused by vessels of the superficial plexus, that currently cannot be removed entirely from OCTA scans [7,8,9,10]. While these methods can reduce the impact of artifacts caused by overlying structures on CC OCTAanalyses, the influence of large choroidal vessels (LCV), which are located below the CC, has not yet been investigated. The goal of this study was to assess the impact of LCV on CC flow deficits (FD) analyses and identify factors that can promote their visibility in OCTA CC enface images in healthy and AMD affected eyes
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