Presence Of Drusen Research Articles

In Vivo Correlation Between Macular Pigment Optical Volume and Retinal Layers Thickness.

This study aims to investigate the potential in vivo relationship between macular pigment (MP) and retinal layers thickness in healthy subjects and dry, non-advanced age-related macular degeneration (AMD). An observational, cross-sectional study was conducted. Healthy subjects >40years and patients with early or intermediate AMD were recruited. Structural OCT and macular pigment optical volume (MPOV) were collected for each subject. Retinal layers parameters were calculated based on the standard early treatment diabetic retinopathy study (ETDRS) map. Additionally, MPOV within 1°, 2°, and 9° of eccentricity was assessed and associated with retinal layers thickness and volume. Linear mixed-effects models were used to test the relationship between MP and structural OCT parameters, while adjusting for known possible confounding factors. A total of 144 eyes of 91 subjects (60.4% females) were evaluated, comprising 43% normal eyes and 57% with early/intermediate AMD. Among the retinal layers, only the outer nuclear layer (ONL) thickness and volume appeared to be associated to higher MP levels. Specifically, the central ONL thickness was identified as a significant predictor of the MPOV 1°(P = 0.04), while the parafoveal ONL thickness (inner ETDRS subfield) was identified as a significant fixed effect on the MPOV 9° (P = 0.037). Age and the presence of drusen or subretinal drusenoid deposits were also tested without showing significant correlations. Among the retinal layers examined, only the ONL thickness demonstrated a significant association with MPOV. Consequently, ONL thickness might serve as a potential biomarker related to MP levels.

Anomaly Detection and Biomarkers Localization in Retinal Images.

Background: To design a novel anomaly detection and localization approach using artificial intelligence methods using optical coherence tomography (OCT) scans for retinal diseases. Methods: High-resolution OCT scans from the publicly available Kaggle dataset and a local dataset were used by four state-of-the-art self-supervised frameworks. The backbone model of all the frameworks was a pre-trained convolutional neural network (CNN), which enabled the extraction of meaningful features from OCT images. Anomalous images included choroidal neovascularization (CNV), diabetic macular edema (DME), and the presence of drusen. Anomaly detectors were evaluated by commonly accepted performance metrics, including area under the receiver operating characteristic curve, F1 score, and accuracy. Results: A total of 25,315 high-resolution retinal OCT slabs were used for training. Test and validation sets consisted of 968 and 4000 slabs, respectively. The best performing across all anomaly detectors had an area under the receiver operating characteristic of 0.99. All frameworks were shown to achieve high performance and generalize well for the different retinal diseases. Heat maps were generated to visualize the quality of the frameworks' ability to localize anomalous areas of the image. Conclusions: This study shows that with the use of pre-trained feature extractors, the frameworks tested can generalize to the domain of retinal OCT scans and achieve high image-level ROC-AUC scores. The localization results of these frameworks are promising and successfully capture areas that indicate the presence of retinal pathology. Moreover, such frameworks have the potential to uncover new biomarkers that are difficult for the human eye to detect. Frameworks for anomaly detection and localization can potentially be integrated into clinical decision support and automatic screening systems that will aid ophthalmologists in patient diagnosis, follow-up, and treatment design. This work establishes a solid basis for further development of automated anomaly detection frameworks for clinical use.

Non-Neovascular Age-Related Macular Degeneration Assessment: Focus on Optical Coherence Tomography Biomarkers.

The imagistic evaluation of non-neovascular age-related macular degeneration (AMD) is crucial for diagnosis, monitoring progression, and guiding management of the disease. Dry AMD, characterized primarily by the presence of drusen and retinal pigment epithelium atrophy, requires detailed visualization of the retinal structure to assess its severity and progression. Several imaging modalities are pivotal in the evaluation of non-neovascular AMD, including optical coherence tomography, fundus autofluorescence, or color fundus photography. In the context of emerging therapies for geographic atrophy, like pegcetacoplan, it is critical to establish the baseline status of the disease, monitor the development and expansion of geographic atrophy, and to evaluate the retina's response to potential treatments in clinical trials. The present review, while initially providing a comprehensive description of the pathophysiology involved in AMD, aims to offer an overview of the imaging modalities employed in the evaluation of non-neovascular AMD. Special emphasis is placed on the assessment of progression biomarkers as discerned through optical coherence tomography. As the landscape of AMD treatment continues to evolve, advanced imaging techniques will remain at the forefront, enabling clinicians to offer the most effective and tailored treatments to their patients.

Segmentation of Drusen in Retinal Images for the Detection of Diabetic Retinopathy

Diabetic retinopathy (DR) is a most complicated eye disease that affects people with diabetes for an extended period. If necessary treatment is not given at the right time, DR leads to a severe loss of vision without prior symptoms. Therefore, patients with diabetes are recommended to undergo continuous screening for early detection of DR. In this paper, we proposed an automated detection process to detect the lesion called Drusen in retinal images. Drusen is not related to DR. The presence of Drusen does not indicate the disease DR. Still, it is used to identify the severity level of diabetes for the patient and to avoid the misdetection rate with other bright lesions (both exudates and cotton wool spots). This method is based on the Background image approach and inverse segmentation to detect the area affected by Drusen in retinal images. Inverse segmentation is used to segment the healthy areas based on regular texture rather than varying the texture of unhealthy areas. The segmented healthy areas are compared with the original image for segmenting Drusen. The segmentation process involved 40 images from the STARE database, producing better results based on accuracy and processing time.

Выяснение причин отслойки нейроэпителия с целью постановки корректного диагноза у пациентов с патологией макулярной области

Purpose. To assess the difficulties of finding out true cause of detachment of neuroepithelium in patients with various retinal pathologies. Material and methods. 3 patients (3 eyes) aged 51 to 59 years with complaints of sensation of a “spot» in front of the eye, decreased vision and metamorphopsia. The best corrected visual acuity ranged from 0.4 to 0.5. Rounded local prominating lesion – zones of local detachment of neuroepithelium, zones of local atrophy or defects in retinal pigment epithelium (RPE) were determined in all 3 eyes in the posterior pole of the eye. Results. According to results of optical coherence tomography (OCT), all 3 eyes had local serous detachment of neuroepithelium from 250 to 270 µm, local inclusions characterized by hyperreflective and heterogeneous RPE layer, episodically located in its layers hyperreflective areas with point breach in the Bruch membrane (“hard» drusen). Irregular RPE elevations (“wavy pattern») with its local fibrovascular detachment were determined. According to the results of OCT angiography, hyperreflective zones of the presence of a neovascular network in the layer of choriocapillaries under the areas of fibrovascular detachment of RPE, coinciding with zones of hyperautofluorescence, were revealed in all 3 eyes. In paired eyes of all 3 patients, “hard» retinal drusen in the macular zone were detected. Conclusions. 1. All 3 eyes were diagnosed with the wet form agerelated macular degeneration due to: their belonging to the older age group, low corrected visual acuity, the presence of complaints of metamorphopsia, irregular elevation and local fibrovascular detachment of RPE, the presence of local hyperautofluorescence, and presence of drusen on the double eye. 2. The use of OCT angiography makes it possible to differentiate between central serous chorioretinopathy and age-related macular degeneration by detecting choroidal neovascularization. Keywords: central serous chorioretinopathy, wet AMD, detachment of neuroepithelium

Deep ensemble learning for automated non-advanced AMD classification using optimized retinal layer segmentation and SD-OCT scans

BackgroundAccurate retinal layer segmentation in optical coherence tomography (OCT) images is crucial for quantitatively analyzing age-related macular degeneration (AMD) and monitoring its progression. However, previous retinal segmentation models depend on experienced experts and manually annotating retinal layers is time-consuming. On the other hand, accuracy of AMD diagnosis is directly related to the segmentation model's performance. To address these issues, we aimed to improve AMD detection using optimized retinal layer segmentation and deep ensemble learning. MethodWe integrated a graph-cut algorithm with a cubic spline to automatically annotate 11 retinal boundaries. The refined images were fed into a deep ensemble mechanism that combined a Bagged Tree and end-to-end deep learning classifiers. We tested the developed deep ensemble model on internal and external datasets. ResultsThe total error rates for our segmentation model using the boundary refinement approach was significantly lower than OCT Explorer segmentations (1.7% vs. 7.8%, p-value = 0.03). We utilized the refinement approach to quantify 169 imaging features using Zeiss SD-OCT volume scans. The presence of drusen and thickness of total retina, neurosensory retina, and ellipsoid zone to inner-outer segment (EZ-ISOS) thickness had higher contributions to AMD classification compared to other features. The developed ensemble learning model obtained a higher diagnostic accuracy in a shorter time compared with two human graders. The area under the curve (AUC) for normal vs. early AMD was 99.4%. ConclusionTesting results showed that the developed framework is repeatable and effective as a potentially valuable tool in retinal imaging research.

Management of wet AMD in an elderly patient - case report

Introduction: Age-related macular degeneration (AMD) is the most common cause of central vision loss in elderly people over 50 years of age. It is characterized by the presence of drusen on the fundus and may be associated with choroidal neovascularization (CNV) or geographic atrophy. AMD is a condition caused by many factors including environmental, genetic, and vascular. Currently, it affects over 25 million people worldwide, but with the progressive aging of the population, the incidence of the disease is increasing. Disease is therefore an important issue in geriatrics.Case report: A 75-year-old patient was referred to the General and Pediatric Ophthalmology Clinic of the Medical University of Lublin due to the three-week deterioration of visual acuity in the left eye. The visual acuity of the left eye was: counting fingers at a distance of 1.5 m. Initial cataracts of this eye and wet AMD were diagnosed. In July 2018. an injection of ranibizumab was administered into the vitreous humor of the left eye. After achieving an improvement in visual acuity to 0.2 (on Snellen charts), in September the patient was qualified to the Drug Program for the treatment of the wet form of AMD. From September to October 2019. the patient received 9 doses of ranibizumab. In October 2019. visual acuity improved to 0.4. In November, due to the unsatisfactory results of the therapy, the drug was changed to aflibercept. The patient received a total of 3 injections of this drug and his visual acuity improved to a value of 0.7. The last injection was given in July 2020 and the clinical condition and visual acuity stabilized. After the end of the drug program, the patient regularly shows up for checkups, and the visual acuity of the left eye has normalized since July 2020. and is now 0.4 (due in part to atrophic changes and scarring).Conclusions: Treatment of the wet form of AMD is a difficult and lengthy process. Early diagnosis of the disease, starting treatment as soon as possible, regular checkups and cooperation with the patient are very important for the success of the therapy. During 3 years of treatment, the patient experienced a significant improvement in visual acuity for one year. The treatment allowed the disease progression to slow down. The morphological condition of the retina improved. The applied treatment and management of the elderly patient turned out to be effective, and the achieved effects of the therapy are satisfactory.

Automatic segmentation of retinal layers in OCT images with intermediate age-related macular degeneration using U-Net and DexiNed

Age-related macular degeneration (AMD) is an eye disease that can cause visual impairment and affects the elderly over 50 years of age. AMD is characterized by the presence of drusen, which causes changes in the physiological structure of the retinal pigment epithelium (RPE) and the boundaries of the Bruch’s membrane layer (BM). Optical coherence tomography is one of the main exams for the detection and monitoring of AMD, which seeks changes through the evaluation of successive sectional cuts in the search for morphological changes caused by drusen. The use of CAD (Computer-Aided Detection) systems has contributed to increasing the chances of correct detection, assisting specialists in diagnosing and monitoring disease. Thus, the objective of this work is to present a method for the segmentation of the inner limiting membrane (ILM), retinal pigment epithelium, and Bruch’s membrane in OCT images of healthy and Intermediate AMD patients. The method uses two deep neural networks, U-Net and DexiNed to perform the segmentation. The results were promising, reaching an average absolute error of 0.49 pixel for ILM, 0.57 for RPE, and 0.66 for BM.

Subthreshold Nano-Second Laser Treatment and Age-Related Macular Degeneration

The presence of drusen is an important hallmark of age-related macular degeneration (AMD). Laser-induced regression of drusen, first observed over four decades ago, has led to much interest in the potential role of lasers in slowing the progression of the disease. In this article, we summarise the key insights from pre-clinical studies into the possible mechanisms of action of various laser interventions that result in beneficial changes in the retinal pigment epithelium/Bruch’s membrane/choriocapillaris interface. Key learnings from clinical trials of laser treatment in AMD are also summarised, concentrating on the evolution of laser technology towards short pulse, non-thermal delivery such as the nanosecond laser. The evolution in our understanding of AMD, through advances in multimodal imaging and functional testing, as well as ongoing investigation of key pathological mechanisms, have all helped to set the scene for further well-conducted randomised trials to further explore potential utility of the nanosecond and other subthreshold short pulse lasers in AMD.

Morphological Changes and Prognostic Factors before and after Photodynamic Therapy for Central Serous Chorioretinopathy.

Central serous chorioretinopathy (CSC) is a disease of unknown etiology, but half-dose photodynamic therapy (hPDT) is well known to be effective for CSC. Infrared reflectance (IR) has been shown to be effective for detecting retinal pigmented epithelial and choroidal lesions, but no reports have focused on chorioretinal changes using IR images after as compared to before hPDT. This study aimed to clarify the features of IR images as well as retinal and choroidal morphological changes before and after treatment with verteporfin hPDT for CSC. We also examined prognostic factors associated with CSC treatment. This was a retrospective study that included 140 eyes of 140 patients (male/female ratio 122:18, mean age 53.4 ± 10.8 years) diagnosed with CSC who underwent hPDT in our hospital during the period from April 2015 to December 2018. We determined changes in visual acuity, therapeutic efficacy, central retinal thickness (CRT), central choroidal thickness (CCT), and IR images at one and three months after hPDT as compared to before treatment. Dry macula was defined as a complete resolution of serous retinal detachment after hPDT. History of smoking, disease duration, presence of drusen, presence of retinal pigment epithelium abnormalities, type of fluorescein angiographic leakage, and presence of choroidal vascular hyperpermeability were investigated as prognostic factors associated with treatment efficacy. CRT and CCT were measured using optical coherence tomography (Spectralis HRA-2; Heidelberg Engineering), and IR images after versus before treatment were compared using ImageJ software (version 1.52) to calculate the mean luminance for a 3 × 3 mm area in the macula. Compared with the values before treatment, CCT, CRT, and visual acuity showed significant improvements at one and three months after treatment, and the mean luminance of IR images was also significantly increased. Furthermore, the luminance on IR images tended to rise, though the values at one month and three months after treatment did not differ significantly. Disease duration was significantly associated with dry macula one month after treatment, and visual acuity and CRT before hPDT were both significantly related to dry macula three months after treatment. IR images tended to improve over time, from before treatment through one and three months after hPDT.

Anti-Vascular Endothelial Growth Factor Injection in Wet Age-Related Macular Degeneration

Introduction. AMD is a macular progressive degeneration that arises at the age of more than 50 years, which is characterized by the presence of drusen which is a deposit of material between the retinal pigment epithelium (RPE) and the Bruch membrane. The prevalence of AMD is 29.2% unilateral and 70.8% bilateral. In unilateral wet AMD, 50% will develop on the other eye in a period of 5 years.
 Case Presentation. A woman, Mrs. S, 59 years old, civil servant working, located in the city, came to the Polyclinic RSMH on January 21, 2019. Anamnesis (Auto-anamnesis) the main complaint of vision of the left eye blurred since, 2 months ago. Since about two months ago, sufferers complained of vision in the left eye blurred, blurred felt suddenly, darker vision in the middle. Since about two weeks ago, sufferers complained that his left eye vision had become blurred. The view in the middle is covered with black shadows and accompanied by waves. Working diagnosis of macular oculi sinistra ec wet age-related macular degeneration. The treatment is informed consent, Pro injection of anti-VEGF intravitreal oculi sinistra, Pro laboratory check, Pro X-ray of thorax PA, Pro consul of internal medicine.
 Conclusion. A clinically significant case of macular edema (CSME) has been reported that is treated with intravitreal anti-VEGF combined with focal photon photocoagulation laser. A woman aged 55 years, with complaints of vision both eyes blurred since ± 6 months ago.

Anatomia ecológica foliar de <i>Myrcia guianensis</i> (Aubl.) DC. na Restinga Cearense

A anatomia foliar ecológica do gênero Myrcia DC. ainda é pouco estudada. A espécie Myrcia guianensis (Aubl.) DC., popularmente conhecida como mapirunga, ocorre em região de litoral no estado do Ceará e possui importância ecológica e potencial medicinal. Objetivou-se caracterizar a anatomia foliar ecológica dessa espécie nas estações de chuva e seca, bem como, ao sol e à sombra na Restinga cearense. Para isso, foram realizadas coletas no Jardim Botânico de São Gonçalo de folhas totalmente expandidas e fixadas em FAA70, sendo substituído por etanol 70% após 24 horas. Seguiu-se para os procedimentos anatômicos usuais no Laboratório de Ecologia da Universidade Estadual do Ceará, a fim de analisar qualitativamente e quantitativamente as estruturas da lâmina foliar, pecíolo e paradérmico. Como resultados obteve-se a presença de características que contribuem para sua sobrevivência em ambiente de Restinga com períodos de deficit hídrico e alta taxa de luminosidade, tais como: presença de cutícula levemente espessa, folha hipoestomática, aumento da densidade estomática em folhas de sol, presença de fibras abundantes nos feixes vasculares da nervura central e presença de drusas. Portanto, conclui-se que a planta em estudo possui grande capacidade aclimatativa às condições analisadas (intensa luminosidade e períodos de deficit hídrico).

Automated retinal layer segmentation in OCT images of age‐related macular degeneration

Age-related macular degeneration (AMD) is a common eye disease that causes progressive degeneration of the central vision. The presence of abundant drusen is a common early feature of AMD. Optical coherence tomography (OCT) can provide detailed structure information on drusen. The physiological structure of the retinal epithelium and drusen complex (RPEDC) and the Bruch's membrane (BM) layer boundaries will be influenced by the presence of drusen with AMD. Therefore, drusen quantification is important to diagnose and cure AMD. The authors proposed an automatic method to segment the inner limiting membrane, the retinal pigment epithelium and drusen complex (RPEDC) and BM layer boundaries from OCT images with AMD (termed as deep forest for layer segmentation (DF-LS)). In their method, image patches are extracted and used to train a deep-forest model to predict three boundary probability maps. In addition, they modify grapy theory and dynamic programming method to find the layer boundary. Finally, the layer boundary is smoothed by using a smoothing operation. The proposed DF-LS method is evaluated on three publicly available datasets (one healthy dataset and two AMD dataset). The proposed DF-LS method can yield superior mean unsigned error with an average error of 0.81 pixel on Tian et al.'s dataset, and 1.35, 1.23 pixel on Chiu et al.'s and Farisu et al.'s dataset, respectively.

Automated detection of age-related macular degeneration in color fundus photography: a systematic review

The rising prevalence of age-related eye diseases, particularly age-related macular degeneration, places an ever-increasing burden on health care providers. As new treatments emerge, it is necessary to develop methods for reliably assessing patients' disease status and stratifying risk of progression. The presence of drusen in the retina represents a key early feature in which size, number, and morphology are thought to correlate significantly with the risk of progression to sight-threatening age-related macular degeneration. Manual labeling of drusen on color fundus photographs by a human is labor intensive and is where automatic computerized detection would appreciably aid patient care. We review and evaluate current artificial intelligence methods and developments for the automated detection of drusen in the context of age-related macular degeneration.

Optimizing optical coherence tomography and histopathology correlation in retinal imaging

ObjectiveTo develop a methodology to correlate optical coherence tomography (OCT) images and histopathological sections from the same eye. Part 1: To determine the best fixative for optimal OCT and histopathological analysis in post-mortem eyes. Part 2: A protocol is proposed to correlate histopathological features and OCT scans from the same post-mortem eyes. DesignExperimental study. ParticipantsPart 1: Twenty-three rabbit eyes and 14 post-mortem human eyes. Part 2: Nineteen post-mortem human eyes. MethodsPart 1: Six different fixatives were tested, and specimens were evaluated on 4 criteria: globe shape, structure opacification, retinal detachment, and nuclear details. Part 2: Based on the findings from Part 1, fixed human eyes were imaged using OCT. Orientation-controlled histopathological processing was performed to obtain serial tissue sections from paraffin embedded tissue, which were matched to corresponding OCT images. ResultsPart 1: Of the 6 fixatives, 2% glutaraldehyde and Davidson's solution met the proposed criteria in rabbit eyes. Of these, glutaraldehyde showed similar results in human eyes and was selected for Part 2. Part 2: Using anatomical landmarks, cross-sectional histopathological sections in the same orientation as the OCT images were correlated to their corresponding OCT images. Retinal lesions such as a macular hole, an epiretinal membrane, and the presence of drusen were easily correlated, proving the reliability of our methodology. Moreover, the photoreceptor's inner/outer junction was correlated to a hyperreflective band on OCT. ConclusionsA standardized protocol was developed to correlate OCT images and histopathological findings by generating serial cross-sections of the retina, which can be used to better understand otherwise ambiguous OCT findings.

Patterns of Fundus Autofluorescence Lifetimes In Eyes of Individuals With Nonexudative Age-Related Macular Degeneration.

PurposeTo investigate fundus autofluorescence (FAF) lifetimes in patients with nonexudative AMD.MethodsA total of 150 eyes of 110 patients (mean age: 73.2 ± 10.7 years) with nonexudative AMD, as well as a healthy group of 57 eyes in 38 subjects (mean age: 66.5 ± 8.7 years), were included. Investigations were conducted at the University Eye Clinic in Jena, Germany, as well as the Moran Eye Center in Salt Lake City, Utah, USA, using the Heidelberg Engineering Spectralis-based fluorescence lifetime imaging ophthalmoscope (FLIO). A 30° retinal field centered at the fovea was investigated. FAF decays were detected in short (498–560 nm) and long (560–720 nm, LSC) spectral channels. The mean fluorescence lifetimes (τm) were calculated. Optical coherence tomography scans and fundus photographs were also recorded.ResultsIn patients with nonexudative AMD, FLIO shows a ring-shaped pattern of prolonged τm in the LSC. This pattern occurs in all patients with AMD (including very early stages) and in one-third of the healthy controls. FAF lifetimes were longer with more advanced stages. The presence of drusen is associated with prolonged τm when compared with the healthy fundus, but drusen identification is difficult with FLIO only.ConclusionsFLIO detects a clear pattern of changes within the fundus, which appears to be AMD-associated. These changes are already visible in early AMD stages and not masked by the presence of other coexisting retinal diseases. These findings may be useful for the early diagnosis of AMD and to distinguish AMD from other retinal diseases.

Prophylactic laser in age-related macular degeneration: the past, the present and the future.

The presence of drusen in the posterior eye is a hallmark feature of the early stages of age-related macular degeneration and their size is an indicator of risk of progression to vision-threatening forms of the disease. Since the initial observations that laser treatment can resolve drusen, there has been great interest in whether laser treatment can be used to reduce the progression of age-related macular degeneration. In this article, we review the development of lasers for the treatment of those with age-related macular degeneration. We provide an overview of the clinical trial results that demonstrated drusen resolution but that had mixed effects on progression of disease. In addition, we provide a summary of the recent developments in pulsed lasers that are designed to reduce the energy applied to the posterior eye to provide the therapeutic effects of conventional continuous wave lasers while reducing the secondary tissue effects.

A Tablet-Based Retinal Function Test in Neovascular Age-Related Macular Degeneration Eyes and At-Risk Fellow Eye.

PurposeTo determine the feasibility of a tablet-based application to detect changes in retinal sensitivity and correlations with underlying pathology in neovascular age-related macular degeneration (nAMD) eyes undergoing treatment and in at-risk fellow eyes.MethodParticipants with nAMD in at least one eye were recruited, examined, and imaged using spectral-domain optical coherence tomography (SD-OCT). Retinal sensitivity was measured within the central 5° at 12 locations using a customized test delivered on an iPad. Test points were superimposed on SD-OCT locations to investigate structure/function relationships.ResultsIncluded in the study were 53 nAMD eyes and 21 at-risk fellow eyes. In nAMD eyes, the mean retinal sensitivity was 24.1 ± 1.8 dB with reduced retinal sensitivity associated with the presence of atrophy (P < 0.01), retinal pigment epithelium (RPE) disruption (P < 0.01), and absent ellipsoid zone (EZ) (P < 0.01), but not with the presence of subretinal fluid (P = 0.94) nor intraretinal fluid (P = 0.52). In at-risk eyes, the average retinal sensitivity was 28.8 ± 0.6 dB, with reduced sensitivity significantly associated with the presence of drusen, atrophy, RPE disruption, and absent EZ (P < 0.01).ConclusionThe tablet-based test of retinal sensitivity was able to be performed by an elderly cohort with nAMD. The ability to correlate differences in sensitivity with pathology is encouraging when considering using the tablet devices as a home monitoring tool with remote surveillance. Dual pathology often present with retinal fluid confounded our ability to correlate fluid with sensitivity.Translational RelevanceThese findings highlight the potential of tablet-based devices in performing visual function measures as a home monitoring tool with remote surveillance for the earlier detection of nAMD.

Choriocapillaris Vascular Density Changes in Patients with Drusen: Cross-Sectional Study Based on Optical Coherence Tomography Angiography Findings.

IntroductionThe purpose of this study was to investigate the extent and morphology of the choriocapillaris’ density defect in patients with drusen in non-neovascular age-related macular degeneration (AMD).MethodsParticipants in this study were 36 patients with non-neovascular AMD and drusen. All patients underwent best-corrected visual acuity, slit-lamp examination, spectral domain-optical coherence tomography (SD-OCT), and optical coherence tomography angiography (OCTA).ResultsIn all studied cases, the presence of drusen was associated with choriocapillaris’ reduced blood flow signal of different extent and severity. Three types of choriocapillaris’ non-perfusion were observed, along with an association between the size of drusen and the morphology of choriocapillaris’ density defect. Moreover, the extent of choriocapillaris’ density change has been related to ellipsoid zone disruption and therefore to visual impairment.ConclusionsOur study showed that in patients with drusen due to non-neovascular AMD, there is choriocapillaris’ impairment of different morphology in OCTA, which is mainly related to the size and location of the drusen.

A Novel Strategy for Quantifying Choriocapillaris Flow Voids Using Swept-Source OCT Angiography.

PurposeTo achieve reproducible imaging of the choriocapillaris and associated flow voids using swept-source OCT angiography (SS-OCTA).MethodsSubjects were enrolled and SS-OCTA was performed using the 3 × 3 mm scan pattern. Blood flow was identified using the complex optical microangiography (OMAG) algorithm. The choriocapillaris was defined as a slab from the outer boundary of Bruch's membrane (BM) to approximately 20 μm below BM. Compensation for the shadowing effect caused by the RPE and BM complex on the choriocapillaris angiogram was achieved by using the structural information from the same slab. A thresholding method to calculate the percentage of flow voids from a region was developed based on a normal database.ResultsTwenty normal subjects and 12 subjects with drusen were enrolled. SS-OCTA identified the choriocapillaris in normal subjects as a lobular plexus of capillaries in the central macula and the lobular arrangement became more evident toward the periphery. In all eyes, signal compensation resulted in fewer choriocapillaris flow voids with improved repeatability of measurements. The best repeatability for the measurement was achieved by using 1 standard deviation (SD) for the thresholding strategy.ConclusionsSS-OCTA can image the choriocapillaris in vivo, and the repeatability of flow void measurements is high in the presence of drusen. The ability to image the choriocapillaris and associated flow voids should prove useful in understanding disease onset, progression, and response to therapies.