Personalized analysis of foveal avascular zone with optical coherence tomography angiography

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Abstract

Aim. To investigate the relationship between the foveal avascular zone (FAZ) and inner nuclear layer (INL) – free zone in order to provide a personalized approach for evaluation of the FAZ area with optical coherence tomography-angiography (OCTA).

Material and methods.Thirty-six healthy individuals (36 eyes) and 9 patients (12 eyes) with nonproliferative diabetic retinopathy (nPDR) were included in this study. The FAZ area as well as INL-free zone were measured in superficial capillary plexus on OCTA images. The FAZ area, INL-free area, and the ratio of the INL-free area to the FAZ area were compared between healthy subjects and nPDR patients.

Results. The mean FAZ area in healthy subjects and nPDR patients was 0.33 ± 0.1 and 0.56 ± 0.28 mm2 (p < 0.05), respectively. The mean INL-free zone in healthy subjects and nPDR patients was 0.33 ± 0.07 and 0.28 ± 0.1 mm2 (p > 0.05), respectively. The ratio of the INL-free area to the FAZ area in healthy subjects and nPDR patients was 1.08 ± 0.25 and 0.57 ± 0.2 (p < 0.001), respectively. Receiver operating characteristic analysis showed that the ratio of the INL-free area to the FAZ area had the higher area under curve (0.98; 91.7% sensitivity and 97.2% specificity) compared to the FAZ area (0.8; 66.7% sensitivity and 87.1% specificity) for differentiating nPDR from healthy eyes.

Conclusion. This study showed that personalized analysis of the FAZ area based on the relationship between the actual FAZ and INL-free zone has better diagnostic accuracy compared to the conventional FAZ area measurement on OCTA images.

About the authors

Maria A. Burnasheva

S.M. Kirov Military Medical Academy

Author for correspondence.
Email: maria.andreevna1@gmail.com

MD, resident of the ophthalmology department

Russian Federation, Saint Petersburg

Alexey N. Kulikov

S.M. Kirov Military Medical Academy

Email: alexey.kulikov@mail.ru

MD, PhD, DSc, assistant professor, head of the ophthalmology department

Russian Federation, Saint Petersburg

Dmitrii S. Maltsev

S.M. Kirov Military Medical Academy

Email: glaz.med@yandex.ru

MD, PhD, ophthalmologist of the ophthalmology department

Russian Federation, Saint Petersburg

References

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Supplementary files

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2. Fig. 1. A representative example of visualization of foveal avascular zone (FAZ) and inner nuclear layer (INL)-free area with optical coherence tomography angiography; a – FAZ is visible on the superficial capillary plexus slab; b – automatic segmentation lines delineating the inner limiting membrane (ILM) and the border between the inner plexiform layer (IPL)/INL set without shift (ILM = 0 µm, IPL/INL = 0 µm); с – INL-free zone is clearly visible on the image of the superficial capillary plexus slab; d – automatic segmentation line delineating ILM shifted toward INL in order to show INL-free zone (ILM = –34 µm, IPL/INL = 0 µm)

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3. Fig. 2. An example of measurement of distance between the inner limiting membrane and the borders of the inner nuclear layer

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4. Fig. 3. Bland-Altman plots showing the agreement between the foveal avascular zone (FAZ) and the inner nuclear layer (INL)-free area in different automatic segmentation lines settings: a – automatic segmentation line delineating the inner limiting membrane (ILM) shifted toward INL for 30 µm. (ILM = –30 µm, IPL/INL = 0 µm); b – automatic segmentation line delineating ILM shifted toward INL for 32 µm (ILM = –32 µm, IPL/INL = 0 µm); c – automatic segmentation line delineating ILM shifted toward INL for 34 µm. (ILM = –34 µm, IPL/INL = 0 µm); d – automatic segmentation line delineating ILM shifted toward INL for 36 µm (ILM = –36 µm, IPL/INL = 0 µm). Note the lowest mean difference between FAZ and INL-free area with automatic segmentation line delineating ILM shifted toward INL for 34 µm

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5. Fig. 4. Scatter plot showing a significant correlation between the foveal avascular zone (FAZ) area and inner nuclear layer (INL)-free area with automatic segmentation line delineating the inner limiting membrane shifted toward INL for 34 µm

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6. Fig. 5. Receiver operating characteristic plots demonstrating diagnostic accuracy of study criteria for mild to moderate nonproliferative diabetic retinopathy: a — the ratio of the inner nuclear layer (INL)-free area with automatic segmentation line delineating the inner limiting membrane shifted toward INL for 34 µm to the foveal avascular zone (FAZ);  b — the FAZ area on optical coherence tomography angiography image

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Copyright (c) 2017 Burnasheva M.A., Kulikov A.N., Maltsev D.S.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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