PMID- 27055248 OWN - NLM STAT- MEDLINE DCOM- 20170503 LR - 20220408 IS - 2168-6173 (Electronic) IS - 2168-6165 (Print) IS - 2168-6165 (Linking) VI - 134 IP - 6 DP - 2016 Jun 1 TI - Select Features of Diabetic Retinopathy on Swept-Source Optical Coherence Tomographic Angiography Compared With Fluorescein Angiography and Normal Eyes. PG - 644-50 LID - 10.1001/jamaophthalmol.2016.0600 [doi] AB - IMPORTANCE: Optical coherence tomographic angiography (OCTA) is a recently developed noninvasive imaging technique that can visualize the retinal and choroidal microvasculature without the injection of exogenous dyes. OBJECTIVE: To evaluate the potential clinical utility of OCTA using a prototype swept-source OCT (SS-OCT) device and compare it with fluorescein angiography (FA) for analysis of the retinal microvasculature in diabetic retinopathy. DESIGN, SETTING, AND PARTICIPANTS: Prospective, observational cross-sectional study conducted at a tertiary care academic retina practice from November 2013 through November 2014. A cohort of diabetic and normal control eyes were imaged with a prototype SS-OCT system. The stage of diabetic retinopathy was determined by clinical examination. Imaging was performed using angiographic 3 x 3-mm and 6 x 6-mm SS-OCT scans to generate 3-dimensional en-face OCT angiograms for each eye. Two trained Boston Image Reading Center readers reviewed and graded FA and OCTA images independently. MAIN OUTCOMES AND MEASURES: The size of the foveal nonflow zone and the perifoveal intercapillary area on OCTA were measured in both normal and diabetic eyes using Boston Image Reading Center image analysis software. RESULTS: The study included 30 patients with diabetes (mean [SD] age, 55.7 [10] years) and 6 control individuals (mean [SD] age, 55.1 [6.4] years). A total of 43 diabetic and 11 normal control eyes were evaluated with OCTA. Fluorescein angiography was performed in 17 of 43 diabetic eyes within 8 weeks of the OCTA. Optical coherence tomographic angiography was able to identify a mean (SD) of 6.4 (4.0) microaneurysms (95% CI, 4.4-8.5), while FA identified a mean (SD) of 10 (6.9) microaneurysms (95% CI, 6.4-13.5). The exact intraretinal depth of microaneurysms on OCTA was localized in all cases (100%). The sensitivity of OCTA in detecting microaneuryms when compared with FA was 85% (95% CI, 53-97), while the specificity was 75% (95% CI, 21-98). The positive predictive value and the negative predictive value were 91% (95% CI, 59-99) and 60% (95% CI, 17-92), respectively. CONCLUSIONS AND RELEVANCE: Optical coherence tomographic angiography enables noninvasive visualization of macular microvascular pathology in eyes with diabetic retinopathy. It identified fewer microaneurysms than FA, but located their exact intraretinal depth. Optical coherence tomographic angiography also allowed the precise and reproducible delineation of the foveal nonflow zone and perifoveal intercapillary area. Evaluation of OCTA may be of clinical utility in the evaluation and grading of diabetic eye disease. FAU - Salz, David A AU - Salz DA AD - New England Eye Center, Tufts Medical Center, Boston, Massachusetts. FAU - de Carlo, Talisa E AU - de Carlo TE AD - New England Eye Center, Tufts Medical Center, Boston, Massachusetts2Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge3Research Laboratory of Electronics, Massachusetts Institute of Technology, Camb. FAU - Adhi, Mehreen AU - Adhi M AD - New England Eye Center, Tufts Medical Center, Boston, Massachusetts2Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge3Research Laboratory of Electronics, Massachusetts Institute of Technology, Camb. FAU - Moult, Eric AU - Moult E AD - Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge3Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge. FAU - Choi, WhooJhon AU - Choi W AD - Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge3Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge. FAU - Baumal, Caroline R AU - Baumal CR AD - New England Eye Center, Tufts Medical Center, Boston, Massachusetts. FAU - Witkin, Andre J AU - Witkin AJ AD - New England Eye Center, Tufts Medical Center, Boston, Massachusetts. FAU - Duker, Jay S AU - Duker JS AD - New England Eye Center, Tufts Medical Center, Boston, Massachusetts. FAU - Fujimoto, James G AU - Fujimoto JG AD - Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge3Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge. FAU - Waheed, Nadia K AU - Waheed NK AD - New England Eye Center, Tufts Medical Center, Boston, Massachusetts. LA - eng GR - R01 CA075289/CA/NCI NIH HHS/United States GR - R01 EY011289/EY/NEI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Observational Study PL - United States TA - JAMA Ophthalmol JT - JAMA ophthalmology JID - 101589539 SB - IM MH - Adult MH - Aged MH - Cross-Sectional Studies MH - Diabetic Retinopathy/*diagnosis MH - False Positive Reactions MH - Female MH - *Fluorescein Angiography MH - Healthy Volunteers MH - Humans MH - Male MH - Middle Aged MH - Predictive Value of Tests MH - Prospective Studies MH - Reproducibility of Results MH - Retinal Vessels/*pathology MH - Sensitivity and Specificity MH - *Tomography, Optical Coherence PMC - PMC5312730 MID - NIHMS845637 COIS- Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Baumal has served as an advisory board member for Allergan and has received a travel grant from Optovue. Dr Duker has received research support from Carl Zeiss Meditec Inc, Optovue Inc, and Topcon Medical Systems Inc. Dr Duker has also been a consultant, stockholder, or board of directors member for Carl Zeiss Meditec, Optovue, Alcon/Novartis, CoDa Therapeutics, Thrombogenics, Allergan, Lumenis, Santen, Hemera Biosciences, EyeNetra Inc, Ophthotech, and Eleven Biotherapeutics. Dr Fujimoto has received royalties from intellectual property owned by the Massachusetts Institute of Technology and licensed to Carl Zeiss Meditec Inc and Optovue Inc and stock options with Optovue Inc. DrWaheed has received personal fees or grants from Iconic, Carl Zeiss Meditec, and Thrombogenics. No other disclosures were reported. EDAT- 2016/04/08 06:00 MHDA- 2017/05/04 06:00 PMCR- 2017/02/16 CRDT- 2016/04/08 06:00 PHST- 2016/04/08 06:00 [entrez] PHST- 2016/04/08 06:00 [pubmed] PHST- 2017/05/04 06:00 [medline] PHST- 2017/02/16 00:00 [pmc-release] AID - 2510812 [pii] AID - 10.1001/jamaophthalmol.2016.0600 [doi] PST - ppublish SO - JAMA Ophthalmol. 2016 Jun 1;134(6):644-50. doi: 10.1001/jamaophthalmol.2016.0600.