<p>Age-related macular degeneration (AMD) is a vision-threatening disease that affects the outer retina and choroid of elderly adults. Because photoreceptors are found in the outer retina and rely primarily on the trophic support of the underlying choriocapillaris, imaging of flow or lack thereof in choriocapillaris by optical coherence tomography angiography (OCTA) has great clinical potential in AMD assessment. We introduce a metric using OCTA, named “focal perfusion loss” (FPL) to describe the effects of age and non-neovascular AMD on choriocapillaris flow. Because OCTA imaging of choriocapillaris is vulnerable to artifacts—namely motion, projections, segmentation errors, and shadows—they are removed by postprocessing software. The shadow detection software is a machine learning algorithm recently developed for the evaluation of the retinal circulation and here adapted for choriocapillaris analysis. It aims to exclude areas with unreliable flow signal due to blocking of the OCT beam by objects anterior to the choriocapillaris (e.g., drusen, retinal vessels, vitreous floaters, and iris). We found that both the FPL and the capillary density were able to detect changes in the choriocapillaris of AMD and healthy age-matched subjects with respect to young controls. The dominant cause of shadowing in AMD is drusen, and the shadow exclusion algorithm helps determine which areas under drusen retain sufficient signal for perfusion evaluation and which areas must be excluded. Such analysis allowed us to determine unambiguously that choriocapillaris density under drusen is indeed reduced.</p>
Elevated intraocular pressure (IOP) is an important risk factor for glaucoma. However, the role of IOP in glaucoma progression, as well as retinal physiology in general, remains incompletely understood. We demonstrate the use of visible light optical coherence tomography to measure retinal responses to acute IOP elevation in Brown Norway rats. We monitored retinal responses in reflectivity, angiography, blood flow, oxygen saturation (sO2), and oxygen metabolism over a range of IOP from 10 to 100 mmHg. As IOP was elevated, nerve fiber layer reflectivity was found to decrease. Vascular perfusion in the three retinal capillary plexuses remained steady until IOP exceeded 70 mmHg and arterial flow was noted to reverse periodically at high IOPs. However, a significant drop in total retinal blood flow was observed first at 40 mmHg. As IOP increased, the venous sO2 demonstrated a gradual decrease despite steady arterial sO2, which is consistent with increased arterial-venous oxygen extraction across the retinal capillary beds. Calculated total retinal oxygen metabolism was steady, reflecting balanced responses of blood flow and oxygen extraction, until IOP exceeded 40 mmHg, and fell to 0 at 70 and 80 mmHg. Above this, measurements were unattainable. All measurements reverted to baseline when the IOP was returned to 10 mmHg, indicating good recovery following acute pressure challenge. These results demonstrate the ability of this system to monitor retinal oxygen metabolism noninvasively and how it can help us understand retinal responses to elevated IOP.
In this study, we demonstrate a novel scanning pattern for improving flow quantification in optical coherence tomography angiography (OCTA) with a high scanning efficiency. A bidirectional interleaved scan pattern was introduced to adjust the adjacent inter-scan time in order to achieve OCTA sensitivity to different flow speeds. This bidirectional scanning protocol uses a triangular function on the fast scanning direction, meaning that it takes the same time in completing B-scans at adjacent lateral positions, acquired in opposite directions. By applying this scheme, the duty cycle is increased to almost 100%. To improve the linear velocity range represented by OCTA signals, different inter-B-scan intervals (at least two) are required to visualize flow at different speeds. In our scanning protocol, the time between the first and second repetition is different than the time between second and third repetition, allowing a total of 3 different inter-scan times (1-2, 2-3 and 1-3) to be computed to improve flow quantification. A retinal OCTA of a healthy subject was acquired using our 400-kHz swept source OCT system. The volumetric scan was acquired in less than two seconds, potentially minimizing the prevalence of motion artifacts, which are more predominant in the scanning intervals most sensitive to slow speed flow. By averaging the three different images generated by 3 different inter-scan times, flow with large linear range (up to 5.2 mm/sec according to our prior calibration) is apparent on en face OCTA.