Korean J Ophthalmol.  2020 Apr;34(2):113-120. 10.3341/kjo.2019.0105.

Repeatability of Manual Measurement of Foveal Avascular Zone Area in Optical Coherence Tomography Angiography Images in High Myopia

Affiliations
  • 1Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea.

Abstract

Purpose
To analyze the repeatability of manual measurement of foveal avascular zone (FAZ) area in an optical coherence tomography angiography (OCTA) image in high myopia.
Methods
This study comprised patients with high myopia and controls. Two consecutive FAZ areas of the superficial and deep capillary plexus were obtained using OCTA. The intraclass correlation coefficient (ICC) and coefficient of variation (CV) were assessed, and univariate and multivariate generalized linear mixed models were conducted to identify factors related to repeatability.
Results
Thirty eyes with high myopia and 34 eyes of healthy subjects were included in the study. The mean age in high myopia and control subjects was 55.5 and 60.8 years, respectively, the mean spherical equivalent was −9.98 and −0.55 diopters, and the mean axial length was 28.0 and 23.9 mm. The ICCs of FAZ area of the superficial capillary plexus (SCP) were 0.891 and 0.919, while the CVs were 8.8% and 8.5%. In measurement of the deep capillary plexus, the ICCs were 0.788 and 0.907, while the CVs were 11.2% and 11.0%, which were acceptable but exhibited lower repeatability than those of SCP. Multivariate analyses showed that older age (p = 0.030) and greater axial length (p = 0.005) were significantly associated with lower repeatability of SCP FAZ area measurements. In addition, greater axial length (p = 0.044) was a significant factor for lower repeatability of deep capillary plexus FAZ area measurements.
Conclusions
Manual measurement of FAZ area using OCTA exhibited relatively good repeatability for high myopia. Age and axial length affected repeatability and should be considered when analyzing FAZ areas in high myopia patients.

Keyword

Foveal avascular zone; High myopia; Optical coherence tomography angiography; Repeatability

Figure

  • Fig. 1 En face images of (A) the superficial capillary plexus and (B) deep capillary plexus using a HRA + optical coherence tomography angiography instrument in the right eye, showing the foveal avascular zone area and the manually marked boundary of the foveal avascular zone area in a high myopia patient.

  • Fig. 2 Bland-Altman plots for agreement between two measurements of the foveal avascular zone (FAZ) area using optical coherence tomography angiography in the high myopia and control groups. (A) Superficial capillary plexus in the high myopia group, (B) deep capillary plexus in the high myopia group, (C) superficial capillary plexus in the control group, and (D) deep capillary plexus in the control group.

  • Fig. 3 Scatter plots with linear regression showing correlation with the differences between two consecutive foveal avascular zone area measurements and significant factors affecting the repeatability of foveal avascular zone area measurements in the linear mixed model. The differences tended to increase with increasing (A) age and (B,C) axial length.


Reference

1. Katz J, Tielsch JM, Sommer A. Prevalence and risk factors for refractive errors in an adult inner city population. Invest Ophthalmol Vis Sci. 1997; 38:334–340. PMID: 9040465.
2. Wang Q, Klein BE, Klein R, Moss SE. Refractive status in the Beaver Dam Eye Study. Invest Ophthalmol Vis Sci. 1994; 35:4344–4347. PMID: 8002254.
3. Wong TY, Foster PJ, Hee J, et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Invest Ophthalmol Vis Sci. 2000; 41:2486–2494. PMID: 10937558.
4. Saw SM, Gazzard G, Shih-Yen EC, Chua WH. Myopia and associated pathological complications. Ophthalmic Physiol Opt. 2005; 25:381–391. PMID: 16101943.
Article
5. Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study. Ophthalmology. 2010; 117:1595–1611. PMID: 20207005.
6. Curtin BJ. The posterior staphyloma of pathologic myopia. Trans Am Ophthalmol Soc. 1977; 75:67–86. PMID: 613534.
7. Ohno-Matsui K, Yoshida T, Futagami S, et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia. Br J Ophthalmol. 2003; 87:570–573. PMID: 12714395.
Article
8. Spaide RF, Klancnik JM Jr, Cooney MJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol. 2015; 133:45–50. PMID: 25317632.
Article
9. Pilotto E, Frizziero L, Crepaldi A, et al. Repeatability and reproducibility of foveal avascular zone area measurement on normal eyes by different optical coherence tomography angiography instruments. Ophthalmic Res. 2018; 59:206–211. PMID: 29421813.
Article
10. Sung MS, Lee TH, Heo H, Park SW. Association between optic nerve head deformation and retinal microvasculature in high myopia. Am J Ophthalmol. 2018; 188:81–90. PMID: 29421295.
Article
11. Balaratnasingam C, Inoue M, Ahn S, et al. Visual acuity is correlated with the area of the foveal avascular zone in diabetic retinopathy and retinal vein occlusion. Ophthalmology. 2016; 123:2352–2367. PMID: 27523615.
Article
12. Kwon J, Choi J, Shin JW, et al. Alterations of the foveal avascular zone measured by optical coherence tomography angiography in glaucoma patients with central visual field defects. Invest Ophthalmol Vis Sci. 2017; 58:1637–1645. PMID: 28297029.
Article
13. Guo J, She X, Liu X, Sun X. Repeatability and reproducibility of foveal avascular zone area measurements using AngioPlex spectral domain optical coherence tomography angiography in healthy subjects. Ophthalmologica. 2017; 237:21–28. PMID: 28088800.
Article
14. Al-Sheikh M, Tepelus TC, Nazikyan T, Sadda SR. Repeatability of automated vessel density measurements using optical coherence tomography angiography. Br J Ophthalmol. 2017; 101:449–452. PMID: 27450146.
Article
15. Carpineto P, Mastropasqua R, Marchini G, et al. Reproducibility and repeatability of foveal avascular zone measurements in healthy subjects by optical coherence tomography angiography. Br J Ophthalmol. 2016; 100:671–676. PMID: 26377414.
Article
16. Corvi F, Pellegrini M, Erba S, et al. Reproducibility of vessel density, fractal dimension, and foveal avascular zone using 7 different optical coherence tomography angiography devices. Am J Ophthalmol. 2018; 186:25–31. PMID: 29169882.
Article
17. Lei J, Durbin MK, Shi Y, et al. Repeatability and reproducibility of superficial macular retinal vessel density measurements using optical coherence tomography angiography en face images. JAMA Ophthalmol. 2017; 135:1092–1098. PMID: 28910435.
Article
18. Manalastas PIC, Zangwill LM, Saunders LJ, et al. Reproducibility of optical coherence tomography angiography macular and optic nerve head vascular density in glaucoma and healthy eyes. J Glaucoma. 2017; 26:851–859. PMID: 28858159.
Article
19. Lee MW, Kim KM, Lim HB, et al. Repeatability of vessel density measurements using optical coherence tomography angiography in retinal diseases. Br J Ophthalmol. 2018; 7. 04. [Epub]. DOI: 10.1136/bjophthalmol-2018-312516.
Article
20. Amoroso F, Miere A, Semoun O, et al. Optical coherence tomography angiography reproducibility of lesion size measurements in neovascular age-related macular degeneration (AMD). Br J Ophthalmol. 2018; 102:821–826. PMID: 28855197.
Article
21. He J, Chen Q, Yin Y, et al. Association between retinal microvasculature and optic disc alterations in high myopia. Eye (Lond). 2019; 33:1494–1503. PMID: 31019262.
Article
22. Vurgese S, Panda-Jonas S, Jonas JB. Scleral thickness in human eyes. PLoS One. 2012; 7:e29692. PMID: 22238635.
Article
23. Spaide RF, Fujimoto JG, Waheed NK. Image artifacts in optical coherence angiography. Retina. 2015; 35:2163–2180. PMID: 26428607.
24. Durbin MK, An L, Shemonski ND, et al. Quantification of retinal microvascular density in optical coherence tomographic angiography images in diabetic retinopathy. JAMA Ophthalmol. 2017; 135:370–376. PMID: 28301651.
Article
25. Lee HJ, Kim MS, Jo YJ, Kim JY. Ganglion cell-inner plexiform layer thickness in retinal diseases: repeatability study of spectral-domain optical coherence tomography. Am J Ophthalmol. 2015; 160:283–289. PMID: 26004405.
Article
26. Rao HL, Kumar AU, Bonala SR, et al. Repeatability of spectral domain optical coherence tomography measurements in high myopia. J Glaucoma. 2016; 25:e526–e530. PMID: 26900832.
Article
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