Choriocapillaris flow deficit associated with intraretinal hyperreflective foci in intermediate age-related macular dege
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Choriocapillaris flow deficit associated with intraretinal hyperreflective foci in intermediate age-related macular degeneration Liran Tiosano 1,2,3 & Iksoo Byon 1,2,4 & Ahmed Roshdy Alagorie 1,2,5 & Yong-Sok Ji 1,2,6 & Srinivas R. Sadda 1,2 Received: 13 December 2019 / Revised: 19 June 2020 / Accepted: 8 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate the choriocapillaris (CC) flow deficit (FD) beneath drusen associated with overlying intraretinal hyperreflective foci (HRF). Methods Patients with intermediate age-related macular degeneration (AMD) who had structural spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) using the Cirrus HD-OCT with AngioPlex software were retrospectively evaluated. A 6 × 6-mm-volume scan was used for the SD-OCT and OCTA. Post-imaging processing steps included generation of drusen map, identification of HRF, and generation of a signal-compensated CC slab prior to binarization and CC FD computation. The CC OCTA image was aligned with the drusen + HRF map to define regions of interest for CC FD measurement. The CC was quantified below drusen with and without overlying HRF and within a 150-μm-wide ring surrounding the drusen (unaffected by potential HRF-related shadowing), and across the entire 6 × 6 macular region. Results Fifty-three eyes with intermediate AMD were included, 25 eyes with HRF, and 28 eyes with no HRF. The mean ± SD FD% over the whole 6 × 6 macular region was 41.1 ± 3.4 in eyes with HRF compared with 39.5 ± 3.5 in eyes without HRF (p = 0.001). The mean ± SD CC FD% below drusen with HRF (54.4 ± 9.3) was significantly greater than below drusen without HRF (49.6 ± 9.5; p = 0.001). There was a strong positive correlation between the quantity of HRF and the extent of the CC FD (Pearson correlation = 0.81). Conclusion Choriocapillaris flow deficits appear to be more severe in eyes with HRF and in particular directly below HRF. As HRF are thought to represent a higher risk or more advanced feature of intermediate AMD, these findings highlight the relationship between the severity of CC FD and overall severity of AMD. Keywords Hyperreflective foci . Choriocapillaris flow deficit . Age-related macular degeneration
Introduction Age-related macular degeneration (AMD) is the leading cause of vision loss among the elderly population in the developed countries [1]. Up to half of the patients who present with intermediate
* Srinivas R. Sadda [email protected] 1
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AMD in one eye and already have advanced AMD in the fellow eye will progress to advanced AMD (i.e., geographic atrophy (GA) and choroidal neovascularization (CNV)) within 5 years [2]. Although intravitreal injections of agents that target vascular endothelial growth factor (VEGF) are now available for the
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Doheny Image Reading and Research Lab, Doheny Eye Institute, 1355 San Pablo Street, Suite 211, Los Angeles, CA 90033, USA
Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Tec
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