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Agemy, Steven A. MD*,†; Scripsema, Nicole K. MD*,†; Shah, Chirag M. MPH; Chui, Toco PhD*,†; Garcia, Patricia M. MD*,†; Lee, Jessica G. MD*,†; Gentile, Ronald C. MD, FACS, FASRS*,†,§; Hsiao, Yi-Sing PhD; Zhou, Qienyuan PhD; Ko, Tony PhD; Rosen, Richard B. MD, ScD(Hon), FACS, FASRS, CRA*,†

doi: 10.1097/IAE.0000000000000862
Original Study

Purpose: To describe a new method of retinal vascular perfusion density mapping using optical coherence tomography angiography and to compare current staging of diabetic retinopathy based on clinical features with a new grading scale based on perifoveal perfusion densities.

Methods: A retrospective review was performed on subjects with diabetic retinopathy and age-matched controls imaged with a spectral domain optical coherence tomography system (Optovue XR Avanti, Fremont, CA). Split-spectrum amplitude-decorrelation angiography (SSADA) generated optical coherence tomography angiograms of the superficial retinal capillaries, deep retinal capillaries, and choriocapillaris. Skeletonized optical coherence tomography angiograms were used to create color-coded perfusion maps and capillary perfusion density values for each image. Capillary perfusion density values were compared with clinical staging, and groups were compared using analysis of variance and Kruskal–Wallis analyses.

Results: Twenty-one control and 56 diabetic retinopathy eyes were imaged. Diabetic eyes were grouped according to clinical stage. Capillary perfusion density values from each microvascular layer were compared across all groups. Capillary perfusion density values were significantly lower in nearly all layers of all study groups compared with controls. Trend analysis showed a significant decrease in capillary perfusion density values as retinopathy progresses for most layers.

Conclusion: Quantitative retinal vascular perfusion density mapping agreed closely with grading based on clinical features and may offer an objective method for monitoring disease progression in diabetic retinopathy.

This study describes a novel quantitative mapping technique for analyzing and displaying retinal perfusion density using optical coherence tomography angiography. Age-matched controls were compared with subjects with diabetic retinopathy, and the results demonstrate its promise as an objective means of scaling progression of diabetic retinopathy in the macula.

*Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York;

Icahn School of Medicine at Mount Sinai, New York, New York;

Stony Brook University School of Medicine, Stony Brook, New York;

§Department of Ophthalmology, Winthrop University Hospital, Mineola, New York; and

Optovue, Inc., Fremont, California.

Reprint requests: Richard B. Rosen, MD, ScD(Hon), FACS, FASRS, CRA, 310 East 14th Street, New York, NY 10003; e-mail:

Supported in part by an unrestricted grant from the Research to prevent Blindness Foundation.

Presented at the “Incorporation of OCT Angiography into clinical practice, drug development, and clinical trials: opportunities and pitfalls” symposium in Rome, Italy on June 6, 2015.

T. Chui has received support from the Marrus Family Foundation not related to this work. R. C. Gentile is a consultant to Alcon. Y.-S. Hsiao, Z. Qienyuan, and T. Ko are employees of Optovue, Inc. R. B. Rosen is a consultant to Ocata Medical, Allergan, Clarity, Nano Retina, and Optovue and has a personal financial interest in Opticology. He has received Investigational support from Genentech for a different project. The remaining authors have any conflicting interests to disclose.

© 2015 by Ophthalmic Communications Society, Inc.