Reliability of foveal avascular zone metrics automatically measured by Cirrus optical coherence tomography angiography in healthy subjects
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To investigate the reliability of the foveal avascular zone (FAZ) metrics automatically measured using Cirrus optical coherence tomography angiography (OCTA) embedded algorithm compared to human manual measurement.
Thirty-five eyes of 35 healthy subjects were enrolled and scanned four times continuously on Zeiss Cirrus HD-OCT 5000. The FAZ metrics (area, circularity and perimeter) of the superficial capillary plexus were measured automatically using the embedded tool and manually measured by the two independent observers using ImageJ. The repeatability of the four scans within all methods of measurements was calculated. The agreement of the manual vs automated measurement was also analyzed.
The repeatability of the automated algorithm was only poor to moderate (intraclass correlation coefficients [ICCs] for the area, perimeter and circularity were 0.600, 0.405 and 0.221, respectively) while the repeatability of the manually measured FAZ area and perimeter was good [([ICCs] ranged from 0.845 to 0.877) except the circularity (ICC = 0.538 to 0.608)]. The ranges of 95% limits of agreement between the manual measurements by the two observers were only 20% to 31% of those of automated–manual agreement. The Cirrus inbuilt algorithm obviously outlined the border of FAZ wrongly in 22.9% cases.
Caution should be taken when using the automated measurement results of FAZ metrics in Cirrus OCTA, because of the low repeatability and poor agreement compared with the manual measurement.
KeywordsOptical coherence tomography angiography Foveal avascular zone Reliability Metrics Automated algorithm Healthy subjects
HC contributed to the study conception and design. Material preparation, data collection and analysis were performed by AL, DF and CL. The first draft of the manuscript was written by AL. HC and CYC revised the manuscript. All authors read and approved the final manuscript.
This study is supported by the Grant for Key Disciplinary Project of Clinical Medicine under the Guangdong High-level University Development Program (002-18119101).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the Institutional Review Board of Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong and with the 1964 Helsinki Declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
- 1.Zhao Q, Yang WL, Wang XN, Wang RK, You QS, Chu ZD, Xin C, Zhang MY, Li DJ, Wang ZY, Chen W, Li YF, Cui R, Shen L, Wei WB (2018) Repeatability and reproducibility of quantitative assessment of the retinal microvasculature using optical coherence tomography angiography based on optical microangiography. Biomed Env Sci BES 31(6):407–412. https://doi.org/10.3967/bes2018.054 CrossRefGoogle Scholar
- 4.Iafe NA, Phasukkijwatana N, Chen X, Sarraf D (2016) Retinal capillary density and foveal avascular zone area are age-dependent: quantitative analysis using optical coherence tomography angiography. Invest Ophthalmol Vis Sci 57(13):5780–5787. https://doi.org/10.1167/iovs.16-20045 CrossRefPubMedGoogle Scholar
- 6.Jia Y, Bailey ST, Hwang TS, McClintic SM, Gao SS, Pennesi ME, Flaxel CJ, Lauer AK, Wilson DJ, Hornegger J, Fujimoto JG, Huang D (2015) Quantitative optical coherence tomography angiography of vascular abnormalities in the living human eye. Proc Natl Acad Sci USA 112(18):E2395–2402. https://doi.org/10.1073/pnas.1500185112 CrossRefPubMedGoogle Scholar
- 8.Hwang TS, Hagag AM, Wang J, Zhang M, Smith A, Wilson DJ, Huang D, Jia Y (2018) Automated quantification of nonperfusion areas in 3 vascular plexuses with optical coherence tomography angiography in eyes of patients with diabetes. JAMA Ophthalmol 136(8):929–936. https://doi.org/10.1001/jamaophthalmol.2018.2257 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Triolo G, Rabiolo A, Shemonski ND, Fard A, Di Matteo F, Sacconi R, Bettin P, Magazzeni S, Querques G, Vazquez LE, Barboni P, Bandello F (2017) Optical coherence tomography angiography macular and peripapillary vessel perfusion density in healthy subjects, glaucoma suspects, and glaucoma patients. Invest Ophthalmol Vis Sci 58(13):5713–5722. https://doi.org/10.1167/iovs.17-22865 CrossRefPubMedGoogle Scholar
- 11.Kumagai K, Furukawa M, Suetsugu T, Ogino N (2018) Foveal avascular zone area after internal limiting membrane peeling for epiretinal membrane and macular hole compared with that of fellow eyes and healthy controls. Retina 38(9):1786–1794. https://doi.org/10.1097/iae.0000000000001778 CrossRefPubMedGoogle Scholar
- 13.Dong J, Jia YD, Wu Q, Zhang S, Jia Y, Huang D, Wang X (2017) Interchangeability and reliability of macular perfusion parameter measurements using optical coherence tomography angiography. Br J Ophthalmol 101(11):1542–1549. https://doi.org/10.1136/bjophthalmol-2016-309441 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Linderman R, Salmon AE, Strampe M, Russillo M, Khan J, Carroll J (2017) Assessing the accuracy of foveal avascular zone measurements using optical coherence tomography angiography: segmentation and scaling. Transl Vis Sci Technol 6(3):16. https://doi.org/10.1167/tvst.6.3.16 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.La Spina C, Carnevali A, Marchese A, Querques G, Bandello F (2017) Reproducibility and reliability of optical coherence tomography angiography for foveal avascular zone evaluation and measurement in different settings. Retina 37(9):1636–1641. https://doi.org/10.1097/iae.0000000000001426 CrossRefPubMedGoogle Scholar
- 17.Bland JM (2010) How can I decide the sample size for a repeatability study? http://www-users.york.ac.uk/~mb55/meas/sizerep.htm. Accessed 17 May 2010
- 19.Fang D, Tang FY, Huang H, Cheung CY, Chen H (2019) Repeatability, interocular correlation and agreement of quantitative swept-source optical coherence tomography angiography macular metrics in healthy subjects. Br J Ophthalmol 103(3):415–420. https://doi.org/10.1136/bjophthalmol-2018-311874 CrossRefPubMedGoogle Scholar
- 21.Bland JM (2011) What is the standard error of the within-subject standard deviation, sw? http://www-users.york.ac.uk/~mb55/meas/seofsw.htm. Accessed 4 Aug 2011
- 23.Anegondi N, Kshirsagar A, Mochi TB, Sinha Roy A (2018) Quantitative comparison of retinal vascular features in optical coherence tomography angiography images from three different devices. Ophthalmic Surg Lasers Imaging Retina 49(7):488–496. https://doi.org/10.3928/23258160-20180628-04 CrossRefPubMedGoogle Scholar
- 25.Dave PA, Dansingani KK, Jabeen A, Jabeen A, Hasnat Ali M, Vupparaboina KK, Peguda HK, Pappurru RR, Agrawal R, Chhablani J (2018) Comparative evaluation of foveal avascular zone on two optical coherence tomography angiography devices. Optom Vis Sci Off Publ Am Acad Optom 95(7):602–607. https://doi.org/10.1097/opx.0000000000001238 CrossRefGoogle Scholar
- 26.Mihailovic N, Brand C, Lahme L, Schubert F, Bormann E, Eter N, Alnawaiseh M (2018) Repeatability, reproducibility and agreement of foveal avascular zone measurements using three different optical coherence tomography angiography devices. PLoS ONE 13(10):e0206045. https://doi.org/10.1371/journal.pone.0206045 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Pilotto E, Frizziero L, Crepaldi A, Della Dora E, Deganello D, Longhin E, Convento E, Parrozzani R, Midena E (2018) Repeatability and reproducibility of foveal avascular zone area measurement on normal eyes by different optical coherence tomography angiography instruments. Ophthalm Res 59(4):206–211. https://doi.org/10.1159/000485463 CrossRefGoogle Scholar
- 28.Yanik Odabas O, Demirel S, Ozmert E, Batioglu F (2018) Repeatability of automated vessel density and superficial and deep foveal avascular zone area measurements using optical coherence tomography angiography: diurnal findings. Retina 38(6):1238–1245. https://doi.org/10.1097/iae.0000000000001671 CrossRefPubMedGoogle Scholar