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Reliability of foveal avascular zone metrics automatically measured by Cirrus optical coherence tomography angiography in healthy subjects

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Funding

This study is supported by the Grant for Key Disciplinary Project of Clinical Medicine under the Guangdong High-level University Development Program (002-18119101).

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Author notes

  1. Aidi Lin and Danqi Fang have contributed equally to this work.

Authors and Affiliations

  1. Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China

    Aidi Lin, Danqi Fang, Cuilian Li & Haoyu Chen

  2. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China

    Carol Y. Cheung

Authors
  1. Aidi Lin
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  2. Danqi Fang
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  3. Cuilian Li
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  4. Carol Y. Cheung
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  5. Haoyu Chen
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Contributions

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.

Corresponding author

Correspondence to Haoyu Chen.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

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.

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Informed consent was obtained from all individual participants included in the study.

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Lin, A., Fang, D., Li, C. et al. Reliability of foveal avascular zone metrics automatically measured by Cirrus optical coherence tomography angiography in healthy subjects. Int Ophthalmol 40, 763–773 (2020). https://doi.org/10.1007/s10792-019-01238-x

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  • DOI: https://doi.org/10.1007/s10792-019-01238-x

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