Glaucoma, Open-Angle Clinical Trial
Official title:
The Relationship Between Macular Optic Coherence Tomography Angiography and Ganglion Cell Layer and Their Combinational Index Using Artificial Neural Network
Macular GCIPLT and vessel density will be measured with Spectralis optical coherence tomography and Topcon swept-source OCT respectively. Linear, quadratic and exponential regression models will be used to investigate relationship between GCIPLT and vessel density. Multilayer neural network will bel used to make single combined parameter and the diagnostic performance will be also compared.
This is a prospective, cross-sectional study. All recruited glaucoma patients and healthy
subjects will be underwent a complete ophthalmic examination including measurement of the
best-corrected visual acuity (BCVA), a slit-lamp examination, gonioscopy, funduscopy,
biometry using the IOL Master (Carl Zeiss Meditec, Dublin, CA, USA), and standard automated
perimetry (SAP). Central corneal thickness (CCT) will be measured using ultrasonic pachymetry
(Pachmate; DGH Technology, Exton, PA, USA). Keratometry will be measured with an Auto
Kerato-Refractometer (ARK-510A; NIDEK, Hiroshi, Japan). All of the patients will be also
examined using red-free RNFL photographs and optic disc stereoscopic photographs. Two
different OCT exam will be performed to measure macular GCIPLT and macular vessel density,
spectral domain optic coherence tomography (SD-OCT) and swept source optic coherence
tomography angiography (SS-OCTA), respectively.
<Optical Coherence Tomography Angiography Imaging> The macular angiographic images will be
obtained using a swept-source OCT (SS-OCT) device (DRI OCT Atlantis; Topcon, Tokyo, Japan).
SS-OCT uses infrared light, wavelength of 1050 nm which is longer than conventional SD-OCT,
at 100,000 A-scans per second. This longer infrared light source has advantages of deep
signal penetration through the retina and choroid. Its axial and transversal resolution is 7
and 20 μm in tissue, respectively. Volumetric OCT scans were taken from 6 × 6 mm cubes. Each
cube consists of 320 clusters of 4 repeated B-scans centered on the fovea. Moving objects
(mostly blood flows) are detected by measuring intensity fluctuations from these repeatedly
scanned OCT images. This methodology is termed as OCTARA (OCT Angiography Ratio Analysis)
algorithm where calculations are based on a ratio between the intensity values across points
within one scan, and identical points in the repeated scans. OCTARA provides relative
sensitivity advantage of the order of 10 ~ 50 times for medium to low blood flow. Automated
segmentation was performed by OCT software to separate each layer of the retina. The en-face
images of the superficial capillary network were derived from an en-face slab, ranged from
the internal limiting membrane (ILM) to the inner border of the inner nuclear layer (INL).
The investigators developed a custom windows software with Microsoft Visual studio 2012 and
C# language with a dot net library. This software calculates the sectoral average vessel
density exactly matching to the GCIPL sectors. It requires two image files, superficial
vascular layer image and color vessel density map, exported from OCTA instrument. Once after
two image files were loaded, fovea is automatically detected but in case software fails, user
can manually set foveal location. Then, it calculates mean sectoral vessel density between
two ellipsoidal boundaries, outer boundary 4800 x 3000 µm and inner boundary 1200 x 1000 µm
(width x height) centered on fovea. This diameter of inner and outer ellipse and angle of
sectorization is exactly matched to the GCIPL sectorization. The mean vessel density was
calculated from color density map. First, custom software scans all pixel colors within the
sectoral boundary. Then, each pixel colors are converted to the vessel density values
according to the manufacturer's guide. Finally, it takes average of all vessel density
values. This mean vessel density is a unitless value ranged from 0 to 100.
<Spectral-Domain Optical Coherence Tomography Imaging> The Cirrus SD-OCT instrument (Carl
Zeiss Meditec, Software version 6.0) will be used to measure macular GCIPLT. After pupil
dilation using 0.5% tropicamide and 0.5% phenylephrine, a single macular scan (200 × 200
macular cube scan protocol) of each eye was acquired. The GCA algorithm automatically
segmented the GCIPL and RNFL and calculated the thickness of the macular GCIPL and RNFL
within a 14.13 mm2 elliptical annulus area centered on the fovea. The inner and outer
ellipsoidal boundary is exactly matched to the sectoral vessel density calculated by our
custom software. Average, minimum, and six sectoral (superotemporal, superior, superonasal,
inferonasal, inferior, and inferotemporal) GCIPLT values were obtained. For quality control,
the investigators set the minimum signal strength of all included SD-OCT scans to 6.0.
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