Volume-rendered projection-resolved OCT angiography: 3D lesion complexity is associated with therapy response in wet age-related macular degeneration

Peter L. Nesper; Brian T. Soetikno; Alison D. Treister; Amani A. Fawzi

doi:10.1167/iovs.17-23361

Volume-rendered projection-resolved OCT angiography: 3D lesion complexity is associated with therapy response in wet age-related macular degeneration

Peter L. Nesper, Brian T. Soetikno, Alison D. Treister, Amani A. Fawzi^*

^*Corresponding author for this work

Ophthalmology

Research output: Contribution to journal › Article › peer-review

21 Scopus citations

Abstract

PURPOSE. To explore whether quantitative three-dimensional (3D) analysis of choroidal neovascularization (CNV) using projection-resolved optical coherence tomography angiography (PR-OCTA) is associated with treatment response in neovascular age-related macular degeneration (nAMD). METHODS. Retrospective, cross-sectional study of 51 eyes of 49 patients undergoing individualized anti-VEGF therapy for nAMD. Patients were classified as ‘‘good’’ or ‘‘poor’’ responders, requiring injections at less or more frequently than 6-week intervals, respectively. Cross-sectional PR-OCTA images were used to measure the distance between Bruch’s membrane and highest CNV flow signal. The number of flow layers within the CNV and the distance between these flow layers (CNV flow thickness) were also analyzed. Two masked, independent graders measured the PR-OCTA parameters. We used 3D volume-rendered PR-OCTA to confirm the number of CNV flow layers and further evaluate CNV complexity. RESULTS. Poor responders had significantly greater distance between Bruch’s membrane and highest CNV flow signal (P < 0.01), greater number of CNV flow layers (P = 0.022), and greater CNV flow thickness (P < 0.01). Volume-rendered PR-OCTA images confirmed the number of CNV flow layers. CONCLUSIONS. Cross-sectional and 3D volume-rendered PR-OCTA provides a novel approach for quantifying CNV complexity. Our results suggest that CNV acquiring more complex 3D vascular structure are associated with more frequent long-term anti-VEGF therapy, reflecting a particular pattern of normalization or complex CNV remodeling process that characterizes these less responsive eyes.

Original language	English (US)
Pages (from-to)	1944-1952
Number of pages	9
Journal	Investigative Ophthalmology and Visual Science
Volume	59
Issue number	5
DOIs	https://doi.org/10.1167/iovs.17-23361
State	Published - Apr 2018

Funding

Supported in part by National Institutes of Health DP3DK108248 (AAF) and F30EY026472 (BTS), and research instrument support by Optovue, Inc. (Fremont, CA, USA). The funders had no role in study design, data collection and analysis, data interpretation, decision to publish, or preparation of the manuscript. Disclosure: P.L. Nesper, None; B.T. Soetikno, None; A.D. Treister, None; A.A. Fawzi, None Supported in part by National Institutes of HealthDP3DK108248 (AAF) and F30EY026472 (BTS), and research instrument support by Optovue, Inc. (Fremont, CA, USA). The funders had no role in study design, data collection and analysis, data interpretation, decision to publish, or preparation of the manuscript.

Keywords

AMD
Choroidal neovascularization
OCT
Optical coherence tomography angiography

ASJC Scopus subject areas

Sensory Systems
Cellular and Molecular Neuroscience
Ophthalmology

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10.1167/iovs.17-23361

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@article{3a1decfe44f24c369b6bf20bf4d8cdfc,

title = "Volume-rendered projection-resolved OCT angiography: 3D lesion complexity is associated with therapy response in wet age-related macular degeneration",

abstract = "PURPOSE. To explore whether quantitative three-dimensional (3D) analysis of choroidal neovascularization (CNV) using projection-resolved optical coherence tomography angiography (PR-OCTA) is associated with treatment response in neovascular age-related macular degeneration (nAMD). METHODS. Retrospective, cross-sectional study of 51 eyes of 49 patients undergoing individualized anti-VEGF therapy for nAMD. Patients were classified as {\textquoteleft}{\textquoteleft}good{\textquoteright}{\textquoteright} or {\textquoteleft}{\textquoteleft}poor{\textquoteright}{\textquoteright} responders, requiring injections at less or more frequently than 6-week intervals, respectively. Cross-sectional PR-OCTA images were used to measure the distance between Bruch{\textquoteright}s membrane and highest CNV flow signal. The number of flow layers within the CNV and the distance between these flow layers (CNV flow thickness) were also analyzed. Two masked, independent graders measured the PR-OCTA parameters. We used 3D volume-rendered PR-OCTA to confirm the number of CNV flow layers and further evaluate CNV complexity. RESULTS. Poor responders had significantly greater distance between Bruch{\textquoteright}s membrane and highest CNV flow signal (P < 0.01), greater number of CNV flow layers (P = 0.022), and greater CNV flow thickness (P < 0.01). Volume-rendered PR-OCTA images confirmed the number of CNV flow layers. CONCLUSIONS. Cross-sectional and 3D volume-rendered PR-OCTA provides a novel approach for quantifying CNV complexity. Our results suggest that CNV acquiring more complex 3D vascular structure are associated with more frequent long-term anti-VEGF therapy, reflecting a particular pattern of normalization or complex CNV remodeling process that characterizes these less responsive eyes.",

keywords = "AMD, Choroidal neovascularization, OCT, Optical coherence tomography angiography",

author = "Nesper, {Peter L.} and Soetikno, {Brian T.} and Treister, {Alison D.} and Fawzi, {Amani A.}",

note = "Publisher Copyright: {\textcopyright} 2018 The Authors.",

year = "2018",

month = apr,

doi = "10.1167/iovs.17-23361",

language = "English (US)",

volume = "59",

pages = "1944--1952",

journal = "Investigative Ophthalmology and Visual Science",

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Volume-rendered projection-resolved OCT angiography: 3D lesion complexity is associated with therapy response in wet age-related macular degeneration. / Nesper, Peter L.; Soetikno, Brian T.; Treister, Alison D. et al.
In: Investigative Ophthalmology and Visual Science, Vol. 59, No. 5, 04.2018, p. 1944-1952.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Volume-rendered projection-resolved OCT angiography

T2 - 3D lesion complexity is associated with therapy response in wet age-related macular degeneration

AU - Nesper, Peter L.

AU - Soetikno, Brian T.

AU - Treister, Alison D.

AU - Fawzi, Amani A.

PY - 2018/4

Y1 - 2018/4

N2 - PURPOSE. To explore whether quantitative three-dimensional (3D) analysis of choroidal neovascularization (CNV) using projection-resolved optical coherence tomography angiography (PR-OCTA) is associated with treatment response in neovascular age-related macular degeneration (nAMD). METHODS. Retrospective, cross-sectional study of 51 eyes of 49 patients undergoing individualized anti-VEGF therapy for nAMD. Patients were classified as ‘‘good’’ or ‘‘poor’’ responders, requiring injections at less or more frequently than 6-week intervals, respectively. Cross-sectional PR-OCTA images were used to measure the distance between Bruch’s membrane and highest CNV flow signal. The number of flow layers within the CNV and the distance between these flow layers (CNV flow thickness) were also analyzed. Two masked, independent graders measured the PR-OCTA parameters. We used 3D volume-rendered PR-OCTA to confirm the number of CNV flow layers and further evaluate CNV complexity. RESULTS. Poor responders had significantly greater distance between Bruch’s membrane and highest CNV flow signal (P < 0.01), greater number of CNV flow layers (P = 0.022), and greater CNV flow thickness (P < 0.01). Volume-rendered PR-OCTA images confirmed the number of CNV flow layers. CONCLUSIONS. Cross-sectional and 3D volume-rendered PR-OCTA provides a novel approach for quantifying CNV complexity. Our results suggest that CNV acquiring more complex 3D vascular structure are associated with more frequent long-term anti-VEGF therapy, reflecting a particular pattern of normalization or complex CNV remodeling process that characterizes these less responsive eyes.

AB - PURPOSE. To explore whether quantitative three-dimensional (3D) analysis of choroidal neovascularization (CNV) using projection-resolved optical coherence tomography angiography (PR-OCTA) is associated with treatment response in neovascular age-related macular degeneration (nAMD). METHODS. Retrospective, cross-sectional study of 51 eyes of 49 patients undergoing individualized anti-VEGF therapy for nAMD. Patients were classified as ‘‘good’’ or ‘‘poor’’ responders, requiring injections at less or more frequently than 6-week intervals, respectively. Cross-sectional PR-OCTA images were used to measure the distance between Bruch’s membrane and highest CNV flow signal. The number of flow layers within the CNV and the distance between these flow layers (CNV flow thickness) were also analyzed. Two masked, independent graders measured the PR-OCTA parameters. We used 3D volume-rendered PR-OCTA to confirm the number of CNV flow layers and further evaluate CNV complexity. RESULTS. Poor responders had significantly greater distance between Bruch’s membrane and highest CNV flow signal (P < 0.01), greater number of CNV flow layers (P = 0.022), and greater CNV flow thickness (P < 0.01). Volume-rendered PR-OCTA images confirmed the number of CNV flow layers. CONCLUSIONS. Cross-sectional and 3D volume-rendered PR-OCTA provides a novel approach for quantifying CNV complexity. Our results suggest that CNV acquiring more complex 3D vascular structure are associated with more frequent long-term anti-VEGF therapy, reflecting a particular pattern of normalization or complex CNV remodeling process that characterizes these less responsive eyes.

KW - AMD

KW - Choroidal neovascularization

KW - OCT

KW - Optical coherence tomography angiography

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Volume-rendered projection-resolved OCT angiography: 3D lesion complexity is associated with therapy response in wet age-related macular degeneration

Abstract

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