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Quantifying vascular density and morphology using different swept-source optical coherence tomography angiographic scan patterns in diabetic retinopathy
  1. Takao Hirano1,2,
  2. Jyunya Kitahara2,
  3. Yuichi Toriyama2,
  4. Hirotsugu Kasamatsu2,
  5. Toshinori Murata2,
  6. Srinivas Sadda1,3
  1. 1 Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, United States
  2. 2 Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
  3. 3 Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
  1. Correspondence to Dr Srinivas Sadda, Doheny Image Reading Center, Doheny Eye Institute, Los Angeles CA 90033, United States; ssadda{at}


Aims To evaluate quantitative metrics of the retinal microvasculature in eyes with diabetic retinopathy (DR) using various en face swept-source optical coherence tomography angiography (SS-OCTA) image sizes.

Methods Non-segmented and segmented images were acquired using an SS-OCTA device (PLEX Elite 9000; Carl Zeiss Meditec, Dublin, California, USA). The scanning protocols included the 3×3 mm, 6×6 mm and 12×12 mm fields of view. Quantitative analysis of the perfusion density (PD), vessel length density (VLD) and fractal dimension (FD) was performed. The area under the receiver operating characteristic curve was estimated to assess the ability of each image size to predict DR.

Results This prospective, cross-sectional study included 60 eyes, (non-DR, 13 eyes; non-proliferative DR (NPDR), 24 eyes; proliferative DR (PDR), 23 eyes) of 46 patients with diabetes and 21 eyes of 16 healthy individuals. In the 12×12 mm images, the PD of healthy individuals was significantly greater than that of patients with NPDR or PDR for all layers (NPDR, p<0.05; PDR, p<0.001 0.001; FD, p<0.001) or PDR (VLD, p<0.001; FD, p<0.001 for all layers). The results were similar for the 3×3 mm and 6×6 mm images. Overall, PD, VLD and FD progressively decreased with worsening DR severity in segmented and non-segmented layers for all SS-OCTA scan sizes. For detecting DR, 3×3 mm images best predicted DR for all evaluated quantitative parameters.

Conclusions Vascular changes in DR can be monitored in detail through quantitative evaluations that combine different SS-OCTA scan sizes and parameters.

  • Imaging
  • Retina

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  • Contributors TH, TM and SS: study conception, design, analysis, interpretation of data, drafting and revising, and final approval. JK, YT and HK: data acquisition, drafting and revising, and final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SS is a consultant for and receives research support from Optos and Carl Zeiss Meditec, serves as a consultant for Centervue, and has access to research instruments provided by Heidelberg Engineering, Topcon Medical Systems, Optos, Carl Zeiss Meditec, Nidek and Centervue.

  • Patient consent Obtained.

  • Ethics approval The Institutional Review Board of the University of California, Los Angeles and the ethics committee of the Shinshu University School of Medicine (approval number 2044) .

  • Provenance and peer review Not commissioned; externally peer reviewed.

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