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Simulating vascular leakage on optical coherence tomography angiography using an overlay technique with corresponding thickness maps
  1. Talisa E de Carlo1,
  2. Sarwar Zahid1,
  3. Kelley J Bohm1,
  4. R V Paul Chan2,
  5. Jennifer I Lim3,
  6. William F Mieler4
  1. 1 Ophthalmology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
  2. 2 Retina, Illinois Eye and Ear Infirmary, Chicago, Illinois, USA
  3. 3 Ophthalmology, University of Illinois, Chicago, Illinois, USA
  4. 4 UIC Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, Illinois, USA
  1. Correspondence to Dr William F Mieler, UIC Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, Illinois 60607, USA; wmieler{at}


Background To demonstrate a technique for using optical coherence tomography angiography (OCTA) to simulate leakage in eyes with diabetic macular oedema and determine the sensitivity and positive predictive value of detecting leaking microvasculature on OCTA using fluorescein angiography (FA) as the comparative norm.

Methods 6×6 mm OCT angiograms were overlaid with the corresponding OCT thickness maps. Microvascular abnormalities on the OCT angiogram underlying areas of thickening on the OCT thickness map were assumed to be leaking. Two independent readers blindly read the OCTA overlay images then the FA images cropped to the same approximate region to delineate areas of leaking microvasculature. The results were compared to determine the sensitivity and positive predictive value of OCTA for detection of leaking vessels.

Results 28 eyes of 19 diabetic patients were included. Each eye demonstrated an average of seven leaking microvascular abnormalities on the OCTA images and 22 leaking abnormalities on the FA images. Sensitivity of leaking microvasculature detection by OCTA was 26.1% and positive predictive value was 68.4%. The correlation coefficient of the two readers’ detection of leaking microvasculature was 0.605 for OCTA reads compared with 0.916 for FA.

Conclusion OCTA as a whole can be used to simulate leakage, but currently, sensitivity of the technique is low. Further understanding of the OCTA technology may yield novel means of detecting retinal pathology.

  • retina
  • imaging
  • diagnostic tests/investigation
  • macula

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  • Contributors TEdC, SZ and KJB contributed to the acquisition of data and data analysis. TEdC drafted the manuscript and all others revised the manuscript. WM, JIL and RVPC contributed to the conception of the work. All authors gave final approval of the version published and agreed to be accountable for all aspects of the work.

  • Funding This study was funded by VitreoRetinal Surgery Association.

  • Competing interests JIL is a consultant for Alcon, Genentech, pSivida, Ophtea, Quark and Kodiak and has previously consulted for Santen, Pfizer/Hospira, Regeneron, Lumenis, Alexion, AbbView and Alimera. She has grants supported by Allergan, Janssen, Ohr, Second Sight, Regeneron, Genentech and Clearside. The other authors do not have any personal financial interest in any related stocks or proprietary interest in any related companies.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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