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Detection of neovascularisation in the vitreoretinal interface slab using widefield swept-source optical coherence tomography angiography in diabetic retinopathy
  1. Edward S Lu1,2,
  2. Ying Cui1,2,3,
  3. Rongrong Le1,2,4,
  4. Ying Zhu1,2,5,
  5. Jay C Wang1,2,
  6. Inês Laíns1,2,
  7. Raviv Katz1,2,
  8. Yifan Lu1,2,
  9. Rebecca Zeng2,
  10. Itika Garg1,2,
  11. David M Wu1,
  12. Dean Eliott1,
  13. Demetrios G Vavvas1,
  14. Deeba Husain1,
  15. Joan W Miller1,
  16. Leo A Kim1,
  17. John B Miller1,2
  1. 1Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
  3. 3Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
  4. 4Department of Ophthalmology, Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
  5. 5Department of Ophthalmology, Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
  1. Correspondence to Dr John B Miller, Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA; john_miller{at}


Aims To compare the efficacy of diabetic retinal neovascularisation (NV) detection using the widefield swept-source optical coherence tomography angiography (WF SS-OCTA) vitreoretinal interface (VRI) Angio slab and SS-OCT VRI Structure slab.

Methods A prospective, observational study was performed at Massachusetts Eye and Ear from January 2019 to June 2020. Patients with proliferative diabetic retinopathy (PDR), patients with non-proliferative diabetic retinopathy and patients with diabetes but without diabetic retinopathy were included. All patients were imaged with WF SS-OCTA using the 12×12 mm Angio scan protocol centred on the fovea and optic disc. The en-face SS-OCTA VRI Angio slab and SS-OCT VRI Structure slab were evaluated for the presence or absence of NV. SS-OCTA B-scan was used to classify NV according to cross-sectional morphology (forward, tabletop or flat). All statistical analyses were performed using SPSS V.26.0.

Results One hundred and forty-two eyes of 89 participants were included in the study. VRI Angio detected NV at higher rates compared with VRI Structure (p<0.05). Combining VRI Angio and Structure improved detection rates compared with VRI Angio alone (p<0.05). Due to segmentation errors of the internal limiting membrane, NV with flat morphological classification had lower rates of detection on VRI Angio compared with NV with forward and tabletop morphology (p<0.05).

Conclusions WF SS-OCTA 12×12 mm VRI Angio and SS-OCT VRI Structure imaging centred on the fovea and optic disc detected NV with high sensitivity and low false positives. The VRI slab may be useful to diagnose and monitor PDR in clinical practice.

  • retina
  • imaging
  • neovascularisation

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  • ESL and YC contributed equally.

  • Contributors EL and YC contributed to conceptualisation, investigation, formal analysis, resources, writing—original draft. RL, YZ, JW and IL contributed to validation, resources, writing—review and editing. RK, YL, RZ and IG contributed to investigation. DW, DE, DV, DH, JWM and LK contributed to resources, writing—review and editing. JBM contributed to project administration, supervision, conceptualisation, resources, writing—review and editing.

  • Funding This work was supported by Lions Clubs International Foundation grant 530 125.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institutional review board of Massachusetts Eye and Ear, and informed consent was obtained from all subjects. All procedures adhered to the tenets of the Declaration of Helsinki and Health Insurance Portability and Accountability Act regulations.

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

  • Data availability statement Data are available upon reasonable request. Deidentified participant data used in this study could be shared upon reasonable request sent to the corresponding author.

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