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. 2022 May 22;12(5):1290.
doi: 10.3390/diagnostics12051290.

Choroidal Vascular Impairment in Intermediate Age-Related Macular Degeneration

Rita Flores  1   2 , Ângela Carneiro  3   4 , Guilherme Neri  1 , Ana C Fradinho  2 , Bruno Quenderra  1 , Maria João Barata  1 , Sandra Tenreiro  2 , Miguel C Seabra  2   5
Affiliations

Choroidal Vascular Impairment in Intermediate Age-Related Macular Degeneration

Rita Flores et al. Diagnostics (Basel). .

Abstract

Age-related macular degeneration (AMD) is a multifactorial disease, whose complete pathogenesis is still unclear. Local hemodynamics may play a crucial role in its manifestation and progression. To evaluate choroidal and retinal vascular parameters, a total of 134 eyes were analyzed, 100 with intermediate AMD and 34 age matched healthy controls. 131 eyes of 104 patients were eligible for complete image assessment and 3 eyes were excluded for insufficient image quality: Group 1: intermediate AMD (n = 97) and Group 2: healthy controls (n = 34). Spectral domain optic coherence tomography (SD-OCT) with enhanced depth imaging (EDI) and optic coherence tomography angiography (OCT-A) were acquired using Spectralis (Heidelberg Engineering). Choroid and retinal capillary plexus were evaluated and image binarization was used to obtain quantitative data. Mean age was 77.67 years old (YO) and 67.2% were women. Total subfoveal choroidal area and luminal area were significantly reduced in Group 1 compared with Group 2 (0.88 mm2 and 0.40 mm2 vs. 1.24 mm2 and 0.55 mm2, respectively) (p < 0.05). Regarding choriocapillary flow density, AMD eyes recorded reduced values (34.83%) compared with controls (36.25%) (p < 0.05). Chorioretinal vasculature is impaired in intermediate AMD patients and vascular parameters could be attractive new prognostic biomarkers. Future therapeutic approaches may target this vascular dysfunction and delay disease progression.

Keywords: OCT-angiography; chorioretinal vasculature; intermediate AMD; optical coherence tomography.

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Conflict of interest statement

Authors declare that they have no competing financial, professional or personal interests that might have influenced the performance or presentation of the work described in this manuscript.

Figures

Figure 1
Figure 1
Examples of image binarization of the Choroid. (A) Macular SD-OCT-EDI centered on fovea and 6000 μm centered section in the fovea. (B) Manual measurement of the choroidal thickness. Yellow lines delimit inner boarder—Bruch’s membrane and outer boarder—escleral transition. (C) Image binarization—converting grey scale in binarized images. (D) Studied area and image software: Black pixels images (vascular lumen) and white pixels images (stroma).
Figure 2
Figure 2
Examples of image binarization of Retinal Capillary Plexus (SCP, DCP) and Choriocapillaris (CC). (A) First row images: Near-infrared reflectance (NIR) and overlap composition with “enface” OCT-A images of SCP; SCP image binarization; Near-infrared reflectance (NIR) and overlap composition with SCP image binarization. (B) Second row images: Near-infrared reflectance (NIR) and overlap composition with “enface” OCT-A images of DCP; DCP image binarization; Near-infrared reflectance (NIR) and overlap composition with DCP image binarization. (C) Third row images: Near-infrared reflectance (NIR) and overlap composition with “enface” OCT-A images of Choriocapillaris; CC image binarization; Near-infrared reflectance (NIR) and overlap composition with CC image binarization.
Figure 3
Figure 3
Choroid evaluation in intermediate AMD. (A–C) Graphical distribution of total choroidal area (TCA), luminal area (LA) and choroidal vascularity index (CVI), respectively, among control and AMD groups through box plots. (D–F) Box plots displayed the distribution of TCA, LA and CVI, respectively, among the control group and the two sub-groups (i.e., DRUSEN and DRUSEN + SDD) defined among AMD patients. Box-and whisker plots show median, first and third quartile, the whiskers extend to 1.5 times the interquartile range (IQR) (values exceeding this are plotted as individual points). TCA: Total choroidal area; LA: Luminal area; CVI: Choroidal vascularity index; DRUSEN: soft or cuticular drusen; DRUSEN + SDD: drusen in association with subretinal drusenoid deposits. (*** p-value ≤ 0.001).
Figure 4
Figure 4
Retinal Capillary Plexus and Choriocapillaris evaluation in intermediate AMD. (A–C) Graphical distribution of SCP, DCP and CC flow density obtained by OCTA among control and AMD groups through box plots, respectively. (D–F) Box plots showed the distribution of SVP, DVP and CC flow density among the control group and the two sub-groups (i.e., DRUSEN and DRUSEN + SDD) defined among AMD patients, respectively. Box-and whisker plots show median, first and third quartile, the whiskers extend to 1.5 times the interquartile range (IQR) (values exceeding this are plotted as individual points). SCP: Superficial capillary plexus; DCP: Deep capillary plexus; CC: Choriocapillaris; FD: Flow density; DRUSEN: soft or cuticular drusen; DRUSEN + SDD: drusen in association with subretinal drusenoid deposits (* p-value <0.05; ** p-value ≤ 0.01).
Figure 5
Figure 5
Correlation analysis with (A) Scatter plots with linear regression lines and coefficient of determination (R-squared) calculated for the total choroidal area and luminal area among control, 1A (Drusens) and 1B (Drusens + SDD) groups. Linear regression lines (blue-control; orange—group 1A and green-group 1B) were calculated and represented using stats’ linregress and seaborn’s lmplot functions, respectively. Light blue-, orange-, and green-coloured regions indicate the 95% confidence interval for each regression line; (B) Correlation scatter plots between choriocapillary (CC) flow density and luminal area (LA) (mm2) in control, 1A (Drusens) and 1B (Drusens + SDD) groups. Best-fitted lines (blue-control; orange—group 1A and green-group 1B) were represented and visualized through seaborn’s lmplot function. Light blue-, orange-, and green-coloured regions indicate the 95% confidence interval for each regression line. Spearman’s rank correlation coefficient (ρ) for each group is in the lower right corner. The correlation coefficients were: 0.6 (control), −0.06 (group 1A) and −0.2 (group 1B). The asterisks represent the p-value of the statistical test: ** p-value < 0.01.
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