You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

 

 

Years (decades)

1–10

11–20

21–30

31–40

41–50

51–60

61–70

71–80

 

Vessel length density

Superficial capillary plexus

Mean ± SD

18.83 ± 1.83

19.52 ± 1.54

19.66 ± 0.66

19.37 ± 0.85

18.95 ± 1.11

18.76 ± 1.18

18.53 ± 0.99

17.60 ± 2.13

p > 0.05

Deep capillary plexus

Mean ± SD

12.66 ± 4.09

14.12 ± 4.09

14.92 ± 2.36

14.23 ± 2.41

13.37 ± 3.26

12.77 ± 3.04

12.23 ± 0.99

10.58 ± 4.28

p > 0.05

Whole retina

Mean ± SD

20.02 ± 1.44

20.67 ± 1.36

20.86 ± 0.55

20.62 ± 0.60

20.36 ± 0.92

20.14 ± 0.98

19.98 ± 0.77

19.41 ± 1.81

p > 0.05

Perfusion density

Superficial capillary plexus

Mean ± SD

0.42 ± 0.04

0.43 ± 0.03

0.43 ± 0.02

0.43 ± 0.02

0.42 ± 0.02

0.41 ± 0.03

0.41 ± 0.02

0.38 ± 0.04

p > 0.05

Deep capillary plexus

Mean ± SD

0.26 ± 0.09

0.29 ± 0.09

0.30 ± 0.05

0.29 ± 0.05

0.27 ± 0.07

0.26 ± 0.06

0.25 ± 0.06

0.21 ± 0.09

p > 0.05

Whole retina

Mean ± SD

0.45 ± 0.03

0.46 ± 0.03

0.46 ± 0.01

0.45 ± 0.01

0.45 ± 0.02

0.44 ± 0.02

0.44 ± 0.02

0.42 ± 0.04

p > 0.05

Foveal avascular Zone

Perimeter

Mean ± SD

2.36 ± 0.52

2.22 ± 0.33

2.43 ± 0.29

2.49 ± 0.49

2.35 ± 0.69

2.31 ± 0.29

2.96 ± 0.33

2.49 ± 1.01

p > 0.05

Circularity index

Mean ± SD

0.72 ± 0.10

0.77 ± 0.05

0.78 ± 0.05

0.76 ± 0.06

0.71 ± 0.15

0.73 ± 0.07

0.74 ± 0.09

0.68 ± 0.14

p > 0.05

Area

Mean ± SD (Range)

0.32 ± 0.10

0.31 ± 0.09

0.37 ± 0.08

0.39 ± 0.14

0.35 ± 0.13

0.31 ± 0.07

0.51 ± 0.10

0.36 ± 0.21

p > 0.05

Table 1 Measurement values of the study parameters in every decade of life.

The difference in the parameters was not statistically significant between the groups when compared in each decade of life. SD standard deviation.

 

Study parameters

r

P

Vessel indices

Average VLD superficial

-0.17

0.01

Average VLD deep

-0.10

0.14

Average VLD retina

-0.11

0.12

Average PD superficial

-0.24

0.001

Average PD deep

-0.11

0.11

Average PD retina

-0.18

0.001

FAZ parameters

Average FAZ perimeter

0.15

0.03

Average FAZ circularity

-0.11

0.11

Average FAZ area

0.19

0.001

Table 2. Correlation of VLD, PD, and FAZ parameters with age.

VLD vessel length density, PD perfusion density, superficial super ficial capillary plexus, deep deep capillary plexus, retina whole retina, FAZ foveal avascular zone, r Pearson ’s correlation coefficient, P signi ficance, values in bold are statistically signi ficant.

 

Study parameters

r

P

Foveal central subfield

Average VLD superficial

-0.26

0.001*

Average VLD deep

-0.18

0.008*

Average VLD retina

-0.28

0.001*

Average PD superficial

-0.26

0.001*

Average PD deep

-0.17

0.009*

Average PD retina

-0.27

0.001*

3mm ETDRS ring

Average VLD superficial

-0.10

0.01*

Average VLD deep

-0.27

0.001*

Average VLD retina

-0.16

0.01*

Average PD superficial

-0.12

0.07

Average PD deep

-0.27

0.001*

Average PD retina

-0.18

0.005*

6mm ETDRS ring

Average VLD superficial

-0.16

0.002*

Average VLD deep

-0.11

0.08

Average VLD retina

-0.10

0.12

Average PD superficial

-0.21

0.001*

Average PD deep

-0.12

0.06

Average PD retina

-0.17

0.01*

Table 3. Relationship between the age and VLD and PD within various ETDRS rings.

VLD vessel length density, PD perfusion density, super ficial super ficial capillary plexus, deep deep capillary plexus, retina whole retina, r Pearson ’s correlation coefficient, P signi ficance, values in bold are statistically signi ficant. *Statistical signi ficance P < 0.05

CME

Age-Related Assessment of Foveal Avascular Zone and Surrounding Capillary Networks With Swept Source Optical Coherence Tomography Angiography in Healthy Eyes

  • Authors: Aditya Verma, MS; Kowsigan Magesan, MSc Optom; T Amose; Ahmed Roshdy Alagorie, MD; Ramya Gnanaraj, DO (Ophthalmology) DNB; SriniVas R. Sadda, MD; Parveen Sen, MS
  • CME Released: 8/11/2022
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 8/11/2023, 11:59 PM EST
Start Activity


Target Audience and Goal Statement

This activity is intended for ophthalmologists and other clinicians caring for patients with ocular diseases and/or age-related ocular changes.

The goal of this activity is to describe the relationship over a wide age range between retinal vascular parameters and foveal avascular zone architecture and age in 222 eyes of 116 healthy participants with no ocular or systemic disease, according to a cross-sectional study using swept source optical coherence tomography angiography, which allows dense scanning of the macular circulation.

Upon completion of this activity, participants will:

  1. Describe the overall relationship between retinal vascular parameters and foveal avascular zone (FAZ) architecture and age in normal healthy eyes over a wide age range, according to a cross-sectional study using swept source optical coherence tomography angiography (SS OCTA)
  2. Determine the relationship between retinal vascular parameters and FAZ architecture and age in normal healthy eyes according to macular region and specific decades of life, according to a cross-sectional study using SS OCTA
  3. Identify clinical implications of the relationship between retinal vascular parameters and FAZ architecture and age in normal healthy eyes over a wide age range, according to a cross-sectional study using SS OCTA


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Medscape policies. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Aditya Verma, MS

    Shri Bhagwan Mahavir VitreoRetinal Services
    Medical Research Foundation
    Tamil Nadu, India

  • Kowsigan Magesan, MSc Optom

    Elite School of Optometry
    Unit of Medical Research Foundation
    Tamil Nadu, India

  • T Amose

    Elite School of Optometry
    Unit of Medical Research Foundation
    Tamil Nadu, India

  • Ahmed Roshdy Alagorie, MD

    Department of Ophthalmology
    Faculty of Medicine
    Tanta University
    Tanta, Egypt

  • Ramya Gnanaraj, DO (Ophthalmology) DNB

    Shri Bhagwan Mahavir VitreoRetinal Services
    Medical Research Foundation
    Tamil Nadu, India

  • SriniVas R. Sadda, MD

    Doheny Eye Institute
    Los Angeles, California
    Department of Ophthalmology
    David Geffen School of Medicine at University of California, Los Angeles (UCLA)

  • Parveen Sen, MS

    Shri Bhagwan Mahavir VitreoRetinal Services
    Medical Research Foundation
    Tamil Nadu, India

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Stocks, stock options, or bonds: AbbVie Inc. (former)

Editor

  • Sobha Sivaprasad, MD

    Editor, Eye

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.


Accreditation Statements

Medscape

Interprofessional Continuing Education

In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Springer Nature. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this Journal-based CME activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

From Eye
CME

Age-Related Assessment of Foveal Avascular Zone and Surrounding Capillary Networks With Swept Source Optical Coherence Tomography Angiography in Healthy Eyes

Authors: Aditya Verma, MS; Kowsigan Magesan, MSc Optom; T Amose; Ahmed Roshdy Alagorie, MD; Ramya Gnanaraj, DO (Ophthalmology) DNB; SriniVas R. Sadda, MD; Parveen Sen, MSFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 8/11/2022

Valid for credit through: 8/11/2023, 11:59 PM EST

processing....

Abstract and Introduction

AIM: To assess the macular capillary networks and foveal avascular zone (FAZ) with swept-source optical coherence tomography angiography in healthy eyes.

METHODS: This cross-sectional, prospective, observational study enrolled 222 eyes of 116 healthy participants with no ocular or systemic disease. SS-OCTA images were captured using the PLEX Elite 9000 (Carl Zeiss Meditec Inc., Dublin, CA, USA) with a 6 × 6mm pattern centered on the foveal center. Vessel length density (VLD), perfusion density (PD), and FAZ parameters were analyzed using the manufacturer’s automated software.

RESULTS: A significant negative correlation was observed between age and average VLD in the superficial plexus, and average PD in both the superficial plexus and the whole retina. A significant positive correlation between age and foveal avascular zone perimeter and area was also noted. Age-wise comparisons showed a trend for an increase in VLD and PD until 40 years of age, with a subsequent decrease in the older age in the macular region. The central subfield showed a decrease in the vessel density measurements in the 21–40 age group. FAZ area and perimeter were the mirror inverse of the central subfield vessel density measurements with a numerically greater area and perimeter in the 21–40 age group compared to the 0–20 and 41–60 age groups. FAZ circularity was significantly reduced after 40 years of age.

CONCLUSION: Age-related changes in the vessel density and FAZ parameters in the healthy macula are complex and vary with the macular location. These results carry significance when interpreting the data from diseased eyes.

Introduction

Optical coherence tomography angiography (OCTA) has significantly enhanced our knowledge of the retinal and inner choroidal microcirculation. OCTA, which utilizes decorrelation signals from OCT scans obtained over time, allows the circulation to be visualized in a depth-resolved volumetric fashion [1,2], offering significant advantages over conventional dye-based fundus fluorescein angiography and indocyanine green angiography [3]. While OCTA cannot currently demonstrate leakage which can provide insight into the integrity of the blood-retinal barrier, the absence of obscuring leakage provides a clearer visualization of the circulation, particularly the deeper layers. The deeper capillary layers can be specifically impacted in various retinal vascular diseases including diabetic retinopathy and retinal vascular occlusive disease [4-8]. A specific phenotype of selective occlusion of the deeper circulation, termed pcentral acute middle maculopathy (PAMM), has also been described [9].

Recently, OCTA has become available on swept-source (SS) OCT devices, which feature a tunable laser with a longer deeper-penetrating wavelength (1050 nm) and faster scanning speed. These devices offer some advantages over spectral-domain (SD) OCT devices for evaluation of the choriocapillaris and inner choroid [10].

OCTA has provided novel insights into the organization and physiology of the normal healthy vasculature. These include a detailed description of the number of layers in which the vascular plexuses are arranged, regional variations between the macular and peripapillary region, a hybrid model of series and pllel organization of the microvascular blood flow, with an apparent directional flow between the superficial (SCP) and deep capillary plexuses (DCP) and preferential venous outflow at the level of the DCP [11-14].

Since the macula is amongst the metabolically most active tissues of the body, it is affected by hypoxic conditions early on in many disease states [15-17]. It is supplied by multiple surrounding capillary plexuses for its high oxygen demand, and therefore, depends upon the health of these capillary beds for its proper integrity and function [18]. Understanding the normal circulation is a critical prerequisite for understanding the impact of diseases. Characterizing the variation in the normal circulation related to age, ethnicity, and retinal region is essential. Not surprisingly, as with other vascular systems, changes have been reported to occur in the retinal microvasculature with age [19,20]. The alterations occurring in the foveal avascular zone (FAZ) and surrounding vessels with age in healthy eyes have been described in the past [21-35]. Though the relationships are not perfectly consistent, generally, a decreased perifoveal vessel density and increased FAZ size have been reported with advancing age [23-32]. The perimeter of the FAZ is supplied by both the SCP and DCP which form a ring of interconnecting capillaries at the margin of the FAZ [36,37]. The FAZ zone is known to be sensitive to ischemic events, and the shape and size of the normal FAZ correlate well with foveal morphology [33]. Recently, researchers have reported early evidence of alterations in the FAZ circularity in patients with diabetes as compared with healthy eyes [38-40]. One important reason for the lack of consistent results in all such studies may be related to the age of the study cohort included for analysis. Thus, precise information regarding age-related alterations in the FAZ and surrounding retinal vasculature becomes a prerequisite to understand the development in health and alterations in diseased states [41]. To address this need, we assessed normal healthy eyes over a wide age range using SS OCTA device which permits dense scanning of the macular circulation to unravel the complex variations in these structures as the age advances.

Table of Contents

  1. Abstract and Introduction
  2. Methods
  3. Results
  4. Discussion