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Vitreoretinal lymphomas (VRLs) present with different clinical characteristics. However, only a few case reports have been published that evaluated the retinal function and the retinal morphology. The relationship between retinal morphology and function of eyes with a vitreoretinal lymphoma (VRL) was investigated via optical coherence tomography (OCT) and electroretinography (ERG). The ERG and OCT findings in 11 eyes of 11 patients (69.4 ± 11.5 years old) who were diagnosed with VRL at the Saitama Medical University Hospital between December 2016 to May 2022 were studied. The decimal best-corrected visual acuity ranged from hand movements to 1.2 (median 0.2). Histopathological studies of the vitreous specimens showed class II VRL in one eye, class III VRL in seven eyes, class IV VRL in two eyes, and class V VRL in one eye. The IgH gene rearrangement was positive in three of the six eyes tested. The OCT images showed morphological abnormalities in 10 of the 11 (90.9%) eyes. Severe attenuation was found for the amplitudes of the b-wave of the DA 0.01 ERG in 6 of 11 eyes (54.5%), the DA 3.0 a-wave in 5 of 11 eyes (45.5%), the DA 3.0 b-wave in 36.4%, the LA 3.0 a-wave in 36.4%, the LA 3.0 b-wave in 18.2%, and flicker responses in 36.4% of the eyes. None of the DA 3.0 ERGs had a negative shape (b/a < 1.0). In the five eyes in which the a-wave was severely attenuated, hyperreflective dots were observed subretinally. The ERG analysis in eyes with a VRL indicates a relatively severe dysfunction of the outer retinal layer and was helpful in determining the site of the morphological changes in eyes with VRL.

The center of the fovea, termed the foveola, is the area of highest visual acuity, has the highest density of cone photoreceptors. We investigated the distance between the automatically-determined center of the foveal avascular zone (FAZ) and the manually-determined highest foveal bulge (FB) point using single swept-source optical coherence tomography angiography (OCTA) instrument. This cross-sectional study included 49 eyes of 49 individuals (34 women and 15 men; median age: 68 years) with no history of ocular disorders. The FAZ in the superficial capillary plexus was automatically determined using the Kanno–Saitama macro method, and the center of the FAZ was automatically determined using ellipse approximation. Another candidate foveal center, the highest FB point, was determined manually on the serial cross-sectional B-scan images. As a result, the foveal center was manually identified as the highest FB point on B-scan OCTA images. The center of the FAZ was more likely to be located inferior to the highest FB point (p = 0.031). In participants with a total (linear) distance of more than 50 μm between the center of the FAZ and the highest FB point, the displacement was significantly more in the horizontal direction than in the vertical direction (p = 0.017). These results can be applicable to further studies regarding the spatial relationships between the center of the FAZ and the highest FB point in various macular diseases or previously-treated eyes.

We evaluated the macular visibility of a newly designed extended depth of focus (EDOF) intraocular lenses (IOL) using a wide viewing system for macular manipulation (Risight;60D, Carl Zeiss Meditec AG) in a model eye and compared it with various other types of IOLs. We used a model eye that was constructed based on the Glustrand model to compare a newly designed EDOF IOL (DIB00V; JohnsonJohnson Surgical Vision), an EDOF IOL with a diffraction grating (ZXR00V; JohnsonJohnson surgical Vision), and a monofocal aspheric (DCB00V; JohnsonJohnson Vision, XY-1; HOYA Surgical Optics, Tokyo, Japan) or spherical IOL (NX70s; Santen Pharmaceutical Co., Ltd). In the model eye, a 1951 United States Air Force (USAF) test was placed at the location of the macula. The contrasts in a range of spatial frequencies were quantified using the images obtained from the 1951 USAF test target. The contrast at each spatial frequency was plotted and integrated to calculate the area under the curve contrast (AUC-contrast). Qualitative evaluations showed that good-quality images were obtained for all IOLs. At a spatial frequency of 16 LP/mm, the average contrast was the highest for the DIB00V and NX70s (0.216 each). The highest average contrast at 32 LP/mm was obtained using the NX70s (0.128), and at 64 LP/mm using the DIB00V (0.123). The horizontal AUC-contrast was the highest for the NX70s (8.754), and the vertical AUC-contrast was the highest for the DIB00V (8.334). On average, the DIB00V had the highest AUC-contrast value (8.227). The high-order aspheric IOL, DIB00V, was found to exhibit good macular visibility despite being an EDOF IOL.

Yuji Yoshikawa, Takuhei Shoji, Junji Kanno, Hisashi Ibuki, Kimitake Ozaki, Hirokazu Ishii, Hiromi Inami, Kei Shinoda Department of Ophthalmology, Saitama Medical University, Iruma, Saitama, JapanCorrespondence: Kei ShinodaDepartment of Ophthalmology, Saitama Medical University, 350-0495 Morohogo 38, Iruma, Saitama, JapanTel +81 49-276-1250Fax +81 49-295-8002Email shinodak@med.teikyo-u.ac.jpPurpose: Optical coherence tomography angiography (OCTA) allows noninvasive observation of the retinal vasculature, and image analysis can be used to calculate the retinal vessel density and foveal avascular zone (FAZ) area. A previous study showed that macular vessel density and the signal strength index (SSI) of OCTA images increased significantly after cataract surgery. However, the effect of aging on OCTA analysis remains unclear. This study aimed to investigate age-related changes in macular vascularization while excluding the effects of cataracts.Patients and Methods: OCTA imaging of the macula was performed in adult patients who had undergone cataract surgery between February 2018 and May 2019 and in young healthy participants between April 2017 and April 2018.Results: The median (quartiles) age of the overall study population was 59.0 (27.0, 69.0) years, and no severe refractive error was observed (axial length: 24.2 ± 1.3 [mean ± SD] mm; spherical equivalent: 0.75 [− 2.25, 0.00] diopter). When we investigated the relationship between macular vessel density and age after excluding the effects of cataracts, we found that the macular vessel density showed age-related changes even in the absence of the effects of the SSI. However, the FAZ area was not affected by age.Conclusion: Macular vessel density decreased with age, even when the effects of cataracts were excluded. The effects of age and cataracts should be considered when designing studies and interpreting OCTA findings of the retinal vasculature.Keywords: optical coherence tomography angiography, macular vessel density, foveal avascular zone, aging, cataract surgery

ObjectiveTo identify the degree of loss of the circumpapillary retinal nerve fibre layer (cpRNFL), the layer from the macular RNFL to the inner plexiform layer (mGCL++), circumpapillary (cpVD) and macular vascular density (mVD), Pulsar perimetry and standard perimetry in early glaucoma.MethodsIn this cross-sectional study, one eye from each of 96 healthy controls and 90 eyes with open-angle glaucoma were measured with cpRNFL, mGCL++, cpVD, mVD, Pulsar perimetry with Octopus P32 test (Pulsar) and standard perimetry with Humphrey field analyser 24-2 test (HFA). For direct comparison, all parameters were converted to relative change values adjusted in both their dynamic range and age-corrected normal value.ResultsThe degree of loss in mGCL++ (−24.7%) and cpRNFL (−25.8%) was greater than that in mVD (−17.3%), cpVD (−14.9%), Pulsar (−10.1%) and HFA (−5.9%) (each pConclusionThe degree of loss of cpRNFL and mGCL++ thickness preceded by approximately 7%–10% and 15%–20% compared with the micro-VD and visual fields in early glaucoma, respectively.Trial registration numberUMIN Clinical Trials Registry (http://www.umin.ac.jp/; R000046076 UMIN000040372).

Background/AimThis study aimed to compare central visual sensitivity under monocular and binocular conditions in patients with glaucoma using the new imo static perimetry.MethodsFifty-one consecutive eyes of 51 patients with open-angle glaucoma who were affected with at least one significant point in the central 10° were examined in this cross-sectional study. Monocular and binocular random single-eye tests were performed using the imo perimeter and the Humphrey field analyser (HFA) 24-2 and 10-2 tests. The eyes were assigned to ‘better’ and ‘worse’ categories based on the visual acuity and central visual thresholding. Central visual sensitivity results obtained by monocular, binocular random single-eye tests and binocular simultaneous both eye test were compared.ResultsThe average mean deviation with the HFA 24-2 was −5.5 (–1.5, –14.6) dB (median, (IQR)) in the better eyes and −18.0 (–12.9, –23.8) dB in the worse eyes. The mean sensitivity in the central 4 points of the visual field (VF) of the worse eyes was lower when measured under the binocular eye condition than under the monocular condition. Conversely, this value of the better eyes was greater when measured under the binocular eye condition than under the monocular condition.ConclusionsThe central sensitivity of the better eyes was better and that of the worse eyes poorer with binocular testing than with monocular testing in patients with glaucoma. Although monocular VF testing is still the most straightforward means to monocularly monitor glaucoma at clinical settings, binocular testing, such as provided with imo perimetry, may be a useful clinical tool to predict the effect of VF impairments on a patient’s quality of visual life.

Changes in retinal vasculature and ocular circulation may play an important role in the glaucoma development and progression. We evaluated the vertical asymmetry across the temporal raphe of the deep retinal layer vessel density, using swept-source optical coherence tomography angiography (SS-OCTA), and its relationship with the central visual field (VF) loss. Thirty-four eyes of 27 patients with open-angle glaucoma were included. SS-OCTA macular scanning was performed within a 3 × 3 mm (300 × 300 pixels) volume, centred on the fovea. The relationships between the vertical asymmetrical deep retinal vessel density reduction (ADRVD) across the temporal raphe and various ocular parameters were analysed. Twenty-two glaucomatous eyes with ADRVDs had central VF loss. Contrarily, ADRVDs were not found in any of the 12 eyes without central VF loss. Thirteen eyes (59.1%) with central VF loss had ADRVDs topographically corresponding to the central VF loss and macular ganglion cell complex thinning. The glaucomatous eyes with ADRVDs exhibited inferior rather than superior central VF loss (P = 0.032). Thus, ADRVD specifically indicates the glaucomatous central visual loss. Further analysis of ADRVD may improve our understanding on glaucoma pathogenesis, offering new treatment insights.

Background/AimsTo evaluate quantitative changes in the foveal avascular zone (FAZ) area after glaucoma surgery using swept-source optical coherence tomography angiography (SS-OCTA).MethodsFifty-four consecutive patients with primary open-angle glaucoma (POAG) who met the inclusion criteria and underwent unilateral glaucoma surgery to reduce intraocular pressure (IOP) between April 2018 and July 2019.Eyes underwent IOP-lowering glaucoma surgery and their fellow (non-surgical) eyes were included. OCTA of the macula was performed in both eyes before glaucoma surgery and 3 months postoperatively. Two blinded examiners reviewed the image quality. Within- and between-group comparisons of the FAZ area and correlation of the FAZ area with age, IOP, central sensitivity and clinical variables.ResultsThe mean (±SD) age was 66.7±11.3 years. After surgery, the IOP and FAZ area significantly decreased from 22.1±9.5 mmHg to 10.3±3.5 mmHg and from 0.485±0.193 mm2 to 0.446±0.174 mm2, respectively (both p2 and 0.396±0.110 mm2, respectively) did not significantly differ (p=0.469). Change in the FAZ area significantly correlated with the preoperative FAZ area, preoperative foveal sensitivity and change in IOP (all pConclusionsThe FAZ area is decreased with IOP-lowering surgery in patients with POAG, and change in the FAZ area was significantly correlated with both preoperative foveal sensitivity and change in IOP.

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To investigate the effects of adjusting the ocular magnification during OCT-based angiography imaging on structure-function relationships and glaucoma detection.Cross-sectional study.A total of 96 healthy control participants and 90 patients with open-angle glaucoma were included.One eye of each patient in the control group and the patient group was evaluated. The layers comprising the macula vascular density (VD) and circumpapillary VD were derived from swept-source OCT angiography imaging. The mean sensitivity (MS) of the standard automated perimetry was measured using the Humphrey 24-2 test. Structure-function relationships were evaluated with simple and partial correlation coefficients. A receiver operating characteristic analysis was performed to evaluate the diagnostic accuracy for glaucoma using the area under the receiver operating characteristic curve (AUC). Ocular magnification was adjusted using Littmann's formula modified by Bennett.The association between the axial length and VD, structure-function relationships, and glaucoma detection with and without magnification correction.The superficial layer of the macular region was not significantly correlated to the axial length without magnification correction (Adjustment of the ocular magnification is important for accurate VD measurements; however, it may not significantly impact structure-function relationships and glaucoma detection.

The extraction of the foveal avascular zone (FAZ) from optical coherence tomography angiography (OCTA) images has been used in many studies in recent years due to its association with various ophthalmic diseases. In this study, we investigated the utility of a dataset for deep learning created using Kanno Saitama Macro (KSM), a program that automatically extracts the FAZ using swept-source OCTA. The test data included 40 eyes of 20 healthy volunteers. For training and validation, we used 257 eyes from 257 patients. The FAZ of the retinal surface image was extracted using KSM, and a dataset for FAZ extraction was created. Based on that dataset, we conducted a training test using a typical U-Net. Two examiners manually extracted the FAZ of the test data, and the results were used as gold standards to compare the Jaccard coefficients between examiners, and between each examiner and the U-Net. The Jaccard coefficient was 0.931 between examiner 1 and examiner 2, 0.951 between examiner 1 and the U-Net, and 0.933 between examiner 2 and the U-Net. The Jaccard coefficients were significantly better between examiner 1 and the U-Net than between examiner 1 and examiner 2 (p < 0.001). These data indicated that the dataset generated by KSM was as good as, if not better than, the agreement between examiners using the manual method. KSM may contribute to reducing the burden of annotation in deep learning.

To evaluate the correlation between macular retinal function and the changes in the macular retinal vascular structure in glaucomatous eyes.The study included patients with glaucoma who visited Saitama Medical University and underwent optical coherence tomography angiography, and multifocal electroretinographic examinations at the same time between February 2020 and April 2021. Correlations among the ocular parameters, macular vessel density, and multifocal electroretinographic parameters were evaluated using a mixed model.Forty-one eyes (mean deviation, -12.4 ± 7.8 dB) of 24 subjects (mean age, 75.2 ± 8.3 years) were included in the analysis. There were no significant correlations for macular vessel density in the superficial retinal layer. However, macular vessel density in the deep retinal layer showed a significant positive correlation with P1-N1 amplitude (coefficient = 0.724; P = 0.001). There were no significant correlations between the optical coherence tomography parameters and any of the multifocal electroretinographic parameters.A decrease in N1-P1 amplitude was observed in glaucomatous eyes in relation to a reduction in macular vessel density in the deep retinal layer, which suggests that ischemia-induced bipolar cell dysfunction may be involved in the intermediate retinal dysfunction associated with glaucoma.Intermediate retinal dysfunction in glaucoma is related to the changes in deep retinal microvasculature.

The center of the fovea, termed the foveola, is the area of highest visual acuity, has the highest density of cone photoreceptors, and is the center of the foveal avascular zone (FAZ). We investigated the distance between the automatically-determined center of the foveal avascular zone (FAZ) and the manually-determined highest foveal bulge (FB) point using swept-source optical coherence tomography angiography (OCTA). This cross-sectional study included 49 eyes of 49 individuals (34 women and 15 men; median age: 68 years) with no history of ocular disorders. The FAZ in the superficial capillary plexus was automatically determined using the Kanno-Saitama Macro method, and the center of the FAZ was automatically determined using ellipse approximation. The foveal center was manually identified as the highest FB point on B-scan OCTA images. The center of the FAZ was more likely to be located inferior to the highest FB point. In participants with a combined distance of more than 50 µm between the center of the FAZ and the highest FB point, the displacement was significantly more in the horizontal direction than in the vertical direction (p = 0.017). These results can be applicable to further studies regarding the spatial relationships between the center of the FAZ and the highest FB point in various macular diseases or previously-treated eyes.

To evaluate the automated determination of the center of an idiopathic macular hole (MH) by using swept-source optical coherence tomography (OCT) images with new macro-based algorithms in ImageJ and to compare the difference between the MH center measurements obtained automatically and manually. This cross-sectional study included 39 eyes of 39 elderly individuals (22 women, 17 men) with stage 3 and 4 MH. The MH center was automatically determined using the ImageJ macro. The foveal center was also manually identified by two masked examiners using horizontal and vertical serial B-scan OCT angiography images. The mean age was 68.8 ± 8.3 years. After adjusting for the effect of magnification, the mean distance between the MH center determined manually by Examiner 1 and that determined automatically was 15.5 ± 9.9 µm. The mean distance between the two manually determined measurements of the MH center was 20.3 ± 19.7 µm. These two mean distance values did not differ significantly (Welch t-test, p = 0.27) and was non-inferior (p < 0.0001). The automated ImageJ-based method for determining the MH center was comparable to manual methods. This study showed that automated measurements were non-inferior to manual measurements, and demonstrated a substitutable usefulness, at least for use in clinical practice.

Background Macular hole (MH) is a retinal break in the fovea involving partial or complete dehiscence of the neural retinal layers affecting the visual quality by decreasing visual acuity (VA) and visual deformation. We describe a case of secondary MH associated with submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV), which showed spontaneous closure. Case presentation A 67-year-old man developed decreased VA in his right eye due to an SMH. The VA was 20/50, and monthly intravitreal injection of aflibercept was administered three times. The SMH gradually decreased, and 10 months later the external limiting membrane was found to be perforated, resulting in MH. The old clot disappeared, and the MH remained for 10 months. Twenty-three months later, serous retinal detachment (SRD) involving the macula appeared and the MH had disappeared. SRD gradually disappeared, and macular configuration recovered. VA gradually improved and became 20/20 38 months later. Conclusion Dynamic change of the ultrastructure in an unusual case of secondary-developed and spontaneously closed MH was clearly observed. Although the mechanism was unknown, the small diameter size and exudative PCV are thought to have contributed to the closure.

Yuji Yoshikawa, Takuhei Shoji, Junji Kanno, Hisashi Ibuki, Kimitake Ozaki, Hirokazu Ishii, Yoshikazu Ichikawa, Itaru Kimura, Kei Shinoda Department of Ophthalmology, Saitama Medical University, Saitama, Japan Purpose: To evaluate microvascular changes in the macular area of eyes with rhegmatogenous retinal detachment (RRD) without macular involvement (macula-on RRD) using swept-source optical coherence tomography angiography (SS-OCTA). Patients and methods: Five patients with macula-on RRD were eligible for analysis. All patients underwent SS-OCTA examination (Triton) for the macular area. The healthy fellow eyes were included as controls. The vessel density (VD) was calculated using binarization, and the foveal avascular zone (FAZ) was measured. The VD and FAZ area were compared between the eyes with RRD and the fellow eyes using the Wilcoxon signed rank test. Results: The patients’ clinical characteristics were as follows: age, 49.0 years (21.0, 54.0) (median [25, 75th percentile]); preoperative best-corrected visual acuity, -0.08 (-0.08, 0.11) for RRD and -0.08 (-0.08, -0.03) for the fellow eye (P=0.50); and axial length, 27.0 (25.1, 28.7) mm for RRD and 27.4 (25.6, 28.5) mm for the fellow eye (P=0.31). The parafoveal VD was not significantly different between the eyes with RRD and the fellow eyes (P=1.00 for the superficial retina andP=0.44 for the whole retina). The FAZ area was also similar for the eyes with RRD and the fellow eyes (P=0.31 for the superficial retina and P=0.13 for the whole retina). Conclusion: The findings of this study suggest that the macular microvasculature remains intact in eyes with macula-on RRD. Keywords: rhegmatogenous retinal detachment, macula, optical coherence tomography angiography, vessel density

Yuji Yoshikawa,1 Takuhei Shoji,1 Junji Kanno,1 Itaru Kimura,1 Masanori Hangai,2 Kei Shinoda1 1Department of Ophthalmology, Saitama Medical University, Saitama, Japan; 2Hangai Eye Institute, Saitama, Japan Purpose: To evaluate the ability of enhanced-depth imaging (EDI) optical coherence tomography angiography (OCTA) to detect vascular signals inside the glaucomatous optic disc.Patients and methods: Ten glaucomatous eyes of 8 subjects and 11 nonglaucomatous eyes of 7 subjects underwent EDI and conventional OCTA for optic disc analysis. The optic disc vessel density (VD) at maximum scan depth (2 mm) was compared between the 2 methods and between glaucomatous and nonglaucomatous eyes. Regression analysis was used to determine the factors affecting disc VD.Results: The median (25th, 75th percentile) of the visual field mean deviation was –20.5 (–25.1, –13.5) dB in glaucoma. The disc VD measured with the EDI method was significantly greater than that measured with the conventional method in glaucoma and nonglaucoma. The disc VD was also significantly lower in glaucoma than in nonglaucoma. The disc VD and mean deviation were significantly and positively correlated in both methods (conventional: R2=0.27, EDI: R2=0.22).Conclusion: The correlation between disc VD and glaucoma severity was comparable between conventional and EDI measurements. Images obtained with EDI-OCTA have the additional benefit of revealing more vascular signals in deeper layers. The disc VD, as determined by both conventional and EDI-OCTA methods, may be an indicator of glaucoma severity. Keywords: optical coherence tomography angiography, enhanced-depth imaging, vessel density, glaucoma severity, mean deviation

The present report aimed to describe the macular structure’s recovery process in a case of optic disc pit maculopathy (ODP-M) with outer layer hole following pars plana vitrectomy (PPV) with juxtapapillary laser treatment (JPL). We performed repeated optical coherence tomography (OCT) examinations to evaluate the macular structural changes. An 80-year-old man presented with distorted vision and decreased visual acuity (VA) in his left eye, experienced for 1 year, prior to presentation. Fundus examination and OCT showed intraretinal fluid (IRF) in the inner and outer retinal layers. Serous retinal detachment (SRD) with an outer layer hole in the macula was also evident. The IRF was connected to the optic disc; however, the SRD was isolated. Best-corrected VA was 20/100. PPV combined with JPL was performed. Posterior vitreous detachment creation and tamponade with sulfur hexafluoride was performed. Postoperatively, the inner retinal IRF at the fovea disappeared. The outer layer hole gradually closed and had completely disappeared 1 month postoperatively. After resolution of the outer layer hole, SRD reduced gradually and disappeared 8 months postoperatively, although the macular outer retinal IRF remained. The outer retinal IRF had partially resolved by the 18th postoperative month. Macular structure was completely recovered 31 months postoperatively, with an improved VA of 20/20. In conclusion, SRD might be associated with outer retinal IRF and outer layer holes. In cases of ODP-M, outer layer holes might induce optic disc-isolated SRD.

Baseline retinochoroidal images from the macula to the periphery are presented using a montaging technique of spectral domain optical coherence tomography. The scan length is approximately three times than that provided by conventional posterior scanning and provides novel spectral domain optical coherence tomography images of normal extramacular vitreoretinal and choroidal anatomy., Purpose: To present baseline images of the vitreous, retina, and choroid from the macula to the periphery in normal patients using a novel montaging technique of spectral domain optical coherence tomography. Methods: Twenty-six normal eyes of 22 healthy volunteers were enrolled in this study. Montaged images of four radial optical coherence tomography scans through the fovea were obtained from each subject. Results: In the macula, there were six identifiable retinal layers as well as four bands in the outer retina. In the periphery, the ganglion cell layer was not identifiable. The external limiting membrane, the second band, and the retinal pigment epithelium were continuously delineated from the macula to the periphery. The third band was not visible in the periphery. Conclusion: Spectral domain optical coherence tomography montaged images provide wide-angle images of the vitreous, retina, and choroid, allowing for evaluation of peripheral findings and examination of relationships between peripheral and posterior disease. The maximum scan length achieved here was 36 mm. The scan length is approximately three times than that provided by conventional posterior scanning and is consistent with known dimensions of the eye. This method is achievable with current commercially available devices and may contribute to decision making in clinical practice.

Purpose The purpose of this study was to evaluate automated measurement of the foveal avascular zone (FAZ) area using the Kanno-Saitama macro (KSM) software in Image J with swept-source optical coherence tomography angiography (SS-OCTA) images. Methods In this cross-sectional study, one photographer scanned the macular area (3 × 3 mm) of healthy volunteers twice on the same day, at the same time. The FAZ area was measured from the en face image of the superficial retinal layer by two masked examiners, using the KSM and the Advanced Retina Imaging (ARI)-network method in Carl Zeiss online analysis. Intra- and interscan reproducibility and FAZ area were compared among the methods. Results Forty eyes of 22 healthy volunteers were included in the analysis. The mean ± SD age of the subjects was 34.6 ± 12.4 years. Intra- and interscan intraclass coefficients ranged from 0.997 to 1.000 and 0.989 to 0.995, respectively. The mean FAZ area was 0.264 ± 0.08 mm2 by the KSM, 0.245 ± 0.08 mm2 by the ARI, and 0.281 ± 0.09 mm2 by the manual method. The mean difference between the KSM and manual methods was 0.015 mm2, which was significantly smaller than the mean difference between the ARI and manual methods (0.034 mm2; P < 0.001). Conclusions Automated determination of the FAZ area is feasible and yields results comparable to those obtained by manual measurement. The FAZ area measured with the KSM program is less user dependent and could potentially contribute to our understanding of the pathophysiology of various retinal diseases, particularly underlying vascular diseases. Translational Relevance This study demonstrates a novel automated determination of the FAZ area using the Image J macro program in SS-OCTA images. This program was feasible and yields results comparable to those obtained by manual measurement.

Purpose To describe the morphologic and anatomic relationships at the vitreoretinal interface, from the macula into the periphery, in patients with idiopathic macular hole. Montaged images of posterior and peripheral spectral-domain (SD) optical coherence tomography (OCT) studies were used to describe the anatomic vitreoretinal relationships. Design Prospective, consecutive, observational case series. Participants Forty-six eyes of thirty-six consecutive patients with idiopathic macular hole and their fellow eyes. Methods Montage images of 4 radial OCT scans (horizontal, vertical, and 2 oblique scans) through the fovea were obtained in each case. Main Outcome Measures Montage SD OCT images. Results In fellow eyes, potential precursor changes to macular hole revealed shallow perifoveal vitreous separation that extends peripherally toward the equator. Two distinct configurations were noted at the posterior vitreous face; eyes without holes had a smooth curvature, whereas eyes with holes were more likely to have wavy, folded, or scalloped vitreous surfaces. At the onset of separation, most posterior vitreous cortex had a smooth curvature, but posterior vitreous folds increased with progressive separation. Also notable were zones of double-layered retinoschisis in regions of adherent posterior vitreous. Resulting granular hyperreflection in the peripheral vitreous was detectable in 50% to 60% of stage 1 or 2 holes but in only 33% of stage 3 or 4 holes. Conclusions The SD OCT montages taken at serial stages of idiopathic macular holes document distinct configurations of the posterior vitreous face, granular hyperreflection in the peripheral vitreous, and areas of peripheral retinoschisis. Montaging SD OCT images provides novel cross-sectional images of the vitreoretinal interface that may have broader application. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Purpose To evaluate the reproducibility of vessel density calculations using different binarization methods obtained via two commercially available swept-source optical coherence tomography angiography (SS-OCTA) systems. Methods Healthy volunteers were imaged using two swept-source optical coherence tomography angiography (SS-OCTA) devices, PLEXElite and Triton. SS-OCTA examinations were performed using a 3 × 3-mm volume scan pattern centered on the fovea. A total of six methods were used for binarization in ImageJ, two global thresholding and four local adaptive thresholding methods. Resultant vessel density values were compared between the instruments and binarization methods. Images for 60 eyes from 30 healthy subjects were assessed by two reviewers who were blinded to the scanning system used. Results Twenty-two eyes were excluded due to poor image quality (17 eyes from Triton, 4 eyes from PLEXElite, and 1 eye from both instruments, P = 0.003). A final 38 eyes from 23 subjects were eligible for analysis. Each binarization method and instrument led to different median values. The coefficients of variation for vessel density measurements ranged from 0.3% to 2.3% and 0.6% to 4.7% for the PLEXElite and Triton, respectively. Local adaptive thresholding methods revealed higher reproducibility than did global thresholding methods for both devices. Conclusions Macular scans with both SS-OCTA instruments showed good reproducibility for vessel density measurements. PLEXElite recorded fewer poor images and had higher reproducibility than did Triton. These findings will inform the selection of proper binarization methods for the clinical detection of vascular diseases affecting the central retina. Translational relevance The reproducibility for macular vessel measurements with SS-OCTA instruments was good. PLEXElite recorded fewer poor images and had higher reproducibility than did Triton.