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Optical Coherence Tomography Angiography in Optic Disc Swelling.

Masoud Aghsaei Fard1, Jalil Jalili2, Alireza Sahraiyan1

  • 1Farabi Eye Hospital BB, Eye Research Center, Tehran University of Medical Science, Tehran, Iran.

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Optical coherence tomography angiography (OCT-A) effectively differentiates optic disc swelling causes. Customized analysis of whole-image capillary density shows the highest accuracy in distinguishing conditions like nonarteritic anterior ischemic optic neuropathy (NAION) and optic neuritis from papilledema.

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Area of Science:

  • Ophthalmology
  • Neuro-ophthalmology
  • Medical Imaging

Background:

  • Optic disc swelling can result from various conditions, including nonarteritic anterior ischemic optic neuropathy (NAION), papilledema, and optic neuritis.
  • Accurate differentiation of these conditions is crucial for appropriate patient management and treatment.
  • Optical coherence tomography angiography (OCT-A) offers a non-invasive method to visualize peripapillary vasculature.

Purpose of the Study:

  • To compare the diagnostic utility of OCT-A in assessing peripapillary total vasculature and capillary networks in eyes with different types of optic disc swelling.
  • To evaluate the effectiveness of both commercial and customized OCT-A analysis software in differentiating between NAION, papilledema, and optic neuritis.

Main Methods:

  • A cross-sectional study involving 29 eyes with NAION, 44 with papilledema, 8 with optic neuritis, and 48 normal controls.
  • OCT-A imaging was performed, and peripapillary total vasculature was analyzed using commercial software.
  • Customized image analysis, including major vessel removal, was employed to measure whole-image capillary density and peripapillary capillary density (PCD).

Main Results:

  • Commercial OCT-A software revealed significantly lower peripapillary total vasculature density in NAION and papilledema eyes compared to controls.
  • Customized software showed significantly lower PCD in NAION eyes versus papilledema eyes, and lower whole-image and PCD in optic neuritis versus papilledema.
  • Whole-image capillary density derived from customized software demonstrated the highest area under the receiver operating characteristic curve for discriminating between NAION and papilledema (0.94) and optic neuritis and papilledema (0.80).

Conclusions:

  • OCT-A is a valuable tool for distinguishing between NAION, optic neuritis, and papilledema.
  • Customized analysis of whole-image capillary density using OCT-A provides the highest diagnostic accuracy for differentiating various causes of optic disc swelling.