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Updated: Dec 18, 2025
Evaluation of Capillary and Other Vessel Contribution to Macular Perfusion Density Measured with Optical Coherence Tomography Angiography
Published on: February 18, 2022
Microaneurysms visualisation using five different optical coherence tomography angiography devices compared to
Salvatore Parrulli1, Federico Corvi2, Mariano Cozzi1
1Eye Clinic, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milano, Italy.
Background:
To compare fluorescein angiography (FA) and five different optical coherence tomography angiography (OCTA) devices and to test their reproducibility in the evaluation of retinal microaneurysms (MAs) secondary to diabetic retinopathy (DR).
Methods:
On the same day, patients with DR were imaged with FA and five OCTA devices: prototype Spectralis OCTA, prototype PlexElite, RTVue XR Avanti, AngioPlex and DRI OCT Triton. For all OCTA devices, a 3×3 volume scan pattern was performed. MAs were evaluated for the superficial capillary plexus (SCP) and deep capillary plexus (DCP).
Results:
Twenty eyes of 15 patients with DR were included. FA counted a significantly higher number of MAs compared to OCTA devices. Spectralis OCTA obtained a significantly higher number of MAs compared to PlexElite, RTVue XR Avanti, AngioPlex and DRI OCT Triton (p<0.0001). PlexElite and AngioPlex showed a greater number of MAs in the SCP, Spectralis OCTA, RTVue XR Avanti and DRI OCT Triton in the DCP. Higher sensitivity (43.3%) but lowest specificity (54.4%) was observed for Spectralis OCTA compared to other devices. The higher specificity (78.5%) and positive predictive value (83.3%) were observed for DRI OCT Triton.
Conclusions:
FA remains the best imaging modality to visualise retinal MAs. Spectralis OCTA was able to detect more MAs compared to other devices, likely due to the higher number of B-scans in the scanned area as well as due to the higher number of repeated B-scans. The high variability between OCTA devices should be taken into account for future clinical trials as in clinical practice.
Insights
Fluorescein angiography (FA) remains superior for detecting retinal microaneurysms (MAs) in diabetic retinopathy (DR). While Spectralis OCTA detected more MAs, significant variability exists among optical coherence tomography angiography (OCTA) devices.
Area of Science:
- Ophthalmology
- Medical Imaging
- Diabetic Retinopathy Research
Background:
- Diabetic retinopathy (DR) is a leading cause of vision loss.
- Retinal microaneurysms (MAs) are early indicators of DR.
- Accurate MA detection is crucial for DR management.
Purpose of the Study:
- Compare the diagnostic performance of fluorescein angiography (FA) and five optical coherence tomography angiography (OCTA) devices.
- Evaluate the reproducibility of OCTA devices in detecting microaneurysms in diabetic retinopathy.
- Assess the sensitivity and specificity of different OCTA devices for MA detection.
Main Methods:
- Retinal imaging of 15 patients with DR using FA and five OCTA devices (Spectralis OCTA, PlexElite, RTVue XR Avanti, AngioPlex, DRI OCT Triton).
- Standardized 3x3 volume scan pattern applied to all OCTA devices.
- Microaneurysms (MAs) evaluated in both superficial (SCP) and deep (DCP) capillary plexuses.
Main Results:
- FA detected significantly more MAs than any OCTA device.
- Spectralis OCTA identified more MAs than other OCTA devices, particularly in the DCP.
- DRI OCT Triton demonstrated the highest specificity (78.5%) and positive predictive value (83.3%) for MA detection.
Conclusions:
- Fluorescein angiography (FA) remains the gold standard for visualizing retinal microaneurysms (MAs).
- Spectralis OCTA showed higher MA detection rates, attributed to more B-scans and repeated scans.
- Significant variability among OCTA devices necessitates careful consideration in clinical trials and practice.
