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Pramil V, Moult EM, Fujimoto JG, Waheed NK. OCT Angiography-based Evaluation of the Choriocapillaris in Neovascular Age Related Macular Degeneration. JOVR [Internet]. 2021Oct.25 [cited 2024Jul.27];16(4):676–681. Available from: https://knepublishing.com/index.php/JOVR/article/view/9758
https://doi.org/10.18502/jovr.v16i4.9758
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authors
-
Varsha Pramil
Varsha Pramil
New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
-
Eric M. Moult
Eric M. Moult
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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James G. Fujimoto
James G. Fujimoto
Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Nadia K. Waheed
Nadia K. Waheed
New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
Published Date
- Oct 25, 2021
OCT Angiography-based Evaluation of the Choriocapillaris in Neovascular Age Related Macular Degeneration
Abstract
Neovascular age-related macular degeneration (AMD) can lead to rapid, irreversible vision loss in untreated eyes. While the pathogenesis of neovascular AMD remains incompletely understood, the choriocapillaris has been hypothesized as the initial site of injury. Due to limitations of dye-based angiography, in vivo imaging of the choriocapillaris has been a longstanding challenge. However, the clinical introduction of optical coherence tomography angiography (OCTA) has enabled researchers and clinicians to noninvasively image the choriocapillaris vasculature, allowing the evaluation of the choriocapillaris in eyes with a variety of pathologies. In this perspective, we review important OCTA-based findings regarding choriocapillaris impairment in neovascular AMD and discuss limitations and future directions of OCTA technologies in the context of this disease.
Keywords:
Choriocapillaris, Neovascular AMD, OCTA, Wet AMD
References
1. Wong WL, Su X, Li X, Cheung CM, Klein R, Cheng CY, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health 2014;2:e106–e116.
2. Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. Lancet 2018;392:1147–1159.
3. Sadda SR, Guymer R, Holz FG, Schmitz-Valckenberg S, Curcio CA, Bird AC, et al. Consensus definition for atrophy associated with age-related macular degeneration on OCT: classification of atrophy report 3. Ophthalmology 2018;125:537–548.
4. Grossniklaus HE, Green WR. Choroidal neovascularization. Am J Ophthalmol 2004;137:496–503.
5. Freund KB, Ho IV, Barbazetto IA, Koizumi H, Laud K, Ferrara D, et al. Type 3 neovascularization: the expanded spectrum of retinal angiomatous proliferation. Retina 2008;28:201–211.
6. Bailey ST, Thaware O, Wang J, Hagag AM, Zhang X, Flaxel CJ, et al. Detection of nonexudative choroidal neovascularization and progression to exudative choroidal neovascularization using OCT angiography. Ophthalmol Retina 2019;3:629–636.
7. McLeod DS, Taomoto M, Otsuji T, Green WR, Sunness JS, Lutty GA. Quantifying changes in RPE and choroidal vasculature in eyes with age-related macular degeneration. Invest Ophthalmol Vis Sci 2002;43:1986–1993.
8. McLeod DS, Grebe R, Bhutto I, Merges C, Baba T, Lutty GA. Relationship between RPE and choriocapillaris in age-related macular degeneration. Invest Ophthalmol Vis Sci 2009;50:4982–4991.
9. Moreira-Neto CA, Moult EM, Fujimoto JG, Waheed NK, Ferrara D. Choriocapillaris loss in advanced age-related macular degeneration. J Ophthalmol 2018;2018:8125267.
10. Biesemeier A, Taubitz T, Julien S, Yoeruek E, Schraermeyer U. Choriocapillaris breakdown precedes retinal degeneration in age-related macular degeneration. Neurobiol Aging 2014;35:2562–2573.
11. Ferrara D, Waheed NK, Duker JS. Investigating the choriocapillaris and choroidal vasculature with new optical coherence tomography technologies. Prog Retin Eye Res 2016;52:130–155.
12. Uji A, Balasubramanian S, Lei J, Baghdasaryan E, Al-Sheikh M, Sadda SR. Choriocapillaris imaging using multiple en face optical coherence tomography angiography image averaging. JAMA Ophthalmol 2017;135:1197–1204.
13. de Carlo TE, Romano A, Waheed NK, Duker JS. A review of optical coherence tomography angiography (OCTA). Int J Retina Vitreous 2015;1:5.
14. Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. Prog Retin Eye Res 2018;64:1–55.
15. Kashani AH, Chen CL, Gahm JK, Zheng F, Richter GM, Rosenfeld PJ, et al. Optical coherence tomography angiography: a comprehensive review of current methods and clinical applications. Prog Retin Eye Res 2017;60:66–100.
16. Faridi A, Jia Y, Gao SS, Huang D, Bhavsar KV, Wilson DJ, et al. Sensitivity and specificity of OCT angiography to detect choroidal neovascularization. Ophthalmol Retina 2017;1:294–303.
17. Giocanti-Auregan A, Dubois L, Dourmad P, Cohen SY. Impact of optical coherence tomography angiography on the non-invasive diagnosis of neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020;258:537–541.
18. Moult E, Choi W, Waheed NK, Adhi M, Lee B, Lu CD, et al. Ultrahigh-speed swept-source OCT angiography in exudative AMD. Ophthalmic Surg Lasers Imaging Retina 2014;45:496–505.
19. Keiner CM, Zhou H, Zhang Q, Wang RK, Rinella NT, Oldenburg CE, et al. Quantifying choriocapillaris hypoperfusion in patients with choroidal neovascularization using swept-source OCT angiography. Clin Ophthalmol 2019;13:1613–1620.
20. Alagorie AR, Verma A, Nassisi M, Nittala M, Velaga S, Tiosano L, et al. Quantitative assessment of choriocapillaris flow deficits surrounding choroidal neovascular membranes. Retina 2020;40:2106–2112.
21. Scharf JM, Corradetti G, Alagorie AR, Grondin C, Hilely A, Wang D, et al. Choriocapillaris flow deficits and treatment-naïve macular neovascularization secondary to age-related macular degeneration. Invest Ophthalmol Vis Sci 2020;61:11.
22. Moult EM, Alibhai AY, Rebhun C, Lee B, Ploner S, Schottenhamml J, et al. Spatial distribution of choriocapillaris impairment in eyes with choroidal neovascularization secondary to age-related macular degeneration: a quantitative OCT angiography study. Retina 2020;40:428–445.
23. Moreira-Neto CA, Moult EM, Fujimoto JG, Waheed NK, Ferrara D. Choriocapillaris loss in advanced age-related macular degeneration. J Ophthalmol 2018;2018:8125267.
24. Seddon JM, McLeod DS, Bhutto IA, Villalonga MB, Silver RE, Wenick AS, et al. Histopathological insights into choroidal vascular loss in clinically documented cases of age-related macular degeneration. JAMA Ophthalmol 2016;134:1272–1280.
25. Corvi F, Cozzi M, Corradetti G, Staurenghi G, Sarraf D, Sadda SR. Quantitative assessment of choriocapillaris flow deficits in eyes with macular neovascularization. Graefes Arch Clin Exp Ophthalmol 2021;259:1811–1819.
26. Borrelli E, Souied EH, Freund KB, Querques G, Miere A, Gal-Or O, et al. Reduced choriocapillaris flow in eyes with type 3 neovascularization and age-related macular degeneration. Retina 2018;38:1968–1976.
27. Treister AD, Nesper PL, Fayed AE, Gill MK, Mirza RG, Fawzi AA. Prevalence of subclinical CNV and choriocapillaris nonperfusion in fellow eyes of unilateral exudative AMD on OCT angiography. Transl Vis Sci Technol 2018;7:19.
28. Pfau M, Möller PT, Künzel SH, von der Emde L, Lindner M, Thiele S, et al. Type 1 choroidal neovascularization is associated with reduced localized progression of atrophy in age-related macular degeneration. Ophthalmol Retina 2020;4:238–248.
29. Hwang CK, Agrón E, Domalpally A, Cukras CA, Wong WT, Chew EY, et al. Progression of geographic atrophy with subsequent exudative neovascular disease in age-related macular degeneration: AREDS2 report 24. Ophthalmol Retina 2021;5:108–117.
30. Ricci F, Bandello F, Navarra P, Staurenghi G, Stumpp M, Zarbin M. Neovascular age-related macular degeneration: therapeutic management and new-upcoming approaches. Int J Mol Sci 2020;21:8242.
31. Wong TY, Chakravarthy U, Klein R, Mitchell P, Zlateva G, Buggage R, et al. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology 2008;115:116–126.
32. Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire MG, Ying GS, et al. Comparison of age-related macular degeneration treatments trials research group: macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2013;120:1860–1870.
33. Finger RP, Wickremasinghe SS, Baird PN, Guymer RH. Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration. Surv Ophthalmol 2014;59:1–18.
34. Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, et al. Defining response to anti-VEGF therapies in neovascular AMD. Eye 2015;29:721–731.
35. Nesper PL, Soetikno BT, Treister AD, Fawzi AA. Volumerendered projection-resolved OCT angiography: 3D lesion complexity is associated with therapy response in wet agerelated macular degeneration. Invest Ophthalmol Vis Sci 2018;59:1944–1952.
36. Nesper PL, Ong JX, Fawzi AA. Exploring the relationship between multilayered choroidal neovascularization and choriocapillaris flow deficits in AMD. Invest Ophthalmol Vis Sci 2021;62:12.
37. Hikichi T, Agarie M. Reduced vessel density of the choriocapillaris during anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci 2019;60:1088– 1095.
38. Lee B, Yoo G, Yun C, Oh J. Short-term effects of antivascular endothelial growth factor on peripapillary choroid and choriocapillaris in eyes with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2019;257:2163–2172.
39. Novais EA, Adhi M, Moult EM, Louzada RN, Cole ED, Husvogt L, et al. Choroidal neovascularization analyzed on ultrahigh-speed swept-source optical coherence tomography angiography compared to spectral-domain optical coherence tomography angiography. Am J Ophthalmol 2016;164:80–88.
40. Miller AR, Roisman L, Zhang Q, Zheng F, Rafael de Oliveira Dias J, Yehoshua Z, et al. Comparison between spectraldomain and swept-source optical coherence tomography angiographic imaging of choroidal neovascularization. Invest Ophthalmol Vis Sci 2017;58:1499–1505. Erratum in: Invest Ophthalmol Vis Sci 2017;58:2166.
41. Lane M, Moult EM, Novais EA, Louzada RN, Cole ED, Lee B, et al. Visualizing the choriocapillaris under drusen: comparing 1050-nm swept-source versus 840-nm spectral-domain optical coherence tomography angiography. Invest Ophthalmol Vis Sci 2016;57:OCT585–590.
42. Zhang Q, Zheng F, Motulsky EH, Gregori G, Chu Z, Chen C-L, et al. A novel strategy for quantifying choriocapillaris flow voids using swept-source OCT angiography. Invest Ophthalmol Vis Sci 2018;59:203-211.
43. Cole ED, Moult EM, Dang S, Choi W, Ploner SB, Lee B, et al. The definition, rationale, and effects of thresholding in OCT angiography. Ophthalmol Retina 2017;1:435–447.
44. Chu Z, Zhang Q, Gregori G, Rosenfeld PJ, Wang RK. Guidelines for imaging the choriocapillaris using OCT angiography. Am J Ophthalmol 2021;222:92–101.
45. Jaillon F, Makita S, Yasuno Y. Variable velocity range imaging of the choroid with dual-beam optical coherence angiography. Opt Express 2012;20:385–396.
46. Tokayer J, Jia Y, Dhalla A-H, Huang D. Blood flow velocity quantification using split-spectrum amplitudedecorrelation angiography with optical coherence tomography. Biomedical Optics Express 2013;4:1909–1924.
47. Braaf B, Vermeer KA, Vienola KV, de Boer JF. Angiography of the retina and the choroid with phase-resolved OCT using interval-optimized backstitched B-scans. Opt Express 2012;20:20516–20534.
48. Choi W, Moult EM, Waheed NK, Adhi M, Lee B, Lu CD, et al. Ultrahigh-speed, swept-source optical coherence tomography angiography in nonexudative agerelated macular degeneration with geographic atrophy. Ophthalmology 2015;122:2532–2544.
49. Ploner SB, Moult EM, Choi W, Waheed NK, Lee B, Novais EA, et al. Toward quantitative optical coherence tomography angiography: visualizing blood flow speeds in ocular pathology using variable interscan time analysis. Retina 2016;36:S118–S126.
50. Kurokawa K, Liu Z, Miller DT. Adaptive optics optical coherence tomography angiography for morphometric analysis of choriocapillaris [Invited]. Biomed Opt Express 2017;8:1803–1822.
51. Migacz JV, Gorczynska I, Azimipour M, Jonnal R, Zawadzki RJ, Werner JS. Megahertz-rate optical coherence tomography angiography improves the contrast of the choriocapillaris and choroid in human retinal imaging. Biomed Opt Express 2018;10:50–65.
52. Marsh-Armstrong B, Migacz J, Jonnal R, Werner JS. Automated quantification of choriocapillaris anatomical features in ultrahigh-speed optical coherence tomography angiograms. Biomed Opt Express 2019;10:5337–5350.
53. Poddar R, Migacz JV, Schwartz DM, Werner JS, Gorczynska I. Challenges and advantages in widefield optical coherence tomography angiography imaging of the human retinal and choroidal vasculature at 1.7-MHz A-scan rate. J Biomed Opt 2017;22:1–14.
54. Chu Z, Zhou H, Cheng Y, Zhang Q, Wang RK. Improving visualization and quantitative assessment of choriocapillaris with swept source OCTA through registration and averaging applicable to clinical systems. Sci Rep 2018;8:16826.
55. Uji A, Balasubramanian S, Lei J, Baghdasaryan E, Al-Sheikh M, Sadda SR. Choriocapillaris imaging using multiple en face optical coherence tomography angiography image averaging. JAMA Ophthalmol 2017;135:1197–1204.
2. Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. Lancet 2018;392:1147–1159.
3. Sadda SR, Guymer R, Holz FG, Schmitz-Valckenberg S, Curcio CA, Bird AC, et al. Consensus definition for atrophy associated with age-related macular degeneration on OCT: classification of atrophy report 3. Ophthalmology 2018;125:537–548.
4. Grossniklaus HE, Green WR. Choroidal neovascularization. Am J Ophthalmol 2004;137:496–503.
5. Freund KB, Ho IV, Barbazetto IA, Koizumi H, Laud K, Ferrara D, et al. Type 3 neovascularization: the expanded spectrum of retinal angiomatous proliferation. Retina 2008;28:201–211.
6. Bailey ST, Thaware O, Wang J, Hagag AM, Zhang X, Flaxel CJ, et al. Detection of nonexudative choroidal neovascularization and progression to exudative choroidal neovascularization using OCT angiography. Ophthalmol Retina 2019;3:629–636.
7. McLeod DS, Taomoto M, Otsuji T, Green WR, Sunness JS, Lutty GA. Quantifying changes in RPE and choroidal vasculature in eyes with age-related macular degeneration. Invest Ophthalmol Vis Sci 2002;43:1986–1993.
8. McLeod DS, Grebe R, Bhutto I, Merges C, Baba T, Lutty GA. Relationship between RPE and choriocapillaris in age-related macular degeneration. Invest Ophthalmol Vis Sci 2009;50:4982–4991.
9. Moreira-Neto CA, Moult EM, Fujimoto JG, Waheed NK, Ferrara D. Choriocapillaris loss in advanced age-related macular degeneration. J Ophthalmol 2018;2018:8125267.
10. Biesemeier A, Taubitz T, Julien S, Yoeruek E, Schraermeyer U. Choriocapillaris breakdown precedes retinal degeneration in age-related macular degeneration. Neurobiol Aging 2014;35:2562–2573.
11. Ferrara D, Waheed NK, Duker JS. Investigating the choriocapillaris and choroidal vasculature with new optical coherence tomography technologies. Prog Retin Eye Res 2016;52:130–155.
12. Uji A, Balasubramanian S, Lei J, Baghdasaryan E, Al-Sheikh M, Sadda SR. Choriocapillaris imaging using multiple en face optical coherence tomography angiography image averaging. JAMA Ophthalmol 2017;135:1197–1204.
13. de Carlo TE, Romano A, Waheed NK, Duker JS. A review of optical coherence tomography angiography (OCTA). Int J Retina Vitreous 2015;1:5.
14. Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi G. Optical coherence tomography angiography. Prog Retin Eye Res 2018;64:1–55.
15. Kashani AH, Chen CL, Gahm JK, Zheng F, Richter GM, Rosenfeld PJ, et al. Optical coherence tomography angiography: a comprehensive review of current methods and clinical applications. Prog Retin Eye Res 2017;60:66–100.
16. Faridi A, Jia Y, Gao SS, Huang D, Bhavsar KV, Wilson DJ, et al. Sensitivity and specificity of OCT angiography to detect choroidal neovascularization. Ophthalmol Retina 2017;1:294–303.
17. Giocanti-Auregan A, Dubois L, Dourmad P, Cohen SY. Impact of optical coherence tomography angiography on the non-invasive diagnosis of neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2020;258:537–541.
18. Moult E, Choi W, Waheed NK, Adhi M, Lee B, Lu CD, et al. Ultrahigh-speed swept-source OCT angiography in exudative AMD. Ophthalmic Surg Lasers Imaging Retina 2014;45:496–505.
19. Keiner CM, Zhou H, Zhang Q, Wang RK, Rinella NT, Oldenburg CE, et al. Quantifying choriocapillaris hypoperfusion in patients with choroidal neovascularization using swept-source OCT angiography. Clin Ophthalmol 2019;13:1613–1620.
20. Alagorie AR, Verma A, Nassisi M, Nittala M, Velaga S, Tiosano L, et al. Quantitative assessment of choriocapillaris flow deficits surrounding choroidal neovascular membranes. Retina 2020;40:2106–2112.
21. Scharf JM, Corradetti G, Alagorie AR, Grondin C, Hilely A, Wang D, et al. Choriocapillaris flow deficits and treatment-naïve macular neovascularization secondary to age-related macular degeneration. Invest Ophthalmol Vis Sci 2020;61:11.
22. Moult EM, Alibhai AY, Rebhun C, Lee B, Ploner S, Schottenhamml J, et al. Spatial distribution of choriocapillaris impairment in eyes with choroidal neovascularization secondary to age-related macular degeneration: a quantitative OCT angiography study. Retina 2020;40:428–445.
23. Moreira-Neto CA, Moult EM, Fujimoto JG, Waheed NK, Ferrara D. Choriocapillaris loss in advanced age-related macular degeneration. J Ophthalmol 2018;2018:8125267.
24. Seddon JM, McLeod DS, Bhutto IA, Villalonga MB, Silver RE, Wenick AS, et al. Histopathological insights into choroidal vascular loss in clinically documented cases of age-related macular degeneration. JAMA Ophthalmol 2016;134:1272–1280.
25. Corvi F, Cozzi M, Corradetti G, Staurenghi G, Sarraf D, Sadda SR. Quantitative assessment of choriocapillaris flow deficits in eyes with macular neovascularization. Graefes Arch Clin Exp Ophthalmol 2021;259:1811–1819.
26. Borrelli E, Souied EH, Freund KB, Querques G, Miere A, Gal-Or O, et al. Reduced choriocapillaris flow in eyes with type 3 neovascularization and age-related macular degeneration. Retina 2018;38:1968–1976.
27. Treister AD, Nesper PL, Fayed AE, Gill MK, Mirza RG, Fawzi AA. Prevalence of subclinical CNV and choriocapillaris nonperfusion in fellow eyes of unilateral exudative AMD on OCT angiography. Transl Vis Sci Technol 2018;7:19.
28. Pfau M, Möller PT, Künzel SH, von der Emde L, Lindner M, Thiele S, et al. Type 1 choroidal neovascularization is associated with reduced localized progression of atrophy in age-related macular degeneration. Ophthalmol Retina 2020;4:238–248.
29. Hwang CK, Agrón E, Domalpally A, Cukras CA, Wong WT, Chew EY, et al. Progression of geographic atrophy with subsequent exudative neovascular disease in age-related macular degeneration: AREDS2 report 24. Ophthalmol Retina 2021;5:108–117.
30. Ricci F, Bandello F, Navarra P, Staurenghi G, Stumpp M, Zarbin M. Neovascular age-related macular degeneration: therapeutic management and new-upcoming approaches. Int J Mol Sci 2020;21:8242.
31. Wong TY, Chakravarthy U, Klein R, Mitchell P, Zlateva G, Buggage R, et al. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology 2008;115:116–126.
32. Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire MG, Ying GS, et al. Comparison of age-related macular degeneration treatments trials research group: macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2013;120:1860–1870.
33. Finger RP, Wickremasinghe SS, Baird PN, Guymer RH. Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration. Surv Ophthalmol 2014;59:1–18.
34. Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, et al. Defining response to anti-VEGF therapies in neovascular AMD. Eye 2015;29:721–731.
35. Nesper PL, Soetikno BT, Treister AD, Fawzi AA. Volumerendered projection-resolved OCT angiography: 3D lesion complexity is associated with therapy response in wet agerelated macular degeneration. Invest Ophthalmol Vis Sci 2018;59:1944–1952.
36. Nesper PL, Ong JX, Fawzi AA. Exploring the relationship between multilayered choroidal neovascularization and choriocapillaris flow deficits in AMD. Invest Ophthalmol Vis Sci 2021;62:12.
37. Hikichi T, Agarie M. Reduced vessel density of the choriocapillaris during anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci 2019;60:1088– 1095.
38. Lee B, Yoo G, Yun C, Oh J. Short-term effects of antivascular endothelial growth factor on peripapillary choroid and choriocapillaris in eyes with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2019;257:2163–2172.
39. Novais EA, Adhi M, Moult EM, Louzada RN, Cole ED, Husvogt L, et al. Choroidal neovascularization analyzed on ultrahigh-speed swept-source optical coherence tomography angiography compared to spectral-domain optical coherence tomography angiography. Am J Ophthalmol 2016;164:80–88.
40. Miller AR, Roisman L, Zhang Q, Zheng F, Rafael de Oliveira Dias J, Yehoshua Z, et al. Comparison between spectraldomain and swept-source optical coherence tomography angiographic imaging of choroidal neovascularization. Invest Ophthalmol Vis Sci 2017;58:1499–1505. Erratum in: Invest Ophthalmol Vis Sci 2017;58:2166.
41. Lane M, Moult EM, Novais EA, Louzada RN, Cole ED, Lee B, et al. Visualizing the choriocapillaris under drusen: comparing 1050-nm swept-source versus 840-nm spectral-domain optical coherence tomography angiography. Invest Ophthalmol Vis Sci 2016;57:OCT585–590.
42. Zhang Q, Zheng F, Motulsky EH, Gregori G, Chu Z, Chen C-L, et al. A novel strategy for quantifying choriocapillaris flow voids using swept-source OCT angiography. Invest Ophthalmol Vis Sci 2018;59:203-211.
43. Cole ED, Moult EM, Dang S, Choi W, Ploner SB, Lee B, et al. The definition, rationale, and effects of thresholding in OCT angiography. Ophthalmol Retina 2017;1:435–447.
44. Chu Z, Zhang Q, Gregori G, Rosenfeld PJ, Wang RK. Guidelines for imaging the choriocapillaris using OCT angiography. Am J Ophthalmol 2021;222:92–101.
45. Jaillon F, Makita S, Yasuno Y. Variable velocity range imaging of the choroid with dual-beam optical coherence angiography. Opt Express 2012;20:385–396.
46. Tokayer J, Jia Y, Dhalla A-H, Huang D. Blood flow velocity quantification using split-spectrum amplitudedecorrelation angiography with optical coherence tomography. Biomedical Optics Express 2013;4:1909–1924.
47. Braaf B, Vermeer KA, Vienola KV, de Boer JF. Angiography of the retina and the choroid with phase-resolved OCT using interval-optimized backstitched B-scans. Opt Express 2012;20:20516–20534.
48. Choi W, Moult EM, Waheed NK, Adhi M, Lee B, Lu CD, et al. Ultrahigh-speed, swept-source optical coherence tomography angiography in nonexudative agerelated macular degeneration with geographic atrophy. Ophthalmology 2015;122:2532–2544.
49. Ploner SB, Moult EM, Choi W, Waheed NK, Lee B, Novais EA, et al. Toward quantitative optical coherence tomography angiography: visualizing blood flow speeds in ocular pathology using variable interscan time analysis. Retina 2016;36:S118–S126.
50. Kurokawa K, Liu Z, Miller DT. Adaptive optics optical coherence tomography angiography for morphometric analysis of choriocapillaris [Invited]. Biomed Opt Express 2017;8:1803–1822.
51. Migacz JV, Gorczynska I, Azimipour M, Jonnal R, Zawadzki RJ, Werner JS. Megahertz-rate optical coherence tomography angiography improves the contrast of the choriocapillaris and choroid in human retinal imaging. Biomed Opt Express 2018;10:50–65.
52. Marsh-Armstrong B, Migacz J, Jonnal R, Werner JS. Automated quantification of choriocapillaris anatomical features in ultrahigh-speed optical coherence tomography angiograms. Biomed Opt Express 2019;10:5337–5350.
53. Poddar R, Migacz JV, Schwartz DM, Werner JS, Gorczynska I. Challenges and advantages in widefield optical coherence tomography angiography imaging of the human retinal and choroidal vasculature at 1.7-MHz A-scan rate. J Biomed Opt 2017;22:1–14.
54. Chu Z, Zhou H, Cheng Y, Zhang Q, Wang RK. Improving visualization and quantitative assessment of choriocapillaris with swept source OCTA through registration and averaging applicable to clinical systems. Sci Rep 2018;8:16826.
55. Uji A, Balasubramanian S, Lei J, Baghdasaryan E, Al-Sheikh M, Sadda SR. Choriocapillaris imaging using multiple en face optical coherence tomography angiography image averaging. JAMA Ophthalmol 2017;135:1197–1204.