Impact of large choroidal vessels on choriocapillaris flow deficit analyses in optical coherence tomography angiography

Purpose To investigate the impact of large choroidal vessels (LCV) on Choriocapillaris (CC) flow deficit (FD) analyses with swept-source optical coherence tomography angiography (SS-OCTA) Design Prospective, cross-sectional study. Methods Macular 6x6mm SS-OCTA scans were obtained from intermediate age-related macular degeneration (iAMD) and healthy eyes. Images were captured and processed according to most common standards and analyzed for percentage of flow-deficits (FD%) within four 1x1mm squares at the corners of each image. Choroidal thickness (CT), iris color and refraction error were considered as potential influential factors for LCV visibility. A linear mixed model and logistic regression models were calculated for statistical evaluation. Results Sixty-nine iAMD and 49 age-matched healthy eyes were enrolled. LCV were visible in at least one sector in 52% of iAMD and 47% of healthy eyes. Within the iAMD group FD% were significantly lower in areas containing LCV (p = 0.0029). Increasing CT resulted in an odds ratio decrease of LCV (OR: 0.94, p<0.0001). Below a CT value of <= 118 mu m LCV could be expected with a sensitivity of 86% and a specificity of 85%. Conclusions LCV can significantly affect CC FD analyses of SS-OCTA images. Their visibility is negatively associated with CT. The impact of LCV should be taken into account when performing CC FD assessments, especially in patients where reduced CT is to be expected and inclusion of affected areas should be considered carefully.

Automated summary

This study found that large choroidal vessels (LCV) have a significant impact on the Choriocapillaris (CC) flow deficit (FD) analyses of swept-source optical coherence tomography angiography (SS-OCTA) images, with their visibility negatively associated with choroidal thickness (CT). In patients with intermediate age-related macular degeneration, areas containing LCV showed significantly lower FD%.