Association of Optical Coherence Tomography Angiography Metrics With Detection of Impaired Macular Microvasculature and Decreased Vision in Amblyopic Eyes The Hong Kong Children Eye Study
Association of Optical Coherence Tomography Angiography Metrics With Detection of Impaired Macular Microvasculature and Decreased Vision in Amblyopic Eyes The Hong Kong Children Eye Study
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DOI：
10.1001/jamaophthalmol.2020.2220
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发表时间：
2020-08-01
影响因子：
8.1
通讯作者：
Yam, Jason C.
中科院分区：
文献类型：
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作者：
Wong, Emily S.;Zhang, Xiu-Juan;Yam, Jason C.
问题：在校正所有已知的混杂因素后，弱视儿童的黄斑微血管异常是否仍然存在？它们与视力是否相关？结果在这项以人群为基础的巢式病例对照研究中，30名弱视儿童和1045名对照儿童，弱视眼黄斑微血管异常，表现为中心凹无血管区圆形度降低，分形维数降低，血管直径指数增加。LogMAR视力与中心凹无血管区圆形度和血管直径指数相关。定量光学相干断层扫描血管造影指标检测弱视眼与视力相关的受损微血管，这表明在弱视评估中的潜在作用。重要性弱视的微血管异常正变得越来越明显，高分辨率成像，如光学相干断层扫描血管造影术（OCT-A）;然而，据我们所知，这些结果的临床意义和使用是未知的。目的探讨弱视儿童眼OCT-A定量指标的变化及其与视力的关系。设计、设置和参与者这项基于人群的巢式病例对照研究包括2016年1月至2017年7月期间从香港中文大学眼科中心基于人群的香港儿童眼科研究（HKCES）中连续招募的6至8岁儿童。所有受试者均接受了OCT-A扫描源OCT和详细的眼科检查。通过定制的自动化图像分析程序定量浅表毛细血管丛的黄斑微血管。进行多变量线性回归，以评估校正所有已知混杂因素后弱视眼和非弱视眼之间OCT-A指标的差异。数据分析于2018年9月至11月进行。主要结果和测量弱视眼和非弱视眼之间OCT-A度量（中心凹无血管区[FAZ]）面积、FAZ圆形度、血管密度、血管直径指数和分形维数的差异。结果在该队列中，有30名弱视参与者（平均[SD]年龄，7.57 [1.2]岁; 16名女孩[53.3%]）和1045名对照组（平均[SD]年龄，7.65 [1.0]岁; 580名女孩[55.5%]）。与对照眼相比，弱视眼FAZ圆度降低（-0.058; 95% CI，-0.096至-0.021，P =.002），分形维数降低（-0.014; 95% CI，-0.024至-0.003; P =.01），血管直径指数增加（0.002; 95% CI，0.002至0.003; P <.001）。未发现FAZ面积和血管密度之间存在差异。LogMAR视力与FAZ圆度（s β，-0.133; P <.001）和血管直径指数（s β，0.097; P =.001）相关，但与血管密度和FAZ面积无关。结论和相关性这项以儿童为研究对象的研究结果支持弱视眼存在黄斑微血管异常。这种变化与视力，推断视网膜参与弱视的发展，并建议在诊断和识别amblyopais.This病例对照研究定量OCT-A指标的潜在作用，评估定量光学相干断层扫描血管造影指标在弱视眼的变化，并探讨其与视力在中国儿童。
Question Are macular microvascular abnormalities in children with amblyopia still present after adjusting for all known confounders and do they correlate with visual acuity? Findings In this population-based nested case-control study of 30 children with amblyopia and 1045 controls, amblyopic eyes had abnormal macular microvascular represented by decreased foveal avascular zone circularity, decreased fractal dimension, and increased vessel diameter index. LogMAR visual acuity correlated with foveal avascular zone circularity and vessel diameter index. Meaning Quantitative optical coherence tomography angiography metrics detect impaired microvasculature in amblyopic eyes that correlates with visual acuity, suggesting a potential role in amblyopia assessment.Importance Microvascular abnormalities in amblyopia are becoming evident with high-resolution imaging, such as optical coherence tomography angiography (OCT-A); however, to our knowledge, the clinical significance and use of these findings are unknown. Objective To assess changes in quantitative OCT-A metrics in amblyopic eyes and explore their association with visual acuity in children. Design, Setting, and Participants This population-based nested case-control study included children aged 6 to 8 years who were consecutively recruited between January 2016 and July 2017 from the population-based Hong Kong Children Eye Study (HKCES) at the Chinese University of Hong Kong Eye Centre. All participants underwent OCT-A with a swept-source OCT and detailed ophthalmic investigations. Macular microvasculature of the superficial capillary plexus was quantified by a customized automated image analysis program. A multivariable linear regression was conducted to evaluate the differences in OCT-A metrics between amblyopic and nonamblyopic eyes after adjustment for all known confounders. Data analysis was conducted from September to November 2018. Main Outcomes and Measures Differences in OCT-A metric (foveal avascular zone [FAZ]) area, FAZ circularity, vessel density, vessel diameter index, and fractal dimension between amblyopic and nonamblyopic eyes. Results There were 30 participants with amblyopia (mean [SD] age, 7.57 [1.2] years; 16 girls [53.3%]) and 1045 controls (mean [SD] age, 7.65 [1.0] years; 580 girls [55.5%]) in this cohort. Compared with control eyes, amblyopic eyes had decreased FAZ circularity (-0.058; 95% CI, -0.096 to -0.021, P = .002), decreased fractal dimension (-0.014; 95% CI, -0.024 to -0.003; P = .01), and increased vessel diameter index (0.002; 95% CI, 0.002 to 0.003; P < .001). A difference was not identified between FAZ area and vessel density. LogMAR visual acuity was associated with FAZ circularity (s beta, -0.133; P < .001) and vessel diameter index (s beta, 0.097; P = .001) but not with vessel density nor FAZ area. Conclusions and Relevance The results of this population-based study in children supports the presence of macular microvascular abnormalities in amblyopic eyes. Such changes as measured by OCT-A metrics are associated with visual acuity, inferring retinal involvement in the development of amblyopia and suggesting a potential role of quantitative OCT-A metrics in the diagnosis and recognition of amblyopia.This case-control study assesses changes in quantitative optical coherence tomography angiography metrics in amblyopic eyes and explores their association with visual acuity in Chinese children.