Large Hypertransmission Defects Exhibit Choriocapillaris Flow Speed Impairment in Nonexudative Age-Related Macular Degeneration

IF 5 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI:10.1016/j.xops.2025.101060

Yunchan Hwang SM , Muhammad Usman Jamil MD , Kwang Min Woo MD , Stephanie M. Kaiser BA , Fatima Babiker MD , Philip J. Rosenfeld MD, PhD , Nadia K. Waheed MD , James G. Fujimoto PhD

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Abstract

Purpose

To investigate choriocapillaris (CC) blood flow speed in regions associated with hypertransmission defects (hyperTDs) in nonexudative age-related macular degeneration (AMD) using variable interscan time analysis (VISTA) OCT angiography (OCTA).

Design

Retrospective cross-sectional analysis of a prospectively collected cohort.

Subjects

Thirty-one eyes from 29 subjects with nonexudative AMD.

Methods

Patients with age-related macular degeneration were imaged using a 600 kHz A-scan rate prototype swept-source OCT with a 5 × 5 mm field of view and 5 B-scan repeats (1.25 ms interscan time). Hypertransmission defects were traced on choroidal en face projections and categorized by their greatest linear dimension (GLD): large (≥250 μm), medium (63–250 μm), and small (<63 μm). Choriocapillaris blood flow speed was quantified using VISTA, which measures OCTA signal saturation dynamics across multiple interscan times. Variable interscan time analysis flow speed (VFS) was evaluated at the macula and within hyperTDs. Choriocapillaris flow speed impairment (ΔVFS) for each hyperTD was calculated as the difference between its VFS and the macular average. To assess spatial extent, ΔVFS was assessed beyond lesion boundaries. Traditional metrics of OCTA signal and flow deficits (FDs) were also evaluated.

Main Outcome Measures

Choriocapillaris blood flow speed impairment (ΔVFS) within and around hyperTDs.

Results

The macular average CC VFS was 1.47 ± 0.34 ms^–1, with no significant difference between eyes with (n = 14) and without (n = 17) hyperTDs. A total of 88 hyperTDs were analyzed: 19 large, 28 medium, and 41 small. Large hyperTDs showed significant CC flow impairment (ΔVFS = –0.37 ± 0.18 ms^–1, P_adjusted < 0.0001), with impairment extending 100 μm beyond lesion boundaries (P_adjusted = 0.0061). Medium-sized hyperTDs demonstrated moderate impairment (ΔVFS = –0.30 ± 0.47 ms^–1, P_adjusted = 0.031), while small hyperTDs did not. In linear mixed-effects modeling, large and medium hyperTDs were associated with significant reductions in flow speed (–0.40 ms^–1, P = 0.014; –0.31 ms^–1, P = 0.030, respectively), corresponding to approximately 25% decreases from macular average. OCT angiography signal and FD metrics also detected size-dependent flow impairment.

Conclusions

Large hyperTDs in nonexudative AMD exhibit reduced CC flow speed extending beyond the lesion boundary. Longitudinal studies will investigate whether CC flow predicts onset and progression of hyperTDs.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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非渗出性老年性黄斑变性的大超透射缺陷表现为绒毛膜毛细血管流速损害

目的应用可变扫描间期分析（VISTA）和OCT血管造影（OCTA）研究非渗出性年龄相关性黄斑变性（AMD）患者超透射缺陷（hypertd）相关区域的绒毛膜毛细血管（CC）血流速度。设计前瞻性收集的队列回顾性横断面分析。29例非渗出性AMD患者31只眼。方法对年龄相关性黄斑变性患者使用600 kHz a扫描速率的原型扫描源OCT， 5 × 5 mm视场和5次重复b扫描（间隔时间1.25 ms）进行成像。在脉络膜表面投影上追踪超透射缺陷，并根据最大线性尺寸（GLD）将其分类为：大（≥250 μm）、中（63 - 250 μm）和小（<63 μm）。绒毛毛细血管血流速度使用VISTA进行量化，该方法测量多个扫描间隔时间的OCTA信号饱和度动态。在黄斑和hypertd内评估变扫描间时间分析流速度（VFS）。每个高td的绒毛膜毛细血管血流速度损伤（ΔVFS）计算为其VFS与黄斑平均值的差值。为了评估空间范围，在病变边界之外评估ΔVFS。传统的OCTA信号和流量缺陷（FDs）指标也进行了评估。主要观察指标：高td内及周围的绒毛膜毛细血管血流速度损伤（ΔVFS）。结果黄斑CC平均VFS为1.47±0.34 ms-1，高tds组（n = 14）与非高tds组（n = 17）无显著差异。共分析了88例hypertd: 19例大、28例中、41例小。大的hypertd表现出明显的CC血流损伤（ΔVFS = -0.37±0.18 ms-1， p调整后<； 0.0001），损伤延伸到病变边界以外100 μm （p调整后= 0.0061）。中型hypertd表现出中度损伤（ΔVFS = -0.30±0.47 ms-1, p - adjusted = 0.031），而小型hypertd则没有。在线性混合效应模型中，大、中等高tds与血流速度显著降低相关（分别为-0.40 ms-1, P = 0.014; -0.31 ms-1, P = 0.030），相当于比平均黄斑速度降低约25%。OCT血管造影信号和FD指标也检测到尺寸相关的血流损伤。结论非渗出性AMD的高tds表现为CC血流速度降低，血流速度超出病变边界。纵向研究将探讨CC血流是否能预测hypertd的发生和进展。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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