Quantitative comparison of a novel wide-field OCT-angiography device with ultrawide-field fluorescein angiography in detecting retinal nonperfusion in vascular retinopathies

Hafner, Michael; Herold, Tina R.; Deiters, Viktoria; Livonius, Bettina von; Priglinger, Siegfried G.; Gerhardt, Maximilian J. (2025): Quantitative comparison of a novel wide-field OCT-angiography device with ultrawide-field fluorescein angiography in detecting retinal nonperfusion in vascular retinopathies. BMC Ophthalmology, 25: 642. ISSN 1471-2415

Abstract

Background

Reliable assessment of retinal nonperfusion is critical in managing vascular retinopathies. While ultrawide-field fluorescein angiography (UWF-FA) is the clinical standard, it is invasive and dye-dependent. Previous wide-field optical coherence tomography angiography (WF-OCTA) systems have been limited by insufficient peripheral coverage. To the best of our knowledge, this is the first quantitative comparison of DREAM WF-OCTA with UWF-FA. The study leverages the device’s increased field of view (≈130° single scan, > 200° montage) and demonstrates that the previously published, semi-automated VMseg approach can also be applied to DREAM data.

Methods

24 eyes from 13 patients with diabetic retinopathy or retinal vein occlusion underwent both UWF-FA (Optos Silverstone, 200°) and WF-OCTA and were analyzed. The ischemic index (ISI) was calculated for each modality using previously developed semi-automated segmentation (VMseg) for WF-OCTA and manual annotation for UWF-FA. Agreement was assessed using correlation, linear regression, and Bland-Altman analyses.

Results

ISI values from WF-OCTA showed strong correlations with UWF-FA ( r = 0.92 for central, r = 0.96 for montage). Central WF-OCTA showed good absolute agreement with UWF-FA in mild ischemia, montage WF-OCTA with extended coverage in mild to moderate and partly severe ischemia. However, Bland-Altman analysis revealed proportional bias with increasing underestimation at higher nonperfusion levels, indicating that field of view limitations persist despite technological advances.

Conclusions

This study demonstrates that the DREAM OCT™ system with improved peripheral coverage enables reliable non-invasive assessment of retinal ischemia in mild to moderate cases. However, WF-OCTA should be considered complementary to UWF-FA, particularly in severe peripheral ischemia. Semi-automated segmentation enhances reproducibility and supports broader clinical adoption of OCTA in ischemia monitoring.

• Doc-Type: Article (LMU Hospital)
• Organisational unit (Faculties): 07 Medicine > Medical Center of the University of Munich > Eye Clinic and Polyclinic
• DFG subject classification of scientific disciplines: Life sciences
• DFG: Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - 491502892