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Original Investigation |

Algorithm for the Measure of Vitreous Hyperreflective Foci in Optical Coherence Tomographic Scans of Patients With Diabetic Macular Edema

Edward Korot, MD1,2; Grant Comer, MD2; Timothy Steffens, MA2; David A. Antonetti, PhD2
[+] Author Affiliations
1Beaumont Eye Institute, Royal Oak, Michigan
2Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
JAMA Ophthalmol. 2016;134(1):15-20. doi:10.1001/jamaophthalmol.2015.3949.
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Importance  Developing a noninvasive measure of diabetic retinopathy disease progression may provide physicians with information needed for patient-specific intervention.

Objective  To develop an algorithm to measure vitreous hyperreflective foci (VHRF) from standard, 3-dimensional optical coherence tomographic (OCT) images in an unbiased manner.

Design, Setting, and Participants  We retrospectively analyzed OCT scans from 97 patients who were evaluated at the Kellogg Eye Center, University of Michigan. Patients with diabetes mellitus without signs of retinopathy (n = 29) and patients with diabetic macular edema (DME) (n = 31) were compared with healthy control participants (n = 37). The algorithm was used to determine whether the VHRF score is associated with DME and may serve as a noninvasive measure of inflammation. The study was conducted from November 14, 2011, to August 5, 2015. Data analysis was performed from May 15, 2014, to August 13, 2015.

Main Outcomes and Measures  An algorithm was developed to enhance the vitreous imaging from OCT to allow automated quantification of VHRF and calculation of a VHRF score. This score was compared between the healthy control, diabetes without retinopathy, and DME groups.

Results  In the 97 scans evaluated, VHRF scores, reported as mean (SD), were increased in patients with DME by 2.95-fold (5.60 [8.65]) compared with healthy controls (1.90 [3.42]; 95% CI, 0.75-7.45; P = .012) and by 6.83-fold compared with patients with diabetes without retinopathy (0.82 [1.26]; 95% CI, 1.46-8.82; P = .005).

Conclusions and Relevance  Scores obtained using the VHRF algorithm may be obtained from OCT images that include the vitreous and could provide a rapid, noninvasive clinical correlate for ocular inflammation. Higher VHRF scores in patients with DME compared with controls and diabetic patients without retinopathy warrant further population-based and longitudinal studies to help determine the value of the VHRF score in selecting therapeutic intervention.

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Figure 1.
Vitreous Hyperreflective Foci (VHRF) Algorithm

A, An optical coherence tomographic (OCT) B-scan of a patient with diabetic macular edema with select VHRF circled. B, Initial 3-dimensional (3-D) rendering of contrast-enhanced OCT scans. C, The VHRF detection algorithm applied and cropped to focus on the vitreous. Spheres represent VHRF, and the retina appears as a solid 3-D object.

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Figure 2.
Vitreous Hyperreflective Foci (VHRF) Scores for Comparison Groups

DME indicates diabetic macular edema; DR, diabetic retinopathy. Horizontal bars represent mean values; error bars, SD.

aP < .05 compared with the DME group.

bP < .005 compared with the DME group.

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Figure 3.
Vitreous Hyperreflective Foci Scores Subgrouped by Vitreoretinal Separation (VRS)

DME indicates diabetic macular edema; DR, diabetic retinopathy. Horizontal bars represent mean values; error bars, SD.

aDME with VRS vs control without VRS and vs diabetes without retinopathy or VRS; P < .0001 with Bonferroni analysis.

bDME with VRS vs control with VRS; P = .002 with Bonferroni analysis.

cDME with VRS vs DME without VRS; P = .001 with Bonferroni analysis.

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Figure 4.
Vitreous Hyperreflective Foci (VHRF) Repeatability

Variance in the VHRF score of successive optical coherence tomographic scans. Each participant had 2 scans per day on 3 days during a 2-week period.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Vitreous Hyperreflective Foci Detection Algorithm.

Three-dimensional rendering of optical coherence tomographic scan of the macula in a patient with diabetic macular edema. Rendering has been cropped to include the vitreous and retina. The algorithm has been applied and shows detected vitreous hyperreflective foci in green and retinal mapping in yellow.

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