Purpose: To evaluate retinal vessel morphology using split-spectrum amplitude-decorrelation angiography with optical coherence tomography in healthy eyes. Methods: Fifty-two eyes of 26 healthy volunteers (age range from 35 to 48 years; mean age 41.94 years; SD: ±4.13) were evaluated by optical coherence tomography angiography in the macular region. The protocol acquisition consisted of a 216 × 216 A-scan that was repeated 5 times in the same position, in 3 × 3 mm centered into the fovea. Results: All 52 eyes showed 2 separate vascular networks in the inner retina: the superficial network, located in the nerve fiber layer and in the ganglion cell layer, and the deep network, detected in the outer plexiform layer. The superficial and deep networks showed interconnections of vertical vessels. The reference planes to observe the 2 networks were defined at 60 μm, with an inner limiting membrane reference (6 μm offset), and 30 μm, with an inner plexiform layer reference (60 μm offset), respectively. Conclusion: Optical coherence tomography angiography can separately detect the superficial vascular and the deep vascular networks. These networks are overlaid and seem to be fused when seen with standard angiographies. Furthermore, optical coherence tomography angiography technology allows for the visualization of abnormal blood column and vessel wall details.

To evaluate the functional effect of short-term supplementation of saffron, a spice containing the antioxidant carotenoids crocin and crocetin, in early age-related macular degeneration (AMD). Twenty-five patients with AMD were randomly assigned to oral saffron 20 mg/d or placebo supplementation over a 3-month period and then reverted to placebo or saffron for a further 3 months. Focal electroretinograms (fERGs) and clinical findings were recorded at baseline and after 3 months of saffron or placebo supplementation. fERGs were recorded in response to a sinusoidally modulated (41 Hz), uniform field presented to the macular region (18°) at different modulations between 16.5% and 93.5%. Main outcome measures were fERG amplitude (in microvolts), phase (in degrees), and modulation thresholds. After saffron, patients' fERGs were increased in amplitude, compared with either baseline or values found after placebo supplementation (mean change after saffron, 0.25 log μV; mean change after placebo, -0.003 log μV; P < 0.01). fERG thresholds were decreased after saffron supplementation but not placebo, compared with baseline (mean change after saffron, -0.26 log units; mean change after placebo, 0.0003 log units). The results indicate that short-term saffron supplementation improves retinal flicker sensitivity in early AMD. Although the results must be further replicated and the clinical significance is yet to be evaluated, they provide important clues that nutritional carotenoids may affect AMD in novel and unexpected ways, possibly beyond their antioxidant properties. (ClinicalTrials.gov number, NCT00951288.).

To assess the longitudinal development of choroidal neovascularization (CNV) Type 2 after intravitreal anti-vascular endothelial growth factor by optical coherence tomography-angiography (OCT-A). Five eyes of five patients with naive CNV Type 2 were assessed by OCT-A in this observational longitudinal study. To perform, the OCT-A used an 840-nm wavelength OCT device (XR-Avanti, Freemont; Optovue) based on split-spectrum amplitude-decorrelation angiography algorithm. The timing of analysis was after 24 hours, between 7 days and 10 days, between 12 days and 18 days, and 30 days after the intravitreal anti-vascular endothelial growth factor injections. The protocol of analysis was 3-mm × 3-mm OCT angiograms centered at the macula. The day after the injection, OCT-A showed the decrease of neovascularization, with apparent vessel fragmentation. The CNV area was reduced with pruning of thinner anastomoses and loss of smaller vessels. Decrease of dimensions of CNV area, microvascular rarefaction, and vessels narrowing was observed between 7 days and 10 days, between 12 days and 18 days because of the further loss of smaller capillaries. Residual flow was always visible to the afferent trunk over the time. The mean age of patients was 72.6 (SD ±16.22) years. All were women, naive cases, and followed from 5 months to 14 months. Over that time, they had a mean number of 5.5 intravitreal injections (from 3 to 8) and a mean number of 11 OCT-A examinations each (from 8 to 26). The most salient result emerging from this study is the consistency in the patterns of cyclic CNV variations after treatment in different patients. This CNV cycle was approximately 62 days long. This study suggests that OCT-A is able to detect the Type 2 CNV developments. This new method allows noninvasive analysis of CNV networks remodeling during anti-vascular endothelial growth factor follow-up. In conclusion, OCT-A provides a useful approach for monitoring the CNV Type 2 over the time.

To analyze the foveal microvasculature features in eyes with branch retinal vein occlusion (BRVO) using optical coherence tomography angiography based on split spectrum amplitude decorrelation angiography technology. A total of 10 BRVO eyes (mean age 64.2 ± 8.02 range between 52 years and 76 years) were evaluated by optical coherence tomography angiography (XR-Avanti; Optovue). The macular angiography scan protocol covered a 3 mm × 3 mm area. The focus of angiography analysis were two retinal layers: superficial vascular network and deep vascular network. The following vascular morphological congestion parameters were assessed in the vein occlusion area in both the superficial and deep networks: foveal avascular zone enlargement, capillary non-perfusion occurrence, microvascular abnormalities appearance, and vascular congestion signs. Image analyses were performed by 2 masked observers and interobserver agreement of image analyses was 0.90 (κ = 0.225, P < 0.01). In both superficial and deep network of BRVO, a decrease in capillary density with foveal avascular zone enlargement, capillary non-perfusion occurrence, and microvascular abnormalities appearance was observed (P < 0.01). The deep network showed the main vascular congestion at the boundary between healthy and nonperfused retina. Optical coherence tomography angiography in BRVO allows to detect foveal avascular zone enlargement, capillary nonperfusion, microvascular abnormalities, and vascular congestion signs both in the superficial and deep capillary network in all eyes. Optical coherence tomography angiography technology is a potential clinical tool for BRVO diagnosis and follow-up, providing stratigraphic vascular details that have not been previously observed by standard fluorescein angiography. The normal retinal vascular nets and areas of nonperfusion and congestion can be identified at various retinal levels. Optical coherence tomography angiography provides noninvasive images of the retinal capillaries and vascular networks.

Objectives. In a previous randomized clinical trial (Falsini et al. (2010)), it was shown that short-term Saffron supplementation improves retinal flicker sensitivity in early age-related macular degeneration (AMD). The aim of this study was to evaluate whether the observed functional benefits from Saffron supplementation may extend over a longer follow-up duration.Design. Longitudinal, interventional open-label study.Setting. Outpatient ophthalmology setting.Participants. Twenty-nine early AMD patients (age range: 55–85 years) with a baseline visual acuity >0.3.Intervention. Saffron oral supplementation (20 mg/day) over an average period of treatment of 14 (±2) months.Measurements. Clinical examination and focal-electroretinogram-(fERG-) derived macular (18°) flicker sensitivity estimate (Falsini et al. (2010)) every three months over a followup of 14 (±2) months. Retinal sensitivity, the reciprocal value of the estimated fERG amplitude threshold, was the main outcome measure.Results. After three months of supplementation, mean fERG sensitivity improved by 0.3 log units compared to baseline values (P<0.01), and mean visual acuity improved by two Snellen lines compared to baseline values (0.75 to 0.9,P<0.01). These changes remained stable over the follow-up period.Conclusion. These results indicate that in early AMD Saffron supplementation induces macular function improvements from baseline that are extended over a long-term followup.