Convolutional Neural Networks Accurately Identify Ungradable Images in a Diabetic Retinopathy Telemedicine Screening Program.

Purpose: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus (DM). Standard of care for patients with DM is an annual eye examination or retinal imaging to assess for DR, the latter of which may be completed through telemedicine approaches. One significant issue is poor-quality images that prevent adequate screening and are thus ungradable. We used artificial intelligence to enable point-of-care (at time of imaging) identification of ungradable images in a DR screening program. Methods: Nonmydriatic retinal images were gathered from patients with DM imaged during a primary care or endocrinology visit from September 1, 2017, to June 1, 2021. The Topcon TRC-NW400 retinal camera (Topcon Corp., Tokyo, Japan) was used. Images were interpreted by 5 ophthalmologists for gradeability, presence and stage of DR, and presence of non-DR pathologies. A convolutional neural network with Inception V3 network architecture was trained to assess image gradeability. Images were divided into training and test sets, and 10-fold cross-validation was performed. Results: A total of 1,377 images from 537 patients (56.1% female, median age 58) were analyzed. Ophthalmologists classified 25.9% of images as ungradable. Of gradable images, 18.6% had DR of varying degrees and 26.5% had non-DR pathology. 10 fold cross-validation produced an average area under receiver operating characteristic curve (AUC) of 0.922 (standard deviation: 0.027, range: 0.882 to 0.961). The final model exhibited similar test set performance with an AUC of 0.924. Conclusions: This model accurately assesses gradeability of nonmydriatic retinal images. It could be used for increasing the efficiency of DR screening programs by enabling point-of-care identification of poor-quality images.

The Role of Optical Coherence Tomography Angiography (OCTA) in Detecting Choroidal Neovascularization in Different Stages of Best Macular Dystrophy: A Case Series.

Best macular dystrophy (BMD) is an autosomal dominant macular dystrophy of childhood onset characterized by bilateral and symmetric vitelliform lesions. Several stages of disease have been well-described in the literature. Choroidal neovascularization (CNV) has traditionally been considered a hallmark of end-stage disease, and anti-vascular endothelial growth factor (anti-VEGF) agents have been used to improve visual prognosis. While CNV was historically detected with fluorescein angiography, optical coherence tomography angiography (OCTA) has recently been employed as a novel mechanism for identifying CNV in BMD. In this case series, we discuss our institutional experience with using OCTA to detect CNV in BMD and contextualize this experience within the broader emerging literature. While OCTA allows for the identification of CNV in less severe stages of BMD, the management of this CNV remains uncertain.

Nonmydriatic Retinal Diabetic Screening in the Primary Care Setting: Assessing Degree of Retinopathy and Incidence of Nondiabetic Ocular Diagnoses.

Purpose: To study the rates and severity of diabetic retinopathy (DR), rates of nondiabetic ocular disease, and rates of referral to eye care providers in the context of nonmydriatic retinal screening performed in primary care and endocrinology clinics. Materials and Methods: This study is a retrospective chart review of patients who had nonmydriatic retinal imaging in the primary care setting. Presence and severity of DR as well as detection of nondiabetic ocular diseases were analyzed. Referral rates for different types of pathology were determined. Results: A total of 324 patients were imaged and 294 (90.7%) had gradable images. Mild DR was found in at least one eye of 71 (24.1%) patients, moderate in 20 (6.8%), severe in 3 (1.0%), and proliferative DR in 2 (0.6%). Macular edema was found in 13 (4.4%) patients. Nondiabetic ocular diseases were suspected in 106 (36.1%) patients. The most prevalent findings included glaucoma suspect (10.9%), age-related macular degeneration suspect (8.8%), and hypertensive retinopathy (5.4%). Seventy (23.8%) patients were referred to an eye care provider for DR, 66 (22.4%) were referred for nondiabetic eye disease, and 21 (7.1%) were referred for both. Conclusion: One-third of patients were found to have some degree of DR. Suspected nondiabetic disease or other pathologies were found in one-third of the study population. Referral for examination by an eye care provider was recommended for approximately half of the patients.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN ADULT-ONSET FOVEOMACULAR VITELLIFORM DYSTROPHY.

PURPOSE: To determine the ability of optical coherence tomography angiography (OCTA) to detect choroidal neovascularization (CNV) in the pseudohypopyon stage of adult-onset foveomacular vitelliform dystrophy. METHODS: Prospective case series of eight consecutive patients with adult-onset foveomacular vitelliform dystrophy with at least one eye in the pseudohypopyon stage (a total of 14 eyes). Patients were assessed with spectral domain OCT, flourescein angiography, and OCTA. Main outcome measures were the presence or absence of CNV and any unifying patterns that could be identified on OCTA for adult-onset foveomacular vitelliform dystrophy. RESULTS: One (12.5%) of eight eyes in the pseudohypopyon stage had CNV on OCTA, without definitive evidence of CNV on flourescein angiography. Twelve of 14 eyes (86%) had OCTA segmentation errors, giving the false appearance of deep capillary plexus drop out. All 14 eyes (100%) had blockage of flow signal under the vitelliform lesion on OCTA that presented as artifactual loss of flow in the choriocapillaris. CONCLUSION: Optical coherence tomography angiography may be superior to flourescein angiography in detecting CNV in adult-onset foveomacular vitelliform dystrophy, especially in the pseudohypopyon stage. There are common artifacts that must be considered when analyzing vitelliform lesions with OCTA, including segmentation errors and inability to visualize flow under the vitelliform lesion in the choriocapillaris.

RETICULAR PSEUDODRUSEN ON INFRARED IMAGING ARE TOPOGRAPHICALLY DISTINCT FROM SUBRETINAL DRUSENOID DEPOSITS ON EN FACE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To evaluate the quantitative and topographic relationship between reticular pseudodrusen (RPD) on infrared reflectance (IR) and subretinal drusenoid deposits (SDD) on en face volumetric spectral domain optical coherence tomography. METHODS: Reticular pseudodrusen were marked on IR images by a masked observer. Subretinal drusenoid deposits were visualized on en face sections of spectral domain optical coherence tomography below the external limiting membrane and identified by a semiautomated technique. Control RPD lesions were generated in a random distribution for each IR image. Binary maps of control and experimental RPD and SDD were merged and analyzed in terms of topographic localization and quantitative drusen load comparison. RESULTS: A total of 54 eyes of 41 patients diagnosed with RPD were included in this study. The average number of RPD lesions on IR images was 320 ± 44.62 compared with 127 ± 26.02 SDD lesions on en face (P < 0.001). The majority of RPD lesions did not overlap with SDD lesions and were located >30 µm away (92%). The percentage of total SDD lesions overlapping RPD was 2.91 ± 0.87% compared with 1.73 ± 0.68% overlapping control RPD lesions (P < 0.05). The percentage of total SDD lesions between 1 and 3 pixels of the nearest RPD lesion was 5.08 ± 1.40% compared with 3.33 ± 1.07% between 1 and 3 pixels of the nearest control RPD lesion (P < 0.05). CONCLUSION: This study identified significantly more RPD lesions on IR compared with SDD lesions on en face spectral domain optical coherence tomography and found that a large majority of SDD (>90% of lesions) were >30 µm away from the nearest RPD. Together, our findings indicate that RPD and SDD are two entities that are only occasionally topographically associated, suggesting that at some stage in their development, they may be pathologically related.

Imaging of a cilioretinal artery embolisation.

Retinal artery occlusion can be the first indicator of a significant cardiovascular disorder and the need for treatment. We present the case of a 69-year-old man with a cilioretinal artery occlusion and retinal ischemia. Retinal imaging, in particular fundus autofluorescence, highlighted an intraluminal hyperautofluorescent lesion which led to the diagnosis of retinal emboli. Subsequently a severe, previously undiagnosed carotid occlusive disease was discovered. The patient underwent prompt endarterectomy.

Disease Awareness Among Patients With Age-Related Macular Degeneration: Patterns and Predictors.

Purpose: To examine the prevalence and predictors of patient awareness of their disease in adults with age-related macular degeneration (AMD). Methods: This study analyzed 5553 adults 40 years or older in the 2005-2008 National Health and Nutrition Examination Survey who underwent retinal imaging. AMD was determined based on retinal images. Patient awareness of their AMD was assessed by a self-reported AMD diagnosis. Multivariable logistic regression models were constructed to examine the association of patient awareness of their AMD with sociodemographic characteristics and specific AMD lesion types on retinal imaging. Results: AMD was identified in 425 of the adults surveyed (6.5%) (95% confidence interval [CI], 5.5%-7.5%), including 87.7% (95% CI, 82.9%-92.5%) with early AMD and 12.3% (95% CI, 7.5%-17.1%) with late AMD. Among adults with either type of AMD on retinal imaging, 17.5% (95% CI, 13.1%-22.0%) were aware of their disease, which included 11.6% (95% CI, 8.4%-14.9%) with early AMD and 59.2% (95% CI, 43.1%-75.3%) with late AMD (P < .0001). In the same group, those aged 60 years or older (odds ratio [OR], 33.46; 95% CI, 7.67-146.03) and with a best-corrected visual acuity of 20/40 or worse (OR, 4.63; 95% CI, 2.95-7.26) had higher awareness of their AMD diagnosis, whereas Hispanic (OR, 0.28; 95% CI, 0.09-0.88) vs White adults and those who did not speak English at home (OR, 0.05; 95% CI, 0.01-0.41) had lower awareness of their diagnosis. Conclusions: Fewer than 1 in 5 adults with AMD were aware of their personal diagnosis, including fewer than 3 in 5 adults with late AMD. Older adults and those with worse vision were more likely to know they have AMD, whereas Hispanic adults and those who did not speak English at home were less likely. Efforts to increase patients' awareness of their AMD may improve rates of follow-up and prevent vision loss.

Machine Teaching Allows for Rapid Development of Automated Systems for Retinal Lesion Detection From Small Image Datasets.

Machine teaching, a machine learning subfield, may allow for rapid development of artificial intelligence systems able to automatically identify emerging ocular biomarkers from small imaging datasets. We sought to use machine teaching to automatically identify retinal ischemic perivascular lesions (RIPLs) and subretinal drusenoid deposits (SDDs), two emerging ocular biomarkers of cardiovascular disease. IRB approval was obtained. Four small datasets of SD-OCT B-scans were used to train and test two distinct automated systems, one identifying RIPLs and the other identifying SDDs. An open-source interactive machine-learning software program, RootPainter, was used to perform annotation and training simultaneously over a 6-hour period. For SDDs at the B-scan level, test-set accuracy = 92%, sensitivity = 100%, specificity = 88%, positive predictive value (PPV) = 82%, and negative predictive value (NPV) = 100%. For RIPLs at the B-scan level, test-set accuracy = 90%, sensitivity = 60%, specificity = 93%, PPV = 50%, and NPV = 95%. Machine teaching demonstrates promise within ophthalmic imaging to rapidly allow for automated identification of novel biomarkers from small image datasets. [Ophthalmic Surg Lasers Imaging Retina 2024;55:475-478.].

Exploring Diagnostic Precision and Triage Proficiency: A Comparative Study of GPT-4 and Bard in Addressing Common Ophthalmic Complaints.

In the modern era, patients often resort to the internet for answers to their health-related concerns, and clinics face challenges to providing timely response to patient concerns. This has led to a need to investigate the capabilities of AI chatbots for ophthalmic diagnosis and triage. In this in silico study, 80 simulated patient complaints in ophthalmology with varying urgency levels and clinical descriptors were entered into both ChatGPT and Bard in a systematic 3-step submission process asking chatbots to triage, diagnose, and evaluate urgency. Three ophthalmologists graded chatbot responses. Chatbots were significantly better at ophthalmic triage than diagnosis (90.0% appropriate triage vs. 48.8% correct leading diagnosis; p < 0.001), and GPT-4 performed better than Bard for appropriate triage recommendations (96.3% vs. 83.8%; p = 0.008), grader satisfaction for patient use (81.3% vs. 55.0%; p < 0.001), and lower potential harm rates (6.3% vs. 20.0%; p = 0.010). More descriptors improved the accuracy of diagnosis for both GPT-4 and Bard. These results indicate that chatbots may not need to recognize the correct diagnosis to provide appropriate ophthalmic triage, and there is a potential utility of these tools in aiding patients or triage staff; however, they are not a replacement for professional ophthalmic evaluation or advice.

Hyperreflective Vasculature: A Negative Prognostic Sign for Retinal Vein Occlusion on Near-Infrared Reflectance Imaging.

BACKGROUND AND OBJECTIVE: To investigate the clinical significance of hyperreflective vasculature visualized on near-infrared reflectance (NIR) in patients with retinal vein occlusion (RVO). METHODS: In this retrospective study, RVO patients with NIR imaging and at least 1-year follow-up, and without confounding disease, were included. Two blinded independent graders identified vascular hyperreflectivity (HR) by detection of whiter signals in vessels. Visual acuity (VA), macular thickness (MT), and number of administered anti-vascular endothelial growth factor (anti-VEGF) injections were assessed. RESULTS: RVO patients with HR (n = 20) and without HR (n = 31) demonstrated similarity in age, sex, and class of RVO. At presentation, the HR group had higher MT (P = 0.002) but no difference in VA (P = 0.1018). At 1 year, patients with HR had worse VA (P = 0.001), decreased MT (P = 0.011), and received more anti-VEGF injections (P < 0.001). CONCLUSION: RVO patients with HR on NIR had significantly worse visual outcomes. Vascular HR on NIR imaging may be a biomarker, portending worse visual prognoses in RVO. [Ophthalmic Surg Lasers Imaging Retina 2023;54:266-270.].

DISAPPEARING CHOROIDAL SPOTS ON OCT ANGIOGRAPHY PRECEDING RECURRENCE OF MULTIFOCAL CHOROIDITIS WITH CHORIORETINAL ATROPHY.

PURPOSE: To describe idiopathic multifocal choroiditis (iMFC) with chorioretinal atrophy developing choroidal flow voids on optical coherence tomography angiography (OCTA) that preceded a recurrence of the disease. METHODS: Case report. RESULTS: A 24-year-old woman presented with visual field changes and occasional photopsias. Systemic work-up for syphilis, tuberculosis, and sarcoidosis, was negative. Clinical findings and multimodal imaging were consistent with iMFC with chorioretinal atrophy, complicated by inactive choroidal neovascularization in her right eye. She was treated with systemic corticosteroids with a taper over 3 months without change in her examination. She was then stable for two years. At that point, the patient experienced increased photopsias, but her examination was unchanged. OCTA showed multiple flow voids in the choroid that were not present 6 months prior. No lesions were seen on other imaging modalities. Structural OCT showed some subtle hyper-reflectivity throughout the choroid that was previously absent. Given the unknown significance of these flow voids, the patient was asked to return for follow-up in one month. Her photopsias improved and her vision remained normal. On repeat examination after one month, the patient had developed a few subtle yellow lesions in the supero-nasal quadrant of the left eye. There were no macular lesions. The repeat OCTA revealed that the flow voids were fading. CONCLUSION: Imaging findings using OCTA in our patient with iMFC showed choroidal flow voids that preceded clinical recurrence, not detected by other imaging modalities. Future studies should determine if OCTA can be used to detect subclinical lesions preceding clinical recurrences of iMFC.

Characterizing the Accessibility and Content of Surgical and Medical Retina Fellowship Program Websites.

Purpose: To assess the accessibility and content of surgical and medical retina fellowship websites. Methods: The websites of all surgical and medical retina fellowship programs were examined. Each program's website was evaluated based on information available on 10 recruitment and 10 training criteria. The presence of the criteria was summed to calculate a total content score (range, 0-20). Also examined were the differences in website content score by number of fellows, geographic location, and Association of University Professors of Ophthalmology (AUPO) compliance. Results: This study identified 102 surgical and 25 medical retina programs. Overall, 91.2% of surgical and 88.0% of medical retina programs had an accessible website. The surgical retina program website contained a mean of 9.8 of the total criteria, including 4.9 recruitment criteria and 5.2 training criteria, with no significant differences by number of fellows, geography, or AUPO status. Medical retina websites contained a mean of 9.3 total criteria, including 4.5 recruitment criteria and 4.9 training criteria. Website content scores for medical retina programs were associated with geography and AUPO status, which was consistent when stratifyed by recruitment and training criteria. Conclusions: Most surgical and medical retina fellowships have an accessible program website. However, there are opportunities to improve the completeness and consistency of information on these websites. Improved websites can help programs attract well-suited candidates and might address multiple inefficiencies in the application process.

Enhancing Mentorship Networks through the Experiences of Women Professors of Ophthalmology.

Purpose The aim of this study is to identify and characterize women professors in ophthalmology to enhance professional development and equity of women in academic ophthalmology. Design Cross-sectional descriptive survey study. Participants Participants in the survey were women in ophthalmology departments who have obtained full professor rank at their respective institutions. Methods A cross-sectional study was conducted using data from an electronic survey of women ophthalmologists and researchers who had obtained full professorship rank in ophthalmology. The survey included questions about degree obtained, training path, fellowship, length and trajectory of academic career, family or medical leave participation, previous positions, and mentorship involvement. Statistical comparisons were made based on response. Main Outcome Measures Survey responses to questions pertaining to three domains: education and training, academic career, and mentorship. Results Women that obtained the professor title within ophthalmology largely held Doctor of Medicine/Doctor of Osteopathic Medicine degrees, were more likely to have completed fellowship training, and on average took 11 to 15 years to obtain the full professor title. The participants held a variety of other positions and titles throughout their academic careers. The vast majority of women reported having between 1 and 3 mentors during their careers with the majority also noting they currently participate in mentoring programs. Surveys were completed by 62 (30% response rate) women full professors of ophthalmology. Conclusion The experiences women have along the academic path to professorship are described in this survey and can help to inform junior faculty. Literature review highlights the importance of mentorship for work productivity, retention, and promotion within academic medicine which is an element seen in the vast majority of our participants' career paths. Guided by the identification of women professors within departments of ophthalmology and characterization of their experiences, a new initiative called Women Professors of Ophthalmology was formed under the Association of University Professors of Ophthalmology's organizational structure in 2021. This group that is tailored for women professors of ophthalmology to foster peer mentorship and guidance is poised to increase the retention and promotion of women in academic ophthalmology.

NOVEL PRPH2/RDS MUTATION IDENTIFIED IN A FAMILY WITH VARYING CLINICAL MANIFESTATIONS: A CASE REPORT.

PURPOSE: To present the case of a family with a novel PRPH2/RDS mutation. METHODS: A case report of a 44-year-old woman and her immediate family, including the father and a sister who shared her PRPH2/RDS mutation. RESULTS: A 44-year-old woman presented with examination findings consistent with a butterfly-type pattern dystrophy. A sister had a similar butterfly-type dystrophy, whereas their father had a severe cone-rod dystrophy. Genetic testing revealed the same novel PRPH2/RDS mutation in all three affected individuals, suggesting that this single mutation can produce at least two disparate retinal disease phenotypes. CONCLUSION: This case describes a novel p.Y225X nonsense mutation in the PRPH2/RDS gene and demonstrates that it is both pathologic and capable of significant phenotypic variability.

Swept-source optical coherence tomography angiography metrics of retinal ischaemic perivascular lesions in patients being evaluated for carotid artery stenosis and controls.

BACKGROUND/AIMS: Retinal microvascular ischaemia may produce localised middle retinal disruption with corresponding scotoma, a phenomenon termed paracentral acute middle maculopathy (PAMM). Small chronic middle retinal atrophic lesions termed retinal ischaemic perivascular lesions (RIPLs) appear qualitatively similar to PAMM lesions and have recently been hypothesised to result specifically from PAMM. However, no studies have quantitatively demonstrated an ischaemic origin of RIPLs. We quantitatively investigated the pathophysiology of RIPLs and their relationship with PAMM with swept-source optical coherence tomography angiography (SS-OCTA). METHODS: A total of 14 controls and 25 patients being evaluated for carotid artery stenosis (CAS) were enrolled. SS-OCTA imaging of each eye was taken. Projection-resolved en face 6 mm × 6 mm superficial capillary plexus (SCP) and deep capillary plexus (DCP) images were quantitatively analysed with two algorithms for changes in vessel linear density (VLD) and vessel tortuosity (VT) at RIPLs relative to both the immediately surrounding macula and the entire macula, as well as between eyes with RIPLs and eyes without RIPLs. RESULTS: All controls and 22 of 25 CAS patients were included in the analysis. RIPLs demonstrated a localised decrease in DCP VLD in CAS patients and controls. RIPLs tended to show a localised decrease in SCP VLD in CAS patients but a localised increase in controls. No changes in VT were found. Eyes with RIPLs had VLD and VT similar to their RIPL-free fellow eyes. CONCLUSION: RIPLs are associated with quantifiable local, but not global, ischaemia, supporting the idea of shared pathophysiology with classic PAMM lesions along a continuum of ischaemia severity.

Macular findings expedite accurate diagnosis of MIDD in a young female patient with newly diagnosed diabetes.

Purpose: To report a case of a 34-year-old female patient with newly diagnosed Maternally Inherited Diabetes and Deafness (MIDD) in the setting of undifferentiated macular dystrophy and newly discovered diabetes. Observations: A 34-year-old woman presented to the retina service with new-onset diabetes and a history of hydroxychloroquine use. Ophthalmologic examination showed findings early in the patient's presentation that within the context of her recent diabetes diagnosis and family history pointed to MIDD as the specific cause of the patient's many different symptoms. This diagnosis was further supported through obtaining previous ophthalmic images of the patient's mother demonstrating circular areas of geographic atrophy seen in advanced MIDD, and the diagnosis was confirmed through genetic testing. Conclusions and importance: As was observed in the patient discussed in this manuscript, recognition of macular dystrophy findings suggestive of MIDD can hasten a timely diagnosis for a patient with diabetes of unspecified etiology. Additionally, knowledge of the underlying cause being MIDD can optimize care for patients in terms of treatment, understanding their risk for various diabetes complications, screening for additional systemic manifestations, and initiating valuable genetic counseling for patients and their families. Given these factors and the surprisingly high prevalence of MIDD among diabetes patients, increased awareness of MIDD and its manifestations can help to optimize diagnosis and management for these patients.

Macrophage-like Cells Are Increased in Retinal Vein Occlusion and Correlate with More Intravitreal Injections and Worse Visual Acuity Outcomes.

Macrophage-like cells (MLCs) are an emerging retinal biomarker. MLCs are increased in retinal vein occlusion (RVO) eyes, but their predictive value is unknown. This study investigated if MLCs can predict meaningful clinical outcomes. This prospective, cross-sectional study involved 46 eyes from 23 patients with unilateral RVO. Patients' unaffected eyes were used as matched controls. MLCs were quantified to determine MLC density and percent image area. We collected demographic, clinical, ocular, and imaging characteristics at the time of MLC imaging. We additionally recorded best corrected visual acuity (BCVA) and number of intravitreal injections at 6 months and 12 months post-imaging. MLC density and percent area increased by 1.86 (p = 0.0266)- and 1.94 (p = 0.0415)-fold in RVO compared to control eyes. We found no significant correlation between MLC parameters and any baseline characteristic. MLC density was positively correlated with the number of intravitreal injections at 6 months (n = 12, r = 0.62, p = 0.03) and 12 months (n = 9, r = 0.80, p = 0.009) post-imaging. MLC percent area was correlated with LogMAR BCVA change over 12 months (n = 17, r = 0.57, p = 0.02). High MLC counts correlated with more future intravitreal injections and worse visual acuity outcomes, suggesting that MLCs are a biomarker for treatment resistant RVO eyes.

Retinal Vessel Density and Treatment Intensity among Adults with Retinal Vein Occlusion: A Swept-Source Optical Coherence Tomography Angiography Study.

Previous studies have shown retinal vein occlusion (RVO) is associated with changes in vessel density visible on swept-source optical coherence tomography angiography (ss-OCTA). This study aimed to characterize retinal changes on ss-OCTA among RVO patients stratified by the need for continuous anti-VEGF therapy. This cross-sectional study of 24 RVO patients ≥ 18 years were imaged with SS-OCT-A. Patients were categorized into continuous vs. limited therapy (≥1 vs. no injections in previous 12 months) based on recurrence of intraretinal fluid (IRF) on OCT. Images were analyzed using ImageJ. T-tests were used to compare vessel density of the macula and peripheral retina. Overall, RVO patients undergoing continuous therapy (n = 14) had higher diabetes prevalence, worse baseline visual acuity, and higher baseline macular thickness compared to the limited (n = 10) therapy group. Continuous therapy was associated with lower macular VD in the combined retina layer and the superficial capillary plexus (SCP), but not in the deep capillary plexus (DCP). Further, the continuous therapy group exhibited lower peripheral VD in the combined retina layer, and no difference in the SCP and DCP layers when analyzed separately. In conclusion, RVO patients requiring continuous anti-VEGF injections demonstrate reduced VD of the macula and in the periphery on SS-OCTA imaging. SS-OCTA may be valuable for monitoring and prognosticating treatment for RVO patients.