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Original Investigation
June 25, 2020

Association of Optical Coherence Tomography Angiography Metrics With Detection of Impaired Macular Microvasculature and Decreased Vision in Amblyopic Eyes: The Hong Kong Children Eye Study

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
  • 2Hong Kong Eye Hospital, Kowloon, Hong Kong
  • 3Zhejiang University School of Medicine, Department of Ophthalmology, Affiliated Hangzhou First People’s Hospital, Hangzhou, China
  • 4Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
JAMA Ophthalmol. Published online June 25, 2020. doi:10.1001/jamaophthalmol.2020.2220
Key Points

Question  Are macular microvascular abnormalities in children with amblyopia still present after adjusting for all known confounders and do they correlate with visual acuity?

Findings  In this population-based nested case-control study of 30 children with amblyopia and 1045 controls, amblyopic eyes had abnormal macular microvascular represented by decreased foveal avascular zone circularity, decreased fractal dimension, and increased vessel diameter index. LogMAR visual acuity correlated with foveal avascular zone circularity and vessel diameter index.

Meaning  Quantitative optical coherence tomography angiography metrics detect impaired microvasculature in amblyopic eyes that correlates with visual acuity, suggesting a potential role in amblyopia assessment.


Importance  Microvascular abnormalities in amblyopia are becoming evident with high-resolution imaging, such as optical coherence tomography angiography (OCT-A); however, to our knowledge, the clinical significance and use of these findings are unknown.

Objective  To assess changes in quantitative OCT-A metrics in amblyopic eyes and explore their association with visual acuity in children.

Design, Setting, and Participants  This population-based nested case-control study included children aged 6 to 8 years who were consecutively recruited between January 2016 and July 2017 from the population-based Hong Kong Children Eye Study (HKCES) at the Chinese University of Hong Kong Eye Centre. All participants underwent OCT-A with a swept-source OCT and detailed ophthalmic investigations. Macular microvasculature of the superficial capillary plexus was quantified by a customized automated image analysis program. A multivariable linear regression was conducted to evaluate the differences in OCT-A metrics between amblyopic and nonamblyopic eyes after adjustment for all known confounders. Data analysis was conducted from September to November 2018.

Main Outcomes and Measures  Differences in OCT-A metric (foveal avascular zone [FAZ]) area, FAZ circularity, vessel density, vessel diameter index, and fractal dimension between amblyopic and nonamblyopic eyes.

Results  There were 30 participants with amblyopia (mean [SD] age, 7.57 [1.2] years; 16 girls [53.3%]) and 1045 controls (mean [SD] age, 7.65 [1.0] years; 580 girls [55.5%]) in this cohort. Compared with control eyes, amblyopic eyes had decreased FAZ circularity (−0.058; 95% CI, −0.096 to −0.021, P = .002), decreased fractal dimension (−0.014; 95% CI, −0.024 to −0.003; P = .01), and increased vessel diameter index (0.002; 95% CI, 0.002 to 0.003; P < .001). A difference was not identified between FAZ area and vessel density. LogMAR visual acuity was associated with FAZ circularity (sβ, −0.133; P < .001) and vessel diameter index (sβ, 0.097; P = .001) but not with vessel density nor FAZ area.

Conclusions and Relevance  The results of this population-based study in children supports the presence of macular microvascular abnormalities in amblyopic eyes. Such changes as measured by OCT-A metrics are associated with visual acuity, inferring retinal involvement in the development of amblyopia and suggesting a potential role of quantitative OCT-A metrics in the diagnosis and recognition of amblyopia.

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