Modeling, Localization, and Segmentation of the Foveal Avascular Zone on Retinal OCT-Angiography Images

The Foveal Avascular Zone (FAZ) is a capillary-free area that is placed inside the macula and its morphology and size represent important biomarkers to detect different ocular pathologies such as diabetic retinopathy, impaired vision or retinal vein occlusion. Therefore, an adequate and precise segmentation of the FAZ presents a high clinical interest. About to this, Angiography by Optical Coherence Tomography (OCT-A) is a non-invasive imaging technique that allows the expert to visualize the vascular and avascular foveal zone. In this work, we present a robust methodology composed of three stages to model, localize, and segment the FAZ in OCT-A images. The first stage is addressed to generate two FAZ normality models: superficial and deep plexus. The second one uses the FAZ model as a template to localize the FAZ center. Finally, in the third stage, an adaptive binarization is proposed to segment the entire FAZ region. A method based on this methodology was implemented and validated in two OCT-A image subsets, presenting the second subset more challenging pathological conditions than the first. We obtained localization success rates of 100% and 96% in the first and second subsets, respectively, considering a success if the obtained FAZ center is inside the FAZ area segmented by an expert clinician. Complementary, the Dice score and other indexes (Jaccard index and Hausdorff distance) are used to measure the segmentation quality, obtaining competitive average values in the first subset: 0.84 +/- 0.01 (expert 1) and 0.85 +/- 0.01 (expert 2). The average Dice score obtained in the second subset was also acceptable (0.70 +/- 0.17), even though the segmentation process is more complex in this case.