{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:54:25Z","timestamp":1791359665665,"version":"4.3.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To develop an AI-based method for quantifying choroidal vessel density (CVD) from ultra-widefield confocal scanning laser ophthalmoscopy (UWF-cSLO) and to validate this metric against swept-source optical coherence tomography (SS-OCT) choroidal parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cross-sectional study, 633 eyes from 354 participants underwent simultaneous UWF-cSLO and SS-OCT imaging on an integrated platform, ensuring precise spatial co-registration. A TransUNet deep-learning model segmented choroidal vessels from red-channel (R; 665\u2005nm) and infrared-channel (IR; 785\u2005nm) images, yielding channel-specific metrics (R-CVD and IR-CVD) and a combined metric (IR\u2009+\u2009R CVD). Eight SS-OCT parameters\u2014including choroidal thickness (CT), choroidal vascularity index (CVI), luminal area, stromal area (SA), total choroidal area (TCA), and vessel volume index (VVI)\u2014served as reference measures. Associations were evaluated using Spearman correlations with participant-level clustered bootstrap confidence intervals, multivariable generalised estimating equations (GEE) adjusted for age and sex, and receiver operating characteristic (ROC) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Segmentation accuracy exceeded 0.95 (Dice coefficient) in both channels. R-CVD exhibited the strongest inverse correlations with structural and volumetric OCT parameters (SA:\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.619; CT:\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.615; TCA:\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.615; all\n                      <jats:italic>q<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), whereas IR\u2009+\u2009R CVD correlated most closely with proportion-based indices (VVI:\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.34; CVI:\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.29). These channel-dependent patterns persisted after adjustment for age and sex in multivariable GEE models. On ROC analysis, R-CVD discriminated thin from thick choroids with an area under the curve (AUC) of 0.789 (sensitivity 72.5%; specificity 74.8%), whereas IR-CVD alone showed near-chance performance (AUC 0.517).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AI-derived CVD from UWF-cSLO correlates strongly with SS-OCT choroidal parameters in a wavelength-dependent manner and may serve as an accessible surrogate for choroidal structural assessment in settings without OCT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1884151","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:48:36Z","timestamp":1791359316000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond tessellation: AI-derived choroidal vessel density on multi-channel cSLO as a surrogate biomarker for OCT choroidal parameters"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuou","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Ocular Disease and Optometry Science","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Wang","sequence":"additional","affiliation":[{"name":"EVision Technology (Beijing) Co. Ltd.","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tengfei","family":"Long","sequence":"additional","affiliation":[{"name":"Aerospace Information Research Institute, Chinese Academy of Sciences (CAS)","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaohong","family":"Li","sequence":"additional","affiliation":[{"name":"Suzhou Microclear Medical Instruments Co., Ltd.","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saiguang","family":"Ling","sequence":"additional","affiliation":[{"name":"EVision Technology (Beijing) Co. Ltd.","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enzhong","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Ocular Disease and Optometry Science","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaoyao","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Ocular Disease and Optometry Science","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirong","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianyu","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyang","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Ocular Disease and Optometry Science","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Ocular Disease and Optometry Science","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Ocular Disease and Optometry Science","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaozhu","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Ocular Disease and Optometry Science","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Li","sequence":"additional","affiliation":[{"name":"Faculty of Biomedical Engineering, Shenzhen University of Advanced Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Miao","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Peking University People\u2019s Hospital","place":["Beijing, China"]},{"name":"Beijing Key Laboratory of Ocular Disease and Optometry Science","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.survophthal.2018.11.002","article-title":"Choroidal imaging biomarkers","volume":"64","author":"Singh","year":"2019","journal-title":"Surv Ophthalmol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"595","DOI":"10.3390\/jcm9020595","article-title":"Choroidal vascularity index: an in-depth analysis of this novel optical coherence tomography parameter","volume":"9","author":"Iovino","year":"2020","journal-title":"J Clin Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"21090","DOI":"10.1038\/srep21090","article-title":"Choroidal vascularity index as a measure of vascular status of the choroid: measurements in healthy eyes from a population-based study","volume":"6","author":"Agrawal","year":"2016","journal-title":"Sci Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1038\/s41598-024-51922-x","article-title":"Validation of reliability, repeatability and consistency of three-dimensional choroidal vascular index","volume":"14","author":"Ma","year":"2024","journal-title":"Sci Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0146344","DOI":"10.1371\/journal.pone.0146344","article-title":"Choroidal vascularity index (CVI) - a novel optical coherence tomography parameter for monitoring patients with panuveitis?","volume":"11","author":"Agrawal","year":"2016","journal-title":"PLoS One"},{"key":"B6","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1167\/tvst.10.9.23","article-title":"Quantitative assessment of fundus tessellated density and associated factors in fundus images using artificial intelligence","volume":"10","author":"Shao","year":"2021","journal-title":"Transl Vis Sci Technol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e103586","DOI":"10.1371\/journal.pone.0103586","article-title":"Objective analyses of tessellated fundi and significant correlation between degree of tessellation and choroidal thickness in healthy eyes","volume":"9","author":"Yoshihara","year":"2014","journal-title":"PLoS One"},{"key":"B8","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1186\/s12886-024-03567-7","article-title":"Choroidal vascularity features of fundus tessellation in adults with high myopia","volume":"24","author":"Xue","year":"2024","journal-title":"BMC Ophthalmol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1016\/j.ajo.2015.03.005","article-title":"Luminal and stromal areas of choroid determined by binarization method of optical coherence tomographic images","volume":"159","author":"Sonoda","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1136\/bjo.78.2.84","article-title":"Clinical investigation of an infrared digital scanning laser ophthalmoscope","volume":"78","author":"Manivannan","year":"1994","journal-title":"Br J Ophthalmol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"11728","DOI":"10.1038\/s41598-019-48040-4","article-title":"Multicolor imaging in central serous chorioretinopathy \u2013 a quantitative and qualitative comparison with fundus autofluorescence","volume":"9","author":"Govindahari","year":"2019","journal-title":"Sci Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s10792-024-03331-2","article-title":"Near-infrared imaging retinal diagnostic applications-a review","volume":"45","author":"Shmueli","year":"2024","journal-title":"Int Ophthalmol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1016\/j.ophtha.2015.05.031","article-title":"Fundus tessellation: prevalence and associated factors: the Beijing eye study 2011","volume":"122","author":"Yan","year":"2015","journal-title":"Ophthalmology"},{"key":"B14","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/j.ajo.2015.01.022","article-title":"International photographic classification and grading system for myopic maculopathy","volume":"159","author":"Ohno-Matsui","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"27782","DOI":"10.1038\/s41598-025-10384-5","article-title":"Choroidal vascularity index is independent of ocular and image-based factors in healthy eyes: a systematic review and meta-analysis","volume":"15","author":"Kumar","year":"2025","journal-title":"Sci Rep"},{"key":"B16","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.survophthal.2025.09.003","article-title":"Choroidal vascularity index as a marker of health and disease: systematic review and meta-analyses","volume":"71","author":"Loh","year":"2026","journal-title":"Surv Ophthalmol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1016\/j.survophthal.2023.11.011","article-title":"Multicolor imaging: current clinical applications","volume":"69","author":"Roy","year":"2023","journal-title":"Surv Ophthalmol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"6440","DOI":"10.1167\/iovs.16-20265","article-title":"Choroidal thickness influences near-infrared reflectance intensity in eyes with geographic atrophy due to age-related macular degeneration","volume":"57","author":"Dolz-Marco","year":"2016","journal-title":"Invest Ophthalmol Vis Sci"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1884151\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:48:37Z","timestamp":1791359317000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1884151\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":18,"alternative-id":["10.3389\/fmed.2026.1884151"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1884151","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1884151"}}