{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:38:13Z","timestamp":1785411493543,"version":"3.56.0"},"reference-count":27,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["R00EY034550"],"award-info":[{"award-number":["R00EY034550"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"award":["R00EY034550"],"award-info":[{"award-number":["R00EY034550"]}],"id":[{"id":"https:\/\/ror.org\/03wkg3b53","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01EY038421"],"award-info":[{"award-number":["R01EY038421"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01EY031731"],"award-info":[{"award-number":["R01EY031731"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Flood-illuminated adaptive optics (AO) imaging enables high-resolution quantification of retinal vascular morphology; however, its repeatability in older adults with lens opacities remains poorly characterized. In this prospective study, 40 subjects (66 eyes) underwent flood AO imaging using the rtx1 system (Imagine Eyes, Orsay, France) at three retinal locations across multiple sessions. Two independent masked graders measured lumen diameter (LD), total diameter (TD), wall cross-sectional area (WCSA), and wall-to-lumen ratio (WLR), with repeatability assessed using intraclass correlation coefficients (ICC). Inter-grader agreement was excellent for LD and TD across all regions (ICC range 0.974\u20130.994) and for WCSA at the superior and inferior regions (ICC range 0.902\u20130.952). Intrasession and intersession repeatability were similarly excellent for LD and TD across all locations. Repeatability remained excellent across age groups and cataract grades. Image region was the only variable significantly associated with image quality (p &lt; 0.0001), with temporal images showing the lowest proportion of good quality ratings (12%). These findings support flood AO imaging as a reliable tool for quantitative vascular assessment in age-related and vascular-related ocular diseases.<\/jats:p>","DOI":"10.3390\/bioengineering13080852","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:13:17Z","timestamp":1784826797000},"page":"852","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative Retinal Vascular Imaging Using Flood-Illuminated Adaptive Optics in Eyes with Lens Opacities"],"prefix":"10.3390","volume":"13","author":[{"given":"Yash","family":"Porwal","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenaan","family":"Elbash","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlon","family":"Diaz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saige","family":"Oechsli","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Magder","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Bower","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3082-4604","authenticated-orcid":false,"given":"Osamah","family":"Saeedi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Liu, L., Wu, Z., Qi, M., Li, Y., Zhang, M., Liao, D., and Gao, P. (2022). Application of Adaptive Optics in Ophthalmology. Photonics, 9.","DOI":"10.3390\/photonics9050288"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Bernabeu, M.O., Lu, Y., Abu-Qamar, O., Aiello, L.P., and Sun, J.K. (2018). Estimation of Diabetic Retinal Microaneurysm Perfusion Parameters Based on Computational Fluid Dynamics Modeling of Adaptive Optics Scanning Laser Ophthalmoscopy. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.00989"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"13450","DOI":"10.1038\/s41598-024-63749-7","article-title":"Detection of Capillary Abnormalities in Early Diabetic Retinopathy Using Scanning Laser Ophthalmoscopy and Optical Coherence Tomography Combined with Adaptive Optics","volume":"14","author":"Torm","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Szewczuk, A., Wawrzyniak, Z.M., Szaflik, J.P., and Zaleska-\u017bmijewska, A. (2024). Is Primary Open-Angle Glaucoma a Vascular Disease? Assessment of the Relationship between Retinal Arteriolar Morphology and Glaucoma Severity Using Adaptive Optics. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020478"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7115","DOI":"10.1167\/iovs.13-13027","article-title":"Imaging of Vascular Wall Fine Structure in the Human Retina Using Adaptive Optics Scanning Laser Ophthalmoscopy","volume":"54","author":"Chui","year":"2013","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1364\/BOE.6.001407","article-title":"Imaging of Retinal Vasculature Using Adaptive Optics SLO\/OCT","volume":"6","author":"Felberer","year":"2015","journal-title":"Biomed. Opt. Express"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/OPX.0b013e3182540562","article-title":"Repeatability of In Vivo Parafoveal Cone Density and Spacing Measurements","volume":"89","author":"Garrioch","year":"2012","journal-title":"Optom. Vis. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1167\/tvst.7.3.21","article-title":"The Reliability of Cone Density Measurements in the Presence of Rods","volume":"7","author":"Morgan","year":"2018","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1167\/tvst.9.2.40","article-title":"Cone Identification in Choroideremia: Repeatability, Reliability, and Automation through Use of a Convolutional Neural Network","volume":"9","author":"Morgan","year":"2020","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4625","DOI":"10.1364\/BOE.524944","article-title":"Measurement of Retinal Blood Flow Precision in the Human Eye with Multimodal Adaptive Optics Imaging","volume":"15","author":"Raghavendra","year":"2024","journal-title":"Biomed. Opt. Express"},{"key":"ref_11","first-page":"5316","article-title":"Improved Performance of Adaptive Optics Correction for Retinal Imaging in Eyes with Lens Opacities","volume":"61","author":"Larsen","year":"2020","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e001628","DOI":"10.1136\/bmjophth-2023-001628","article-title":"Impact of Lens Autofluorescence and Opacification on Retinal Imaging","volume":"9","author":"Rennen","year":"2024","journal-title":"BMJ Open Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4552","DOI":"10.1364\/OE.14.004552","article-title":"Adaptive Optics Flood-Illumination Camera for High-Speed Retinal Imaging","volume":"14","author":"Rha","year":"2006","journal-title":"Opt. Express"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zaleska-\u017bmijewska, A., Szewczuk, A., Wawrzyniak, Z.M., \u017bmijewska, M., and Szaflik, J.P. (2025). Assessment of Retinal Microcirculation in Primary Open-Angle Glaucoma Using Adaptive Optics and OCT Angiography: Correlation with Structural and Functional Damage. J. Clin. Med., 14.","DOI":"10.20944\/preprints202506.0106.v1"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kowalczuk, L., Dornier, R., Navarro, A., Jeunet, F., Moser, C., Behar-Cohen, F., and Mantel, I. (2025). Adaptive Optics-Transscleral Flood Illumination Imaging of Retinal Pigment Epithelium in Dry Age-Related Macular Degeneration. Cells, 14.","DOI":"10.20944\/preprints202504.0434.v1"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1001\/archopht.1989.01070020053028","article-title":"Lens opacities classification system II (LOCS II)","volume":"107","author":"Chylack","year":"1989","journal-title":"Arch. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1167\/tvst.9.8.41","article-title":"Imaging of Age-Related Macular Degeneration by Adaptive Optics Scanning Laser Ophthalmoscopy in Eyes with Aged Lenses or Intraocular Lenses","volume":"9","author":"Zhang","year":"2020","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"671","DOI":"10.18240\/ijo.2023.05.01","article-title":"Analysis of Retinal Arteriolar and Venular Parameters in Primary Open Angle Glaucoma","volume":"16","author":"Wang","year":"2023","journal-title":"Int. J. Ophthalmol."},{"key":"ref_20","first-page":"5916","article-title":"Repeatability and Reproducibility of Retinal Vessel Caliber Measurements Using Adaptive Optics Fundus Camera","volume":"57","author":"Soliman","year":"2016","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1136\/bjophthalmol-2019-315780","article-title":"Different Effect of Media Opacity on Automated and Manual Measurement of Foveal Avascular Zone of Optical Coherence Tomography Angiographies","volume":"105","author":"Zhang","year":"2021","journal-title":"Br. J. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Yu, S., Frueh, B., Steinmair, D., Ebneter, A., Wolf, S., Zinkernagel, M.S., and Munk, M.R. (2018). Cataract Significantly Influences Quantitative Measurements on Swept-Source Optical Coherence Tomography Angiography Imaging. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0204501"},{"key":"ref_23","first-page":"5302","article-title":"Different Effect of Optical Media Opacities on Vessel Density Measured by Different Optical Coherence Tomography Angiography Algorithms","volume":"61","author":"Chen","year":"2020","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1097\/IJG.0000000000001147","article-title":"Influence of Posterior Subcapsular Cataract on Structural OCT and OCT Angiography Vessel Density Measurements in the Peripapillary Retina","volume":"28","year":"2019","journal-title":"J. Glaucoma"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Br\u00fccher, V.C., Storp, J.J., Kerschke, L., Nelis, P., Eter, N., and Alnawaiseh, M. (2019). Influence of Mydriasis on Optical Coherence Tomography Angiography Imaging in Patients with Age-Related Macular Degeneration. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0223452"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hohberger, B., M\u00fcller, M., Hosari, S., and Mardin, C.Y. (2019). OCT-Angiography: Mydriatic Phenylephrine and Tropicamide Do Not Influence Retinal Microvasculature in Macula and Peripapillary Region. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0221395"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tsai, J., Asanad, S., Whiting, M., Zhang, X., Magder, L., and Saeedi, O. (2023). Repeatability and Comparability of Retinal Blood Vessel Cali-ber Measurements by OCTA. 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