Quantification of Choriocapillaris with Phansalkar Local Thresholding: Pitfalls to Avoid.

PURPOSE: To demonstrate the proper use of the Phansalkar local thresholding method (Phansalkar method) in choriocapillaris (CC) quantification with optical coherence tomography angiography (OCTA).
DESIGN: Retrospective, observational case series.
METHODS: Swept source OCTA imaging was performed using 3×3 mm and 6×6 mm scanning patterns. The CC slab was extracted after semiautomatic segmentation of the retinal pigment epithelium/Bruch membrane complex. Retinal projection artifacts were removed before further analysis, and CC OCTA images from drusen eyes were compensated using a previously published strategy. CC flow deficits (FDs) were segmented with 2 previously published algorithms: the fuzzy C-means approach (FCM method) and the Phansalkar method. With the Phansalkar method, different parameters were tested and a local window radius of 1 to 15 pixels was used. FD density, mean FD size, and FD number were calculated for comparison.
RESULTS: Six normal eyes from 6 subjects and 6 eyes with drusen secondary to age-related macular degeneration from 6 subjects were analyzed. With both 3×3 mm and 6×6 mm scans from all eyes, the FD metrics were highly dependent on the selection of the local window radius when using the Phansalkar method. Larger window radii resulted in higher FD density values. FD number increased with the increase in the window radius but then decreased, with an inflection point at about 1 to 2 intercapillary distances. Mean FD size decreased then increased with increasing window radii.
CONCLUSIONS: Multiple parameters, especially the local window radius, should be optimized before using the Phansalkar method for the quantification of CC FDs with OCTA imaging. It is recommended that the proper use of the Phansalkar method should include the selection of the window radius that is related to the expected intercapillary distance in normal eyes.