Optical coherence tomography angiography (OCTA) is a novel non-invasive imaging technique that allows visualizations of vasculature and foveal avascular zone (FAZ) across retinal layers. Clinical researches suggest that the morphology and contour irregularity of FAZ are important biomarkers of various ocular pathologies. Therefore, precise segmentation of FAZ has great clinical interest. Also, there is no existing research reporting that FAZ features can improve the performance of deep diagnostic classification networks. In this paper, we propose a novel multi-level boundary shape and distance aware joint learning framework, named BSDA-Net, for FAZ segmentation and diagnostic classification from OCTA images. Two auxiliary branches, namely boundary heatmap regression and signed distance map reconstruction branches, are constructed in addition to the segmentation branch to improve the segmentation performance, resulting in more accurate FAZ contours and fewer outliers. Moreover, both low-level and high-level features from the aforementioned three branches, including shape, size, boundary, and signed directional distance map of FAZ, are fused hierarchically with features from the diagnostic classifier. Through extensive experiments, the proposed BSDA-Net is found to yield state-of-the-art segmentation and classification results on the OCTA-500, OCTAGON, and FAZID datasets.
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