Analysis of international publication trends in artificial intelligence in ophthalmology

PURPOSE

Artificial intelligence (AI) has entered the field of medicine, and ophthalmology is no exception. The objective of this study was to report on scientific production and publication trends, to identify journals, countries, international collaborations, and major MeSH terms involved in AI in ophthalmology research.

METHODS

Scientometric methods were used to evaluate global scientific production and development trends in AI in ophthalmology using PubMed and the Web of Science Core Collection.

RESULTS

A total of 1356 articles were retrieved over the period 1966-2019. The yearly growth of AI in ophthalmology publications has been 18.89% over the last ten years, indicating that AI in ophthalmology is a very attractive topic in science. Analysis of the most productive journals showed that most were specialized in computer and medical systems. No journal was found to specialize in AI in ophthalmology. The USA, China, and the UK were the three most productive countries. The study of international collaboration showed that, besides the USA, researchers tended to collaborate with peers from neighboring countries. Among the twenty most frequent MeSH terms retrieved, there were only four related to clinical topics, revealing the retina and glaucoma as the most frequently encountered subjects of interest in AI in ophthalmology. Analysis of the top ten Journal Citation Reports categories of journals and MeSH terms for articles confirmed that AI in ophthalmology research is mainly focused on engineering and computing and is mainly technical research related to computer methods.

CONCLUSIONS

This study provides a broad view of the current status and trends in AI in ophthalmology research and shows that AI in ophthalmology research is an attractive topic focusing on retinal diseases and glaucoma. This study may be useful for researchers in AI in ophthalmology such as clinicians, but also for scientists to better understand this research topic, know the main actors in this field (including journals and countries), and have a general overview of this research theme.

[Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)]

For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.

Prediction of Cardiovascular Parameters With Supervised Machine Learning From Singapore "I" Vessel Assessment and OCT-Angiography: A Pilot Study

Purpose

Assessment of cardiovascular risk is the keystone of prevention in cardiovascular disease. The objective of this pilot study was to estimate the cardiovascular risk score (American Hospital Association [AHA] risk score, Syntax risk, and SCORE risk score) with machine learning (ML) model based on retinal vascular quantitative parameters.

Methods

We proposed supervised ML algorithm to predict cardiovascular parameters in patients with cardiovascular diseases treated in Dijon University Hospital using quantitative retinal vascular characteristics measured with fundus photography and optical coherence tomography – angiography (OCT-A) scans (alone and combined). To describe retinal microvascular network, we used the Singapore “I” Vessel Assessment (SIVA), which extracts vessel parameters from fundus photography and quantitative OCT-A retinal metrics of superficial retinal capillary plexus.

Results

The retinal and cardiovascular data of 144 patients were included. This paper presented a high prediction rate of the cardiovascular risk score. By means of the Naïve Bayes algorithm and SIVA + OCT-A data, the AHA risk score was predicted with 81.25% accuracy, the SCORE risk with 75.64% accuracy, and the Syntax score with 96.53% of accuracy.

Conclusions

Performance of these algorithms demonstrated in this preliminary study that ML algorithms applied to quantitative retinal vascular parameters with SIVA software and OCT-A were able to predict cardiovascular scores with a robust rate. Quantitative retinal vascular biomarkers with the ML strategy might provide valuable data to implement predictive model for cardiovascular parameters.

Translational Relevance

Small data set of quantitative retinal vascular parameters with fundus and with OCT-A can be used with ML learning to predict cardiovascular parameters.

Quality-of-Life Improvement After Scleral Lens Fitting in Patients With Keratoconus

OBJECTIVES

To assess the quality-of-life improvement after scleral lens fitting in patients with keratoconus.

METHODS

We conducted a prospective observational study of all consecutive patients with keratoconus starting scleral lens fitting in 2019, from January 2 to December 27, at the Dijon University Hospital, France. Quality of life was assessed before and after wearing scleral lenses for 3 months through the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25) questionnaire. We investigated factors potentially influencing quality of life: final visual acuity, keratoconus stage, and maximum keratometry reading.

RESULTS

In total, 41 eyes of 24 patients were successfully fitted with scleral lenses, 92.9% were 18 mm in diameter and 7.1% were 17 mm. The visual acuity improved by -0.4±0.3 logarithm of the minimum angle of resolution (P<0.001) after scleral lens fitting. Visual gain increased with keratometry and keratoconus severity (P<0.001; P<0.01). The NEI-VFQ 25 score increased by 19.5±19.1 points on average (P<0.001). No association was found between the factors under study and improvement in quality of life.

CONCLUSION

Our study confirms the functional improvement in patients with keratoconus fitted with scleral lenses, especially in patients with more advanced disease. Moreover, it suggests a major role of these lenses in improving quality of life, independently of the severity of the disease and the visual gain.

Myocardial infarction during giant cell arteritis: A cohort study

BACKGROUND

Cardiovascular risk is increased in giant cell arteritis (GCA). We aimed to characterize myocardial infarction (MI) in a GCA cohort, and to compare the GCA and non-GCA population affected by MI.

METHODS

In patients with a biopsy-proven diagnosis of GCA between 1 January 2001 and 31 December 2016 in Côte D'Or (France), we identified patients with MI by crossing data from the territorial myocardial infarction registry (Observatoire des Infarctus de Côte d'Or) database. Five controls (non-GCA + MI) were paired with one case (GCA + MI) after matching for age, sex, cardiovascular risk factors and prior cardiovascular disease. MI were characterized as type 1 MI (T1MI), resulting from thrombus formation due to atherothrombotic disease, or type 2 MI (T2MI), due to a myocardial supply/demand mismatch. GCA-related MI was defined as MI occurring within 3 months of a GCA flare (before or after).

RESULTS

Among 251 biopsy-proven GCA patients, 13 MI cases were identified and paired with 65 controls. MI was GCA-related in 6/13 cases, accounting for 2.4% (6/251) of our cohort. T2MI was more frequently GCA-related than GCA-unrelated (80% vs. 16.7%, p = 0.080), and GCA diagnosis was the only identified triggering factor in 75% of GCA-related T2MI. GCA-unrelated MI were more frequently T1MI and occurred in patients who had received a higher cumulative dose of prednisone (p = 0.032). GCA was not associated with poorer one-year survival.

CONCLUSIONS

GCA-related MI are mainly T2MI probably caused by systemic inflammation rather than coronaritis. GCA-unrelated MI are predominantly T1MI associated with atherothrombotic coronary artery disease.

Retinal Vessel Phenotype in Patients with a History of Retinal Vein Occlusion

INTRODUCTION

The aim of the study was to estimate the phenotype of retinal vessels using central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), tortuosity, and fractal analysis in the unaffected contralateral eye of patients with central or branch retinal vein occlusion (CRVO or BRVO).

METHODS

Thirty-four patients suffering from CRVO, 15 suffering from BRVO, and 49 controlled matched subjects had a fundus image analyzed using the VAMPIRE software. The intraclass correlation coefficient and a Bland-Altman plot were done for the reproducibility study.

RESULTS

There was a lack of evidence of difference between the control group and the CRVO group for CRAE (p = 0.06), CRVE (p = 0.3), and arterio-venule ratio (AVR, p = 0.6). Contralateral eyes of CRVO exhibited a significantly higher arterial and minimum arterial tortuosity values (p = 0.012), as compared with control eyes. Contralateral eyes of patients with a history of BRVO had a significantly higher CRAE (p = 0.02), AVR (p = 0.006), and minimal arterial tortuosity (p = 0.05). Fractal analysis showed that contralateral eyes of BRVO had higher values of fractal parameters (D0a, p = 0.005).

CONCLUSION

This study suggests that CVRO or BRVO is not triggered by the same retinal vascular phenotypes in the contralateral eye. The morphology of retinal vasculature may be associated with the occurrence of RVO, independently of known risk factors.

Hematological Malignancies in Giant Cell Arteritis: a French population-based study

OBJECTIVES

An increased risk of hematological malignancies (HM) has been reported in giant cell arteritis (GCA) patients. Our study aimed to investigate the incidence and the type of HM occurring in GCA.

METHODS

All patients with GCA and HM living in Côte D'Or (France) were identified by crossing data from the RHEMCO (Registre des Hémopathies Malignes de Côte d'Or) and those having a positive temporal artery biopsy between 1st January 2001 and 31 December 2018.

RESULTS

Among 276 biopsy-proven GCA patients, 14 HM were identified in 12 patients (4.3%). In comparison with the general population aged over 50 years, the incidence of myeloid HM and myeloproliferative syndromes were increased in GCA patients (standardized incidence ratios = 2.71 and 5.16, respectively), with a specific increase in men with GCA (SIR = 4.82 and 9.04, respectively) but not in women. In addition, the study of standardized incidence ratios depending on the chronology between GCA and HM diagnoses suggests that there was an increased risk of developing GCA in men but not in women, after a diagnosis of myeloid HM (SIR = 9.56), especially if it was a MPS (SIR = 17.56).

CONCLUSIONS

Our study shows a particular epidemiology of HM in GCA patients, which is characterized by an increased incidence of myeloid HM, especially MPS, in male GCA patients. The chronology of the diagnoses of GCA and HM raises the hypothesis that clonal hematopoiesis may be implicated in some cases of GCA.

Diagnostic ability of spectral-domain optical coherence tomography peripapillary retinal nerve fiber layer thickness to discriminate glaucoma patients from controls in an elderly population (The MONTRACHET study)

PURPOSE

To evaluate the capacity of retinal nerve fibre layer (RNFL) thickness measured by SD-OCT to discriminate glaucoma patients from controls in an elderly population.

METHODS

The MONTRACHET (Maculopathy, Optic Nerve, nuTRition, neurovAsCular and HEarT diseases) Study is a population-based study including participants aged 75 years and over. All participants underwent a complete eye examination with optic nerve photographs, visual field testing and OCT peripapillary RNFL thickness measurement. Glaucoma was defined according to the ISGEO (International Society for Epidemiologic and Geographical Ophthalmology) classification. Performance indicators were calculated including area under the receiver operating characteristics curves (AUC), likelihood ratios (LR) and diagnostic odds ratios (DOR).

RESULTS

In total, 1061 participants were included in the study, of whom 89 were classified as having glaucoma and 972 were classified as normal. The mean (SD) age of the population was 82.3 (3.7) years. The average RNFL thickness was significantly lower in the glaucoma group than in controls 64.0 (14.9) µm versus 88.9 (12.4) µm, respectively, p < 0.001) and in all sectors compared with controls. The average RNFL thickness had the highest AUC (0.901) followed by the temporal-inferior (0.879) and temporal-superior sectors (0.862). When RNFL thickness was classified as abnormal by SD-OCT, the average RNFL thickness had the best sensitivity (83.75%) followed by the temporal-inferior sector (75.64%). The specificity for these two parameters was 87.34% and 91.08%, respectively. The highest DOR was 28.70 for average RNFL thickness and reached 34.84 when using the reference database of the OCT manufacturer.

CONCLUSION

This study confirms that SD-OCT could be useful as an additional test to discriminate glaucoma patients from controls in an elderly population.

Development of a 1-year risk-prediction nomogram for good functional response with anti-VEGF agents in naive diabetic macular oedema

PURPOSE

To develop a risk-prediction nomogram based on baseline variables for good functional response during the 1st year of treatment with anti-VEGF agents in naive diabetic macular oedema (DME).

METHODS

This retrospective study included patients presenting naive-DME treated with anti-VEGF therapy at Dijon University Hospital (France) between 1 February 2012 and 31 March 2015 (derivation cohort). We studied baseline variables that had significant associations with a good functional response to anti-VEGF agents during the 1st year of treatment. We used a program to generate a nomogram based on a binary logistic regression predictive model. Then, this nomogram was tested on data from a separate cohort of naive-DME patients from a multicenter study involving 20 French ophthalmologic centres between January 2014 and June 2015 (validation cohort).

RESULTS

Age, baseline BCVA and ellipsoid zone integrity on spectral-domain optical coherence tomography (SD-OCT) are functional prognostic factors and were used to build a nomogram. The nomogram showed excellent discrimination for good functional responders (area under the curve (AUC) = 0.906, 95% confidence interval (95% CI) = [0.849-0.964], p = 0.004). The discriminative power of this nomogram was tested on the validation cohort data, demonstrating good discrimination of good functional responders (AUC = 0.942, 95% CI = [0.898-0.986], p < 0.001).

CONCLUSION

This nomogram provides a useful estimation of a good functional response in naive-DME patients treated with anti-VEGF agents.

Association between the retinal vascular network and retinal nerve fiber layer in the elderly: The Montrachet study

PURPOSE

To investigate the association between the characteristics of the retinal vascular network in the elderly and retinal nerve fiber layer (RNFL) thickness in a population-based study.

METHODS

We conducted a population-based study, the Montrachet study (Maculopathy Optic Nerve, nuTRition neurovAsCular, and HEarT disease), in participants aged ≥ 75 years. RNFL thickness was assessed with spectral-domain optical coherence tomography (SD-OCT). Analysis of the retinal vascular network was performed by means of the Singapore "I" Vessel Assessment (SIVA) software based on fundus photography.

RESULTS

Data from 970 participants were suitable for analysis. Patients with optic neuropathy were excluded. In multivariable analysis, each standard deviation (SD) decrease in the caliber of the six largest arterioles and veins in zone B and the six largest arterioles and veins in zone C was associated with a decrease in global RNFL thickness (β = -1.62 μm, P = 0.001; β = -2.39 μm, P < 0.001; β = -1.56 μm, P = 0.002; and β = -2.64 μm, P < 0.001, respectively).

CONCLUSIONS

Our study found that decreased retinal vessels caliber were associated with a decreased RNFL thickness in the elderly without optic neuropathy.

Vascular density with optical coherence tomography angiography and systemic biomarkers in low and high cardiovascular risk patients

We aimed to compare retinal vascular density in Optical Coherence Tomography Angiography (OCT-A) between patients hospitalized for acute coronary syndrome (ACS) and control patients and to investigate correlation with angiogenesis biomarkers. Patients hospitalized for an acute coronary syndrome (ACS) in the Intensive Care Unit were included in the "high cardiovascular risk" group while patients without cardiovascular risk presenting in the Ophthalmology department were included as "control". Both groups had blood sampling and OCT-A imaging. Retina microvascularization density in the superficial capillary plexus was measured on 3 × 3 mm angiograms centered on the macula. Angiopoietin-2, TGF-β1, osteoprotegerin, GDF-15 and ST-2 were explored with ELISA or multiplex method. Overall, 62 eyes of ACS patients and 42 eyes of controls were included. ACS patients had significantly lower inner vessel length density than control patients (p = 0.004). A ROC curve found that an inner vessel length density threshold below 20.05 mm^-1 was moderately associated with ACS. Significant correlation was found between serum levels of angiopoietin-2 and osteoprotegerin, and retinal microvascularization in OCT-A (R = - 0.293, p = 0.003; R = - 0.310, p = 0.001). Lower inner vessel length density measured with OCT-A was associated with ACS event and was also correlated with higher concentrations of angiopoietin-2 and osteoprotegerin.

Prognostic factors of overall survival for patients with FIGO stage IIIc or IVa ovarian cancer treated with neo-adjuvant chemotherapy followed by interval debulking surgery: A multicenter cohort analysis from the FRANCOGYN study group

INTRODUCTION

The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer (OC) treated by neo-adjuvant chemotherapy (NAC) followed by interval debulking surgery.

MATERIALS AND METHODS

Data from 483 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovarian cancer treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analysis were performed to define prognostic factors of overall survival.

RESULTS

The median overall survival was 52 after a median follow up of 30 months. After univariate analysis, factors significantly associated with decreased overall survival were; no pelvic and/or para-aortic lymphadenectomy (p = 0.002), residual disease (CC1/CC2/CC3) after surgery (p < 0.001), positive cytology after NAC (p < 0.001), omental disease after NAC (p = 0.002), no pathologic complete response (pCR) (p = 0.002). In multivariate analysis, factors significantly associated with decreased overall survival were; residual disease after surgery (HR = 1.93; CI95% (1.16-3.21), p = 0.01) and positive cytology after NAC (HR = 1.59; CI95% (1.01-2.55), p = 0.05). Patients with no residual disease after surgery had a median overall survival of 64 months versus 35 months for patients with residual disease. Patients with negative cytology after NAC had a median overall survival of 71 months versus 43 months for patients with positive cytology after NAC.

CONCLUSION

In this first and largest French based retrospective study, complete cytoreductive surgery in ovarian cancer remains the main prognostic factor of overall survival.

[Comparing prediction performances of 18F-FDG PET and CGFL/Curie nomogram to predict pathologic complete response after neoadjuvant chemotherapy for HER2-positive breast cancers]

OBJECTIVES

The aim of this study was to compare the value of ¹⁸F-fluorodesoxyglucose positron emission tomography (¹⁸F-FDG PET/CT) with CGFL/Curie nomogram to predict a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in women with human epidermal growth factor 2 (HER2)-positive breast cancer treated by trastuzumab.

METHODS

Fifty-one women with HER2-positive breast cancer treated with trastuzumab plus taxane-based NAC were retrospectively included from January 2005 to December 2015. For ¹⁸F-FDG PET/CT, the analyzed predictor was the maximum standardized uptake value of the primary tumor and axillary nodes after the first course of NAC (PET₂.SUV_max). pCR was defined by no residual infiltrative tumor but in situ tumor was accepted. Accuracy of CGFL/Curie nomogram and PET₂.SUV_max was evaluated measuring sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Combined prediction was evaluated testing predictor's associations.

RESULTS

For CGFL/Curie nomogram's performances, Se, Sp, PPV and NPV were respectively: 76% (95%CI: 58-90%), 57% (95%CI: 43-66%), 55% (95%CI: 42-65), 77% (95%CI: 59-90%). For PET₂.SUV_max's performances, Se, Sp, PPV and NPV were respectively: 67% (95%CI: 48-81%), 77% (95%CI: 64-97%), 67% (95%CI: 48-82%), 77% (95%CI: 64-87%). ROC curves for these predictors were similar; the areas under the curve were 0.6 (95%CI: 0.56-0.64) for PET₂.SUV_max and 0.55 (95%CI: 0.50-0.59) for CGFL/Curie nomogram. Combined prediction was efficient with Se at 80%, VPN at 76%, Sp at 78% and VPP at 81%.

CONCLUSIONS

CGFL/Curie nomogram and PET₂.SUV_max were two efficient predictors of pCR in patients with HER2-positive breast cancer. Combined prediction has an improved accuracy.

Retinal vessel phenotype in patients with primary open-angle glaucoma

PURPOSE

To characterize the phenotype of retinal vessels using central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), tortuosity and fractal dimension (FD) in primary open-angle glaucoma (POAG) subjects.

METHODS

This prospective case-control multicentre study included 61 POAG subjects and 61 controls matched for age, systemic hypertension and body mass index. Fundus images of the right eye were acquired using a non-mydriatic camera. Central retinal artery equivalent (CRAE), CRVE, arteriole-to-venule ratio, FD and tortuosity of the vascular network were measured using VAMPIRE software (Vessel Assessment and Measurement Platform for Images of the Retina). Primary open-angle glaucoma (POAG) patients underwent 24.2 sita-standard visual field and peri-papillary optical coherence tomography (OCT) examinations. Data were expressed as median and interquartile range (75-25th percentiles).

RESULTS

The control group was comparable to the POAG group for sex ratio, refraction and intraocular pressure. The mean CRAE and the mean CRVE were significantly lower in the POAG group than in the control group [150.5 (137.9; 157.1) μm versus 161.3 (154.0; 168.4) μm and 204.8 (190.1; 218.1) μm versus 233.5 (222.3; 246.9) μm, respectively; p < 0.001] and for fractal parameters as well. No significant difference was found for tortuosity between the two groups. There was a significant correlation between CRAE and retinal nerve fibre layer (RNFL) thickness (r = 0.27; p = 0.03). VAMPIRE parameters were not correlated with visual field indices.

CONCLUSION

Primary open-angle glaucoma (POAG) was associated with a narrowing of arterial and venous retinal vessels, a higher arteriole-to-venule ratio and lower values of FD. The relationship between CRAE and RNFL thickness needs further investigation.

Influence of cardiac hemodynamic variables on retinal vessel density measurement on optical coherence tomography angiography in patients with myocardial infarction

INTRODUCTION

Quantitative measurements of retinal microvasculature by optical coherence tomography angiography (OCT-A) have been used to assess cardiovascular risk profile. However, to date, there are no studies focusing on OCT-A imaging in the setting of the altered hemodynamic status found in high-risk cardiovascular patients.

METHODS

To determine the potential association between retinal vascular density on OCT-A and a comprehensive battery of hemodynamic variables in patients with myocardial infarction (MI) using data from the acute phase and at 3 months follow-up after cardiac rehabilitation. This prospective longitudinal study included patients who presented with MI in the cardiology intensive care unit at Dijon University Hospital. Main outcomes and measurements were retinal vessel density on OCT-A, hemodynamic status based on left ventricular ejection fraction (LVEF), and indexed cardiac output during the acute phase of myocardial infarction and at 3 months follow-up.

RESULTS

Overall, 30 patients were included in this pilot study. The median (IQR) age was 64 years (55-71) with 87% men. At admission, the mean (SD) LVEF was 53% (11), and the mean indexed cardiac output was 2.70 (0.83) L/min/m². On OCT-A, the mean inner retinal vascular density was 19.09 (2.80) mm^-1. No significant association was found between retinal vascular density and hemodynamic variables.

CONCLUSION

We found no significant association between retinal vascular density on OCT-A and hemodynamic variables in the acute phase of a myocardial infarction or after 3 months of cardiac rehabilitation. Therefore, OCT-A findings do not seem to be influenced by the hemodynamic changes associated with myocardial infarction.

Accuracy of the ISNT rule and its variants for differentiating glaucomatous from normal eyes in a population-based study

AIMS

To evaluate the accuracy of the ISNT rule (I=inferior, S=superior, N=nasal, T=temporal) and its variants with neuroretinal rim width and retinal nerve fibre layer (RNFL) thickness measurements differentiating normal from glaucomatous eyes.

METHODS

The diagnosis accuracy of the ISNT rule and its variants was evaluated in a population-based study. Neuroretinal rim widths were measured on monoscopic optic disc photographs with an image-processing program. RNFL thickness measurements were obtained with spectral-domain optical coherence tomography (SD-OCT).

RESULTS

In this study including 940 normal subjects and 93 patients with glaucoma, the sensitivity of the ISNT rule with optic disc photographs was 94.1% (95% CI 90.2 to 98.1), whereas its specificity was 49.2% (46.9 to 51.6). When using the IST rule, the sensitivity decreased to 69.9% (62.1 to 77.6) with a higher specificity, 87.0% (85.3 to 88.6). All the diagnosis indicators were somewhat lower for the different rules using RNFL thickness: the sensitivity of the ISNT rule was 79.4% (72.6 to 86.2) and its specificity was 34.1% (31.9 to 36.4). With the IST rule, the sensitivity decreased to 50.0% (41.6 to 58.4) while the specificity increased to 64.9% (62.7 to 67.2).

CONCLUSIONS

The ISNT and IST rules applied to neuroretinal rim width measurement by optic disc photographs are useful and simple tools for differentiating normal from glaucomatous eyes. The translation of these rules to RNFL thickness by SD-OCT is of limited value.

Subretinal Drusenoid Deposits in the Elderly in a Population-Based Study (the Montrachet Study)

Purpose

The aim of this study was to investigate the prevalence of subretinal drusenoid deposits (SDD) and to identify associated factors in an elderly population.

Methods

The participants of the population-based Montrachet study underwent an exhaustive ophthalmologic examination, including color fundus photography and macular spectral domain-optical coherence tomography (SD-OCT), coupled with infrared reflectance imaging. The presence of SDD and other age-related macular degeneration lesions, according to the European Eye Epidemiology SD-OCT classification of macular diseases, and subfoveal choroidal thickness were recorded. Moreover, the association of SDD and both clinical and demographic factors as well as plasma levels of vitamin E and lutein/zeaxanthin (L/Z) were analyzed.

Results

The mean age of patients was 82.3 ± 3.8 years and 62.7% were female. The prevalence of SDD was 18.1% (n = 205) in the subjects with at least one eye interpretable (n = 1135). In multivariate analysis, SDD was positively associated with increasing age (OR, 4.6; 95% CI, 2.8-7.7; P < 0.001 for subjects aged >85 years), female sex (OR, 1.7; 95% CI, 1.2-2.4; P = 0.005), and plasma L/Z level (OR, 1.2; 95% CI, 1.0-1.5; P = 0.039), and negatively associated with lipid-lowering drugs use (OR, 0.5; 95% CI, 0.3-0.9; P = 0.014 for statin medications) and subfoveal choroidal thickness (OR, 0.8; 95% CI, 0.7-0.9; P = 0.002).

Conclusions

The prevalence of SDD was high in subjects older than 75 years, more frequent in women, and was associated with a thinner choroid. The association with lipid-lowering drugs deserves further investigation.