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Xu C, Saini C, Wang M, Devlin J, Wang H, Greenstein SH, Brauner SC, Shen LQ. Combined Model of OCT Angiography and Structural OCT Parameters to Predict Paracentral Visual Field Loss in Primary Open-Angle Glaucoma. Ophthalmol Glaucoma 2023; 6:255-265. [PMID: 36252920 PMCID: PMC10102259 DOI: 10.1016/j.ogla.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess a model combining OCT angiography (OCTA) and OCT parameters to predict the severity of paracentral visual field (VF) loss in primary open-angle glaucoma (POAG). DESIGN Cross-sectional study. PARTICIPANTS Forty-four patients with POAG and 42 control subjects underwent OCTA and OCT imaging with a swept-source OCT device. METHODS The circumpapillary microvasculature was quantified for vessel density (cpVD) and flow (cpFlow) after delineation of Bruch's membrane opening and removal of large vessels. Retinal nerve fiber layer thickness (RNFLT) and Bruch's membrane opening-minimum rim width (BMO-MRW) were measured from structural OCT. Paracentral total deviation (PaTD) was defined as the average of the total deviation values within the central 10 degrees on Humphrey VF testing (24-2) for upper and lower hemifields. The OCT and OCTA parameters were measured in the affected hemisphere corresponding to the hemifield with lower PaTD for POAG patients. Models were created to predict affected PaTD based on RNFLT alone; RNFLT and BMO-MRW; OCTA alone; or RNFLT, BMO-MRW and OCTA parameters. The models were compared using coefficient of determination (r2) and Bayesian information criterion (BIC) score. Bayesian information criterion decrease of ≥6 indicates strong evidence for model improvement. MAIN OUTCOME MEASURES Performance of models containing OCT and OCTA parameters in predicting PaTD. RESULTS Patients with POAG and controls were similar in age and sex (65.9 ± 9.5 years and 38.4% male overall, P ≥ 0.56 for both). Average RNFLT, minimum RNFLT, average BMO-MRW, minimum BMO-MRW, cpVD, and cpFlow were all significantly lower (all P < 0.001) in the affected hemisphere in patients with POAG than in controls. In patients with POAG, the average mean deviation was -4.33 ± 3.25 dB; the PaTD of the affected hemifield averaged -4.55 ± 5.26 dB and correlated significantly with both OCTA and structural OCT parameters (r ≥ 0.43, P ≤ 0.004 for all). The model containing RNFLT, BMO-MRW, and OCTA parameters was superior in predicting affected PaTD (r2 = 0.47, BIC = 290.7), with higher r2 and lower BIC compared with all 3 other models. CONCLUSIONS A combined model of OCTA and structural OCT parameters can predict the severity of paracentral VF loss of the affected hemifield, supporting clinical utility of OCTA in patients with POAG with paracentral VF loss. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Christine Xu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Chhavi Saini
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mengyu Wang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Julia Devlin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Haobing Wang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Scott H Greenstein
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Stacey C Brauner
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Lucy Q Shen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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LeTran VH, Burkemper B, O'Fee JR, Souverein EA, Lee JC, Phillips MJ, Dinh-Dang D, Song BJ, Xu BY, Wong BJ, Richter GM. Wedge Defects on Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma: Prevalence and Associated Clinical Factors. J Glaucoma 2022; 31:242-249. [PMID: 35089892 DOI: 10.1097/ijg.0000000000001991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Among subjects with glaucoma, wedge-shaped defects on optical coherence tomography angiography (OCTA) were associated with disc hemorrhages (DH), paracentral visual field (VF) defects, increased cup-to-disc ratio (CDR), and thinner retinal nerve fiber layer (RNFL). PURPOSE To examine determinants of wedge defects on peripapillary OCTA in glaucoma. MATERIALS AND METHODS A total of 278 eyes of 186 subjects with mild to severe primary open-angle glaucoma underwent 6×6 spectral-domain OCTA imaging of the superficial peripapillary retina from 2016 to 2020 at an academic practice. Wedge defects were defined as focal microvasculature loss that extends outward from the optic nerve in an arcuate, wedge shape. Logistic regression models controlling for intereye correlation identified variables significantly associated with wedge defects. Eyes with profound microvasculature loss in both hemispheres were excluded. Candidate variables included: age, sex, race or ethnicity, diabetes, hypertension, follow-up duration, baseline untreated intraocular pressure, intraocular pressure at time of imaging, DH history, paracentral VF defects, CDR, central corneal thickness, spherical equivalent, VF mean deviation, RNFL thickness, and glaucoma stage. RESULTS Of 278 eyes, 126 (45.3%) had wedge defects in at least 1 hemisphere. In our multivariable logistic regression model, wedge defects were associated with DH history [odds ratio (OR): 3.19, 95% confidence interval (CI): 1.05-9.69, P=0.041], paracentral VF defects [OR: 4.38 (95% CI: 2.11-9.11), P<0.0001], larger CDR [OR: 1.27 (95% CI: 1.03-1.56), P=0.024, per 0.1 increase], and thinner RNFL [OR: 1.71 (95% CI: 1.25-2.34), P=0.0009, per 10 μm decrease]. CONCLUSION DH history and paracentral VF defects were independently associated with wedge defects on OCTA, which was present in 45.3% of primary open-angle glaucoma patients. These findings may provide insight into glaucoma pathogenesis.
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Affiliation(s)
- Vivian H LeTran
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Bruce Burkemper
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - John R O'Fee
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Erik A Souverein
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Jae C Lee
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Mark J Phillips
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Brian J Song
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Benjamin Y Xu
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Brandon J Wong
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Grace M Richter
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Qian X, Huang C, Li R, Song BJ, Tchelepi H, Shung KK, Chen S, Humayun MS, Zhou Q. Super-resolution Ultrasound Localization Microscopy for Visualization of the Ocular Blood Flow. IEEE Trans Biomed Eng 2021; 69:1585-1594. [PMID: 34652993 PMCID: PMC9113921 DOI: 10.1109/tbme.2021.3120368] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The ocular vascular system plays an important role in preserving the visual function. Alterations in either anatomy or hemodynamics of the eye may have adverse effects on vision. Thus, an imaging approach that can monitor alterations of ocular blood flow of the deep eye vasculature ranging from capillary-level vessels to large supporting vessels would be advantageous for detection of early stage retinal and optic nerve diseases. METHODS We propose a super-resolution ultrasound localization microscopy (ULM) technique that can assess both the microvessel and flow velocity of the deep eye with high resolution. Ultrafast plane wave imaging was acquired using an L22-14v linear array on a high frequency Verasonics Vantage system. A robust microbubble localization and tracking technique was applied to reconstruct ULM images. The experiment was first performed on pre-designed flow phantoms in vitro and then tested on a New Zealand white rabbit eye in vivo calibrated to various intraocular pressures (IOP) 10 mmHg, 30 mmHg and 50 mmHg. RESULTS We demonstrated that retinal/choroidal vessels, central retinal artery, posterior ciliary artery, and vortex vein were all visible at high resolution. In addition, reduction of vascular density and flow velocity were observed with elevated IOPs. CONCLUSION These results indicate that super-resolution ULM is able to image the deep ocular tissue while maintaining high resolution that is comparable with optical coherence tomography angiography. SIGNIFICANCE Capability to detect subtle changes of blood flow may be clinically important in detecting and monitoring eye diseases such as glaucoma.
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Aydın R, Barış M, Durmaz-Engin C, Al-Aswad LA, Blumberg DM, Cioffi GA, Liebmann JM, Tezel TH, Tezel G. Early localized alterations of the retinal inner plexiform layer in association with visual field worsening in glaucoma patients. PLoS One 2021; 16:e0247401. [PMID: 33630899 PMCID: PMC7906339 DOI: 10.1371/journal.pone.0247401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/06/2021] [Indexed: 01/16/2023] Open
Abstract
Glaucoma is a chronic neurodegenerative disease of the optic nerve and a leading cause of irreversible blindness, worldwide. While the experimental research using animal models provides growing information about cellular and molecular processes, parallel analysis of the clinical presentation of glaucoma accelerates the translational progress towards improved understanding, treatment, and clinical testing of glaucoma. Optic nerve axon injury triggers early alterations of retinal ganglion cell (RGC) synapses with function deficits prior to manifest RGC loss in animal models of glaucoma. For testing the clinical relevance of experimental observations, this study analyzed the functional correlation of localized alterations in the inner plexiform layer (IPL), where RGCs establish synaptic connections with retinal bipolar and amacrine cells. Participants of the study included a retrospective cohort of 36 eyes with glaucoma and a control group of 18 non-glaucomatous subjects followed for two-years. The IPL was analyzed on consecutively collected macular SD-OCT scans, and functional correlations with corresponding 10–2 visual field scores were tested using generalized estimating equations (GEE) models. The GEE-estimated rate of decrease in IPL thickness (R = 0.36, P<0.001) and IPL density (R = 0.36, P<0.001), as opposed to unchanged or increased IPL thickness or density, was significantly associated with visual field worsening at corresponding analysis locations. Based on multivariate logistic regression analysis, this association was independent from the patients’ age, the baseline visual field scores, or the baseline thickness or alterations of retinal nerve fiber or RGC layers (P>0.05). These findings support early localized IPL alterations in correlation with progressing visual field defects in glaucomatous eyes. Considering the experimental data, glaucoma-related increase in IPL thickness/density might reflect dendritic remodeling, mitochondrial redistribution, and glial responses for synapse maintenance, but decreased IPL thickness/density might correspond to dendrite atrophy. The bridging of experimental data with clinical findings encourages further research along the translational path.
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Affiliation(s)
- Rukiye Aydın
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Mine Barış
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Ceren Durmaz-Engin
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Lama A. Al-Aswad
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Dana M. Blumberg
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - George A. Cioffi
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Jeffrey M. Liebmann
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Tongalp H. Tezel
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Gülgün Tezel
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- * E-mail:
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Disc Hemorrhages Are Associated With the Presence and Progression of Glaucomatous Central Visual Field Defects. J Glaucoma 2020; 29:429-434. [PMID: 32287146 DOI: 10.1097/ijg.0000000000001487] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRECIS In this prospective cohort study, disc hemorrhages were associated with more severe central damage on 24-2 and 10-2 visual fields (VFs), and faster progression globally on 24-2 VFs and centrally on 10-2 VFs. PURPOSE To study the relationship between disc hemorrhage (DH) and the presence and progression of glaucomatous central VF damage. METHODS Cross-sectional and longitudinal analyses were performed on data from the African Descent and Glaucoma Evaluation Study (ADAGES) cohort. Two masked investigators reviewed disc photographs for the presence and location of DH. 24-2 central VF damage was based on the number of test locations within the central 10 degrees of the 24-2 field pattern deviation and their mean total deviation (MTD). 10-2 central VF damage was based on pattern deviation and MTD. Main outcome measures were the association between DH and presence of central VF damage and between DH and worsening of VF. RESULTS DH was detected in 21 of 335 eyes (6.2%). In the cross-sectional analysis, DH was significantly associated with more severe central damage on 24-2 [incidence rate ratio=1.47; 95% confidence interval (CI)=1.02-2.12; P=0.035] and 10-2 VFs (incidence rate ratio=1.81; 95% CI=1.26-2.60; P=0.001). In the longitudinal analysis, DH eyes progressed faster than non-DH eyes based on 24-2 global MTD rates (difference in slopes, β=-0.06; 95% CI=-0.11 to -0.01; P=0.009) and 10-2 MTD rates (β=-0.10; 95% CI=-0.14 to -0.06; P< 0.001), but not 24-2 central MTD rates (β=-0.02; 95% CI=-0.078 to 0.026; P=0.338). CONCLUSION DH was associated with the presence and progression of central VF defects. DH identification should prompt intensive central VF monitoring and surveillance with 10-2 fields to detect progression.
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Chiou CA, Wang M, Taniguchi EV, Nascimento E Silva R, Khoroshilov A, Li D, Wang H, Greenstein SH, Brauner SC, Turalba AV, Pasquale LR, Shen LQ. Characterization of Prelaminar Wedge-Shaped Defects in Primary Open-Angle Glaucoma. Curr Eye Res 2020; 46:895-902. [PMID: 33054505 DOI: 10.1080/02713683.2020.1836229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the clinical relevance of prelaminar wedge defects (PLWDs) detected by swept-source optical coherence tomography (SS-OCT) in primary open-angle glaucoma (POAG). MATERIALS AND METHODS In this retrospective case-control study, PLWDs were defined as triangular-shaped defects at the surface of the optic nerve prelaminar tissue, not adjacent to blood vessels, present on cross-sectional SS-OCT scans. Two observers masked to diagnosis independently reviewed scans to detect PLWDs and lamina cribrosa defects. History of disc hemorrhage, occurring within 2 years prior to imaging, was obtained from chart review. One eye per subject was randomly selected. Two-sided t-tests, analysis of variance with Bonferroni correction, and multivariable logistic regression analysis were performed to explore demographic and clinical features associated with PLWDs. RESULTS 40 POAG and 23 control eyes were included. PLWDS were found in 27.5% of POAG (n = 11) and 4.3% of controls (n = 1, p = .04). Eyes with repeat SS-OCT imaging (7 POAG and 0 controls) had persistent PLWDs. More POAG eyes with PLWDs had a history of disc hemorrhage (45.5%) than POAG eyes without PLWDs (3.4%, p = .004). On multivariable analysis, compared to POAG without PLWDs, POAG with PLWDs had increased odds of observed disc hemorrhage (OR = 21.6, 95% CI, 2.2-589.0, p = .02) after adjusting for age, gender, visual field mean deviation and maximum intraocular pressure (IOP). POAG with PLWDs had more lamina cribrosa defects (45.5%) than POAG without PLWDs (3.4%, p = .01) but did not differ significantly from controls (8.7%, p = .07). Compared to all patients without PLWDs, patients with PLWDs had increased odds of having lamina cribrosa defects (OR = 44.8; 95% CI, 6.3-703.6, p < .001) after adjusting for age, gender, and maximum IOP. CONCLUSIONS PLWDs were more frequently found in POAG than control eyes and were associated with a history of disc hemorrhage and lamina cribrosa defects. PLWDs may be a useful imaging biomarker of glaucomatous damage.
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Affiliation(s)
- Carolina A Chiou
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Mengyu Wang
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Elise V Taniguchi
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Anna Khoroshilov
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Dian Li
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Haobing Wang
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | | | - Stacey C Brauner
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Angela V Turalba
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Ophthalmology and Visual Services, Atrius Health, Boston, Massachusetts, USA
| | - Louis R Pasquale
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lucy Q Shen
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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7
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Cousins CC, Pan BX, Chou JC, Shen LQ, Gordon MO, Kass MA, Ritch R, Pasquale LR. Densitometric Profiles of Optic Disc Hemorrhages in the Ocular Hypertension Treatment Study. Am J Ophthalmol 2020; 217:10-19. [PMID: 32335057 DOI: 10.1016/j.ajo.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The origin of blood in glaucoma-related disc hemorrhages (DH) remains unknown. A prior clinic-based study of primary open-angle glaucoma (POAG)-related DH showed that they had grayscale pixel intensities more similar to blood from retinal macroaneurysms and adjacent retinal arterioles than to blood from retinal vein occlusions or adjacent retinal venules, suggesting an arterial source. Here we assessed the densitometric profile of DH from fundus photographs in the Ocular Hypertension Treatment Study (OHTS). DESIGN Retrospective cross-sectional study of prospectively collected images. METHODS Stereo disc photographs of 161 DH events from 83 OHTS participants (mean age [standard deviation (SD)]: 65.6 [9.2] years; 46.6% female; 13.0% black race) were imported into ImageJ to measure densitometry differences (adjacent arterioles minus DH [ΔA] or venules minus DH [ΔV]). Their size as percentage of disc area, ratio of length to midpoint width, and location relative to the disc margin were also analyzed. We performed t tests to compare ΔA and ΔV, analysis of variance to compare ΔA and ΔV across DH recurrent events, and multivariable linear regression to identify determinants of ΔA and ΔV. RESULTS Mean (SD) ΔA and ΔV were -2.2 (8.7) and -11.4 (9.7) pixel intensity units, respectively (P < .001). ΔA and ΔV each did not differ significantly across recurrence of DH (P ≥ .92) or between DH events with and without POAG (P ≥ .26). CONCLUSIONS OHTS DH had densitometric measurements more similar in magnitude to adjacent arterioles than venules, supporting an arterial origin for DH. Vascular dysregulation may contribute to disc hemorrhage formation in ocular hypertension.
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An D, House P, Barry C, Turpin A, McKendrick AM, Chauhan BC, Manners S, Graham S, Yu DY, Morgan WH. Recurrent Optic Disc Hemorrhage and Its Association with Visual Field Deterioration in Glaucoma. Ophthalmol Glaucoma 2020; 3:443-452. [PMID: 32741638 DOI: 10.1016/j.ogla.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/16/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the association among optic disc hemorrhage (ODH) recurrence, location, and visual field (VF) progression. DESIGN Prospective, observational study. PARTICIPANTS Patients with bilateral glaucoma or unilateral glaucoma with a fellow glaucoma suspect eye were enrolled. METHODS Patients received optic disc photography every 3 months and VF testing every 4 months. The disc was partitioned into 8 sectors to match 8 visual field (VF) sectors. The frequency of ODH in each sector was quantified over an average of 64 months. Global VF progression rate was calculated using linear regression on mean deviation. Sectoral progression rate was calculated using linear regression on the sensitivity at each VF location over time and then selecting the largest and second largest significant (P < 0.05) negative slope within that sector. The association between ODH and VF progression rate globally and within a sector was calculated using linear mixed modeling. MAIN OUTCOME MEASURES Global and sectoral VF progression, ODH frequency, and ODH recurrence (globally and sectoral) and its association with VF progression rate. RESULTS A total of 151 eyes from 77 patients completed the study with mean follow-up of 64 months, 20 disc photographs, and 16 VF tests. With global VF analysis, eyes with ODH in 2 different sectors of the disc had worse progression rate than eyes with ODH in 1 sector (P = 0.012) and eyes with no ODH (P < 0.001). Regarding the largest sectoral VF progression, sectors with 1 ODH had a faster VF progression rate than those with no ODH (P < 0.017) and progressed at a similar rate to those with 2 to 8 ODH (P = 0.592). Sectors with >8 ODH had faster VF progression than all other groups (all P < 0.001). CONCLUSIONS High-frequency ODH within optic disc sectors, equivalent to detecting ODH in 45% of 3 monthly eye examination visits, was associated with significantly worse VF progression than sectors with moderate or only 1 observed ODH. In addition, ODH occurring in different sectors in the same eye was more strongly associated with greater global VF progression compared with those occurring within the same sector.
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Affiliation(s)
- Dong An
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Philip House
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Christopher Barry
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Andrew Turpin
- School of Computing and Information Systems, The University of Melbourne, Doug McDonell Building, Victoria, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
| | - Balwantray C Chauhan
- Department of Ophthalmology & Visual Sciences, Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Siobhan Manners
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Stuart Graham
- Department of Clinical Medicine, Macquarie University, New South Wales, Australia
| | - Dao-Yi Yu
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - William H Morgan
- Centre for Ophthalmology and Visual Science and the Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia.
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Teikari P, Najjar RP, Schmetterer L, Milea D. Embedded deep learning in ophthalmology: making ophthalmic imaging smarter. Ther Adv Ophthalmol 2019; 11:2515841419827172. [PMID: 30911733 PMCID: PMC6425531 DOI: 10.1177/2515841419827172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/20/2018] [Indexed: 01/22/2023] Open
Abstract
Deep learning has recently gained high interest in ophthalmology due to its ability to detect clinically significant features for diagnosis and prognosis. Despite these significant advances, little is known about the ability of various deep learning systems to be embedded within ophthalmic imaging devices, allowing automated image acquisition. In this work, we will review the existing and future directions for 'active acquisition'-embedded deep learning, leading to as high-quality images with little intervention by the human operator. In clinical practice, the improved image quality should translate into more robust deep learning-based clinical diagnostics. Embedded deep learning will be enabled by the constantly improving hardware performance with low cost. We will briefly review possible computation methods in larger clinical systems. Briefly, they can be included in a three-layer framework composed of edge, fog, and cloud layers, the former being performed at a device level. Improved egde-layer performance via 'active acquisition' serves as an automatic data curation operator translating to better quality data in electronic health records, as well as on the cloud layer, for improved deep learning-based clinical data mining.
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Affiliation(s)
- Petteri Teikari
- Visual Neurosciences Group, Singapore Eye Research Institute, Singapore
- Advanced Ocular Imaging, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Raymond P. Najjar
- Visual Neurosciences Group, Singapore Eye Research Institute, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Leopold Schmetterer
- Visual Neurosciences Group, Singapore Eye Research Institute, Singapore
- Advanced Ocular Imaging, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Medical University of Vienna, Vienna, Austria
| | - Dan Milea
- Visual Neurosciences Group, Singapore Eye Research Institute, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
- Neuro-Ophthalmology Department, Singapore National Eye Centre, Singapore
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10
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Yamamoto T. The impact of disc hemorrhage studies on our understanding of glaucoma: a systematic review 50 years after the rediscovery of disc hemorrhage. Jpn J Ophthalmol 2018; 63:7-25. [PMID: 30465174 DOI: 10.1007/s10384-018-0641-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW To trace the influence of disc hemorrhage studies on our understanding of glaucoma. SOURCES Major articles published during the last 50 years since the rediscovery of disc hemorrhage were identified. A total of 196 articles were selected from 435 articles retrieved using the keywords glaucoma and disc hemorrhage as of August 9 2018 from PubMed. RECENT FINDINGS The main characteristics of disc hemorrhage, including its morphology, recurrence rate, duration, increased incidence in glaucoma, and role in the progression of normal tension glaucoma was well understood by the year 2000. Since then, studies have focused on more sophisticated and accurate methods of elucidating both structural and functional progression, with special attention to the role of the lamina cribrosa. Nevertheless, both the mechanism of disc hemorrhage development and its fuller relationship with glaucoma remain unclear. Disc hemorrhage research requires careful study of glaucomatous optic neuropathy. This has been facilitated by recent advances in optical coherence tomography (OCT) angiography and other OCT technologies. Furthermore, animal studies of disc hemorrhage promise new insights into glaucomatous optic neuropathy.
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Affiliation(s)
- Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, 501-1194, Japan.
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Wei FF, Huang QF, Zhang ZY, Van Keer K, Thijs L, Trenson S, Yang WY, Cauwenberghs N, Mujaj B, Kuznetsova T, Allegaert K, Struijker-Boudier HAJ, Verhamme P, Vermeer C, Staessen JA. Inactive matrix Gla protein is a novel circulating biomarker predicting retinal arteriolar narrowing in humans. Sci Rep 2018; 8:15088. [PMID: 30305657 PMCID: PMC6180139 DOI: 10.1038/s41598-018-33257-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022] Open
Abstract
Active matrix Gla protein (MGP), a potent inhibitor of calcification in large arteries, protects against macrovascular complications. Recent studies suggested that active MGP helps maintaining the integrity of the renal and myocardial microcirculation, but its role in preserving the retinal microcirculation remains unknown. In 935 randomly recruited Flemish participants (mean age, 40.9 years; 50.3% women), we measured plasma desphospho-uncarboxylated MGP (dp-ucMGP), a marker of poor vitamin K status using an ELISA-based assay at baseline (1996-2010) and retinal microvascular diameters using IVAN software (Vasculomatic ala Nicola, version 1.1) including the central retinal arteriolar (CRAE) and venular (CRVE) equivalent and the arteriole-to-venule ratio (AVR) at follow-up (2008-2015). CRAE (P = 0.005) and AVR (P = 0.080) at follow-up decreased across tertiles of the dp-ucMGP distribution. In unadjusted models, for a doubling of dp-ucMGP at baseline, CRAE and AVR at follow-up respectively decreased by 1.40 µm (95% confidence interval [CI], 0.32 to 2.48; P = 0.011) and 0.006 (CI, 0.001 to 0.011; P = 0.016). In multivariable-adjusted models accounting for sex, baseline characteristics and follow-up duration, these estimates were -1.03 µm (CI, -1.96 to -0.11; P = 0.028) and -0.007 (CI, -0.011 to -0.002; P = 0.007). Additional adjustment for changes from baseline to follow-up in major baseline characteristics yielded as estimates -0.91 µm (CI, -1.82 to -0.01; P = 0.048) and -0.006 (95% CI, -0.011 to -0.001; P = 0.014), respectively. Circulating inactive dp-ucMGP is a long-term predictor of smaller retinal arteriolar diameter in the general population. Our observations highlight the possibility that vitamin K supplementation might promote retinal health.
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Affiliation(s)
- Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Qi-Fang Huang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Karel Van Keer
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Sander Trenson
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Nicholas Cauwenberghs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Blerim Mujaj
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Karel Allegaert
- Research Unit Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
- Department of Pediatric Surgery and Intensive Care and Neonatology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Peter Verhamme
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
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