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Hong S, Yang H, Gardiner SK, Luo H, Sharpe GP, Caprioli J, Demirel S, Girkin CA, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Jiravarnsirikul A, Zangalli C, Chauhan BC, Burgoyne CF. Optical Coherence Tomographic Optic Nerve Head Morphology in Myopia III: The Exposed Neural Canal Region in Healthy Eyes-Implications for High Myopia. Am J Ophthalmol 2024; 258:55-75. [PMID: 37673378 PMCID: PMC10841091 DOI: 10.1016/j.ajo.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE To determine the prevalence and magnitude of optical coherence tomography (OCT) exposed neural canal (ENC), externally oblique choroidal border tissue (EOCBT), and exposed scleral flange (ESF) regions in 362 non-highly myopic (spherical equivalent -6.00 to 5.75 diopters) eyes of 362 healthy subjects. DESIGN Cross-sectional study. METHODS After OCT optic nerve head (ONH) imaging, Bruch membrane opening (BMO), the anterior scleral canal opening (ASCO), and the scleral flange opening (SFO) were manually segmented. BMO, ASCO, and SFO points were projected to the BMO reference plane. The direction and magnitude of BMO/ASCO offset as well as the magnitude of ENC, EOCBT, and ESF was calculated within 30° sectors relative to the foveal-BMO axis. Hi-ESF eyes demonstrated an ESF ≥100 µm in at least 1 sector. Sectoral peri-neural canal choroidal thickness (pNC-CT) was measured and correlations between the magnitude of sectoral ESF and proportional pNC-CT were assessed. RESULTS Seventy-three Hi-ESF (20.2%) and 289 non-Hi-ESF eyes (79.8%) were identified. BMO/ASCO offset as well as ENC, EOCBT, and ESF prevalence and magnitude were greatest inferior temporally where the pNC-CT was thinnest. Among Hi-ESF eyes, the magnitude of each ENC region correlated with the BMO/ASCO offset magnitude, and the sectors with the longest ESF correlated with the sectors with proportionally thinnest pNC-CT. CONCLUSIONS ONH BMO/ASCO offset, either as a cause or result of ONH neural canal remodeling, corresponds with the sectoral location of maximum ESF and minimum pNC-CT in non-highly myopic eyes. Longitudinal studies to characterize the development and clinical implications of ENC Hi-ESF regions in non-highly myopic and highly myopic eyes are indicated.
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Affiliation(s)
- Seungwoo Hong
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Yebon Eye Clinic (S.H.), Seoul, Korea
| | - Hongli Yang
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Haomin Luo
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Department of Ophthalmology, Hunan Provincial People's Hospital, Hunan Normal University (H.L.), Changsha, Hunan Province, China
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University (G.P.S., B.C.C.), Halifax, Nova Scotia, Canada
| | - Joseph Caprioli
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA (J.C.), Los Angeles, California, USA
| | - Shaban Demirel
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham (C.A.G.), Birmingham, Alabama, USA
| | - Christian Y Mardin
- Department of Ophthalmology, University of Erlangen (C.Y.M.), Erlangen, Germany
| | - Harry A Quigley
- Wilmer Eye Institute, Johns Hopkins University (H.A.Q.), Baltimore, Maryland, USA
| | | | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Anuwat Jiravarnsirikul
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University (A.J.), Bangkok, Thailand
| | - Camila Zangalli
- Department of Glaucoma, Hospital de Olhos Niteroi (C.Z.), Rio de Janeiro, Brazil
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University (G.P.S., B.C.C.), Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA.
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Chen D, Ran Ran A, Fang Tan T, Ramachandran R, Li F, Cheung CY, Yousefi S, Tham CCY, Ting DSW, Zhang X, Al-Aswad LA. Applications of Artificial Intelligence and Deep Learning in Glaucoma. Asia Pac J Ophthalmol (Phila) 2023; 12:80-93. [PMID: 36706335 DOI: 10.1097/apo.0000000000000596] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 01/28/2023] Open
Abstract
Diagnosis and detection of progression of glaucoma remains challenging. Artificial intelligence-based tools have the potential to improve and standardize the assessment of glaucoma but development of these algorithms is difficult given the multimodal and variable nature of the diagnosis. Currently, most algorithms are focused on a single imaging modality, specifically screening and diagnosis based on fundus photos or optical coherence tomography images. Use of anterior segment optical coherence tomography and goniophotographs is limited. The majority of algorithms designed for disease progression prediction are based on visual fields. No studies in our literature search assessed the use of artificial intelligence for treatment response prediction and no studies conducted prospective testing of their algorithms. Additional challenges to the development of artificial intelligence-based tools include scarcity of data and a lack of consensus in diagnostic criteria. Although research in the use of artificial intelligence for glaucoma is promising, additional work is needed to develop clinically usable tools.
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Affiliation(s)
- Dinah Chen
- Department of Ophthalmology, NYU Langone Health, New York City, NY
- Genentech Inc, South San Francisco, CA
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment And Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Ting Fang Tan
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Center, Singapore
| | | | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment And Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Siamak Yousefi
- Department of Ophthalmology, The University of Tennessee Health Science Center, Memphis, TN
| | - Clement C Y Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment And Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Ramachandran R, Joiner DB, Patel V, Popplewell D, Misra P, Kaplan CM, Hood DC, Al-Aswad LA. Comparison between the Recommendations of Glaucoma Specialists and OCT Report Specialists for Further Ophthalmic Evaluation in a Community-Based Screening Study. Ophthalmol Glaucoma 2022; 5:602-613. [PMID: 35688330 DOI: 10.1016/j.ogla.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To compare glaucoma referral patterns between glaucoma and OCT report specialists and to determine what influence, if any, a designated OCT reading could have on a glaucoma specialist's judgments. DESIGN Retrospective, exploratory study. SUBJECTS We included 483 eyes (243 individuals) from high-risk New York City neighborhoods screened as part of a mobile van glaucoma screening study from July 2017 to October 2017. METHODS All participants underwent comprehensive testing, including visual acuity, commercial OCT imaging, gonioscopy, intraocular pressure, frequency-doubling testing, and funduscopic assessment. Three glaucoma specialists independently evaluated all the collected data to determine whether a further glaucoma workup referral was recommended. Two OCT report specialists evaluated only the OCT image for each eye using the commercial report as well as a specialized, customized report. In phase II, the glaucoma specialists then re-evaluated a subset of these eyes, this time with an OCT report specialist's judgments made available. MAIN OUTCOME MEASURES Comparison of glaucoma specialist referrals made by glaucoma specialists versus OCT report specialists. RESULTS Intergrader agreement between glaucoma specialists was 60% (κ = 0.43) and between report specialists was 95% (κ = 0.77). There was an agreement between a single OCT report specialist and the consensus (2 of 3) of glaucoma specialists in 74% of eyes (κ= 0.32). Of the eyes studied, 25% were referred for further glaucoma evaluation by the glaucoma specialists alone and 1% were referred for further glaucoma workup by only the report specialist. With the addition of the report specialist's judgments, referral pattern changes varied by glaucoma specialist but overall agreement increased to 85% (κ = 0.53). CONCLUSIONS There was a fair level of agreement regarding glaucoma referral recommendations between glaucoma specialists with access to comprehensive screening data and OCT report specialists with access to only OCT data. Overall agreement increased when the designated OCT evaluation was made available to the glaucoma specialists. These results may aid in the design of future large-scale glaucoma screening studies.
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Affiliation(s)
| | - Devon B Joiner
- Department of Psychology, Columbia University, New York, New York
| | - Vipul Patel
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | | | - Poonam Misra
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - Chad M Kaplan
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - Donald C Hood
- Department of Psychology, Columbia University, New York, New York; Department of Ophthalmology, Columbia University, New York, New York
| | - Lama A Al-Aswad
- Department of Ophthalmology, NYU Langone Health, New York, New York; Department of Ophthalmology, Columbia University, New York, New York.
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Al-Aswad LA, Ramachandran R, Schuman JS, Medeiros F, Eydelman MB. Artificial Intelligence for Glaucoma: Creating and Implementing Artificial Intelligence for Disease Detection and Progression. Ophthalmol Glaucoma 2022; 5:e16-e25. [PMID: 35218987 PMCID: PMC9399304 DOI: 10.1016/j.ogla.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
On September 3, 2020, the Collaborative Community on Ophthalmic Imaging conducted its first 2-day virtual workshop on the role of artificial intelligence (AI) and related machine learning techniques in the diagnosis and treatment of various ophthalmic conditions. In a session entitled "Artificial Intelligence for Glaucoma," a panel of glaucoma specialists, researchers, industry experts, and patients convened to share current research on the application of AI to commonly used diagnostic modalities, including fundus photography, OCT imaging, standard automated perimetry, and gonioscopy. The conference participants focused on the use of AI as a tool for disease prediction, highlighted its ability to address inequalities, and presented the limitations of and challenges to its clinical application. The panelists' discussion addressed AI and health equities from clinical, societal, and regulatory perspectives.
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Affiliation(s)
- Lama A Al-Aswad
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York; Department of Population Health, NYU Langone Health, NYU Grossman School of Medicine, New York, New York.
| | - Rithambara Ramachandran
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York; Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, New York; Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, Brooklyn, New York; Center for Neural Science, NYU, New York, New York; Neuroscience Institute, NYU Langone Health, New York, New York
| | - Felipe Medeiros
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina
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Bartlett RL, Frost BE, Mortlock KE, Fergusson JR, White N, Morgan JE, North RV, Albon J. Quantifying biomarkers of axonal degeneration in early glaucoma to find the disc at risk. Sci Rep 2022; 12:9366. [PMID: 35672326 PMCID: PMC9174204 DOI: 10.1038/s41598-022-12036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
To evaluate regional axonal-related parameters as a function of disease stage in primary open angle glaucoma (POAG) and visual field (VF) sensitivity. Spectral domain optical coherence tomography was used to acquire 20° scans of POAG (n = 117) or healthy control (n = 52) human optic nerve heads (ONHs). Region specific and mean nerve fibre layer (NFL) thicknesses, border NFL and peripapillary NFL, minimum rim width (MRW)/ area (MRA) and prelamina thickness; and volume were compared across POAG disease stages and with visual field sensitivity. Differences identified between early glaucoma (EG), preperimetric glaucoma (PG) and control (C) ONHs included thinner PG prelamina regions than in controls (p < 0.05). Mean border NFL was thinner in EG (p < 0.001) and PG (p = 0.049) compared to control eyes; and EG mean, and inferior and ST, border NFL was thinner than in PG (p < 0.01). Mean, superior and inferior PG peripapillary NFL were thinner than in controls (p < 0.05), and EG ST peripapillary NFL was thinner than in PG (p = 0.023). MRW differences included: PG SN and inferior less than in controls (p < 0.05); thinner EG mean regional, inferior, nasal, and ST MRW versus PG MRW (p < 0.05). Regional border NFL, peripapillary NFL, MRW, MRA, prelamina thickness (except centre, p = 0.127) and prelamina volume (p < 0.05) were significantly associated with VF mean deviation (MD). Novel axon-derived indices hold potential as biomarkers to detect early glaucoma and identify ONHs at risk.
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Affiliation(s)
- R L Bartlett
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - B E Frost
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- School of Biosciences, Cardiff University, Cardiff, UK
| | - K E Mortlock
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J R Fergusson
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - N White
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J E Morgan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - R V North
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J Albon
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK.
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK.
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The treatment of end-stage corneal disease: penetrating keratoplasty compared with Boston type 1 keratoprosthesis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2781-2790. [PMID: 35384455 DOI: 10.1007/s00417-022-05646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 11/04/2022] Open
Abstract
Penetrating keratoplasty (PKP) yields excellent results for restoring vision in end-stage corneal diseases. However, its success is limited to high-risk diseases such as aniridia, chemical burns, autoimmune corneal diseases, and herpetic eye disease. Boston type 1 keratoprosthesis (BKPro) offers another option to these patients. Since 1992, improvements in perioperative management and device construction have significantly increased the use of BKPro worldwide and challenged the therapeutic role of PKP in these patients. This review aims to evaluate BKPro's place in the treatment algorithm of these high-risk patients to assist surgeons' decision-making. PKP and BKPro are compared in three outcome categories: visual acuity, graft retention and failure, and complications profile. Special attention is given to comparing secondary BKPro versus repeated PKP as well as primary BKPro versus primary PKP. We conclude that secondary BKPro bears a better prognosis than repeated PKP in most high-risk patients. Similarly, primary BKPro likely confers improved outcomes over primary PKP in most high-risk recipients. However, current evidence is based on retrospective designs, and controlled prospective randomized trials are required to validate these conclusions.
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Akpek EK, Karakus S, Yohannan J, Jabbour S, Sotimehin AE, Li G, Ramulu PY. Reliability of Several Glaucoma Tests in Patients With Boston Type 1 Keratoprosthesis. Cornea 2022; 41:310-316. [PMID: 34133397 DOI: 10.1097/ico.0000000000002800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Managing glaucoma after Boston type 1 keratoprosthesis (KPro) surgery remains challenging. We herein assessed the fitness of commonly used clinical tests to evaluate glaucoma in KPro eyes versus eyes with penetrating keratoplasty (PK) as controls. METHODS Sixteen patients with KPro and 14 patients with PK tested in an identical manner. After the 10-2 visual field with size V stimulus, intraocular pressure (IOP) was estimated with palpation by the first observer. Then, retinal nerve fiber layer (RNFL) thickness analysis was performed twice using optical coherence tomography by an ophthalmic photographer, before and after a short break. After the second observer estimated the IOP, the visual field was repeated. Finally, color photographs of the optic disk were captured by an ophthalmic photographer. The cup-to-disk ratio was assessed by 2 masked observers, at 2 different time points, in a random manner. Agreements between and within observers and reliability of repeated measurements were evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS Inter-rater agreement of palpation IOP estimate was moderate for eyes with KPro (ICC = 0.47) and fair for eyes with PK (ICC = 0.27). Visual field and RNFL thickness showed high test-retest reliability in both KPro and PK eyes (ICC > 0.80 for both). Inter-rater agreement of cup-to-disk ratio assessments was substantial in eyes with both KPro (ICC = 0.62) and PK (ICC = 0.70). CONCLUSIONS The 10-2 visual field and RNFL thickness seem sufficiently repeatable and might allow the detection of glaucoma progression in KPro eyes. Such testing is important, given limited inter-rater agreement regarding the palpation IOP estimate.
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Affiliation(s)
- Esen K Akpek
- Ocular Surface Disease Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Sezen Karakus
- Ocular Surface Disease Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Jithin Yohannan
- Glaucoma Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Samir Jabbour
- Ocular Surface Disease Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Ayodeji E Sotimehin
- Glaucoma Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gavin Li
- Ocular Surface Disease Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Pradeep Y Ramulu
- Glaucoma Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Rezapour J, Bowd C, Dohleman J, Belghith A, Proudfoot JA, Christopher M, Hyman L, Jonas JB, Fazio MA, Weinreb RN, Zangwill LM. The influence of axial myopia on optic disc characteristics of glaucoma eyes. Sci Rep 2021; 11:8854. [PMID: 33893383 PMCID: PMC8065167 DOI: 10.1038/s41598-021-88406-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/05/2021] [Indexed: 12/21/2022] Open
Abstract
This study characterizes differences in glaucomatous eyes with and without high axial myopia using custom automated analysis of OCT images. 452 eyes of 277 glaucoma patients were stratified into non (n = 145 eyes), mild (n = 214 eyes), and high axial myopia (axial length (AL) > 26 mm, n = 93 eyes). Optic disc ovality index, tilt and rotation angle of Bruch´s membrane opening (BMO) and peripapillary choroidal thickness (PCT) were calculated using automated and deep learning strategies. High myopic optic discs were more oval and had larger BMO tilt than mild and non-myopic discs (both p < 0.001). Mean PCT was thinnest in high myopic eyes followed by mild and non-myopic eyes (p < 0.001). BMO rotation angle, global retinal nerve fiber layer (RNFL) thickness and BMO-minimum rim width (MRW) were similar among groups. Temporal RNFL was thicker and supranasal BMO-MRW was thinner in high myopic eyes. BMO tilt and PCT showed moderate and temporal RNFL and nasal BMO-MRW showed weak but significant associations with AL in multivariable analyses (all p < 0.05). Large BMO tilt angle and thin PCT are characteristics of highly myopic discs and were not associated with severity of glaucoma. Caution should be exercised when using sectoral BMO-MRW and RNFL thickness for glaucoma management decisions in myopic eyes.
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Affiliation(s)
- Jasmin Rezapour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Jade Dohleman
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Leslie Hyman
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Science, School of Medicine, The University of Alabama At Birmingham, Birmingham, AL, USA
- Department of Biomedical Engineering, School of Engineering, The University of Alabama At Birmingham, Birmingham, AL, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA.
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9
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Fortune B. Optical coherence tomography evaluation of the optic nerve head neuro‐retinal rim in glaucoma. Clin Exp Optom 2021; 102:286-290. [DOI: 10.1111/cxo.12833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/09/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Health, Portland, Oregon, USA,
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10
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Bak E, Lee KM, Kim M, Oh S, Kim SH. Angular Location of Retinal Nerve Fiber Layer Defect: Association With Myopia and Open-Angle Glaucoma. Invest Ophthalmol Vis Sci 2021; 61:13. [PMID: 32902578 PMCID: PMC7488617 DOI: 10.1167/iovs.61.11.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare retinal nerve fiber layer (RNFL) defects' angle measurements determined from the center of the optic disc and Bruch's membrane opening (BMO), as a function of myopia and open-angle glaucoma (OAG) subtypes. Methods In total, 118 patients with OAG were grouped by axial length (AL; high myopia, AL >26 mm; mild to moderate myopia, 24 ≤ AL ≤26 mm; nonmyopia, AL <24 mm) and OAG subtype (normal-tension glaucoma [NTG], high-tension glaucoma [HTG]). The disc and BMO centers were determined by a merged image of red-free fundus photography and spectral-domain optical coherence tomography. The angular location of the RNFL defect close to the fovea (angle α) was measured from the disc center and BMO center, respectively (angle αdisc and angle αBMO). The difference between angle αdisc and αBMO (Δα), as well as the RNFL defect width (angle γ), was evaluated. Results Angle αdisc was smaller in myopic eyes and correlated significantly with AL (P = 0.001), whereas it did not differ among OAG subgroups. Angle αBMO and angle γ were not different in the myopic and OAG subgroups. The Δ α was larger for eyes with higher degree of myopia and had significant correlation with AL (P < 0.001) and was larger in NTG eyes than in HTG eyes (P = 0.023). Conclusions The angular location of the RNFL defect measured from the disc center, but not from the BMO center, was closer to the fovea for glaucomatous eyes with higher values of AL. The present study may facilitate understanding of the characteristic locational pattern of the RNFL defect in myopic glaucomatous eyes.
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Affiliation(s)
- Eunoo Bak
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seok Hwan Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Boramae Medical Center, Seoul, Korea
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11
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Wolfram C, Schuster AK. [Glaucoma care in Germany-Results of a survey among German ophthalmologists-Part 1: diagnostics]. Ophthalmologe 2021; 119:38-45. [PMID: 33733713 PMCID: PMC8763939 DOI: 10.1007/s00347-021-01352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Die Möglichkeiten in der Glaukomversorgung sind in den letzten Jahren immer vielfältiger geworden. Unter den Mitgliedern der Deutschen Ophthalmologischen Gesellschaft (DOG) und des Berufsverbands der Augenärzte Deutschlands (BVA) wurde eine anonymisierte Befragung durchgeführt, um zu erfassen, welche Behandlungswege in der Versorgung von Glaukompatienten gewählt werden, welche diagnostischen Parameter den Augenärztinnen und Augenärzten wichtig sind und welche Rolle Behandlungsleitlinien in der Alltagspraxis zukommt. Ziel der Arbeit Meinungsbild unter der deutschen Augenärzteschaft über die aktuelle Glaukomversorgung, zentrale diagnostische Parameter und ihre Anwendung in der Alltagspraxis. Material und Methoden Die Befragung wurde durch einen Online-Fragebogen mit insgesamt 26 Fragen (107 Items) zur Versorgungspraxis in der Glaukomdiagnostik und der Glaukomtherapie durchgeführt. Vollständig ausgefüllte Fragebögen lagen von 1361 Personen vor. Ergebnisse Die Papillenbeurteilung an der Spaltlampe hat für Augenärzte weiterhin den höchsten diagnostischen Stellenwert. Auch der Rolle der optischen Kohärenztomographie (OCT) kommt eine sehr hohe diagnostische Bewertung zu. Bei der Interpretation verschiedener diagnostischer Parameter ergibt sich eine höhere Sicherheit für papillennahe Parameter unter den Befragten. Eine leitliniengemäße Versorgung wird nach Selbstauskunft der Augenärzte weitgehend betrieben. Etwa zwei Drittel der Befragten führen im ersten Behandlungsjahr zwei oder mehr Gesichtsfelduntersuchungen durch und ebenso eine strukturelle Papillendarstellung einmal im Jahr. Die Rolle der Gonioskopie wird kontrovers gesehen und nicht einheitlich intensiv praktiziert. Diskussion Die Diagnosestellung beim Glaukom ist eine große klinische Herausforderung. Die verschiedenen diagnostischen Parameter haben einen unterschiedlich hohen Wert für Augenärzte. Morphometrische Verfahren haben eine sehr hohe Bedeutung gewonnen und ermöglichen eine assistierte, jedoch keine automatisierte Diagnostik. Mehr Behandlungsleitlinien und Standards bei der Glaukomversorgung werden gewünscht und sollten in Aus- und Weiterbildung und in den Behandlungsalltag implementiert sein.
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Affiliation(s)
- Christian Wolfram
- Augenklinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Alexander K Schuster
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
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12
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Gedde SJ, Lind JT, Wright MM, Chen PP, Muir KW, Vinod K, Li T, Mansberger SL. Primary Open-Angle Glaucoma Suspect Preferred Practice Pattern®. Ophthalmology 2021; 128:P151-P192. [DOI: 10.1016/j.ophtha.2020.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022] Open
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13
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Ha A, Kim YK, Kim JS, Jeoung JW, Park KH. Temporal Raphe Sign in Elderly Patients With Large Optic Disc Cupping: Its Evaluation as a Predictive Factor for Glaucoma Conversion. Am J Ophthalmol 2020; 219:205-214. [PMID: 32652053 DOI: 10.1016/j.ajo.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine baseline clinical features associated with conversion to glaucoma in elderly patients with large optic-disc cupping. DESIGN Retrospective cohort study. METHODS Seventy-two eyes of 72 untreated elderly (≥65-year-old) patients with large vertical cup-to-disc ratio (CDR ≥0.7) and without any other glaucomatous findings were included. They had undergone a full ophthalmologic examination twice per year for at least 5 years. The optic nerve head (ONH), peripapillary retinal nerve fiber layer (RNFL), and macular ganglion cell-inner plexiform layer (GCIPL) were imaged with Cirrus high-definition optical coherence tomography (OCT). Presence of temporal raphe sign on the OCT's GCIPL thickness map was assessed as one of the morphologic factors. Conversion to normal-tension glaucoma (NTG) was defined as structural or functional deterioration on either red-free RNFL photography or standard automated perimetry, respectively. The utility of the baseline factors associated with conversion to NTG were identified. RESULTS During the 5.5-year follow-up, 19 eyes (26.4%) converted to NTG. There were no significant differences in demographics, systemic factors, intraocular pressure factors, or OCT parameters between the nonconverters and converters. Interestingly, the temporal raphe sign was observed in the converters (18/19, 94.7%) much more frequently than in the nonconverters (3/53, 5.7%, P < .001) at baseline. A Cox proportional hazards model indicated the significant influences of temporal raphe sign positivity (hazard ratio 6.823, 95% confidence interval 2.574, 18.088, P < .001) on conversion to NTG. CONCLUSIONS In elderly subjects with large CDR, temporal raphe sign positivity on the baseline macular GCIPL thickness map was associated with faster conversion to NTG.
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Affiliation(s)
- Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Republic of Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Soo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea.
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14
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Lee EJ, Han JC, Park DY, Kee C. A neuroglia-based interpretation of glaucomatous neuroretinal rim thinning in the optic nerve head. Prog Retin Eye Res 2020; 77:100840. [PMID: 31982595 DOI: 10.1016/j.preteyeres.2020.100840] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Neuroretinal rim thinning (NRR) is a characteristic glaucomatous optic disc change. However, the precise mechanism of the rim thinning has not been completely elucidated. This review focuses on the structural role of the glioarchitecture in the formation of the glaucomatous NRR thinning. The NRR is a glia-framed structure, with honeycomb geometry and mechanically reinforced astrocyte processes along the transverse plane. When neural damage selectively involves the neuron and spares the glia, the gross structure of the tissue is preserved. The disorganization and loss of the glioarchitecture are the two hallmarks of optic nerve head (ONH) remodeling in glaucoma that leads to the thinning of NRR tissue upon axonal loss. This is in contrast to most non-glaucomatous optic neuropathies with optic disc pallor where hypertrophy of the glioarchitecture is associated with the seemingly absent optic disc cupping. Arteritic anterior ischemic optic neuropathy is an exception where pan-necrosis of ONH tissue leads to NRR thinning. Milder ischemia indicates selective neuronal loss that spares glia in non-arteritic anterior ischemic optic neuropathy. The biological reason is the heterogeneous glial response determined by the site, type, and severity of the injury. The neuroglial interpretation explains how the cellular changes underlie the clinical findings. Updated understandings on glial responses illustrate the mechanical, microenvironmental, and microglial modulation of activated astrocytes in glaucoma. Findings relevant to the possible mechanism of the astrocyte death in advanced glaucoma are also emerging. Ultimately, a better understanding of glaucomatous glial response may lead to glia-targeting neuroprotection in the future.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
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15
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Maupin E, Baudin F, Arnould L, Seydou A, Binquet C, Bron AM, Creuzot-Garcher CP. Accuracy of the ISNT rule and its variants for differentiating glaucomatous from normal eyes in a population-based study. Br J Ophthalmol 2020; 104:1412-1417. [PMID: 31959590 DOI: 10.1136/bjophthalmol-2019-315554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Allasane Seydou
- Clinical Investigation Centre, Clinical Epidemiology Unit, University Hospital, Dijon, France
| | - Christine Binquet
- Clinical Investigation Centre, Clinical Epidemiology Unit, University Hospital, Dijon, France
| | - Alain M Bron
- Ophthalmology, University Hospital, Dijon, France
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Catherine P Creuzot-Garcher
- Ophthalmology, University Hospital, Dijon, France
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
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16
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Suh MH, Park JW, Khandelwal N, Agrawal R. Peripapillary Choroidal Vascularity Index and Microstructure of Parapapillary Atrophy. Invest Ophthalmol Vis Sci 2020; 60:3768-3775. [PMID: 31499532 DOI: 10.1167/iovs.18-26286] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the association between the microstructure of β-zone parapapillary atrophy (βPPA) and choroidal vascularity index (CVI) determined by spectral-domain optical coherence tomography (SD-OCT) in glaucomatous eyes. Methods A total of 160 eyes of 160 primary open-angle glaucoma patients with βPPA were included. Total choroidal area (TCA), luminal area (LA), and CVI were measured at a 3.5-mm distance from the Bruch's membrane (BM) opening center by image binarization of SD-OCT B-scans. The widths of βPPA with BM (βPPA+BM) and without BM (βPPA-BM), and juxtapapillary choroidal thickness (JPCT) were measured on six radial SD-OCT images. OCT angiography-derived parapapillary deep-layer microvasculature dropout (MvD_P) was also derived. Results In the multivariate regression analysis, larger βPPA+BM was significantly associated with smaller TCA and smaller LA (P < 0.05, respectively), but not with CVI and JPCT (P > 0.05, respectively). Meanwhile, βPPA-BM was not significantly associated with TCA, LA, CVI, or JPCT in the multivariate regression analysis (P > 0.05). Conclusions Despite significant relationship between the choroidal thinning and larger βPPA+BM, choroidal vascularity was not associated with the βPPA+BM width. These findings suggest that the presumed common pathogenic mechanism between RPE atrophy and peripapillary choroidal thinning may not be mediated by the impaired choroidal perfusion in glaucomatous eyes. Future studies on the mechanisms in explaining the relationship between the atrophy of retinal pigment epithelium (RPE) and choroid in glaucoma are needed.
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Affiliation(s)
- Min Hee Suh
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jun Woo Park
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Neha Khandelwal
- National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
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17
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Hong S, Yang H, Gardiner SK, Luo H, Hardin C, Sharpe GP, Caprioli J, Demirel S, Girkin CA, Liebmann JM, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Chauhan BC, Burgoyne CF. OCT-Detected Optic Nerve Head Neural Canal Direction, Obliqueness, and Minimum Cross-Sectional Area in Healthy Eyes. Am J Ophthalmol 2019; 208:185-205. [PMID: 31095953 DOI: 10.1016/j.ajo.2019.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To assess anterior scleral canal opening (ASCO) offset relative to Bruch's membrane opening (BMO) (ASCO/BMO offset) so as to determine neural canal direction, obliqueness, and minimum cross-sectional area (NCMCA) in 362 healthy eyes. DESIGN Cross-sectional study. METHODS After optical coherence tomography optic nerve head and retinal nerve fiber layer thickness (RNFLT) imaging, BMO and ASCO were manually segmented. Planes, centroids, size, and shape were calculated. Neural canal direction was defined by projecting the neural canal axis vector (connecting BMO and ASCO centroids) onto the BMO plane. Neural canal obliqueness was defined by the angle between the neural canal axis and the BMO plane perpendicular vector. NCMCA was defined by projecting BMO and ASCO points onto a neural canal axis perpendicular plane and measuring the area of overlap. The angular distance between superior and inferior peak RNFLT was measured, and correlations between RFNLT, BMO, ASCO, ASCO/BMO offset, and NCMCA were assessed. RESULTS Mean (SD) NCMCA was significantly smaller than either the BMO or ASCO area (1.33 (0.42), 1.82 (0.38), 2.22 (0.43) mm2, respectively), and most closely correlated to RNFLT (P < .001, R2 = 0.158). Neural canal direction was most commonly superior-nasal (55%). Mean neural canal obliqueness was 39.4° (17.3°). The angular distance between superior and inferior peak RNFLT correlated to neural canal direction (P ≤ .008, R2 = 0.093). CONCLUSIONS ASCO/BMO offset underlies neural canal direction, obliqueness, and NCMCA. RNFLT is more strongly correlated to NCMCA than to BMO or ASCO, and its peripapillary distribution is influenced by neural canal direction.
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Affiliation(s)
- Seungwoo Hong
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology, Medical College, the Catholic University of Korea, Seoul, Korea
| | - Hongli Yang
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, USA
| | - Haomin Luo
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China; Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA
| | - Christy Hardin
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Joseph Caprioli
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shaban Demirel
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, USA
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey M Liebmann
- Einhorn Clinical Research Center, Moise and Chella Safra Advanced Ocular Imaging Laboratory, New York Eye and Ear Infirmary of Mount Sinai Health System, New York, USA
| | | | - Harry A Quigley
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon, USA
| | | | - Claude F Burgoyne
- Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute, Portland, Oregon, USA.
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18
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Torres LA, Sharpe GP, Hutchison DM, Zangalli CS, Burk RO, Reis AS, Costa VP, Nicolela MT, Chauhan BC, Vianna JR. Influence of Bruch's Membrane Opening Area in Diagnosing Glaucoma With Neuroretinal Parameters From Optical Coherence Tomography. Am J Ophthalmol 2019; 208:94-102. [PMID: 31351051 DOI: 10.1016/j.ajo.2019.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE To determine whether the glaucoma diagnostic accuracy of age- and Bruch membrane opening area (BMOA)-adjusted normative classifications of minimum rim width (MRW) and retinal nerve fiber layer thickness (RNFLT) is dependent on BMOA, in a European descent population. DESIGN Retrospective, cross-sectional study. METHODS We included 182 glaucoma patients and 166 healthy controls for the primary study, and 105 glaucoma patients in a second sample used for a replication study. Optical coherence tomography (Spectralis) measurements of BMOA, global MRW, and RNFLT and normative classifications from the device software were exported for analysis. Sensitivity and specificity were calculated for a conservative criterion (abnormal = "outside normal limits" classification) and a liberal criterion (abnormal = "outside normal limits" or "borderline" classifications). The dependence of sensitivity and specificity on BMOA was analyzed with comparison among subgroups divided by tertiles of BMOA, and with logistic regression. RESULTS For the conservative criterion, MRW sensitivity was independent of BMOA (P ≥ .76), while RNFLT sensitivity increased in the large BMOA subgroup (P = .04, odds ratio: 1.2 per mm2 [P = .02]). For the liberal criterion, MRW and RNFLT sensitivities were independent of BMOA (P ≥ .53). Specificities were independent of BMOA (P ≥ .07). For the replication sample, which included younger patients with larger BMOA and worse visual field damage than the primary sample, sensitivities were independent of BMOA for both criteria (P ≥ .10). CONCLUSIONS RNFLT sensitivity was higher in eyes with larger BMOA; however, age and visual field damage may influence that association. MRW diagnostic accuracy was not dependent on BMOA.
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Daneshvar R, Yarmohammadi A, Alizadeh R, Henry S, Law SK, Caprioli J, Nouri-Mahdavi K. Prediction of Glaucoma Progression with Structural Parameters: Comparison of Optical Coherence Tomography and Clinical Disc Parameters. Am J Ophthalmol 2019; 208:19-29. [PMID: 31247169 DOI: 10.1016/j.ajo.2019.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To test the hypothesis that baseline optical coherence tomography (OCT) measures predict visual field (VF) progression in a cohort of patients with suspected or established glaucoma and to compare their performance to semiquantitative optic disc measures. DESIGN This was an observational cohort study. METHODS The setting of this study was an academic institution. The study population included 171 eyes of 95 patients with good-quality baseline retinal nerve fiber layer (RNFL) and macular OCT images and disc photographs with >2 years of follow-up and ≥5 VFs. The observation procedures were baseline macular and RNFL OCT measures and cup-to-disc ratio and disc damage likelihood score. The main outcome measure was prediction of glaucomatous VF deterioration according to trend and event analyses. RESULTS Median (interquartile range) baseline mean deviation and follow-up were -2.9 (-6.4 to -1.1) dB and 54 (44-65) months, respectively. Seventeen and 25 eyes progressed by final visit based on pointwise event analysis and trend analysis of visual field index (VFI), respectively. Thinner central corneal thickness (P = .005), female gender (P = .015), and thinner average peripapillary RNFL (P = .001) predicted VF progression on proportional hazard models. Thinner RNFL at baseline (P = .006) or thinner average ganglion cell-inner plexiform layer (P = .028) along with higher baseline VFI (P = .018 and .048, respectively) predicted VFI progression. Neither optic disc measures predicted VF progression in any of the explored models. CONCLUSIONS Baseline structural OCT measures predicted subsequent VF progression in contrast to semi-quantitative optic disc measures. OCT-based structural measures should be included in prognostic models of glaucomatous VF deterioration.
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Ting DS, Peng L, Varadarajan AV, Keane PA, Burlina PM, Chiang MF, Schmetterer L, Pasquale LR, Bressler NM, Webster DR, Abramoff M, Wong TY. Deep learning in ophthalmology: The technical and clinical considerations. Prog Retin Eye Res 2019; 72:100759. [DOI: 10.1016/j.preteyeres.2019.04.003] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/22/2022]
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21
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Hong SW, Koenigsman H, Yang H, Ren R, Reynaud J, Kinast RM, Mansberger SL, Fortune B, Demirel S, Gardiner SK, Burgoyne CF. Glaucoma Specialist Detection of Optical Coherence Tomography Suspicious Rim Tissue in Glaucoma and Glaucoma Suspect Eyes. Am J Ophthalmol 2019; 199:28-43. [PMID: 30414397 DOI: 10.1016/j.ajo.2018.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/19/2018] [Accepted: 10/26/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess glaucoma specialists' detection of optic nerve head (ONH) rim tissue that is thin by optical coherence tomography (OCT) criteria. DESIGN Reliability analysis. METHODS Five clinicians marked the disc margin (DM) and rim margin (RM) on stereophotographs of 151 glaucoma or glaucoma suspect eyes obtained within 3 months of OCT imaging. The photo and OCT infrared image for each eye were co-localized and regionalized into 12 sectors relative to the axis between the Bruch membrane opening (BMO) centroid and the fovea. For each clinician, the distance from BMO centroid to their DM (DM radius) and RM (RM radius) was used to generate sectoral rim width (RW) (DM radius-RM radius) and cup-to-disc ratio (CDR) (RM radius/DM radius) estimates. OCT minimum rim width (MRW) was determined by sector. Among all eyes, for each OCT MRW suspicious sector (<5% of OCT normative database), we determined each clinician's detection (clinician CDR ≥ 0.7). RESULTS Clinicians most commonly failed to detect OCT suspicious rim tissue in the nasal sectors. Among 502 sectors with suspicious OCT MRW, all 5 clinicians rated CDR ≥ 0.7 in only 29.5% and all 5 clinicians rated CDR < 0.7 in 21%. OCT suspicious rim thickness was most common (32% of eyes) in the nasal and inferior sectors. MRW vs clinician RW discordance was greatest nasally, while BMO vs clinician DM discordance was greatest temporally. CONCLUSIONS Clinicians most commonly failed to detect OCT suspicious rim thickness nasally where suspicious rim tissues were also most common.
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