1
|
Mathew DJ, Sivak JM. Lipid mediators in glaucoma: Unraveling their diverse roles and untapped therapeutic potential. Prostaglandins Other Lipid Mediat 2024; 171:106815. [PMID: 38280539 DOI: 10.1016/j.prostaglandins.2024.106815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Glaucoma is a complex neurodegenerative disease characterized by optic nerve damage and visual field loss, and remains a leading cause of irreversible blindness. Elevated intraocular pressure (IOP) is a critical risk factor that requires effective management. Emerging research underscores dual roles of bioactive lipid mediators in both IOP regulation, and the modulation of neurodegeneration and neuroinflammation in glaucoma. Bioactive lipids, encompassing eicosanoids, specialized pro-resolving mediators (SPMs), sphingolipids, and endocannabinoids, have emerged as crucial players in these processes, orchestrating inflammation and diverse effects on aqueous humor dynamics and tissue remodeling. Perturbations in these lipid mediators contribute to retinal ganglion cell loss, vascular dysfunction, oxidative stress, and neuroinflammation. Glaucoma management primarily targets IOP reduction via pharmacological agents and surgical interventions, with prostaglandin analogues at the forefront. Intriguingly, additional lipid mediators offer promise in attenuating inflammation and providing neuroprotection. Here we explore these pathways to shed light on their intricate roles, and to unveil novel therapeutic avenues for glaucoma management.
Collapse
Affiliation(s)
- D J Mathew
- Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Ophthalmology and Vision Science, University of Toronto School of Medicine, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto School of Medicine, Toronto, Canada
| | - J M Sivak
- Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Ophthalmology and Vision Science, University of Toronto School of Medicine, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto School of Medicine, Toronto, Canada.
| |
Collapse
|
2
|
Yuan Y, Xiong R, Wang W, Xu BY, Liao C, Yang S, Li C, Zhang J, Yin Q, Zheng Y, Friedman DS, Foster PJ, He M. Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect. JAMA Ophthalmol 2024; 142:216-223. [PMID: 38236591 PMCID: PMC10797526 DOI: 10.1001/jamaophthalmol.2023.5286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 01/19/2024]
Abstract
Importance Identifying primary angle closure suspect (PACS) eyes at risk of angle closure is crucial for its management. However, the risk of progression and its prediction are still understudied in long-term longitudinal studies about PACS. Objective To explore baseline predictors and develop prediction models for the 14-year risk of progression from PACS to primary angle closure (PAC). Design, Setting, and Participants This cohort study involved participants from the Zhongshan Angle Closure Prevention trial who had untreated eyes with PACS. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under both light and dark conditions. Primary angle closure was defined as peripheral anterior synechiae in 1 or more clock hours, intraocular pressure (IOP) greater than 24 mm Hg, or acute angle closure. Based on baseline covariates, logistic regression models were built to predict the risk of progression from PACS to PAC during 14 years of follow-up. Results The analysis included 377 eyes from 377 patients (mean [SD] patient age at baseline, 58.28 [4.71] years; 317 females [84%]). By the 14-year follow-up visit, 93 eyes (25%) had progressed from PACS to PAC. In multivariable models, higher IOP (odds ratio [OR], 1.14 [95% CI, 1.04-1.25] per 1-mm Hg increase), shallower central anterior chamber depth (ACD; OR, 0.81 [95% CI, 0.67-0.97] per 0.1-mm increase), and shallower limbal ACD (OR, 0.96 [95% CI, 0.93-0.99] per 0.01 increase in peripheral corneal thickness) at baseline were associated with an increased 14-year risk of progression from PACS to PAC. As for AS-OCT measurements, smaller light-room trabecular-iris space area (TISA) at 500 μm from the scleral spur (OR, 0.86 [95% CI, 0.77-0.96] per 0.01-mm2 increase), smaller light-room angle recess area (ARA) at 750 μm from the scleral spur (OR, 0.93 [95% CI, 0.88-0.98] per 0.01-mm2 increase), and smaller dark-room TISA at 500 μm (OR, 0.89 [95% CI, 0.80-0.98] per 0.01-mm2 increase) at baseline were identified as predictors for the 14-year risk of progression. The prediction models based on IOP and central and limbal ACDs showed moderate performance (area under the receiver operating characteristic curve, 0.69; 95% CI, 0.63-0.75) in predicting progression from PACS to PAC, and inclusion of AS-OCT metrics did not improve the model's performance. Conclusions and Relevance This cohort study suggests that higher IOP, shallower central and limbal ACDs, and smaller TISA at 500 μm and light-room ARA at 750 μm may serve as baseline predictors for progression to PAC in PACS eyes. Evaluating these factors can aid in customizing PACS management.
Collapse
Affiliation(s)
- Yixiong Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ruilin Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China
| | - Benjamin Y. Xu
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Chimei Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Qiuxia Yin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - David S. Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Paul J. Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Experimental Ophthalmology, The Hong Kong Polytechnic University, Hong Kong, China
| |
Collapse
|
3
|
Sihota R, Mahalingam K, Maurya AK, Sharma A, Bukke AN, Dada T. Primary congenital glaucoma: An iridotrabeculodysgenesis? Indian J Ophthalmol 2024; 72:328-334. [PMID: 38099353 PMCID: PMC11001238 DOI: 10.4103/ijo.ijo_370_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/24/2023] [Accepted: 08/11/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To analyze primary congenital glaucoma (PCG) anterior chamber and angle anomalies over 360° as possible biomarkers of severity and prognosis. METHODS A cross-sectional observational study was conducted analyzing anterior segment anomalies of PCG patients over 4 years of age who underwent trabeculectomy combined with trabeculotomy and age-matched controls using anterior segment optical coherence tomography (ASOCT), CASIA-2. Anterior iridotrabecular adhesions or anterior iris insertion was identified and quantified from the scleral spur using the iridotrabecular contact (ITC) index parameter as a surrogate. RESULTS There was a variable but significantly increased anterior iridotrabecular adhesion on ITC index, ITC area, corneal volume, anterior chamber volume, iris volume, anterior chamber depth, and small/absent trabecular meshwork in PCG eyes compared to control eyes. In PCG eyes, anterior iridotrabecular adhesion had a positive correlation with pre-operative central corneal thickness (CCT) (r = 0.53, P = 0.02), review iris thickness (r = 0.4, P = 0.04), and ITC area (r = 0.85, P < 0.001). Review iris thickness had a negative correlation with pre-operative vertical cup-disc ratio (r = -0.51, P = 0.008). Iris hypoplasia with fewer or absent folds, collarette, pupillary ruff, and pupillary ruff to collarette distance was significantly different from controls. CONCLUSION ASOCT in PCG eyes has shown that they have variable anterior iridotrabecular tissue adhesions, anomalous tissue/membranes in the angle, and iris hypoplasia correlating with pre-operative cup-disc ratio. These features could be used as gonioscopic and clinical biomarkers to assess the severity and prognosis of the disease. The presence of abnormal iris morphology and iridotrabecular tissue anomalies in PCG suggests that it is more than just isolated trabeculodysgenesis and is probably best considered as part of the anterior segment dysgenesis spectrum.
Collapse
Affiliation(s)
- Ramanjit Sihota
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Karthikeyan Mahalingam
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Maurya
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Naik Bukke
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Liao C, Quigley H, Jiang Y, Huang S, Huang W, Friedman D, Foster PJ, He M. Iris volume change with physiologic mydriasis to identify development of angle closure: the Zhongshan Angle Closure Prevention Trial. Br J Ophthalmol 2024; 108:366-371. [PMID: 37236768 DOI: 10.1136/bjo-2022-322981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/05/2023] [Indexed: 05/28/2023]
Abstract
AIMS To assess dynamic change of iris area (Iarea) and volume (VOL) with physiologic pupil dilation for progression of primary angle closure suspects. METHODS Participants underwent baseline examinations including gonioscopy and anterior segment OCT (AS-OCT) as part of the Zhongshan Angle Closure Prevention Trial. The AS-OCT images were obtained both in the dark and light. Progression was defined as development of primary angle closure or an acute angle closure attack. Static ocular biometrics and dynamic changes were compared between progressors and non-progressors and multivariable logistic regression was developed to assess risk factors for progression. RESULTS A mean 16.8% decrease in Iarea and a mean 6.26% decrease in VOL occurred with pupil dilation, while 22.96% non-progressors and 40% progressors presented VOL increases with pupil dilation. Iarea in light and dark and VOL in light were significantly smaller in progressors. In a multivariable logistic model, older age (p=0.008), narrower horizontal angle opening distance (AOD) 250 µm from the scleral spur (AOD250, p=0.001), flatter iris curvature (IC, p=0.006) and lower loss of iris volume (ΔVOL, p=0.04) were significantly associated with progression. With receiver operating characteristic analysis, the area under the curve for ΔVOL alone was 0.621, while that for the combined index (age, AOD250, IC and ΔVOL) was 0.824. Eyes with elevated intraocular pressure had less VOL loss compared with progressors developing peripheral anterior synechiae alone (p=0.055 for ΔVOL adjusted for pupil enlargement). CONCLUSION A smaller change in ΔVOL is an additive risk factor to identify eyes more likely to develop angle closure disease. TRIAL REGISTRATION NUMBER ISRCTN45213099.
Collapse
Affiliation(s)
- Chimei Liao
- Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, China
| | - Harry Quigley
- Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Yuzhen Jiang
- Ophthalmology, National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Shengsong Huang
- Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
| | - Wenyong Huang
- Ophthalmology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - David Friedman
- Ophthalmology, Harvard University, Boston, Massachusetts, USA
| | - Paul J Foster
- Division of Epidemiology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mingguang He
- Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
- Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Founti P, Narayan A, Raja A, Nathwani N, Tur SB, Thomas R, Scott A, Martins A, Nolan W. Outcomes of newly referred patients with suspected angle closure: do we need to redefine the clinical pathways? Eye (Lond) 2024; 38:514-519. [PMID: 37684375 PMCID: PMC10858203 DOI: 10.1038/s41433-023-02713-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND/OBJECTIVES To investigate outcomes of referrals for suspected angle closure and explore whether anterior segment optical coherence tomography (AS-OCT) can be used to tighten triaging criteria in a glaucoma virtual clinic. SUBJECTS/METHODS Retrospectively collected data. The first audit (04/2018-03/2019) identified referrals for suspected angle closure without other glaucoma-related findings (primary angle closure suspect (PACS) referrals). All patients underwent gonioscopy. The second audit (04-08/2019) identified patients with suspected angle closure in a virtual clinic. Management outcomes were assessed, using gonioscopy as reference standard. The outcomes of the second audit were re-audited after changing the triaging criterion from angle width <10° to iridotrabecular contact (ITC) in ≥1 quadrants on AS-OCT. RESULTS Out of 1754 glaucoma referrals (first audit), 24.6% (431/1754) were PACS referrals. Of these, only 10.7% (42/393) had an occludable angle on gonioscopy, with 97.6% (41/42) being PACS. Of these, 78% (32/41) underwent laser peripheral iridotomy. Out of 137 referrals in the virtual clinic (second audit), 66.4% (91/137) were triaged to the face-to-face clinic. Of these, 31.9% (29/91) were discharged. AS-OCT had positive and negative predictive value of 74.3% (95% confidence intervals (CI) 57.8-86.0) and 82.1% (95% CI 70.0-90.2%), respectively, in detecting ITC in ≥1 quadrants. In the re-audit 45.9% (45/98) of those with suspected angle closure were triaged for gonioscopy, with 24.4% (11/45) of them being discharged. CONCLUSION PACS referrals represent a substantial burden to hospital-based services and their accuracy is low. ITC in ≥1 quadrants on AS-OCT can be useful in triaging those who need further evaluation with gonioscopy.
Collapse
Affiliation(s)
- Panayiota Founti
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Akshay Narayan
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Aneela Raja
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Neil Nathwani
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Rachel Thomas
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew Scott
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Alessandra Martins
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Save Sight Institute, Discipline of Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia
| | - Winifred Nolan
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Moorfields and UCL Institute of Ophthalmology, London, UK
| |
Collapse
|
6
|
Wang M, Zhu J, Keyal K, Liao X, Chen L, Li H, Wang F. Evaluation of the Effect of Scleral Buckling on Anterior Segment and Refractive Changes Using Anterior Segment Optical Coherence Tomography. Semin Ophthalmol 2024; 39:74-82. [PMID: 37309176 DOI: 10.1080/08820538.2023.2223271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE To evaluate the changes of anterior segment and refractive parameters after scleral buckling (SB) surgery for uncomplicated rhegmatogenous retinal detachment (RRD) using anterior segment optical coherence tomography (AS-OCT). METHODS Thirty-six RRD eyes were consecutively enrolled. Analysis concerned the central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), iris-trabecular contact (ITC), angel opening distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA),trabecular iris angle (TIA) and refractive parameters, including average keratometry (AvgK), cylindrical power (CYL), regular astigmatism, asymmetry and high order irregularity (HOI) at baseline and 1 day, 1 month, 2 months, 6 months and 12 months postoperatively. AS-OCT was performed at RRD diagnosis and day 1, week 1, month 1 and month 6 after SB to evaluate the scleral buckling. RESULTS A statistically significant postoperative CCT increase, ACD and ACV decrease were observed at 1 day and 1 month postoperatively. ITC analysis showed that the angle of the entire circumference narrowed at 1 month postoperatively. There was a significant decrease in all the angle parameters (AOD500/750, ARA500/750, TISA500/750, and ARA500/750) at 1 day and 1 month after SB surgery. However, all of the above parameters returned to the preoperative level at 12 months. Refractive parameters including AvgK, regular astigmatism, CYL, asymmetry, and HOI of anterior corneal surface and total corneal increased on the 1 day and 1 month after SB surgery and persisted even after 12 months follow-up. However, there was no significant difference in refractive parameters of posterior corneal surface during follow-up. CONCLUSION The changes in the structure of anterior segments after SB surgery were almost returned to the preoperative levels at 12 months postoperatively. However, SB surgery has a long-term effect on refractive parameters throughout a 12-month follow-up.
Collapse
Affiliation(s)
- Minli Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Juming Zhu
- Department of Ophthalmology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School; The First people's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Khusbu Keyal
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Xin Liao
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Lei Chen
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Hui Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Fang Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
- Shanghai Bright Eye Hospital, Shanghai, China
| |
Collapse
|
7
|
Wen Y, Jiang D, Tang K, Chen W. Current clinical applications of anterior segment optical coherence tomography angiography: a review. Graefes Arch Clin Exp Ophthalmol 2023; 261:2729-2741. [PMID: 36862203 DOI: 10.1007/s00417-023-05997-3] [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: 08/16/2022] [Revised: 01/20/2023] [Accepted: 02/04/2023] [Indexed: 03/03/2023] Open
Abstract
Optical coherence tomography (OCT) is a revolutionary in vivo imaging technology that presents real-time information on ocular structures. Angiography based on OCT, known as optical coherence tomography angiography (OCTA), is a noninvasive and time-saving technique originally utilized for visualizing retinal vasculature. As devices and built-in systems have evolved, high-resolution images with depth-resolved analysis have assisted ophthalmologists in accurately localizing pathology and monitoring disease progression. With the aforementioned advantages, application of OCTA has extended from the posterior to anterior segment. This nascent adaptation showed good delineation of the vasculature in the cornea, conjunctiva, sclera, and iris. Thus, neovascularization of the avascular cornea and hyperemia or ischemic changes involving the conjunctiva, sclera, and iris has become prospective applications for AS-OCTA. Although traditional dye-based angiography is regarded as the gold standard in demonstrating vasculature in the anterior segment, AS-OCTA is expected to be a comparable but more patient-friendly alternative. In its initial stage, AS-OCTA has exhibited great potential in pathology diagnosis, therapeutic evaluation, presurgical planning, and prognosis assessments in anterior segment disorders. In this review of AS-OCTA, we aim to summarize scanning protocols, relevant parameters, and clinical applications as well as limitations and future directions. We are sanguine about its wide application in the future with the development of technology and refinement in built-in systems.
Collapse
Affiliation(s)
- Yajing Wen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Dan Jiang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Kexin Tang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wei Chen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| |
Collapse
|
8
|
Al-Timimi Z, Huang-Lung J, Keay L, Healey P, Yang E, Dunn H. A Systematic Review of Glaucoma Diagnosis in Prevalence Studies and Quality of Reporting. J Glaucoma 2023; 32:874-884. [PMID: 37406297 DOI: 10.1097/ijg.0000000000002248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/19/2023] [Indexed: 07/07/2023]
Abstract
PRCIS This systematic review has revealed that variable definitions of glaucoma continue to be used in prevalence studies, despite the introduction of the International Society of Geographic and Epidemiologic Ophthalmology (ISGEO) criteria. PURPOSE To systematically review diagnostic criteria and examinations performed in glaucoma prevalence studies over time and determine the quality of reporting. Accurate estimates of glaucoma prevalence are crucial to inform resource allocation. However, diagnosis of glaucoma comprises inherently subjective examinations and the cross-sectional nature of prevalence studies precludes monitoring for progression. METHODS A systematic review of PubMed, Embase, Web of Science, and Scopus was performed to examine diagnostic protocols used by glaucoma prevalence studies and evaluate uptake of the ISGEO criteria, introduced in 2002 to standardize glaucoma diagnosis in prevalence studies. Detection bias and compliance with the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) guidelines were evaluated. RESULTS Ten thousand five hundred forty-four articles were identified. After deduplication, 5589 articles were screened, yielding 136 articles pertaining to 123 studies. An absence of data in many countries was identified. Ninety-two percent of studies stated diagnostic criteria, and 62% used the ISGEO criteria since their publication. Weaknesses of the ISGEO criteria were identified. Temporal variations in the performance of various examinations were observed, including heterogeneity in angle assessment. Mean STROBE compliance was 82% (range 59-100%); 72 articles had a low risk of detection bias, 4 had a high risk, and 60 had some concerns. CONCLUSION Heterogeneous diagnostic definitions persist in glaucoma prevalence studies, despite introduction of the ISGEO criteria. Standardization of criteria remains imperative and the development of new criteria represent a valuable opportunity to achieve this goal. In addition, methods of determining diagnoses are poorly reported, suggesting a need for improvement in study conduct and reporting. Accordingly, we propose the Reporting of quality Of GlaUcoma Epidemiological Studies (ROGUES) Checklist. We have also identified a need for further prevalence studies in regions with limited data and to update Australian angle closure glaucoma prevalence. Design and reporting of future studies can be informed by this review's insights into diagnostic protocols previously used.
Collapse
Affiliation(s)
- Zayn Al-Timimi
- Rural Clinical School, University of New South Wales, Port Macquarie
| | - Jessie Huang-Lung
- School of Optometry and Vision Science, University of New South Wales, Sydney
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney
| | - Paul Healey
- Clinical Ophthalmology and Eye Health, Westmead Clinical School
| | - Eleanor Yang
- School of Optometry and Vision Science, University of New South Wales, Sydney
| | - Hamish Dunn
- Rural Clinical School, University of New South Wales, Port Macquarie
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
9
|
Ding X, Huang L, Peng C, Xu L, Liu Y, Yang Y, Wang N, Gu M, Sun C, Wu Y, Guo W. Evaluation of Schlemm's canal with swept-source optical coherence tomography in primary angle-closure disease. BMC Ophthalmol 2023; 23:256. [PMID: 37286943 DOI: 10.1186/s12886-023-03001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
PURPOSE To perform an in vivo evaluation of the changes in Schlemm's canal (SC) among patients with primary angle-closure disease (PACD) using swept-source optical coherence tomography (SS-OCT). METHODS Patients diagnosed with PACD who had not undergone surgery were recruited. The SS-OCT quadrants scanned herein included the nasal and temporal sections at 3 and 9 o'clock, respectively. The diameter and cross-sectional area of the SC were measured. A linear mixed-effects model was performed to analyze the effects of parameters on the SC changes. The hypothesis of interest was related to the angle status (iridotrabecular contact, ITC/open angle, OPN), which was further explored with pairwise comparisons of the estimated marginal means (EMMs) of the SC diameter and SC area. In the ITC regions, the relationship between the trabecular-iris contact length (TICL) percentage and SC parameters was also studied by a mixed model. RESULTS A total of 49 eyes of 35 patients were included for measurements and analysis. The percentage of observable SCs in the ITC regions was only 58.5% (24/41), whereas it was 86.0% (49/57) in the OPN regions (χ2 = 9.44, p = 0.002). ITC was significantly associated with a decreasing SC size. The EMMs for the diameter and cross-sectional area of SC at the ITC and OPN regions were 203.34 μm versus 261.41 μm (p = 0.006) and 3174.43 μm2 versus 5347.63 μm2 (p = 0.022), respectively. Sex, age, spherical equivalent refraction, intraocular pressure, axial length, extent of angle closure, history of acute attack and treatment with LPI were not significantly associated with SC parameters. In the ITC regions, a larger TICL percentage was significantly associated with a decrease in SC diameter and area (p = 0.003 and 0.019, respectively). CONCLUSIONS The morphologies of SC could be affected by the angle status (ITC/OPN) in patients with PACD, and ITC was significantly associated with a decreasing SC size. These changes in SC as described by OCT scans might help to elucidate the progression mechanisms of PACD.
Collapse
Affiliation(s)
- Xuming Ding
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Lulu Huang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Cheng Peng
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Li Xu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yixin Liu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yijie Yang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Ning Wang
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Mengyang Gu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chengyang Sun
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yue Wu
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Wenyi Guo
- Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Huangpu District, No. 639 Zhizaoju Road, Shanghai, 200011, China.
| |
Collapse
|
10
|
Qin J, Zhang Y, Zhang C, Niu Y, Yang F, Wang X, Li X, Yu Y. Efficacy and safety of laser peripheral iridoplasty with different energy levels and locations in the treatment of primary angle closure disease assessed by swept-source anterior segment optical coherence tomography. BMC Ophthalmol 2023; 23:149. [PMID: 37041488 PMCID: PMC10088107 DOI: 10.1186/s12886-023-02899-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To explore the efficacy and safety of laser peripheral iridoplasty (LPIp) with different energy levels and locations in the treatment of primary angle closure disease (PACD) assessed by swept-source anterior segment optical coherence tomography (AS-OCT). METHODS We enrolled patients with PACD following best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber gonioscopy, ultrasound biomicroscopy(UBM), optic disc OCT, and visual field examinations. After Pentacam and AS-OCT measurements, the patients were randomly divided into four treatment groups for LPIp with two different energy levels (high vs. low energy) and two locations (far from the periphery vs. near the periphery) and combined with laser peripheral iridotomy. BCVA, IOP, pupil diameter, central anterior chamber depth, anterior chamber volume, anterior opening distance (AOD)500, AOD750, trabecular iris angle (TIA)500, and TIA750 in four quadrants before and after laser treatment were compared. RESULTS We followed up 32 patients (64 eyes; average age, 61.80 ± 9.79 years; 8 patients/16 eyes per group) for up to 2 years. The IOP of all enrolled patients was decreased after surgery compared to that before (t = 3.297, P = 0.002), the volume of the anterior chamber was increased (t=-2.047, P = 0.047), and AOD500, AOD750, TIA500, and TIA750 were increased (all P < 0.05). Within-group comparisons showed that BCVA in the low-energy/far-periphery group was improved after surgery (P < 0.05). After surgery, the IOP was decreased in the two high-energy groups, whereas the volume of the anterior chamber, AOD500, AOD750, TIA500, and TIA750 were increased in all groups (all P < 0.05). However, when comparing every two groups, the high-energy/far-periphery group showed a stronger effect on pupil dilation than the low-energy/near-periphery group (P = 0.045). The anterior chamber volume in the high-energy/near-periphery group was larger than that in the high-energy/far-periphery group (P = 0.038). The change in TIA500 was for 6 points smaller in the low-energy/near-periphery group than in the low-energy/far-periphery group (P = 0.038). Other parameters showed no significant group differences. CONCLUSION LPIp combined with iridotomy can effectively reduce IOP, increase anterior chamber volume, increase chamber angle opening distance, and widen the trabecular iris angle. Intraoperatively, high-energy laser spots positioned one spot diameter from the scleral spur can obtain the best effect and safety. Swept-source AS-OCT can safely and effectively quantify the anterior chamber angle.
Collapse
Affiliation(s)
- Jiayin Qin
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China.
| | - Yan Zhang
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Chengxia Zhang
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Yaqian Niu
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Fei Yang
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Xijuan Wang
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Xiaochun Li
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Yang Yu
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| |
Collapse
|
11
|
Savur S, Kaup S, Dinesh A, Shivalli S, Kondal D. Can ultrasonic biometric indices with optimal cut-offs be a potential screening tool for primary angle closure disease? A case-control study. Eye (Lond) 2023; 37:1284-1289. [PMID: 35624303 PMCID: PMC10101967 DOI: 10.1038/s41433-022-02118-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES Despite a significant disease burden and potential to cause blindness, primary angle closure disease (PACD) does not have a population-based screening programme. Biometric indices using ultrasound A-scan is a potential tool for glaucoma case-detection. Given that genetic and environmental factors influence these parameters and paucity of data on their discrimination thresholds in Indian populace, we conducted a matched case-control study to determine the biometric indices and their discrimination thresholds associated with PACD. METHODS We studied 172 eyes of 86 participants (43 cases; 43 controls). We compared the following biometric parameters of cases (PACD, occludable angle ≥180° ± raised intraocular pressure) with age and gender-matched controls (1:1): Anterior chamber depth (ACD), lens thickness (LT), axial length (AXL), lens position (LP), relative lens position (RLP), lens axial factor (LAF), simple crowding value (Cs), ACD/AXL). We performed conditional logistic regression (to identify factors associated with PACD) and Receiver operating characteristic (ROC) analysis (to determine discrimination thresholds). RESULTS Reduced ACD (Adj OR 0.01; 95% CI: 0.0003-0.15, p < 0.001) and increased LT (Adj OR 10.3; 95% CI:2.42-43.93, p < 0.001) were associated with PACD. On ROC analysis, ACD, Cs, and ACD/AXL had optimum sensitivity/specificity at ≤3.015, ≥0.056 and ≤0.1303, respectively. ACD (88.4%) and Cs (94.2%) had highest sensitivity and specificity, respectively. CONCLUSION Ultrasonic biometric parameters differed significantly between PACD and controls. ACD and Cs (at discrimination thresholds of ≤3.015 mm and ≥ 0.056, respectively) using ultrasound A-scan could be a potential tool for PACD case-detection that requires evaluation of its diagnostic yield and cost-effectiveness.
Collapse
Affiliation(s)
- Sheetal Savur
- Department of Ophthalmology, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, India
| | - Soujanya Kaup
- Department of Ophthalmology, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, India.
| | - Anagha Dinesh
- Department of Ophthalmology, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, India
| | - Siddharudha Shivalli
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Dimple Kondal
- Public Health Foundation of India, Gurgaon, India
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
12
|
Zhang X, Guo PY, Lin C, Li F, Nguyen A, Sakata R, Higashita R, Okamoto K, Yu M, Aihara M, Aung T, Lin S, Leung CKS. Assessment of Iris Trabecular Contact in Eyes with Gonioscopic Angle-Closure. Ophthalmology 2023; 130:111-119. [PMID: 36652194 DOI: 10.1016/j.ophtha.2022.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/24/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the extent of iris trabecular contact (ITC) measured by anterior segment OCT (AS-OCT) and its association with primary angle-closure (PAC) and PAC glaucoma (PACG) in eyes with gonioscopic angle-closure and to determine the diagnostic performance of ITC for detection of gonioscopic angle-closure. DESIGN Multicenter, prospective study. PARTICIPANTS A total of 119 healthy participants with gonioscopic open-angle and 170 patients with gonioscopic angle-closure (94 with PAC suspect and 76 with PAC/PACG) were included. METHODS One eye of each subject was randomly selected for AS-OCT imaging. Angle-opening distance (AOD500) and trabecular iris space area (TISA500) were measured every 10° for 360°. Two criteria of ITC500 were examined: (1) AOD500 = 0 mm and (2) TISA500 = 0 mm2. The association between the extent of ITC500 and PAC/PACG in eyes with gonioscopic angle-closure was analyzed with logistic regression analysis. MAIN OUTCOME MEASURES Sensitivity and specificity of ITC500 for detection of gonioscopic angle-closure; odds ratio (OR) of PAC/PACG. RESULTS The sensitivity of ITC500 ≥ 10° for detection of gonioscopic angle-closure ranged from 82.4% (AOD500 = 0 mm) to 84.7% (TISA500 = 0 mm2), and the specificity was 85.7% (for both AOD500 = 0 mm and TISA500 = 0 mm2). The extent of ITC500 determined by AS-OCT, not cumulative gonioscopy score (i.e., the sum of the modified Shaffer grades over 4 quadrants), was associated with the odds of PAC/PACG in eyes with gonioscopic angle-closure; the odds of PAC/PACG increased by 5% for every 10° increase in ITC500 (OR, 1.051, 95% confidence interval [CI], 1.022-1.080 for AOD500 = 0 mm; OR, 1.049, 95% CI, 1.022-1.078 for TISA500 = 0 mm2). Axial length and anterior chamber depth were not associated with PAC/PACG in eyes with gonioscopic angle-closure (P ≥ 0.574). CONCLUSIONS A greater extent of ITC measured by AS-OCT, not angle-closure determined by gonioscopy, was associated with a greater odds of PAC/PACG in eyes with gonioscopic angle-closure.
Collapse
Affiliation(s)
- Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, PRC
| | - Philip Yawen Guo
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, PRC
| | - Chen Lin
- Department of Ophthalmology, Shenzhen People's hospital, Shenzhen, PRC
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, PRC
| | - Anwell Nguyen
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Rei Sakata
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | | | | | - Marco Yu
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore; National University of Singapore, Singapore
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore; National University of Singapore, Singapore
| | - Shan Lin
- Department of Ophthalmology, University of California San Francisco, San Francisco, California; Glaucoma Center of San Francisco, San Francisco, California
| | - Christopher Kai-Shun Leung
- Hong Kong Eye Hospital, Hong Kong, PRC; Department of Ophthalmology, The University of Hong Kong, Hong Kong, PRC; Department of Ophthalmology, Queen Mary Hospital, Hong Kong, PRC.
| |
Collapse
|
13
|
Lin S, Hu Y, Ye C, Congdon N, You R, Liu S, Liu C, Lv F, Zhang S. Detecting eyes with high risk of angle closure among apparently normal eyes by anterior segment OCT: a health examination center-based model. BMC Ophthalmol 2022; 22:513. [PMID: 36577987 PMCID: PMC9798562 DOI: 10.1186/s12886-022-02739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The main barriers keeping individuals with high-risk of angle closure from seeking eye-care service are the absence of both disease awareness and convenient and low-cost access to the ocular health care system. Present study described the efficacy of a health examination center-based screening model designed to detect eyes with high risk of angle closure (HRAC) among healthy individuals using anterior segment optical coherence tomography (AS-OCT). METHODS From March 1 to April 30, 2017, consecutive individuals aged ≥ 40 years undergoing routine physical examinations at a health examination center were invited to enroll. Presenting visual acuity (PVA), intraocular pressure (IOP) measurement, non-mydriatic fundus photography and AS-OCT were performed by three trained nurses. Participants with PVA < 6/12 in the better-seeing eye, IOP ≥ 24 mmHg, or abnormal fundus photography in either eye were referred to the outpatient clinic, but not included in the analysis. Eyes with HRAC were defined as having trabecular-iris angle < 12 degrees in ≥ 3 quadrants. Configuration of the iris was classified into flat, bowing, bombe, thick peripheral iris and mixed mechanism. RESULTS Altogether, 991 participants (77.3%) with readable OCT images (mean age 55.5 ± 9.0 years; 58.4% men) were included. HRAC was diagnosed in 78 eyes (7.9%, 61.3 ± 8.2 years, 41.0% men). The prevalence of HRAC increased with age (p < 0.001) and was much higher among women (11.2%) than men (5.5%) (p = 0.001). The mixed mechanism iris configuration was most common among eyes with HRAC (37/78, 47.4%). CONCLUSION HRAC is prevalent among asymptomatic Chinese adults undergoing routine health screening. Health examination center-based eye screening with AS-OCT administered by non-specialists may be a good model to screen narrow angles in the population at large.
Collapse
Affiliation(s)
- Sigeng Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China.,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Ying Hu
- Department of Ophthalmology, The Forth People's Hospital of Shenyang, Huanggu District, NO. 20 Huanghenan Street, Shenyang, 110031, Liaoning, China
| | - Cong Ye
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China.,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Orbis International, New York, NY, USA
| | - Ruirong You
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China.,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Shanshan Liu
- Department of Ophthalmology, The Forth People's Hospital of Shenyang, Huanggu District, NO. 20 Huanghenan Street, Shenyang, 110031, Liaoning, China
| | - Chi Liu
- Department of Ophthalmology, The Forth People's Hospital of Shenyang, Huanggu District, NO. 20 Huanghenan Street, Shenyang, 110031, Liaoning, China.
| | - Fan Lv
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China.,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, China
| | - Shaodan Zhang
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No.270 Xueyuanxi Street, Lucheng District, Wenzhou, 325027, Zhejiang, China. .,Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, China.
| |
Collapse
|
14
|
Mukhopadhyay D, Patel K, Huda S. Increase in anterior chamber angle depth after topical pilocarpine measured by spectral domain optical coherence tomography: A possible additional indicator for laser peripheral iridotomy in primary angle-closure suspects in an opportunistic set-up. Indian J Ophthalmol 2022; 70:4174-4179. [PMID: 36453309 PMCID: PMC9940567 DOI: 10.4103/ijo.ijo_764_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Indication of laser peripheral iridotomy (LPI) is often conjectural due to dependency on gonioscopy and strict dichotomous classification of occludability. Indentation gonioscopy is the gold standard but is under-utilized for various reasons. The prevalence of primary angle closure disease (PACD) in eastern India is 1.5-1.9%, with a 22% five-year progression rate. Many angle closure patients may go blind without timely diagnosis and iridotomy. General ophthalmologists need alternate, validated methods for diagnoses. Pilocarpine eye drop causes miosis, and flattens the iris, producing angle changes detectable by spectral domain optical coherence tomography (SD-OCT). We hypothesized that the amount of angle change may be a suitable indicator for iridotomy. Methods Our prospective cross-sectional single-masked observational study evaluated pilocarpine-induced changes in angle parameters detected by SD-OCT. Out of 372 patients enrolled, 273 patients (539 eyes) remained, with a mean age of 48.6 years (SD = 10.36). All eyes were graded by the Van Herick (VH) method, gonioscopy, and anterior segment (AS) SD-OCT and reassessed after pilocarpine drops. Results The sensitivity and specificity of tomography measurements against gonioscopy grades were 61% and 85%, respectively. The receiver operating characteristic (ROC) curve was 0.85. Pilocarpine-induced angle widening was significant in gonioscopically narrower angles. Low Van Herick grades (217 eyes), narrow gonioscopy grades (238 eyes), and a narrow OCT angle value (165 eyes) were candidates for iridotomy. Conclusion Our study results showed that pilocarpine-induced angle widening detected by SD-OCT could be a strong objective indicator for LPI.
Collapse
Affiliation(s)
- Debdas Mukhopadhyay
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India,Correspondence to: Prof. Debdas Mukhopadhyay, BKG Eye Institute, Gour Road, Mokdompur, Malda - 732 103, West Bengal, India. E-mail:
| | - Khevna Patel
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India
| | - Sadaf Huda
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India
| |
Collapse
|
15
|
Bhargava M, Bhambhani V, Paul RS. Anterior segment optical coherence tomography characteristics and management of a unique spectrum of foreign bodies in the cornea and anterior chamber. Indian J Ophthalmol 2022; 70:4284-4292. [PMID: 36453330 PMCID: PMC9940523 DOI: 10.4103/ijo.ijo_878_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To report anterior-segment optical coherence tomography (ASOCT) characteristics of different types of corneal and anterior chamber (AC) foreign bodies (FBs) and their usefulness in diagnosis and management. Methods This is a retrospective descriptive clinical study involving 11 eyes of 11 patients who presented at the outpatient department of a tertiary ophthalmic care center from January 2017 to January 2022. All patients had a diagnosed or suspected corneal FB. All participants underwent a comprehensive ophthalmological examination, followed by slit-lamp photography and ASOCT. FB removal was done where required by an external, internal, or combined approach. Results The mean age of patients was 28.2 (7-53) years. Ten were male, and one was female. Seven patients had a definitive positive history of injury; in one, there was a history suggestive of trauma, one had the post-operative complication of scleral buckling surgery, and two patients had a history of insect fall in the eyes. Three patients had acute, four had sub-acute, and four had chronic presentations. Descemet's membrane (DM) breach was suspected in three cases of deep FB, which was later confirmed on ASOCT. In two cases, DM was presumed to be intact clinically, but ASOCT showed an AC penetration. The FB was removed in seven patients, one via slit-lamp, one via an external approach, two via an internal approach, and three via a combined approach. Conclusion ASOCT facilitates non-invasive rapid imaging of ocular tissue at various depths, provides an accurate assessment of FB characteristics, and thereby serves as an additional tool in our armamentarium for diagnosis and management of deep corneal and AC FBs.
Collapse
Affiliation(s)
- Mona Bhargava
- Department of Cornea and Ocular Surface, Aditya Birla Sankara Nethralaya (A Unit of Medical Research Foundation, Chennai, India), Kolkata, West Bengal, India,Correspondence to: Dr. Mona Bhargava, Aditya Birla Sankara Nethralaya, 147/1, Mukundapur, E M Bypass Road (A Unit of Medical Research Foundation, Chennai, India), Kolkata, West Bengal, India. E-mail:
| | - Varsha Bhambhani
- Department of Cornea and Ocular Surface, Aditya Birla Sankara Nethralaya (A Unit of Medical Research Foundation, Chennai, India), Kolkata, West Bengal, India
| | - Raj S Paul
- Department of Cornea and Ocular Surface, Aditya Birla Sankara Nethralaya (A Unit of Medical Research Foundation, Chennai, India), Kolkata, West Bengal, India
| |
Collapse
|
16
|
Lee YJ, Choe S, Wy S, Jang M, Jeoung JW, Choi HJ, Park KH, Sun S, Kim YK. Demographics Prediction and Heatmap Generation From OCT Images of Anterior Segment of the Eye: A Vision Transformer Model Study. Transl Vis Sci Technol 2022; 11:7. [DOI: 10.1167/tvst.11.11.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yun Jeong Lee
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sooyeon Choe
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seoyoung Wy
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Mirinae Jang
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Jin Choi
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sukkyu Sun
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Chou CC, Shih PJ, Wang CY, Jou TS, Chen JP, Wang IJ. Corvis Biomechanical Factor Facilitates the Detection of Primary Angle Closure Glaucoma. Transl Vis Sci Technol 2022; 11:7. [PMID: 36180025 PMCID: PMC9547358 DOI: 10.1167/tvst.11.10.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To characterize the corneal biomechanical properties of primary angle closure glaucoma (PACG) and to investigate the diagnostic performance of combining corneal biomechanical parameters and anterior segment parameters in detecting PACG. Methods This retrospective cross-sectional study evaluated 79 and 81 eyes of normal controls and patients with PACG, respectively. Corvis Biomechanical Factor (CBiF) and anterior chamber volume (ACV) were measured using the Corvis ST and Pentacam, respectively. We performed multivariable logistic regression, adjusted for age, sex, central corneal thickness, intraocular pressure, and ACV to evaluate the effect of CBiF on PACG. The area under the receiver operating curve (AUC) was calculated to compare the diagnostic performance of ACV, CBiF, and ACV-CBiF combination for detecting PACG. Results The median CBiF of the control and PACG groups was 6.61 (interquartile range [IQR], 6.39–6.88) and 6.20 (IQR, 5.93–6.48), respectively (P < 0.001). A lower CBiF, suggestive of decreased corneal biomechanical stability, increased the odds of PACG (odds ratio, 0.029; 95% confidence interval [CI], 0.003–0.266; P = 0.002) in the multivariable logistic regression model. The ACV–CBiF combination yielded the highest AUC (0.934; 95% CI, 0.882–0.968) compared with ACV alone (0.878; 95% CI, 0.823–0.928). The ACV-CBiF combination had significantly higher discriminatory ability than that of ACV alone (DeLong test, P = 0.004). Conclusions Lower CBiF and ACV may act as independent predictors for PACG. Combining ACV and CBiF may enhance detection of PACG. Translational Relevance The combination of corneal biomechanical parameters and anterior segment parameters enhances the detection of PACG.
Collapse
Affiliation(s)
- Chien-Chih Chou
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Po-Jen Shih
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chun-Yuan Wang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzuu-Shuh Jou
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Precision Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jun-Peng Chen
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Jong Wang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
18
|
Beck AD, Freedman SF, Nizam A, Lambert SR. Anterior segment optical coherence tomography findings in the Infant Aphakia Treatment Study (IATS): a secondary analysis of a randomized clinical trial. J AAPOS 2022; 26:229.e1-229.e6. [PMID: 36122874 PMCID: PMC9729428 DOI: 10.1016/j.jaapos.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/18/2022] [Accepted: 05/23/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To correlate the diagnosis of glaucoma among children in the Infant Aphakia Treatment Study (IATS) by age 10 years with anterior segment optical coherence tomography (AS-OCT) findings. METHODS A multicenter randomized controlled trial of 114 infants with unilateral congenital cataract who were 1-6 months of age at surgery. Data on long-term glaucoma-related status and outcomes were collected when children were 10.5 years old. Participants were randomized at cataract surgery to either primary intraocular lens (IOL) or no IOL implantation (contact lens [CL]). AS-OCT findings in eyes with glaucoma were compared to eyes which did not have glaucoma and to the fellow eyes, between fellow and treated eyes, and between the IOL and CL groups. RESULTS There were no significant differences in the mean nasal and temporal anterior chamber angle (ACA) or mean nasal and temporal angle opening distance (AOD) for nonglaucomatous, glaucomatous, and fellow eyes (P = 0.31, 0.16, 0.43, 0.08 resp.). There were also no significant differences in mean nasal and temporal ACA and AOD between fellow and treated eyes (P = 0.44, 0.67, 0.57, 0.38 resp.), or between IOL and CL groups (P = 0.36, 0.35, 0.49, 0.44, resp.). CONCLUSIONS AS-OCT confirmed that eyes with glaucoma in IATS had predominantly open angles with similar ACA and AOD to eyes without glaucoma and to fellow eyes. Furthermore, congenital cataract surgery with or without an IOL did not result in a significant difference in ACA or AOD compared to fellow eyes in IATS.
Collapse
Affiliation(s)
- Allen D Beck
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Azhar Nizam
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University, Stanford, California
| |
Collapse
|
19
|
Predicting demographic characteristics from anterior segment OCT images with deep learning: A study protocol. PLoS One 2022; 17:e0270493. [PMID: 35951641 PMCID: PMC9371292 DOI: 10.1371/journal.pone.0270493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/11/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Anterior segment optical coherence tomography (AS-OCT) is a non-contact, rapid, and high-resolution in vivo modality for imaging of the eyeball’s anterior segment structures. Because progressive anterior segment deformation is a hallmark of certain eye diseases such as angle-closure glaucoma, identification of AS-OCT structural changes over time is fundamental to their diagnosis and monitoring. Detection of pathologic damage, however, relies on the ability to differentiate it from normal, age-related structural changes. Methods and analysis This proposed large-scale, retrospective cross-sectional study will determine whether demographic characteristics including age can be predicted from deep learning analysis of AS-OCT images; it will also assess the importance of specific anterior segment areas of the eyeball to the prediction. We plan to extract, from SUPREME®, a clinical data warehouse (CDW) of Seoul National University Hospital (SNUH; Seoul, South Korea), a list of patients (at least 2,000) who underwent AS-OCT imaging between 2008 and 2020. AS-OCT images as well as demographic characteristics including age, gender, height, weight and body mass index (BMI) will be collected from electronic medical records (EMRs). The dataset of horizontal AS-OCT images will be split into training (80%), validation (10%), and test (10%) datasets, and a Vision Transformer (ViT) model will be built to predict demographics. Gradient-weighted Class Activation Mapping (Grad-CAM) will be used to visualize the regions of AS-OCT images that contributed to the model’s decisions. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC) will be applied to evaluate the model performance. Conclusion This paper presents a study protocol for prediction of demographic characteristics from AS-OCT images of the eyeball using a deep learning model. The results of this study will aid clinicians in understanding and identifying age-related structural changes and other demographics-based structural differences. Trial registration Registration ID with open science framework:10.17605/OSF.IO/FQ46X.
Collapse
|
20
|
Palanisamy S, Raja V, Senthilkumar VA, Mani I, Krishnadas R. Correlation of pattern of visual field loss by perimetry and anterior chamber angle parameters by anterior segment optical coherence tomography in primary angle-closure glaucoma. Indian J Ophthalmol 2022; 70:2895-2901. [PMID: 35918939 DOI: 10.4103/ijo.ijo_232_22] [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: 11/05/2022] Open
Abstract
Purpose To correlate and analyze the pattern of the visual field (VF) defects by perimetry and anterior chamber angle parameters by AS-OCT in primary angle-closure glaucoma (PACG) across varied severity levels on presentation to a tertiary eye care center. Methods This was a cross-sectional study, which included 323 eyes of clinically diagnosed cases of PACG. Glaucoma severity was categorized according to mean deviation (MD) as mild (-6.00 dB or more), moderate (-6.01 to -12.00 dB), and severe (-12.01 to -30.00 dB). AS-OCT measured the nasal (N) and temporal (T) angle opening distance at 500 μm (AOD 500) and 750 μm (AOD 750), anterior chamber angle (ACA), lens vault (LV), and anterior chamber width (ACW). The VF severity was then correlated with the AS-OCT parameters using statistical analysis. Results The mean age ± standard deviation (SD) of the patients included in the study was 56.03 ± 8.6 years, with a 1:1.2 gender ratio. The number of eyes with mild, moderate, and severe VFs were 140 (43.3%), 88 (27.24%), and 95 (29.41%), respectively. There was no statistically significant correlation in the mean anterior chamber angle parameters (AOD 500, AOD 750, ACA 500, ACA 750, LV, ACW, and axial length (AL)) among the groups. However, the correlation between AOD 500 and LV thickness was found to be significant (P = 0.0000) with a negative Spearman's rank correlation coefficient (r = -0.3329). Conclusion The ACA parameters obtained by AS-OCT along the horizontal axis after elimination of pupillary block by laser peripheral iridotomy do not correlate and cannot be used to assess the disease severity of PACG.
Collapse
Affiliation(s)
- Sreeramyaa Palanisamy
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamilnadu, India
| | - Vidya Raja
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamilnadu, India
| | | | - Iswarya Mani
- Department of Biostatistics, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamilnadu, India
| | - R Krishnadas
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamilnadu, India
| |
Collapse
|
21
|
Ye H, Yang Y, Mao K, Wang Y, Hu Y, Xu Y, Fei P, Lyv J, Chen L, Zhao P, Zheng C. Generating Synthesized Ultrasound Biomicroscopy Images from Anterior Segment Optical Coherent Tomography Images by Generative Adversarial Networks for Iridociliary Assessment. Ophthalmol Ther 2022; 11:1817-1831. [PMID: 35882767 PMCID: PMC9437167 DOI: 10.1007/s40123-022-00548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The aim of this study was to investigate the feasibility of generating synthesized ultrasound biomicroscopy (UBM) images from swept-source anterior segment optical coherent tomography (SS-ASOCT) images using a cycle-consistent generative adversarial network framework (CycleGAN) for iridociliary assessment on a cohort presenting for primary angle-closure screening. Methods The CycleGAN architecture was adopted to synthesize high-resolution UBM images trained on the SS-ASOCT dataset from the department of ophthalmology, Xinhua Hospital. The performance of the CycleGAN model was further tested in two separate datasets using synthetic UBM images from two different ASOCT modalities (in-distribution and out-of-distribution). We compared the ability of glaucoma specialists to assess the image quality of real and synthetic images. UBM measurements, including anterior chamber, iridociliary parameters, were compared between real and synthetic UBM images. Intra-class correlation coefficients, coefficients of variation, and Bland–Altman plots were used to assess the level of agreement. The Fréchet Inception Distance (FID) was measured to evaluate the quality of the synthetic images. Results The whole trained dataset included anterior chamber angle images, of which 4037 were obtained by SS-ASOCT and 2206 were obtained by UBM. The image quality of real versus synthetic SS-ASOCT images was similar as assessed by two glaucoma specialists. The Bland–Altman analysis also suggested high consistency between measurements of real and synthetic UBM images. In addition, there was fair to excellent agreement between real and synthetic UBM measurements for the in-distribution dataset (ICC range 0.48–0.97) and the out-of-distribution dataset (ICC range 0.52–0.86). The FID was 21.3 and 24.1 for the synthetic UBM images from the in-distribution and out-of-distribution datasets, respectively. Conclusion We developed a CycleGAN model to translate UBM images from non-contact SS-ASOCT images. The CycleGAN synthetic UBM images showed fair to excellent reproducibility when compared with real UBM images. Our results suggest that the CycleGAN technique is a promising tool to evaluate the iridociliary and anterior chamber in an alternative non-contact method.
Collapse
Affiliation(s)
- Hongfei Ye
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Yuan Yang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Kerong Mao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Yafu Wang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Yiqian Hu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Yu Xu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Ping Fei
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Jiao Lyv
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Li Chen
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China.
| | - Ce Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665, Kongjiang Road, Shanghai, 200092, China.
| |
Collapse
|
22
|
Azzopardi M, Prokosch-Willing V, Michelessi M, Fea AM, Oddone F, Mercieca K. The current use of glaucoma virtual clinics in Europe. Eye (Lond) 2022; 37:1350-1356. [PMID: 35690678 PMCID: PMC9188015 DOI: 10.1038/s41433-022-02111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives To assess and describe current utilisation, characteristics and perspectives on virtual glaucoma clinics (VGCs) amongst European glaucoma specialists. Methods Cross-sectional, anonymized, online questionnaire distributed to all European Glaucoma Society-registered specialists. Questions were stratified into five domains: Demographics, Questions about VGC use, Questions for non-VGC users, COVID-19 effects, and VGC advantages/disadvantages. Results 30% of 169 participants currently use VGCs, with 53% based in the United Kingdom. Of those using VGCs, 85% reported higher patient acceptance compared to traditional care. The commonest virtual model was asynchronous remote monitoring (54%). Nurses (49%) and ophthalmic technicians (46%) were mostly responsible for data collection, with two-thirds using a mixture of professionals. Consultant ophthalmologists were the main decision-makers in 51% of VGCs. Preferred cohorts were: ocular hypertension (85%), glaucoma suspects (80%), early/moderate glaucoma in worse eye (68%), stable glaucoma irrespective of treatment (59%) and stable glaucoma on monotherapy (51%). Commonest investigations were: IOP (90%), BCVA (88%), visual field testing (85%) and OCT (78%), with 33 different combinations. Reasons for face-to-face referral included: visual field progression (80%), ‘above-target’ IOP (63%), and OCT progression (51%). Reasons for not using VGCs included: lack of experience (47%), adequate systems in place (42%), no appropriate staff (34%) and insufficient time/money (34%). 55% of non-VGC users are interested in their use with 38% currently considering future implementation. 83% stated VGC consultations have increased during the COVID-19 pandemic; 86% of all participants felt that the pandemic has highlighted the importance of VGCs. Conclusions A significant proportion of European glaucoma units are currently using VGCs, while others are considering implementation. Financial reimbursement and consensus guidelines are potentially crucial steps in VGC uptake.
Collapse
Affiliation(s)
| | | | | | - Antonio Maria Fea
- Dipartimento di Scienze Chirurgiche, Universita degli Studi di Torino, Torino, Italy
| | | | - Karl Mercieca
- University Hospital Bonn, Eye Clinic, Ernst Abbe Strasse 2, Bonn, Germany. .,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| |
Collapse
|
23
|
Esporcatte BLB, Vessani RM, Melo LAS, Yanagimori NS, Bufarah GH, Allemann N, Tavares IM. Diagnostic Performance of Optical Coherence Tomography and Nonspecialist Gonioscopy to Detect Angle Closure. J Curr Glaucoma Pract 2022; 16:53-58. [PMID: 36060038 PMCID: PMC9385383 DOI: 10.5005/jp-journals-10078-1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim To compare the usefulness of gonioscopy performed by general ophthalmologists (GO) and anterior segment optical coherence tomography (AS-OCT) in detecting angle closure in patients with a shallow anterior chamber. Methods Forty-four patients with a shallow anterior chamber (defined by a ratio of peripheral anterior chamber depth to peripheral corneal thickness lower than 1/2) were included in this cross-sectional study. Gonioscopy was performed in all subjects by two glaucoma experts (GE1 and GE2) and one GO. Anterior segment imaging was performed using Visante® OCT (Carl Zeiss Meditec Inc.). Agreement between examiners was assessed with first-order agreement coefficients (AC1). Diagnostic accuracies of GO gonioscopy and AS-OCT were evaluated using sensitivity, specificity, and area under the receiver operating characteristic (AROC) curves. Results For static gonioscopy, the agreement between GE1 and GE2 was substantial (AC1 = 0.65), and that between GE1 and GO was moderate (AC1 = 0.50). For indentation gonioscopy, the agreement between GE1 and GE2 was slightly lower (AC1 = 0.55); however, the agreement between GE1 and GO showed a larger reduction (AC1 = 0.12). GO's gonioscopy presented a low specificity (25%) and the AROC to angle closure detection was lower than AS-OCT (0.56–0.73). Combined information of GO gonioscopy and AS-OCT improved specificity (85.7%) and AROC (0.77) of angle closure evaluation. Conclusion Agreement between GO and glaucoma experts was moderate for static gonioscopy and slight for indentation gonioscopy. AS-OCT performed better than GO gonioscopy in detecting angle closure in patients with a shallow anterior chamber. The addition of AS-OCT to clinical information in patients with GO positive gonioscopy improved the specificity and AROC of gonioscopy test. How to cite this article Esporcatte BLB, Vessani RM, Melo Jr LAS, et al. Diagnostic Performance of Optical Coherence Tomography and Nonspecialist Gonioscopy to Detect Angle Closure. J Curr Glaucoma Pract 2022;16(1):53–58.
Collapse
Affiliation(s)
- Bruno LB Esporcatte
- Department of Ophthalmology and Visual Sciences, Universidade Federal De São Paulo, São Paulo, Brazil
- Bruno LB Esporcatte, Department of Ophthalmology and Visual Sciences, Universidade Federal De São Paulo, São Paulo, Brazil, e-mail:
| | - Roberto M Vessani
- Department of Ophthalmology and Visual Sciences, Universidade Federal De São Paulo, São Paulo, Brazil
| | - Luiz AS Melo
- Department of Ophthalmology and Visual Sciences, Universidade Federal De São Paulo, São Paulo, Brazil
| | - Norton S Yanagimori
- Department of Ophthalmology and Visual Sciences, Universidade Federal De São Paulo, São Paulo, Brazil
| | - Guilherme H Bufarah
- Department of Ophthalmology and Visual Sciences, Universidade Federal De São Paulo, São Paulo, Brazil
| | - Norma Allemann
- Department of Ophthalmology and Visual Sciences, Universidade Federal De São Paulo, São Paulo, Brazil
| | - Ivan M Tavares
- Department of Ophthalmology and Visual Sciences, Universidade Federal De São Paulo, São Paulo, Brazil
| |
Collapse
|
24
|
Craven ER, Chopra V, Goldberg JL, Marion KM, Chen X, Chang CT, Chen MY. Comparison of Iridocorneal Angle Assessments in Open-Angle Glaucoma and Ocular Hypertension Patients: Anterior Segment Optical Coherence Tomography and Gonioscopy. Clin Ophthalmol 2022; 16:1301-1312. [PMID: 35510274 PMCID: PMC9058653 DOI: 10.2147/opth.s322962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/03/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To quantitatively compare iridocorneal angle assessments using gonioscopy and anterior segment optical coherence tomography (AS-OCT). Patients US and Chinese patients with open-angle glaucoma (OAG) and/or ocular hypertension (OHT). Methods Analysis was pooled from 2 multicenter, noninterventional studies conducted in the US and China. Gonioscopy Shaffer grade and an AS-OCT method that approximates the angle width relative to local morphologic variations were compared by measuring the same iridocorneal angles. A third, separate, single-center, noninterventional study was conducted to verify results observed from the pooled analysis. Results From the pooled studies, a total of 239 eyes were measured using Shaffer grade and AS-OCT. Of these, 6 were Shaffer grade 2, 37 in Shaffer grade 3, and 196 in Shaffer grade 4. There was a trend of increasing Shaffer grade with increasing AS-OCT angle width. Open iridocorneal angles, Shaffer grade ≥3, had a ~98% sensitivity and 88% positive predictive value for identifying AS-OCT angle width ≥300 µm, using the AS-OCT method. To verify these results, a total of 28 right eyes were imaged for the third study. A trend of increasing Shaffer grade with increasing AS-OCT angle width was observed, and angles with Shaffer grade ≤2 had AS-OCT angle width <300 µm. Conclusion The AS-OCT method can determine the space in the anterior chamber and can potentially identify angles that are the appropriate size for certain glaucoma devices. Information gathered from AS-OCT can provide additional comprehensive and quantitative assessment to gonioscopy.
Collapse
Affiliation(s)
- E Randy Craven
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Correspondence: E Randy Craven, 600 N. Wolfe Street, Baltimore, MD, 21287, USA, Tel +1 240-482-1100, Fax +1 240-482-1105, Email
| | | | | | | | - Xiaoming Chen
- West China Hospital Sichuan University, Sichuan, People’s Republic of China
| | | | | |
Collapse
|
25
|
Ye S, Bao C, Chen Y, Shen M, Lu F, Zhang S, Zhu D. Identification of Peripheral Anterior Synechia by Corneal Deformation Using Air-Puff Dynamic Anterior Segment Optical Coherence Tomography. Front Bioeng Biotechnol 2022; 10:856531. [PMID: 35433648 PMCID: PMC9011042 DOI: 10.3389/fbioe.2022.856531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Indentation gonioscopy is commonly used in the clinic to evaluate peripheral anterior synechia (PAS) of angle closure glaucoma (ACG). The examination requires contacting with the cornea, resulting in an uncomfortable feeling for patients, and it only provides qualitative outcomes which may be affected by subjective judgment of the clinicians. Previous studies had reported to identify the presence of PAS by measuring the changes of morphological parameters of the anterior chamber angle (ACA) under the pupillary light reflex, by anterior segment optical coherence tomography (AS-OCT). However, this method was invalid for some subjects who had low sensitiveness to light. This article describes an air-puff dynamic anterior segment optical coherence tomography (DAS-OCT) system that can evaluate the presence of PAS in a non-contact approach. The peripheral cornea is deformed by an air puff jetted from the DAS-OCT, causing a transfer of force to the ACA, just as how indentation gonioscopy works. The dynamic changes of the ACA before and after the air puff are recorded by OCT. Ten eyes of normal subjects were enrolled in this study to validate the repeatability and availability of the measurements. Then, ten samples of the ACA from five subjects with ACG were recruited and were assigned into two groups, the non PAS group (NPAS) and PAS group, according to the results of gonioscopy. The ACA structural parameters including the angle opening distance at 750 μm to the scleral spur (AOD750) and the trabecular-iris space area at 750 μm anterior to the scleral spur (TISA750) were then calculated automatically by a custom-written algorithm. The intraclass correlation coefficient (ICC) of measured parameters was all above 0.85 for normal subjects, exhibiting good repeatability. For patients, both parameters showed significant differences between the two groups after the air puff, while no differences were observed before the air puff. AOD750dif and TISA750dif between two groups showed more significant differences, indicating that they could be used as indicators to identify the presence of PAS. In conclusion, the DAS-OCT system proposed in this study is demonstrated effective to identify the presence of PAS by measuring the changes of the ACA via a noncontact approach. It shows great potential for applications in guidance for diagnosis of angle closure glaucoma.
Collapse
Affiliation(s)
- Shuling Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | | | - Yulei Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Shaodan Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Shaodan Zhang, ; Dexi Zhu,
| | - Dexi Zhu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Shaodan Zhang, ; Dexi Zhu,
| |
Collapse
|
26
|
Chen X, Wang X, Tang Y, Sun X, Chen Y. Optical coherence tomography analysis of anterior segment parameters before and after laser peripheral iridotomy in primary angle-closure suspects by using CASIA2. BMC Ophthalmol 2022; 22:144. [PMID: 35351034 PMCID: PMC8962180 DOI: 10.1186/s12886-022-02366-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/16/2022] [Indexed: 01/19/2023] Open
Abstract
Background Laser peripheral iridotomy (LPI) is effective in primary angle-closure suspects (PACS); however, predictors for anterior segment alterations after LPI are limited. We aimed to evaluate the anterior segment biometric parameters before and after LPI in PACS using the recently developed, CASIA 2 device of anterior segment optical coherence tomography (AS-OCT). Methods We performed LPI in 52 PACS. Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber width (ACW), anterior chamber volume (ACV), iris curvature (ICURVE), iridotrabecular contact (ITC), lens vault (LV), lens thickness (LT), radius of the lens, angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) at different distances (i.e., 500 μm from the sclera spur), were evaluated before and after LPI using CASIA 2. Results Eyes of PACS after LPI had a greater ACV, AOD, ARA, TISA, and TIA, and a lower ITC and ICURVE (all p < 0.001) than those before LPI. On a 360° scan, the anterior chamber angle in the superior quadrant increased the most after the LPI. A higher baseline LT was significantly associated with a greater postoperative increase in AOD 500, ARA 500, TISA 500, and TIA 500 (p = 0.001, p = 0.010, p = 0.004, and p < 0.001, respectively). Conclusions We found that LPI widens the anterior chamber angle in the PACS, especially, in the superior quadrant around the iridotomy hole. Eyes with a thicker lens are more likely to experience angle opening because of the LPI.
Collapse
|
27
|
Wanichwecharungruang B, Pattanapongpaiboon W, Kongsomboon K, Parivisutt N, Annopawong K, Seresirikachorn K. Diagnostic performance of anterior segment optical coherence tomography in detecting plateau iris. BMJ Open Ophthalmol 2022; 7:e000931. [PMID: 35402728 PMCID: PMC8943722 DOI: 10.1136/bmjophth-2021-000931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the diagnostic performance of manual grading of anterior segment optical coherence tomography (AS-OCT) in detection of plateau iris configuration (PIC) based on the presence of standardised ultrasound biomicroscopy (UBM) criteria in at least two quadrants; namely, clinical diagnosis of PIC (DxPIC). Methods and analysis In this cross-sectional study, paired AS-OCT and UBM images were evaluated by three glaucoma specialists. AS-OCT was classified into two mechanisms, PIC versus non-PIC, of primary angle closure disease (PACD) and AS-OCT-PIC diagnostic performance was tested with DxPIC. Results One hundred and seventy-nine eyes of 142 patients were enrolled for analysis, and DxPIC was found in 85 eyes (47.49%). Intraobserver agreement rates of AS-OCT classification by the graders were 0.77, 0.701 and 0.742 (all p<0.001), and interobserver agreement rates, between a senior glaucoma specialist and the other two glaucoma specialists, were 0.68 and 0.702 (all p<0.001). Plateau iris was classified in AS-OCT images by the three graders, rated 32.96%–39.1% and 24.58%–34.08% in the horizontal and vertical axes, respectively. Diagnostic performance was analysed, yielding sensitivity ranging from 56.47% to 77.78%, and specificity of 48.94% to 64.29%. We applied disease prevalence of 30%, revealing positive predictive values varying from 32.16% to 44.44%, and negative predictive values of 72.4% to 85.71%. Accuracy ranged from 51.2% to 65%. Agreement between the two devices was fair, kappa range 0.31–0.351. Conclusion Performance of manual grading of AS-OCT in detection of DxPIC was relatively poor; therefore, unadjusted AS-OCT does not appear to be good for manual PIC screening in PACD patients and cannot serve as a substitute for UBM in PIC detection.
Collapse
Affiliation(s)
- Boonsong Wanichwecharungruang
- Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- Ophthalmology, Rangsit University College of Medicine, Mueang Pathum Thani, Thailand
| | | | | | | | | | - Kasem Seresirikachorn
- Ophthalmology, Rajavithi Hospital, Bangkok, Thailand
- Ophthalmology, Rangsit University College of Medicine, Mueang Pathum Thani, Thailand
| |
Collapse
|
28
|
Wang YX, Yang H, Wei CC, Xu L, Wei WB, Jonas JB. High myopia as risk factor for the 10-year incidence of open-angle glaucoma in the Beijing Eye Study. Br J Ophthalmol 2022:bjophthalmol-2021-320644. [PMID: 35193858 DOI: 10.1136/bjophthalmol-2021-320644] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the 10-year incidence of open-angle glaucoma (OAG) and its associations in an adult Chinese population. METHODS Longitudinal observational population-based study. Out of 4439 participants aged 40+ years participating in the Beijing Eye Study in 2001, 2695 individuals (60.7%) were re-examined in 2011, while 397 participants had died (8.5%). RESULTS Incident OAG was found in 75 participants among 2494 individuals free of glaucoma at baseline. The 10-year OAG incidence (mean: 3.0%; 95% CI 2.5 to 3.5) increased from 1.8% (95% CI 1.3 to 2.4) in individuals aged 40-49 years, to 5.9% (95% CI 3.1 to 9.6) in participants aged 70+ years. OAG incidence was highest in the high myopia group (13.3%±6.3%, OR: 7.3; 95% CI 3.3 to 16.3), followed by the moderately myopic group (8.1%±4.3%, OR: 4.2; 95% CI 2.0 to 8.8) and the low myopic group (6.2%±2.8%, OR: 3.2; 95% CI 1.7 to 5.8), as compared with the emmetropic/hyperopic group (2.1%±0.8%). In multivariable analysis, higher OAG incidence was associated with older age (OR: 1.06; 95% CI 1.03 to 1.09), longer axial length (OR: 1.72; 95% CI 1.45 to 2.05), higher intraocular pressure (IOP) in 2001 (OR: 1.18; 95% CI 1.08 to 1.29), higher vertical cup/disc ratio (VCDR) (OR: 60.8; 95% CI 6.7 to 556) and thinner central corneal thickness (CCT) (OR: 0.98; 95% CI 0.97 to 0.99). CONCLUSIONS In a 10-year follow-up, high myopia was a major risk factor for the development of OAG with a 7.3-fold risk increase as compared with emmetropic eyes. Higher age, IOP, VCDR and thinner CCT were additionally related with an increased OAG incidence. The findings may be of importance to clinical protocols and screening strategies.
Collapse
Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, People's Republic of China
| | - Hua Yang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, People's Republic of China
| | - Chuan Chuan Wei
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, People's Republic of China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, People's Republic of China
| | - Wen Bin Wei
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, People's Republic of China
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, People's Republic of China.,Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| |
Collapse
|
29
|
Yang Y, Wu Y, Guo C, Han Y, Deng M, Lin H, Yu M. Diagnostic Performance of Deep Learning Classifiers in Measuring Peripheral Anterior Synechia Based on Swept Source Optical Coherence Tomography Images. Front Med (Lausanne) 2022; 8:775711. [PMID: 35155465 PMCID: PMC8825342 DOI: 10.3389/fmed.2021.775711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/27/2021] [Indexed: 01/16/2023] Open
Abstract
Purpose To develop deep learning classifiers and evaluate their diagnostic performance in detecting the static gonioscopic angle closure and peripheral anterior synechia (PAS) based on swept source optical coherence tomography (SS-OCT) images. Materials and Methods Subjects were recruited from the Glaucoma Service at Zhongshan Ophthalmic Center of Sun Yat-sun University, Guangzhou, China. Each subject underwent a complete ocular examination, such as gonioscopy and SS-OCT imaging. Two deep learning classifiers, using convolutional neural networks (CNNs), were developed to diagnose the static gonioscopic angle closure and to differentiate appositional from synechial angle closure based on SS-OCT images. Area under the receiver operating characteristic (ROC) curve (AUC) was used as outcome measure to evaluate the diagnostic performance of two deep learning systems. Results A total of 439 eyes of 278 Chinese patients, which contained 175 eyes of positive PAS, were recruited to develop diagnostic models. For the diagnosis of static gonioscopic angle closure, the first deep learning classifier achieved an AUC of 0.963 (95% CI, 0.954–0.972) with a sensitivity of 0.929 and a specificity of 0.877. The AUC of the second deep learning classifier distinguishing appositional from synechial angle closure was 0.873 (95% CI, 0.864–0.882) with a sensitivity of 0.846 and a specificity of 0.764. Conclusion Deep learning systems based on SS-OCT images showed good diagnostic performance for gonioscopic angle closure and moderate performance in the detection of PAS.
Collapse
Affiliation(s)
- Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yanyan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States
| | - Mingjie Deng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
30
|
Pasaoglu I, Basarir B. Comparison of anterior chamber angle parameters and iris structure of juvenile open-angle glaucoma and pigmentary glaucoma. Indian J Ophthalmol 2022; 70:558-563. [PMID: 35086237 PMCID: PMC9023982 DOI: 10.4103/ijo.ijo_2012_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To compare the quantitative measurements of the anterior chamber angle (ACA) and iris parameters in patients with juvenile open-angle glaucoma (JOAG), pigmentary glaucoma (PG), and healthy controls using anterior segment optical coherence tomography (AS-OCT). Methods: This was a retrospective, cross-sectional study of 25 eyes with JOAG, 25 eyes with PG, and 25 control eyes. Anterior chamber depth, angle-opening distance 500 and 750, trabecular–iris space 500 and 750, scleral spur angle, iris thickness (IT, measured at the thickest part), and iris bowing were obtained using AS-OCT (Visante” OCT 3.0 Model 1000, Carl Zeiss Meditec, Inc). Results: The quantitative ACA parameters were found to be significantly higher in JOAG and PG patients compared to healthy controls (P < 0.001); there was no significant difference between the eyes with JOAG and PG (P > 0.05). In eyes with JOAG and PG, there was significantly backward bowing of the iris in temporal and nasal angles compared to control subjects (P < 0.001). Median iris bowing was not significantly different between the patients with JOAG and PG (P > 0.05). The temporal and nasal angle iris thickness were significantly thinner in eyes with JOAG than the eyes with PG (P < 0.001) and age-matched control subjects (P < 0.001). The median IT did not differ between the patients with PG and control subjects (P > 0.05). In patients with JOAG, the intraocular pressure (IOP) was inversely correlated with IT (r = -0.43, P < 0.05). Conclusion: AS-OCT provided quantitative data on the ACA and iris parameters in JOAG and PG. The evaluation of the ACA and iris structures using AS-OCT revealed higher ACA measurements and posterior bowing of the iris in patients with JOAG and PG. Furthermore, the patients with JOAG were found to have thinner IT than the ones with PG and healthy controls.
Collapse
Affiliation(s)
- Isil Pasaoglu
- Department of Glaucoma, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Berna Basarir
- Department of Glaucoma, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
31
|
Römkens HCS, Beckers HJM, Schouten JSAG, Berendschot TTJM, Webers CAB. Effect of combined water drinking test and dark room provocative testing in Caucasian eyes with narrow angles. Eye (Lond) 2022; 36:167-174. [PMID: 33654318 PMCID: PMC8727610 DOI: 10.1038/s41433-021-01398-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To assess the usefulness of water drinking test and dark room provocative testing (WDT + DRPT) in current clinical practice by evaluating input parameters from Swept-source Optical Coherence Tomography (SS-OCT) images, and to determine if clinical factors like axial length, central endothelial cell count (CECC) and retinal nerve fibre layer thickness (RNFL) thickness are associated with a positive WDT + DRPT. METHODS SS-OCT examination was performed in consecutive subjects presenting as new patients in the outpatient clinic aged > 40 years. If at least one eye met the inclusion criteria (anterior chamber angles <20° and anterior chamber depth < 2.5 mm on SS-OCT), subjects were included in this study and WDT + DRPT was carried out. The eye with the smallest angle was analysed. The difference in parameters between eyes with a positive (≥8 mmHg) and negative (<8 mmHg) increase in intraocular pressure (IOP) after WDT + DRPT were statistically analysed. Second, the correlation between IOP increase after WDT + DRPT and anterior chamber angle parameters (RNFL thickness, CECC and axial length) was studied. RESULTS A total of 95 subjects with a mean age of 64 years were included. There was an association between IOP increase after WDT + DRPT and anterior chamber angle characteristics, however this was not of clinical significance. No positive results after WDT + DRPT were found in patients with anterior chamber angles ≥ 20°. CONCLUSIONS The present findings indicate that this combined provocative test has no definite correlative or predictive value in angle closure disease. Further, the test is not useful in predicting early diagnosis or possible CECC or RNFL loss.
Collapse
Affiliation(s)
- Hellen C. S. Römkens
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center, Maastricht, the Netherlands
| | - Henny J. M. Beckers
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jan S. A. G. Schouten
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center, Maastricht, the Netherlands ,Canisisus Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Tos T. J. M. Berendschot
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carroll A. B. Webers
- grid.412966.e0000 0004 0480 1382Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
32
|
Ma P, Wu Y, Oatts J, Patlidanon J, Yu Y, Ying GS, Kline B, Tun TA, He M, Aung T, Li S, Yang Y, Han Y. Evaluation of the Diagnostic Performance of Swept-Source Anterior Segment Optical Coherence Tomography in Primary Angle Closure Disease. Am J Ophthalmol 2022; 233:68-77. [PMID: 34283974 DOI: 10.1016/j.ajo.2021.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of swept-source anterior segment optical coherence tomography (SS-OCT) in differentiating eyes with primary angle closure disease (PACD) from eyes of control subjects, as well as eyes with PAC and PAC glaucoma (PACG) from eyes with PAC suspect (PACS) disease. DESIGN Multicenter cross-sectional study. METHODS Chinese patients were classified into control, PACS, and PAC/PACG groups. The area under the receiving operating characteristic curve (AUC) from logistic regression models was used to evaluate discriminating ability. Sensitivity and specificity were calculated, and performance of the models was validated using an independent dataset. RESULTS A total of 2928 SS-OCT images from 366 eyes of 260 patients were recruited to develop diagnostic models. The validation dataset included 1176 SS-OCT images from 147 eyes of 143 patients. For distinguishing PACD from control eyes, average anterior chamber depth had the highest AUC (0.94). With a cutoff of 2.2 mm for average anterior chamber depth, the sensitivity and specificity were 90.2% and 85.2% in the training set. For distinguishing PAC/PACG from PACS, a multivariate model had an AUC of 0.83, with sensitivity and specificity of 82.0% and 62.8% in the training set. The validation set confirmed the findings. CONCLUSIONS SS-OCT of the anterior segment showed excellent diagnostic performance distinguishing PACD from normal eyes and moderate diagnostic ability distinguishing eyes with PAC/PACG from eyes with PACS. ACD alone may provide a simple and effective way to diagnose PACD from control subjects. As ACD can be obtained using other more available modalities, this has implications for the early diagnosis of PACD.
Collapse
Affiliation(s)
- Ping Ma
- From the Department of Ophthalmology (P.M., J.O., P.J., K.B., T.A.), University of California, San Francisco, San Francisco, Caliornia, USA; Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yanyan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Julius Oatts
- From the Department of Ophthalmology (P.M., J.O., P.J., K.B., T.A.), University of California, San Francisco, San Francisco, Caliornia, USA
| | - Jutima Patlidanon
- From the Department of Ophthalmology (P.M., J.O., P.J., K.B., T.A.), University of California, San Francisco, San Francisco, Caliornia, USA
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brad Kline
- From the Department of Ophthalmology (P.M., J.O., P.J., K.B., T.A.), University of California, San Francisco, San Francisco, Caliornia, USA
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China;; Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shuning Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China;.
| | - Ying Han
- From the Department of Ophthalmology (P.M., J.O., P.J., K.B., T.A.), University of California, San Francisco, San Francisco, Caliornia, USA; From the Department of Ophthalmology (P.M., J.O., P.J., K.B., T.A.), University of California, San Francisco, San Francisco, Caliornia, USA; Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA..
| |
Collapse
|
33
|
Diagnostic accuracy of AS-OCT vs gonioscopy for detecting angle closure: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2021; 260:1-23. [PMID: 34223989 PMCID: PMC8255337 DOI: 10.1007/s00417-021-05271-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aims to review the literature that compares the accuracy of Anterior Segment-Optical Coherence Tomography (AS-OCT) against gonioscopy in detecting eyes with angle closure. It is currently unclear how AS-OCT fits into clinical practice for detecting angle closure. This is a systematic review and meta-analysis. Methods A literature search was performed on Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials to identify studies that investigated the diagnostic accuracy of AS-OCT in detecting eyes with angle closure as diagnosed by gonioscopy. Eligible studies included in the analysis met stringent inclusion criteria determining the sensitivity and specificity of AS-OCT. Results The initial search identified 727 studies, of which 23 were included in the final analysis. We found substantial variation in the parameters being studied and methodologies. The sensitivity of AS-OCT ranged from 46 to 100% (median 87%). Twenty-one studies identified parameters that showed sensitivity above 80%. The specificity ranged from 55.3 to 100% (median 84%). Conclusion AS-OCT demonstrates good sensitivity for detecting angle closure. It may provide an avenue to address high rates of undiagnosed angle closure, such as found in developing Asian countries. However, AS-OCT is not yet able to replace gonioscopy. Clinicians should consider whether the diagnostic accuracy of AS-OCT is acceptable for their specific clinical use before adopting it. More studies are needed to determine the utility of AS-OCT, including longitudinal studies to determine the significance of eyes classified to have closed angles by AS-OCT but open on gonioscopy. Supplementary Information The online version contains supplementary material available at 10.1007/s00417-021-05271-4.
Collapse
|
34
|
Iridocorneal angle assessment in children with spontaneously regressed retinopathy of prematurity. Int Ophthalmol 2021; 41:3641-3650. [PMID: 34169359 DOI: 10.1007/s10792-021-01926-7] [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: 12/19/2020] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess anterior segment anatomic parameters in school-aged children with spontaneously regressed retinopathy of prematurity (sr-ROP) and in children born preterm without ROP history (preT). METHODS sr-ROP and preT children were compared with healthy, born at term children (control group). Biometric characteristics were measured with the IOLMaster. Iridocorneal angle structure was evaluated using Visante AS-OCT, and angle opening distance, trabecular iris space area and scleral spur angle were calculated. Best-corrected visual acuity (BCVA) was measured with the ETDRS chart. RESULTS We examined 22 eyes of 11 children with sr-ROP, 26 eyes of 13 preT children and 24 eyes of 12 healthy controls, with a median age of 8 years. sr-ROP children exhibited worse mean BCVA and reduced AL compared to controls (p = 0.001 and p = 0.007, respectively). A narrower iridocorneal angle was found in sr-ROP compared to the preT and the control groups. Preterm children were found to have similar anterior chamber angle metrics compared to the full-term control group. CONCLUSION In this study, school-aged children with a history of sr-ROP had narrower angles compared to preterm- and term-born children. AS-OCT demonstrated structural differences of the iridocorneal angle in sr-ROP, possibly reflecting a mild developmental arrest of the anterior segment.
Collapse
|
35
|
Dai Y, Zhang S, Shen M, Jin Z, Zhou Y, Ye S, Bao C, Zhu D. Identification of peripheral anterior synechia with anterior segment optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2021; 259:2753-2759. [PMID: 33974133 DOI: 10.1007/s00417-021-05220-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To generate a model that evaluates the presence and extent of peripheral anterior synechia (PAS) based on anterior segment optical coherence tomography (AS-OCT). METHODS The extent of PAS involvement in the eyes of patients with angle closure was assessed by indentation gonioscopy, and the part of non-PAS and PAS were assigned into two groups (NPAS and PAS). Anterior chamber angles were then imaged by AS-OCT with light-emitting diode (LED) irradiation directly into the pupils, leading to pupillary constriction and increasing anterior chamber angle width. Parameters including the angle opening distance at 750 μm anterior to the scleral spur (AOD750) and trabecular-iris space area at 750 μm anterior to the scleral spur (TISA750) were then obtained. The differences before and after LED irradiation of AOD750 and TISA750 were calculated and used to generate a PAS model based on binary logistic regression. Validation data were then tested. RESULTS A total of 258 AS-OCT images in 14 eyes were assigned to the modeling data, and 120 were assigned to the validation data. There were no differences in AOD750 and TISA750 in the dark between NPAS and PAS (PAOD750 = 0.258, PTISA750 = 0.486), whereas after LED light exposure, TISA750light was larger in NPAS than in PAS (P = 0.047). The light-dark differences of both parameters showed significant differences between the two groups (PAOD750dif = 0.019, PTISA750dif < 0.001). The area under the curve of the model performance was 0.841, and the overall correct rate was 80.8% based on the validation data. CONCLUSIONS The present study demonstrates that the AS-OCT-based PAS model could be useful in the identifying of the presence of synechial angle closure and evaluating the extent of PAS in a single eye.
Collapse
Affiliation(s)
- Yingying Dai
- Zhejiang Industry and Trade Vocational College, Wenzhou, Zhejiang, China
| | - Shaodan Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zi Jin
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuheng Zhou
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuling Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chenhong Bao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dexi Zhu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| |
Collapse
|
36
|
Soebijantoro I, Gondhowiardjo TD, Soesatyo M. Association Between Anterior Chamber Angle and Corneal Endothelial Cell Density in Chronic Angle Closure. Clin Ophthalmol 2021; 15:1957-1964. [PMID: 34007148 PMCID: PMC8121679 DOI: 10.2147/opth.s309005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the association between corneal endothelial cell density (ECD) and degree of anterior chamber angle (ACA) opening in eyes with chronic angle closure glaucoma. Methods The study was conducted at JEC Eye Hospitals in Indonesia. Treatment-naïve patients aged ≥40 years with IOP >21 mmHg and peripheral anterior chamber depth (ACD) grade 2 or less by Van Herick's technique were recruited. Trabecular iris angle (TIA; degree) was measured using anterior segment optical coherence tomography (AS-OCT) and classified as: grade 1 ≤10°, grade 2 11-20°, and grade 3 >20°. Noncontact specular microscopy was performed, and the following corneal parameters were obtained:ECD (cells/mm2), coefficient of variation (CV; μm2/cell), percentage of hexagonal cells, and central corneal thickness (CCT; μm). Results A total of 52 eyes from 52 subjects were recruited (16 grade 1 TIA, 24 grade 2 TIA, and 12 grade 3 TIA). Presenting IOP was not significantly different between groups. The median central corneal ECD was 2684.5 (1433-2934), 2587.0 (1902-3103), and 2441.0 (1659-3005) cells/mm2 in grade 1, 2, and 3 TIA, respectively, with no significant differences across the groups (P = 0.67). The CV was lowest in grade 3 TIA (36.4 ± 7.2 μm2/cell), and highest in grade 1 TIA (38.3 ± 9.6 μm2/cell), but the differences were not significant (P = 0.74). Likewise, the percentage of hexagonality and CCT was not significantly different. TIA was not correlated with IOP but was modestly correlated with age. Conclusion The corneal ECD and morphological characteristics such as CV and hexagonality were not significantly different across various TIA grading in chronic angle closure. This may reflect the lack of chronic and gradual IOP insult on corneal endothelial parameters as TIA did not show direct effect towards IOP.
Collapse
|
37
|
Porporato N, Tun TA, Baskaran M, Wong DWK, Husain R, Fu H, Sultana R, Perera S, Schmetterer L, Aung T. Towards 'automated gonioscopy': a deep learning algorithm for 360° angle assessment by swept-source optical coherence tomography. Br J Ophthalmol 2021; 106:1387-1392. [PMID: 33846160 DOI: 10.1136/bjophthalmol-2020-318275] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/05/2021] [Accepted: 03/28/2021] [Indexed: 11/03/2022]
Abstract
AIMS To validate a deep learning (DL) algorithm (DLA) for 360° angle assessment on swept-source optical coherence tomography (SS-OCT) (CASIA SS-1000, Tomey Corporation, Nagoya, Japan). METHODS This was a reliability analysis from a cross-sectional study. An independent test set of 39 936 SS-OCT scans from 312 phakic subjects (128 SS-OCT meridional scans per eye) was analysed. Participants above 50 years with no previous history of intraocular surgery were consecutively recruited from glaucoma clinics. Indentation gonioscopy and dark room SS-OCT were performed. Gonioscopic angle closure was defined as non-visibility of the posterior trabecular meshwork in ≥180° of the angle. For each subject, all images were analysed by a DL-based network based on the VGG-16 architecture, for gonioscopic angle-closure detection. Area under receiver operating characteristic curves (AUCs) and other diagnostic performance indicators were calculated for the DLA (index test) against gonioscopy (reference standard). RESULTS Approximately 80% of the participants were Chinese, and more than half were women (57.4%). The prevalence of gonioscopic angle closure in this hospital-based sample was 20.2%. After analysing a total of 39 936 SS-OCT scans, the AUC of the DLA was 0.85 (95% CI:0.80 to 0.90, with sensitivity of 83% and a specificity of 87%) to classify gonioscopic angle closure with the optimal cut-off value of >35% of circumferential angle closure. CONCLUSIONS The DLA exhibited good diagnostic performance for detection of gonioscopic angle closure on 360° SS-OCT scans in a glaucoma clinic setting. Such an algorithm, independent of the identification of the scleral spur, may be the foundation for a non-contact, fast and reproducible 'automated gonioscopy' in future.
Collapse
Affiliation(s)
- Natalia Porporato
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore
| | - Tin A Tun
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore
| | - Damon W K Wong
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore
| | - Huazhu Fu
- Inception Institute of Artificial Intelligence, Abu Dhabi, UAE
| | | | - Shamira Perera
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Austria, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria, Austria
| | - Tin Aung
- Singapore Eye Research Institute/Singapore National Eye Centre, Singapore .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
38
|
Zheng C, Bian F, Li L, Xie X, Liu H, Liang J, Chen X, Wang Z, Qiao T, Yang J, Zhang M. Assessment of Generative Adversarial Networks for Synthetic Anterior Segment Optical Coherence Tomography Images in Closed-Angle Detection. Transl Vis Sci Technol 2021; 10:34. [PMID: 34004012 PMCID: PMC8088224 DOI: 10.1167/tvst.10.4.34] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 03/08/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To develop generative adversarial networks (GANs) that synthesize realistic anterior segment optical coherence tomography (AS-OCT) images and evaluate deep learning (DL) models that are trained on real and synthetic datasets for detecting angle closure. METHODS The GAN architecture was adopted and trained on the dataset with AS-OCT images collected from the Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, synthesizing open- and closed-angle AS-OCT images. A visual Turing test with two glaucoma specialists was performed to assess the image quality of real and synthetic images. DL models, trained on either real or synthetic datasets, were developed. Using the clinicians' grading of the AS-OCT images as the reference standard, we compared the diagnostic performance of open-angle vs. closed-angle detection of DL models and the AS-OCT parameter, defined as a trabecular-iris space area 750 µm anterior to the scleral spur (TISA750), in a small independent validation dataset. RESULTS The GAN training included 28,643 AS-OCT anterior chamber angle (ACA) images. The real and synthetic datasets for DL model training have an equal distribution of open- and closed-angle images (all with 10,000 images each). The independent validation dataset included 238 open-angle and 243 closed-angle AS-OCT ACA images. The image quality of real versus synthetic AS-OCT images was similar, as assessed by the two glaucoma specialists, except for the scleral spur visibility. For the independent validation dataset, both DL models achieved higher areas under the curve compared with TISA750. Two DL models had areas under the curve of 0.97 (95% confidence interval, 0.96-0.99) and 0.94 (95% confidence interval, 0.92-0.96). CONCLUSIONS The GAN synthetic AS-OCT images appeared to be of good quality, according to the glaucoma specialists. The DL models, trained on all-synthetic AS-OCT images, can achieve high diagnostic performance. TRANSLATIONAL RELEVANCE The GANs can generate realistic AS-OCT images, which can also be used to train DL models.
Collapse
Affiliation(s)
- Ce Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fang Bian
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
- Department of Ophthalmology, Deyang People's Hospital, Sichuan, China
| | - Luo Li
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaolin Xie
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
| | - Hui Liu
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Jianheng Liang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Xu Chen
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
- Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai, China
| | - Zilei Wang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tong Qiao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianlong Yang
- Ningbo Institute of Industrial Technology, Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
| |
Collapse
|
39
|
Gupta R, Kumar R, Chauhan L. Anterior chamber morphology changes in eyes with narrow angles by Scheimpflug imaging: Pilocarpine versus laser peripheral iridotomy. Int Ophthalmol 2021; 41:2099-2108. [PMID: 33763794 DOI: 10.1007/s10792-021-01767-4] [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: 05/07/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate morphometric variables, like anterior chamber angle (ACA), anterior chamber volume (ACV) and central anterior chamber depth (CACD) after pilocarpine administration and after prophylactic laser peripheral iridotomy (LPI) in eyes with primary angle-closure disease (PACD). DESIGN Prospective cohort study METHODS: Ninety-one eyes of 91 patients with narrow angles were consecutively enrolled in this prospective interventional study. All patients were classified into primary angle-closure suspect (PACS), primary angle-closure (PAC) and primary angle-closure glaucoma (PACG). If both eyes were eligible, one eye was randomly selected for study inclusion. ACV, ACD and ACA were evaluated using Scheimpflug imaging technology at three time points: at baseline (T0), 45 min after application of pilocarpine before LPI (T1) and at one-month post-LPI (T2). RESULTS PACS, PAC and PACG groups included 25 (27.4%), 24 (26.3%) and 42 (46.1%) eyes, respectively. At both time points T1 and T2, mean pupil diameter, ACV and ACA changed significantly (P = 0.00). In all subgroups, ACD decreased significantly at T1 and then increased significantly at T2. ACA was widened by 6 degrees in angles < 26 degrees as compared to 3 degrees in > 26 degrees eyes. In PACG group, mean ACV increased significantly between T0 and T2 (P = 0.0). Other parameters like mean cornea volume (P = 0.27), central corneal thickness (P = 0.29) showed no significant change between time points (T0, T1 and T2). Pilocarpine instillation caused a significant increase in ACA, ACV and ACD CONCLUSION: Scheimpflug imaging detected significant changes in ACD post-LPI and post-pilocarpine in all groups. However, ACV changed significantly only in PACS and PACG. CLINICAL TRIALS REGISTRATION Gels and blots/image manipulation: Author declares that the final image submitted represent the original data. All unprocessed images are with corresponding author and will make available if required.
Collapse
Affiliation(s)
- Richa Gupta
- Department of Glaucoma, CL Gupta Eye Institute, Ram Ganga Vihar, Phase 2(Ext), Moradabad, 244001, India.
| | - Raj Kumar
- Department of Optometry and Visual Sciences, CL Gupta Eye Institute, Ram Ganga Vihar, Phase 2(Ext), Moradabad, 244001, India
| | - Lokesh Chauhan
- Department of Clinical Research, C L Gupta Eye Institute, Ram Ganga Vihar, Phase 2(Ext), Moradabad, 244001, India
| |
Collapse
|
40
|
Watanabe S, Oie Y, Miki A, Soma T, Koh S, Kawasaki S, Tsujikawa M, Jhanji V, Nishida K. Correlation Between Angle Parameters and Central Corneal Thickness in Fuchs Endothelial Corneal Dystrophy. Cornea 2021; 39:540-545. [PMID: 31842041 DOI: 10.1097/ico.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the correlation between anterior chamber parameters and central corneal thickness (CCT) or peripheral corneal thickness (PCT) in patients with Fuchs endothelial corneal dystrophy (FECD) using anterior segment optical coherence tomography. METHODS This case-control study included 20 eyes from 20 patients with FECD and 31 eyes from 31 patients with healthy corneas. CCT was measured as an indicator of FECD severity. Anterior chamber angle parameters, including trabecular-iris angle (TIA500) and angle opening distance (AOD500), were measured as an indicator of peripheral anterior chamber morphology. We also analyzed PCT and lens vault (LV). The relationships between CCT or PCT and anterior chamber parameters were also analyzed in patients with FECD. RESULTS Patients with FECD had a larger CCT (593.9 ± 54.6 μm vs. 533.0 ± 25.4 μm, P < 0.001), smaller TIA500 (21.8 ± 9.9 vs. 32.5 ± 11.2 degrees, P = 0.002), smaller AOD500 (0.21 ± 0.11 vs. 0.34 ± 0.18 mm, P = 0.002), and greater LV (0.60 ± 0.27 vs. 0.40 ± 0.29 mm, P = 0.02) than control subjects. In patients with FECD, CCT was negatively correlated with the angle parameters TIA500 (R = 0.29, P = 0.009) and AOD500 (R = 0.19, P = 0.03). There were no significant correlations between PCT and TIA500 (R = 0.008, P = 0.29) or AOD500 (R = 0.007, P = 0.29). There were also no significant correlations between CCT and LV (R = 0.02, P = 0.55). CONCLUSIONS Larger CCT was significantly associated with narrower anterior chamber angle width, but not with LV. We showed that the severity of FECD is associated with angle chamber morphology.
Collapse
Affiliation(s)
- Shinya Watanabe
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; and
| | - Yoshinori Oie
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; and
| | - Atsuya Miki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; and
| | - Takeshi Soma
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; and
| | - Shizuka Koh
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; and
| | - Satoshi Kawasaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; and
| | - Motokazu Tsujikawa
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; and
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; and
| |
Collapse
|
41
|
Uejyo C, Henzan IM, Nakamura Y, Ishikawa S, Sakai H, Sawaguchi S, Kumar RS, Iwase A, Tomidokoro A, Araie M. Evaluation of anterior chamber angle by van Herick grading and ultrasound biomicroscopy in light and dark conditions for finding appositional angle closure and plateau iris configuration. Acta Ophthalmol 2021; 99:e86-e95. [PMID: 32567220 DOI: 10.1111/aos.14502] [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: 09/03/2019] [Accepted: 05/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate association of the van Herick (VH) grades with the ultrasound biomicroscopic (UBM) parameters, appositional irido-trabecular contact (A-ITC) and plateau iris (PI) in a randomly sampled population. METHODS A 10% random sample of all residents aged 40 or older of the Kumejima study underwent UBM under dark and light conditions in the four quadrants of right eyes. RESULTS Of 301 right eyes with eligible UBM images, 101 (33.6%) and 200 (66.4%) were classified as VH ≤ 2 and VH ≥ 3, respectively. The UBM parameters on angle width and ciliary body configuration were significantly different between VH ≤ 2 and VH ≥ 3 eyes (p < 0.001). A-ITC was found in at least one quadrant in 54.5% and 75.2% of VH ≤ 2 eyes under light and dark conditions, respectively; and 20.5% and 45.5% of VH ≥ 3 eyes. When 'VH ≤ 2' was used to screen eyes with A-ITC in three or more quadrants, the sensitivity and specificity were 74.1% and 75.3%, respectively. A-ITC was significantly associated with shallower anterior chamber (p = 0.018) and higher intraocular pressure (p = 0.044) in VH ≥ 3 eyes. Plateau iris (PI) was found in 15.8% and 6.0% of VH ≤ 2 and VH ≥ 3 eyes, respectively. Plateau iris (PI) was significantly associated with the UBM parameters on angle width and ciliary body configuration. When 'VH ≤ 2' was used to screen eyes with PI, the sensitivity and specificity were 57.1% and 68.9%, respectively. CONCLUSIONS The VH grade of ≤2 and ≥3 showed significant association with UBM angle width and ciliary body configuration parameters. The VH ≤ 2 criterion should be useful for screening of A-ITC and PI.
Collapse
Affiliation(s)
- Chiharu Uejyo
- Department of Ophthalmology Faculty of Medicine University of Ryukyu Naha Okinawa Japan
| | | | - Yuko Nakamura
- Department of Ophthalmology Faculty of Medicine University of Ryukyu Naha Okinawa Japan
| | - Shusaku Ishikawa
- Department of Ophthalmology Faculty of Medicine University of Ryukyu Naha Okinawa Japan
| | - Hiroshi Sakai
- Department of Ophthalmology Faculty of Medicine University of Ryukyu Naha Okinawa Japan
| | - Shoichi Sawaguchi
- Department of Ophthalmology Faculty of Medicine University of Ryukyu Naha Okinawa Japan
| | - Rajesh S. Kumar
- Eye Institute Cleveland Clinic Abu Dhabi United Arab Emirates
| | | | | | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers Setagaya Tokyo Japan
| |
Collapse
|
42
|
Hao H, Zhao Y, Yan Q, Higashita R, Zhang J, Zhao Y, Xu Y, Li F, Zhang X, Liu J. Angle-closure assessment in anterior segment OCT images via deep learning. Med Image Anal 2021; 69:101956. [PMID: 33550010 DOI: 10.1016/j.media.2021.101956] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
Precise characterization and analysis of anterior chamber angle (ACA) are of great importance in facilitating clinical examination and diagnosis of angle-closure disease. Currently, the gold standard for diagnostic angle assessment is observation of ACA by gonioscopy. However, gonioscopy requires direct contact between the gonioscope and patients' eye, which is uncomfortable for patients and may deform the ACA, leading to false results. To this end, in this paper, we explore a potential way for grading ACAs into open-, appositional- and synechial angles by Anterior Segment Optical Coherence Tomography (AS-OCT), rather than the conventional gonioscopic examination. The proposed classification schema can be beneficial to clinicians who seek to better understand the progression of the spectrum of angle-closure disease types, so as to further assist the assessment and required treatment at different stages of angle-closure disease. To be more specific, we first use an image alignment method to generate sequences of AS-OCT images. The ACA region is then localized automatically by segmenting an important biomarker - the iris - as this is a primary structural cue in identifying angle-closure disease. Finally, the AS-OCT images acquired in both dark and bright illumination conditions are fed into our Multi-Sequence Deep Network (MSDN) architecture, in which a convolutional neural network (CNN) module is applied to extract feature representations, and a novel ConvLSTM-TC module is employed to study the spatial state of these representations. In addition, a novel time-weighted cross-entropy loss (TC) is proposed to optimize the output of the ConvLSTM, and the extracted features are further aggregated for the purposes of classification. The proposed method is evaluated across 66 eyes, which include 1584 AS-OCT sequences, and a total of 16,896 images. The experimental results show that the proposed method outperforms existing state-of-the-art methods in applicability, effectiveness, and accuracy.
Collapse
Affiliation(s)
- Huaying Hao
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China; Glaucoma Artificial Intelligence Diagnosis and Imaging Analysis Joint Research Lab, Guangzhou & Ningbo, China
| | - Yitian Zhao
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China; Glaucoma Artificial Intelligence Diagnosis and Imaging Analysis Joint Research Lab, Guangzhou & Ningbo, China.
| | - Qifeng Yan
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China; Glaucoma Artificial Intelligence Diagnosis and Imaging Analysis Joint Research Lab, Guangzhou & Ningbo, China
| | - Risa Higashita
- Tomey Corporation, Nagoya, Japan; Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Jiong Zhang
- Laboratory of Neuro Imaging (LONI), Keck School of Medicine, University of SouthernCalifornia, Los Angeles, USA
| | - Yifan Zhao
- School of Aerospace, Transport and Manufacturing, Cranfield University, Bedford, UK
| | - Yanwu Xu
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China; Glaucoma Artificial Intelligence Diagnosis and Imaging Analysis Joint Research Lab, Guangzhou & Ningbo, China
| | - Fei Li
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China; Glaucoma Artificial Intelligence Diagnosis and Imaging Analysis Joint Research Lab, Guangzhou & Ningbo, China
| | - Xiulan Zhang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China; Glaucoma Artificial Intelligence Diagnosis and Imaging Analysis Joint Research Lab, Guangzhou & Ningbo, China
| | - Jiang Liu
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China; Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China; Glaucoma Artificial Intelligence Diagnosis and Imaging Analysis Joint Research Lab, Guangzhou & Ningbo, China.
| |
Collapse
|
43
|
Anterior Chamber Angle Assessment Techniques: A Review. J Clin Med 2020; 9:jcm9123814. [PMID: 33255754 PMCID: PMC7759936 DOI: 10.3390/jcm9123814] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 12/16/2022] Open
Abstract
Assessment of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination. It is intrinsically related to the diagnosis and treatment of glaucoma and has a role in its prevention. Although slit-lamp gonioscopy is considered the gold-standard technique for ACA evaluation, its poor reproducibility and the long learning curve are well-known shortcomings. Several new imaging techniques for angle evaluation have been developed in the recent years. However, whether these instruments may replace or not gonioscopy in everyday clinical practice remains unclear. This review summarizes the last findings in ACA evaluation, focusing on new instruments and their application to the clinical practice. Special attention will be given to the comparison between these new techniques and traditional slit-lamp gonioscopy. Whereas ultrasound biomicroscopy and anterior segment optical coherence tomography provide quantitative measurements of the anterior segment’s structures, new gonio-photographic systems allow for a qualitative assessment of angle findings, similarly to gonioscopy. Recently developed deep learning algorithms provide an automated classification of angle images, aiding physicians in taking faster and more efficient decisions. Despite new imaging techniques made analysis of the ACA more objective and practical, the ideal method for ACA evaluation has still to be determined.
Collapse
|
44
|
Russell G, Hertzberg SNW, Anisimova N, Gavrilova N, Petrovski BÉ, Petrovski G. Digital Image Analysis of the Angle and Optic Nerve: A Simple, Fast, and Low-Cost Method for Glaucoma Assessment. J Ophthalmol 2020; 2020:3595610. [PMID: 33194227 PMCID: PMC7641696 DOI: 10.1155/2020/3595610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To devise a simple, fast, and low-cost method for glaucoma assessment using digital image analysis of the angle and optic nerve in human subjects. METHODS Images from glaucoma and fundus assessment were used in this study, including color fundus photographs, standard optic nerve optical coherence tomography (OCT), and digital slit-lamp images of the angle/gonioscopy. Digital image conversion and analysis of the angle using ImageJ (NIH, USA) and adaptive histogram equalization contrast-limited AHE (CLAHE) to prevent noise amplification were implemented. Angle and optic nerve images were analyzed separately in the red, green, and blue (RGB) channels followed by 3D volumetric analysis of the degrees of angle depth and cup volume of the optic nerve. Horizontal tomogram reconstitution and nerve fiber detection methods were developed and compared to standard OCT images. RESULTS Digital slit-lamp angle images showed similar accuracy as standard anterior OCT measurements. Comparative analysis of RGB channels produced volumetric cup and horizontal tomogram, which closely resembled the 3D OCT appearance and B-scan of the cup, respectively. RGB channel splitting and image subtraction produced a map closely resembling that of the retinal nerve fiber layer (RNFL) thickness map on OCT. CONCLUSIONS While OCT imaging is rapidly progressing in the area of optic disc and chamber angle assessment, rising healthcare costs and lack of availability of the technology open a demand for alternative and cost-minimizing forms of image analysis in glaucoma. Volumetric, geometric, and segmentational data obtained through digital image analysis correspond well to those obtained by OCT imaging.
Collapse
Affiliation(s)
- Greg Russell
- Eyenuk Inc., Clinical Development, Woodland Hills, CA, USA
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
| | - Silvia N. W. Hertzberg
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Natalia Anisimova
- The A. I. Evdokimov Моscow State University of Medicine and Dentistry of the Ministry of Healthcare the Russian Federation, Moscow, Russia
- Eye Center “Vostok-Prozrenie”, Moscow, Russia
| | | | | | - Goran Petrovski
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
45
|
Pham TH, Devalla SK, Ang A, Soh ZD, Thiery AH, Boote C, Cheng CY, Girard MJA, Koh V. Deep learning algorithms to isolate and quantify the structures of the anterior segment in optical coherence tomography images. Br J Ophthalmol 2020; 105:1231-1237. [PMID: 32980820 DOI: 10.1136/bjophthalmol-2019-315723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/14/2020] [Accepted: 08/03/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Accurate isolation and quantification of intraocular dimensions in the anterior segment (AS) of the eye using optical coherence tomography (OCT) images is important in the diagnosis and treatment of many eye diseases, especially angle-closure glaucoma. METHOD In this study, we developed a deep convolutional neural network (DCNN) for the localisation of the scleral spur; moreover, we introduced an information-rich segmentation approach for this localisation problem. An ensemble of DCNNs for the segmentation of AS structures (iris, corneosclera shell adn anterior chamber) was developed. Based on the results of two previous processes, an algorithm to automatically quantify clinically important measurements were created. 200 images from 58 patients (100 eyes) were used for testing. RESULTS With limited training data, the DCNN was able to detect the scleral spur on unseen anterior segment optical coherence tomography (ASOCT) images as accurately as an experienced ophthalmologist on the given test dataset and simultaneously isolated the AS structures with a Dice coefficient of 95.7%. We then automatically extracted eight clinically relevant ASOCT measurements and proposed an automated quality check process that asserts the reliability of these measurements. When combined with an OCT machine capable of imaging multiple radial sections, the algorithms can provide a more complete objective assessment. The total segmentation and measurement time for a single scan is less than 2 s. CONCLUSION This is an essential step towards providing a robust automated framework for reliable quantification of ASOCT scans, for applications in the diagnosis and management of angle-closure glaucoma.
Collapse
Affiliation(s)
- Tan Hung Pham
- Department of Biomedical Engineering, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore
| | | | - Aloysius Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhi-Da Soh
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Alexandre H Thiery
- Statistics and Applied Probability, National University of Singapore, Singapore
| | - Craig Boote
- Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Ching-Yu Cheng
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Michael J A Girard
- Ophthalmic Engineering and Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore
| | - Victor Koh
- Department of Ophthalmology, National University Hospital, Singapore
| |
Collapse
|
46
|
Anterior Segment Optical Coherence Tomography: Is There a Clinical Role in the Management of Primary Angle Closure Disease? J Glaucoma 2020; 29:60-66. [PMID: 31490798 DOI: 10.1097/ijg.0000000000001355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary angle closure disease (PACD) covers a spectrum that includes primary angle closure suspect, primary angle closure, primary angle closure glaucoma, and acute primary angle closure. Accumulating evidence suggests that the pathogenesis of PACD is complex, with multiple contributory factors including variations in the anatomic or biometric characteristics of the angle segment structures. Advances in anterior segment optical coherence tomography technology have further enhanced our understanding of the risk factors and mechanisms involved in the disease process. This review discusses the potential clinical role of the anterior segment optical coherence tomography in the diagnosis, mechanistic evaluation, and as a predictor for future clinical outcomes of patients with PACD.
Collapse
|
47
|
Abstract
As the upgrading of smartphone technology revolutionizes the field of ophthalmic imaging, we put forward one more of its novel applications. This article presents the possibility of iridocorneal angle (ICA) estimation through smartphone-captured images. Such measured inferior ICA (at 6'o clock position) was comparable to the anterior segment optical coherence tomography measured trabecular iris angle at 500 μ at 270 degrees (P=0.06). They both had an excellent positive correlation (ρ=0.81, P<0.001). Therefore, smartphone image-aided angle estimation may be a simple, effective, and economical method for quantification of ICAs, paving a more evident way for identification of angle-closure disease.
Collapse
|
48
|
Atalay E, Yu DJ, Nongpiur ME. When to use anterior segment optical coherence tomography. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1767596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Eray Atalay
- Department of Ophthalmology, Eskisehir Osmangazi University Faculty of Medicine, Turkey
| | - Daryle Jason Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Monisha Esther Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
49
|
Ting DSJ, Foo VH, Yang LWY, Sia JT, Ang M, Lin H, Chodosh J, Mehta JS, Ting DSW. Artificial intelligence for anterior segment diseases: Emerging applications in ophthalmology. Br J Ophthalmol 2020; 105:158-168. [PMID: 32532762 DOI: 10.1136/bjophthalmol-2019-315651] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/21/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
With the advancement of computational power, refinement of learning algorithms and architectures, and availability of big data, artificial intelligence (AI) technology, particularly with machine learning and deep learning, is paving the way for 'intelligent' healthcare systems. AI-related research in ophthalmology previously focused on the screening and diagnosis of posterior segment diseases, particularly diabetic retinopathy, age-related macular degeneration and glaucoma. There is now emerging evidence demonstrating the application of AI to the diagnosis and management of a variety of anterior segment conditions. In this review, we provide an overview of AI applications to the anterior segment addressing keratoconus, infectious keratitis, refractive surgery, corneal transplant, adult and paediatric cataracts, angle-closure glaucoma and iris tumour, and highlight important clinical considerations for adoption of AI technologies, potential integration with telemedicine and future directions.
Collapse
Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.,Singapore Eye Research Institute, Singapore
| | | | | | - Josh Tjunrong Sia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore.,Cornea And Ext Disease, Singapore National Eye Centre, Singapore
| | - Haotian Lin
- Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - James Chodosh
- Ophthalmology, Massachusetts Eye and Ear Infirmary Howe Laboratory Harvard Medical School, Boston, Massachusetts, USA
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore.,Cornea And Ext Disease, Singapore National Eye Centre, Singapore
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore .,Vitreo-retinal Department, Singapore National Eye Center, Singapore
| |
Collapse
|
50
|
Dai Y, Zhang S, Shen M, Zhou Y, Wang M, Ye J, Zhu D. Modeling of gonioscopic anterior chamber angle grades based on anterior segment optical coherence tomography. EYE AND VISION 2020; 7:30. [PMID: 32518803 PMCID: PMC7268764 DOI: 10.1186/s40662-020-00196-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/12/2020] [Indexed: 01/15/2023]
Abstract
Background To quantitatively assess anterior chamber angle (ACA) structure by anterior segment optical coherence tomography (AS-OCT) and develop a model to evaluate angle width as defined by gonioscopy. Methods The ACAs of each quadrant were evaluated by gonioscopy, classified by the Scheie grading system, and assigned into one of the three grades: small angle (SA), moderate angle (MA), and large angle (LA). The eyes were imaged by AS-OCT, and ACA structural parameters including angle opening distance at the scleral spur (AODSS) and at 750 μm anterior to the scleral spur (AOD750), trabecular-iris space area at 750 μm anterior to the scleral spur (TISA750), and a newly defined parameter “light intersection distance” (LID), were measured. The ACA structural data were used to construct an ordered logistic regression model for assignment of ACAs to one of the three angle grades. The validity of the model was then tested. Results A total of 169 quadrants from 53 subjects were included in the analysis, of which 111 quadrants were included in the modeling data and 58 in the testing data. In pairwise comparisons of SA, MA, and LA by ANOVA, the measured parameters were as follows: AOD750 (0.174 ± 0.060 vs. 0.249 ± 0.068 vs. 0.376 ± 0.114 mm; P < 0.001), TISA750 (0.075 ± 0.035 vs. 0.117 ± 0.036 vs. 0.181 ± 0.062 mm2; P < 0.001), and LID (− 0.300 ± 0.187 vs. -0.085 ± 0.170 vs. 0.122 ± 0.156 mm; P < 0.001). The ACA grading model based on LID showed a relatively high correction rate of 72.4%, and the model efficiency, calculated using the receiver operating characteristic, showed an area under the curve of 0.740. Weighted kappa statistics showed a good agreement for multiple ACA grades (0.772). Conclusions The AS-OCT-based multiple ACA grades model was demonstrated as a non-contact approach for ACA assessment with high speed and high spatial resolution, providing guidance for diagnosis of angle closure.
Collapse
Affiliation(s)
- Yingying Dai
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Shaodan Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Yuheng Zhou
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Mengyi Wang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Jie Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Dexi Zhu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
| |
Collapse
|