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Victoria VM, Constanza PM, Victoria GM, Virginia SP, Jose L, Gustavo B, Cecilia SM. Nitro-Oleic acid protects from neovascularization, oxidative stress, gliosis and neurodegeneration in oxygen-induced retinopathy. Redox Biol 2025; 83:103634. [PMID: 40273475 PMCID: PMC12051658 DOI: 10.1016/j.redox.2025.103634] [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: 01/10/2025] [Revised: 03/25/2025] [Accepted: 04/09/2025] [Indexed: 04/26/2025] Open
Abstract
Inflammation and oxidative stress are involved in Proliferative Retinopathies (PR). Müller glial cells (MGCs) and microglia play pivotal roles in pathological neovascularization (NV) and neurodegeneration in PR. Nitro-fatty acids are important electrophilic signaling mediators with anti-inflammatory and antioxidant properties. Herein, our goal was to evaluate the cytoprotective effect of nitro-oleic acid (NO2-OA) on neurons, MGCs and microglia in a mouse model of oxygen-induced retinopathy (OIR). NO2-OA induced vascular regrowth and reduced NV at P17 OIR, although no difference in the proangiogenic/antiangiogenic (VEGF-A/PEDF) balance was found between NO2-OA treatment and vehicle. In addition, Western blot and immunofluorescence assays showed that NO2-OA prevented gliosis at P17 OIR and decreased the number and activation of IBA1+ retinal myeloid cells. However, NO2-OA did not restore the decrease in expression of glutamine synthase (GS). Loss of retinal function in OIR mouse model measured by electroretinography was ameliorated, mainly at P26 OIR, after NO2-OA treatment. Western blot analysis of retinas from OIR mice revealed decreased levels of caspase-3 protein and increased number of TUNEL-positive cells at P26 compared to RA. Notably, these alterations were partially prevented after NO2-OA treatment. Besides, NO2-OA attenuates oxidative stress induced in MGCs exposed to aqueous humor from patients with different stages of PR. These findings highlight NO2-OA as a promising therapeutic strategy targeting both vascular and neuroglial components in PR, suggesting its potential clinical relevance.
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Affiliation(s)
- Vaglienti María Victoria
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, 5000, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, 5000, Argentina
| | - Paz María Constanza
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, 5000, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, 5000, Argentina
| | - Gutierrez Maria Victoria
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, 5000, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, 5000, Argentina
| | - Subirada Paula Virginia
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, 5000, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, 5000, Argentina
| | - Luna Jose
- Centro Privado de Ojos Romagosa S.A, Argentina
| | - Bonacci Gustavo
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, 5000, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, 5000, Argentina.
| | - Sánchez María Cecilia
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, 5000, Argentina; Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, 5000, Argentina.
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Raja D, Zhao CS, Shah SV, Mohammadi S, Brant AR, Moshfeghi DM. Telescreening for Retinopathy of Prematurity after 40 Weeks Postmenstrual Age. Ophthalmol Retina 2025:S2468-6530(25)00154-X. [PMID: 40180314 DOI: 10.1016/j.oret.2025.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2025] [Revised: 03/05/2025] [Accepted: 03/26/2025] [Indexed: 04/05/2025]
Affiliation(s)
| | - Cindy S Zhao
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Sarthak V Shah
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Saeed Mohammadi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Arthur R Brant
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Darius M Moshfeghi
- Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
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Wang Q, Xiao Y, Ma X. Optimizing visible retinal area in pediatric ultra-widefield fundus imaging: The effectiveness of mydriasis and eyelid lifting. Photodiagnosis Photodyn Ther 2025; 52:104532. [PMID: 40015615 DOI: 10.1016/j.pdpdt.2025.104532] [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: 12/27/2024] [Revised: 02/23/2025] [Accepted: 02/24/2025] [Indexed: 03/01/2025]
Abstract
BACKGROUND The increase in visible retinal area (VRA) enhances the detection of peripheral retinal pathologies. This study aims to maximize the VRA in children using ultra-widefield (UWF) fundus imaging. METHODS This cross-sectional, observational study included 53 children (106 eyes) who underwent examination in the Ophthalmology Department of Zhoupu Hospital from February to October 2023. Fundus images were captured using the ultra-widefield Optos imaging system (Daytona P200T). Parameters such as uncorrected visual acuity (UCVA), Spherical equivalent refraction (SER), axial length (AL), non-contact tonometry (NCT), and pupil diameters (both undilated and dilated) were measured. A custom image segmentation tool based on deep learning technology was used to quantify the VRA. The eyes were categorized into four groups: undilated without eyelid lifting, undilated with eyelid lifting, dilated without eyelid lifting, and dilated with eyelid lifting. RESULTS Significant differences in VRA between the four groups (χ² = 79.686, P < 0.001). Mydriasis increased VRA by 8.4 % (P = 0.001), eyelid lifting increased VRA by 18.1 % (P < 0.001), and combining both increased VRA by 20 % (P < 0.001). UCVA was negatively correlated with VRA in the undilated condition without eyelid lifting (r= -0.237, P = 0.014), SER was negatively correlated with VRA and AL was positively correlated with VRA under dilation without eyelid lifting (r = -0.310, P = 0.001; r = 0.264, P = 0.006). CONCLUSION Combining mydriasis with manual eyelid lifting significantly enhances the VRA in UWF fundus imaging, effectively mitigating the effects of artifacts caused by eyelashes and eyelids. This technique improves the detection rate of peripheral retinal pathologies.
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Affiliation(s)
- Qingxia Wang
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Department of Ophthalmology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai 201318, China
| | - Yuanyuan Xiao
- Department of Ophthalmology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai 201318, China
| | - Xiaoyun Ma
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Department of Ophthalmology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai 201318, China.
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Daulton MR, Haque ME, Moshfeghi DM, Lambert SR, Pershing S. Disparities in Childhood Blindness Resulting from Retinopathy of Prematurity Using the IRIS® Registry. Ophthalmology 2025:S0161-6420(25)00169-1. [PMID: 40089027 DOI: 10.1016/j.ophtha.2025.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Revised: 02/25/2025] [Accepted: 03/04/2025] [Indexed: 03/17/2025] Open
Affiliation(s)
- Melanie R Daulton
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California.
| | - Md Enamul Haque
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Darius M Moshfeghi
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Scott R Lambert
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Suzann Pershing
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Charvet CJ, de Sousa AA, Vassilopoulos T. Translating time: Challenges, progress, and future directions. Brain Res Bull 2025; 221:111212. [PMID: 39824228 PMCID: PMC11904871 DOI: 10.1016/j.brainresbull.2025.111212] [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: 08/03/2024] [Revised: 01/11/2025] [Accepted: 01/14/2025] [Indexed: 01/20/2025]
Abstract
Mice are the dominant model system to study human health and disease. Yet, there is a pressing need to use diverse model systems to address long-standing issues in biomedical sciences. Mice do not spontaneously recapitulate many of the diseases we seek to study. Accordingly, the relevance of studying mice to understand human disease is limited. We discuss examples associated with limitations of the mouse model, and how the inclusion of a richer array of model systems can help address long standing issues in biomedical sciences. We also discuss a tool called Translating Time, an online resource (www.translatingtime.org) that equates corresponding ages across model systems and humans. The translating time resource can be used to bridge the gap across species and make predictions when data are sparse or unavailable as is the case for human fetal development. Moreover, the Translating Time tool can map findings across species, make inferences about the evolution of shared neuropathologies, and inform the optimal model system for studying human biology in health and in disease. Resources such as these can be utilized to integrate information across diverse model systems to improve the study of human biology in health and disease.
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Affiliation(s)
- Christine J Charvet
- Department of Anatomy, Physiology & Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
| | - Alexandra A de Sousa
- Department of Anatomy, Physiology & Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
| | - Tatianna Vassilopoulos
- Department of Anatomy, Physiology & Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
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Moshfeghi HP, Zaidi M, Kumm J, Hoyek S, Chaaya C, Scarboro SD, Wood E, Patel NA. The U.S.A. eligible retinopathy of prematurity screening population 2003-2022: WONDER-ROP Study. Early Hum Dev 2025; 201:106192. [PMID: 39842136 DOI: 10.1016/j.earlhumdev.2025.106192] [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: 10/28/2024] [Revised: 01/02/2025] [Accepted: 01/03/2025] [Indexed: 01/24/2025]
Abstract
PURPOSE To delineate the trends of the United States population eligible for retinopathy of prematurity (ROP) screening as defined by the Joint Statement Screening Guidelines of the American Academies of Pediatrics and Ophthalmology from the Centers for Disease Control using the Wide-ranging Online Data for Epidemiologic Research (WONDER) Database. DESIGN National, retrospective study. SUBJECTS Infants with ROP in the United States between 2003 and 2022. METHODS Data collected from WONDER database over the 20-year period 2003-2022. MAIN OUTCOME MEASURED The parameters of state, infant birth weight (BW), and last menstrual period estimated gestational age (EGA). Four categories of qualification for ROP Screening eligibility were created: BW, EGA, combined BW and EGA (double eligible infants), and Unique Eligible Infants (UEI). RESULTS The number of eligible for ROP screening in the U.S peaked at 56,106 in 2007 and has steadily declined to 41,083 in 2022, averaging 47,088 per year throughout the study period. During the first ten-year period, there was an average of 50,895 eligible infants per year vs 43,281 infants per year during the second ten-year period. This was a statistically significant trend. BW slightly surpassed EGA as a driver for screening eligibility every year. Both the numbers of eligible micropremature (24-26 weeks GA and/or BW 600-800 g) infants and numbers of eligible nanopremature (<24 weeks GA and/or BW <600 g) infants mirrored the trendline overall eligibility trends. At the state level, Texas surpassed California in 2012 in terms of the highest number of eligible infants, and Florida surpassed New York in 2011 as the state with the third most eligible infants. These changes persisted until the end of the study period. State level changes were driven by EGA. For micropremature infants, California and New York demonstrated a decline in eligibility driven by both BW and EGA. CONCLUSION Consistent with a drop in overall births, the numbers of eligible infants for ROP screening at birth have been decreasing since its peak in 2007, with stabilization in the 2020's. Nationally, BW drives eligibility. Both micro- and nano-premature infants have decreased in a manner that corresponds to overall eligibility with nano-premature infants having a slight relative decrease. This data adds important context to studies on infant survivability and ROP screening epidemiology.
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Affiliation(s)
| | - Moosa Zaidi
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Jochen Kumm
- Pr3vent, Inc, Palo Alto, CA, United States of America
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Celine Chaaya
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | | | - Edward Wood
- Austin Retina Associates, Austin, TX, United States of America
| | - Nimesh A Patel
- Pr3vent, Inc, Palo Alto, CA, United States of America; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America.
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Daruich A, Bremond-Gignac D, Aziz A, Barjol A, Beylerian M, Blanco R, Cairet P, Caputo G, Chapron T, Kermorvant E, Le Meur G, Nicaise C. [National protocol for diagnosis and care of retinopathy of prematurity: Summary for the attending physician]. J Fr Ophtalmol 2025; 48:104333. [PMID: 39454240 DOI: 10.1016/j.jfo.2024.104333] [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: 08/29/2024] [Accepted: 09/05/2024] [Indexed: 10/28/2024]
Abstract
Retinopathy of prematurity (ROP, ORPHA: 90050) is the main cause of visual impairment in preterm infants and the leading preventable cause of childhood blindness in high- and middle-income countries. However, severe stages of the disease remain rare. While screening recommendations for the disease are well-established in France, management of ROP requiring treatment is less standardized, especially since new therapeutic options have been approval on this indication. The management of preterm infants requiring treatment for ROP is complex and involves a multidisciplinary team, including pediatric ophthalmologists, vitreoretinal surgeons, neonatologists, pediatric anesthetists, nurses, and orthoptists, within an adapted structure for premature infants care. There is a genuine need to unify national practices, with a strong demand from physicians involved in ROP care along the country. The objective of this National Diagnostic and Care Protocol (PNDS) is to provide guidelines for diagnostic and management for ROP, and to optimize and harmonize the management of this disease across the country. The main treatment indications, the different treatment modalities including laser photocoagulation, anti-VEGF injections, and vitreoretinal surgery as well as follow-up calendar, are reviewed to establish the best practice recommendations on ROP.
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Affiliation(s)
- A Daruich
- Département d'ophtalmologie, hôpital universitaire Necker-Enfants malades, AP-HP, université Paris Cité, Paris, France; Inserm, UMRS1138, équipe 17 « De la physiopathologie des maladies oculaires au développement clinique », Sorbonne Paris Cité, centre de recherche des Cordeliers, Paris, France.
| | - D Bremond-Gignac
- Département d'ophtalmologie, hôpital universitaire Necker-Enfants malades, AP-HP, université Paris Cité, Paris, France; Inserm, UMRS1138, équipe 17 « De la physiopathologie des maladies oculaires au développement clinique », Sorbonne Paris Cité, centre de recherche des Cordeliers, Paris, France
| | - A Aziz
- Service d'ophtalmologie, hôpital universitaire Nord, AP-HM, Marseille, France
| | - A Barjol
- Service d'ophtalmologie, hôpital de la Fondation Rothschild, Paris, France
| | - M Beylerian
- Service d'ophtalmologie, hôpital universitaire Nord, AP-HM, Marseille, France
| | - R Blanco
- Service d'ophtalmologie, hôpital intercommunal de Créteil, Créteil, France
| | - P Cairet
- Département d'anesthésie et de soins intensifs, hôpital universitaire Necker-Enfants malades, AP-HP, Paris, France
| | - G Caputo
- Service d'ophtalmologie, hôpital de la Fondation Rothschild, Paris, France
| | - T Chapron
- Service d'ophtalmologie, hôpital de la Fondation Rothschild, Paris, France
| | - E Kermorvant
- Unité de soins intensifs néonatals, Necker-Enfants malades, AP-HP, université Paris Cité, Paris, France
| | - G Le Meur
- Service d'ophtalmologie, CHU de Nantes, université de Nantes, Nantes, France
| | - C Nicaise
- Unité de soins intensifs néonatals, Assistance publique-Hôpitaux de Marseille, centre hospitalier universitaire Hôpital Nord, Marseille, France
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Patel NA, Altamirano F, Hoyek S, De Bruyn H, Fulton A, Gise R, Mantagos IS, Wu C, Gonzalez E, VanderVeen DK. Validation of the "TWO-ROP" Algorithm at a Multi-Neonatal Intensive Care Unit Tertiary Referral Center. Ophthalmol Retina 2025; 9:63-68. [PMID: 39032607 DOI: 10.1016/j.oret.2024.07.010] [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: 03/27/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE We aim to validate the previously published TWO-ROP algorithm on an external data set. DESIGN Retrospective consecutive study. SUBJECTS Infants screened for retinopathy of prematurity (ROP) between January 2013 and August 2023 at a tertiary referral multi-site. METHODS Infants with higher birth weight (BW) and greater gestational age (GA) were included and stratified into 3 groups as follows: group 1 (BW <1500 g, GA ≥30 weeks), group 2 (BW ≥1500 g, GA <30 weeks), and group 3 (BW ≥1500 g, GA ≥30 weeks). MAIN OUTCOME MEASURES The rate of ROP, treatment-warranted ROP (TW-ROP), and number of inpatient examinations were evaluated in the 3 groups. RESULTS In total, 1095 (33.8%) patients met the inclusion criteria. The number of patients in groups 1, 2, and 3 was 837 (76.4%), 72 (6.6%), and 186 (17.0%), respectively. Retinopathy of prematurity was detected in 120 (11.0%) patients; the rate was 9.8% in group 1, 20.8% in group 2, and 12.4% in group 3 (P = 0.013). The overall mean number of inpatient examinations for patients undergoing traditional, TWO-ROP 36-week, and TWO-ROP 40-week screening systems was 1.95, 1.43, and 0.99, respectively (P < 0.001). Stage 3 was found in 9 eyes of 5 patients (0.5%, all zone II). Three eyes of 2 patients (0.2%) had plus disease. Two patients had bilateral laser treatment at 44 and 39.4 weeks postconceptional age (PCA); 3 out of 4 of these eyes met type 1 treatment criteria. Overall, the ROP screening burden saved was 9.0% and 16.7% for the TWO-ROP 36-week and 40-week systems, respectively. The sensitivity for TW-ROP was 100% for TWO-ROP 36-week system and 99.4% for TWO-ROP 40-week system. CONCLUSION The TWO-ROP algorithm can reduce the number of inpatient examinations while maintaining safety. To ensure timely management, we recommend that the single first ROP examination occur at 38 to 39 weeks PCA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Nimesh A Patel
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
| | - Francisco Altamirano
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sandra Hoyek
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Hanna De Bruyn
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne Fulton
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan Gise
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Iason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolyn Wu
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Efren Gonzalez
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Kim S, Rachitskaya A, Babiuch A, Eisenberg M, Ghasia F, Sears J, Williamson A, Traboulsi EI. Characterization of pediatric low vision and socioeconomic determinants of health at an academic center: a 5-year analysis. J AAPOS 2024; 28:104033. [PMID: 39522590 DOI: 10.1016/j.jaapos.2024.104033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/07/2024] [Accepted: 08/25/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE To investigate the demographics, eye surgeries, and social determinants of health in pediatric patients with low vision in one or both eyes. METHODS This is a cross-sectional study of children 3-18 years of age examined at an academic eye center from 2014 to 2019. Low vision was present if one eye had a distance best-corrected visual acuity (BCVA) of <20/70. ZIP code was used to estimate patient income via a public third-party database. RESULTS Of 47,571 children examined during the study period, 882 had at least one eye with low vision. Of the 882, 88 (10%) had BCVA of <20/400 in at least one eye, and 228 patients (26%) had bilateral low vision. The most common cause of low vision was refractive/strabismic amblyopia (n = 304). The severest forms of vision loss (BCVA<20/200) were predominantly due to retinal dystrophies or detachment (n = 91). Three hundred patients (34%) had undergone at least one ophthalmic surgery-predominantly extraocular muscle procedures in eyes with mild visual loss and vitreoretinal surgeries in those with more severe loss. The severity of vision loss was significantly associated with a higher likelihood and number of surgeries (P < 0.0001). Income and insurance coverage did not have a significant association with BCVA or the likelihood of surgery. CONCLUSIONS Refractive and strabismic amblyopia are the predominant causes of reduced worse-eye vision in children, and retinal diseases commonly caused severe vision loss. The type and number of surgeries correlate with the severity of vision loss. We did not find any association of income and insurance type with studied outcomes.
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Affiliation(s)
- Suzie Kim
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
| | | | | | | | - Fatema Ghasia
- Cleveland Clinic Cole Eye Institute, Cleveland, Ohio
| | | | | | - Elias I Traboulsi
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; Cleveland Clinic Cole Eye Institute, Cleveland, Ohio
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Moir JT, Hyman MJ, Skondra D, Rodriguez SH. Risk factors for severe retinopathy of prematurity stratified by birth weight and gestational age in privately insured infants. J AAPOS 2024; 28:104049. [PMID: 39550054 DOI: 10.1016/j.jaapos.2024.104049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/19/2024] [Accepted: 08/01/2024] [Indexed: 11/18/2024]
Abstract
PURPOSE To evaluate risk factors associated with severe retinopathy of prematurity ROP (sROP) in two separate cohorts of infants. METHODS We performed a retrospective study of the Merative MarketScan Commercial Database between 2003 and 2022. Infants with ROP were stratified into two cohorts: group A (defined as infants with both birth weight [BW] <1000 g and gestational age [GA] <29 weeks) and group B (defined as infants with either BW ≥1000 g or GA ≥29 weeks). Infants with sROP were defined as those who received treatment for ROP. Outpatient and inpatient claims using International Classification of Diseases and Current Procedural Terminology codes were used to identify neonatal comorbidities. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for sROP requiring treatment with respect to various comorbidities. RESULTS A total of 425 of 8,789 infants with ROP developed sROP (4.8%). We identified 2,726 infants in group A, of whom 387 (14.2%) required a procedure, and 6,063 in group B, of whom 38 (0.6%) required a procedure. In group A, intraventricular hemorrhage (OR = 1.38; 95% CI, 1.09-1.74) and patent ductus arteriosus ligation (OR = 1.65; 95% CI, 1.25-2.16) were the comorbidities that significantly increased the odds of sROP on multivariable analysis. In group B, infection (OR = 1.96; 95% CI, 1.01-3.80) was the only comorbidity that significantly increased the adjusted odds of sROP. CONCLUSIONS Risk factors for sROP may differ between smaller and larger infants. Infection may serve as an important risk factor for ROP progression amongst larger infants due to its connection with poor postnatal growth.
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Affiliation(s)
- John T Moir
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Max J Hyman
- The Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medicine, Chicago, Illinois
| | - Sarah H Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago Medicine, Chicago, Illinois.
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Gáll T, Pethő D, Erdélyi K, Egri V, Balla JG, Nagy A, Nagy A, Póliska S, Gram M, Gábriel R, Nagy P, Balla J, Balla G. Heme: A link between hemorrhage and retinopathy of prematurity progression. Redox Biol 2024; 76:103316. [PMID: 39260060 PMCID: PMC11415884 DOI: 10.1016/j.redox.2024.103316] [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: 08/02/2024] [Accepted: 08/15/2024] [Indexed: 09/13/2024] Open
Abstract
Neovascularization is implicated in the pathology of retinopathy of prematurity (ROP), diabetic retinopathy (DR), and age-related macular degeneration (AMD), which are the leading causes of blindness worldwide. In our work, we analyzed how heme released during hemorrhage affects hypoxic response and neovascularization. Our retrospective clinical analysis demonstrated, that hemorrhage was associated with more severe retinal neovascularization in ROP patients. Our heme-stimulated human retinal pigment epithelial (ARPE-19) cell studies demonstrated increased expression of positive regulators of angiogenesis, including vascular endothelial growth factor-A (VEGFA), a key player of ROP, DR and AMD, and highlighted the activation of the PI3K/AKT/mTOR/VEGFA pathway involved in angiogenesis in response to heme. Furthermore, heme decreased oxidative phosphorylation in the mitochondria, augmented glycolysis, facilitated HIF-1α nuclear translocation, and increased VEGFA/GLUT1/PDK1 expression suggesting HIF-1α-driven hypoxic response in ARPE-19 cells without effecting the metabolism of reactive oxygen species. Inhibitors of HIF-1α, PI3K and suppression of mTOR pathway by clinically promising drug, rapamycin, mitigated heme-provoked cellular response. Our data proved that oxidatively modified forms of hemoglobin can be sources of heme to induce VEGFA during retinal hemorrhage. We propose that hemorrhage is involved in the pathology of ROP, DR, and AMD.
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Affiliation(s)
- Tamás Gáll
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Dávid Pethő
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary; HUN-REN-UD Vascular Biology and Myocardium Pathophysiology Research Group, Hungarian Academy of Sciences, University of Debrecen, Debrecen, H-4032, Hungary; Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
| | - Katalin Erdélyi
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest H-1122, Hungary
| | - Virág Egri
- Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Jázon György Balla
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Annamária Nagy
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary; HUN-REN-UD Vascular Biology and Myocardium Pathophysiology Research Group, Hungarian Academy of Sciences, University of Debrecen, Debrecen, H-4032, Hungary
| | - Annamária Nagy
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen H-4032, Hungary
| | - Szilárd Póliska
- Genomic Medicine and Bioinformatic Core Facility, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary
| | - Magnus Gram
- Pediatrics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Neonatology, Skåne University Hospital, Lund, Sweden; Biofilms - Research Center for Biointerfaces, Department of Biomedical Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Róbert Gábriel
- Department of Experimental Zoology and Neurobiology, University of Pécs, Pécs, H-7624, Hungary; János Szentágothai Research Centre, University of Pécs, Pécs, H-7624, Hungary
| | - Péter Nagy
- Department of Molecular Immunology and Toxicology and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest H-1122, Hungary; Chemistry Institute, University of Debrecen, Debrecen, H-4032, Hungary; Department of Anatomy and Histology, HUN-REN-UVMB Laboratory of Redox Biology, University of Veterinary Medicine; Budapest, Hungary
| | - József Balla
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary; HUN-REN-UD Vascular Biology and Myocardium Pathophysiology Research Group, Hungarian Academy of Sciences, University of Debrecen, Debrecen, H-4032, Hungary
| | - György Balla
- Department of Internal Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary; Department of Pediatrics, Faculty of Medicine, University of Debrecen, Debrecen, H-4032, Hungary.
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12
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Ashby N, Miller C, Yeh C, Huang C, Song H, Dingalele M, Kindundu G, Fashina T, Hartley CD, Mwanza JC. Update on Epidemiologic Trends in Causes of Childhood Blindness and Severe Visual Impairment in East Africa. Int Ophthalmol Clin 2024; 64:75-82. [PMID: 39480211 DOI: 10.1097/iio.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2024]
Abstract
OBJECTIVE The initiative 2030 In Sight and the International Agency for the Prevention of Blindness have developed a plan to mitigate the global burden of preventable sight loss. One priority of this initiative is obtaining population eye health data. East Africa is a region that has historically been plagued by high rates of vision loss, and it is imperative to understand what causes are at play. Two large cross-sectional studies were previously published in 1995 and 2009, reporting the causes of childhood blindness (BL) and severe visual impairment (SVI) in East Africa. An update regarding more recent causes is warranted to better understand the trends of childhood BL/SVI in this region. METHODS A search strategy was developed a priori to identify relevant terms and align them with a standardized definition of East Africa. This strategy was then employed across PubMed, Google Scholar, and Scopus, with the yield of the overall search depicted in a Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 flow diagram. In the articles gathered by the search, causes of BL/SVI were typically categorized by anatomy and etiology. RESULTS Eight articles met the criteria, with data from 6 countries, consisting of 534 cases of childhood BL/SVI. Common anatomic locations identified included the cornea, lens, and whole globe. Among the most common etiologies were corneal scarring/opacity and cataract. Systemic etiologies and disease associations included measles, toxoplasmosis, and prematurity. Presumptive infectious disease and hereditary conditions were also identified as a category, but specific identification of etiologies and genetic diagnosis was largely unavailable. CONCLUSIONS BL/SVI due to the cornea was among the common anatomic sites of disease in our study. The identification of measles as an associated systemic etiology requires further understanding in the context of increased vaccination programs. Multiple articles acknowledged that cataract has become the predominant cause of BL/SVI owing to increased measles vaccination and vitamin A supplementation. Additional research should be conducted to gain a complete understanding of childhood BL/SVI in East Africa, and responses at regional and national levels are likely necessary to address treatable causes of vision impairment.
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Affiliation(s)
- Nathaniel Ashby
- Creighton University School of Medicine, Creighton University, Omaha, NE
| | - Chase Miller
- Creighton University School of Medicine, Creighton University, Omaha, NE
| | - Caleb Yeh
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE
| | - Crystal Huang
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE
| | - Helen Song
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE
| | - Merveille Dingalele
- Department of Ophthalmology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Grace Kindundu
- Department of Ophthalmology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Tolulope Fashina
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE
| | - Caleb D Hartley
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE
| | - Jean-Claude Mwanza
- Department of Ophthalmology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC
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13
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Nguyen TAL, Raileanu V, Smith B, Griffin A, Shah S. Excellent accuracy of trained neonatal nurses in the detection of referral-warranted retinopathy of prematurity within an established telemedicine screening programme. J Paediatr Child Health 2024; 60:369-374. [PMID: 39034445 DOI: 10.1111/jpc.16621] [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: 02/15/2024] [Revised: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
AIM To evaluate level of agreement of specialist trained retinopathy of prematurity (ROP) nurses compared with an experienced paediatric ophthalmologist in detection of referral-warranted ROP (RWROP) using wide-field digital retinal imaging. METHODS This is a prospective, observational, blinded study of neonates in a level III neonatal intensive care unit, from July 2020 to November 2022. Image capture using wide-field digital retinal imaging followed by ROP grading and staging was completed by trained ROP nurses. This was then compared with findings by an experienced paediatric ophthalmologist. The primary outcome was presence of RWROP in either eye. RESULTS One hundred and ninety-five neonates (55% male) with a total of 768 screening visits were included. At the initial screen, nurse and ophthalmologist agreed about presence of RWROP for 191 of 195 neonates (98%, kappa = 0.79, P < 0.0001), with 100% sensitivity for RWROP detection. Including all 768 screening episodes, agreement was 98% for RWROP. There was disagreement in 16 screenings (2%) for 11 (6%) neonates. Of the five screenings (0.7%) that the ophthalmologist thought were RWROP and the nurse did not, three were disagreements about whether the zone was posterior zone 2 or zone 1. CONCLUSIONS We found excellent levels of agreement and add evidence that interpretations by specialist trained nurses could be safely integrated into a 'hybrid ROP screening system'.
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Affiliation(s)
- Thuan Anh Le Nguyen
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Vanessa Raileanu
- Neonatal Critical Care Unit, Mater Mothers' Hospitals, Brisbane, Queensland, Australia
| | - Bernice Smith
- Neonatal Critical Care Unit, Mater Mothers' Hospitals, Brisbane, Queensland, Australia
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Shaheen Shah
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
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Duff SM, Alvarez-Falcon S, Freedman SF, El-Dairi M. Single-line macular optic coherence tomography to confirm optic neuropathies in awake infants and young children. J AAPOS 2024; 28:103968. [PMID: 38987015 DOI: 10.1016/j.jaapos.2024.103968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Handheld optical coherence tomography (HH-OCT) can image awake, young children but lacks integrated segmentation/analysis software. OCT imaging of eyes with optic neuropathies demonstrates ganglion cell layer (GCL) and ganglion cell complex (GCC) thinning, with a normal or thickened inner nuclear layer (INL). We compared pediatric normative data with GCL/INL and GCC/INL ratios from HH-OCT macular scans of awake young children with clinically diagnosed optic neuropathies. METHODS Macular HH-OCT from awake children with optic neuropathies was prospectively obtained using Bioptigen (Leica Microsystems, Wetzlar, Germany). The GCL, GCC, and INL were manually measured by two readers using ImageJ from single-line macular scans at the thickest points nasal and temporal to the fovea, respectively, and the GCL/INL and GCC/INL ratios were calculated and compared with normative data. RESULTS HH-OCT images from 17 right eyes of 17 children (mean age, 4.3 ± 2.9 years) with optic neuropathies were analyzed. Mean nasal (17 eyes) and temporal (16 eyes) GCL/INL ratios with optic neuropathies were 0.44 ± 0.38 (95% CI, 0.26-0.62) and 0.26 ± 0.22 (95% CI, 0.15-0.36), respectively. Corresponding normative GCL/INL ratios are 1.26 ± 0.20 (95% CI, 1.19-1.34) and 1.23 ± 0.27 (95% CI, 1.13-1.33), respectively (P < 0.0001). Severe thinning precluded GCL measurements in 2 eyes nasally and 5 eyes temporally, resulting in GCL measurements of zero. Mean nasal (17 eyes) and temporal (16 eyes) GCC/INL ratios were 1.93 ± 0.70 (95% CI,1.60-2.27) and 1.67 ± 0.44 (95% CI,1.46-1.87). Corresponding normative ratios are 2.85 ± 0.38 (95% CI, 2.71-2.99) and 2.87 ± 0.42 (95% CI, 2.70-3.03), respectively (P < 0.0001). CONCLUSIONS GCL/INL and GCC/INL ratios calculated from single-line macular HH-OCT scans in awake young children with optic neuropathies differ significantly from normative values and may thus have utility in helping to establish a diagnosis of optic neuropathy.
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Affiliation(s)
- Sarah Madison Duff
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | | | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Mays El-Dairi
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
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15
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Shats D, Balasubramanian T, Sidelnikov D, Das U, Onyekaba NA, Forbes HE, Lu N, Williams K, Levin MR, Sundararajan S, Vij S, Gadagkar H, Rege A, Saeedi O, Chen V, Alexander JL. Association of Speckle-Based Blood Flow Measurements and Fluorescein Angiography in Infants with Retinopathy of Prematurity. OPHTHALMOLOGY SCIENCE 2024; 4:100463. [PMID: 38591050 PMCID: PMC11000102 DOI: 10.1016/j.xops.2023.100463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/01/2023] [Accepted: 12/26/2023] [Indexed: 04/10/2024]
Abstract
Purpose To determine the correlation between blood flow metrics measured by intravenous fluorescein angiography (IVFA) and the blood flow velocity index (BFVi) obtained by laser speckle contrast imaging (LSCI) in infants with retinopathy of prematurity (ROP). Design Prospective comparative pilot study. Subjects Seven eyes from 7 subjects with ROP. Methods Unilateral LSCI and IVFA data were obtained from each subject in the neonatal intensive care unit. Five LSCI-based metrics and 5 IVFA-based metrics were extracted from images to quantify blood flow patterns in the same region of interest. Correlation between LSCI-based and IVFA-based blood flow metrics was compared between 2 subgroups of ROP severity: moderate ROP (defined as stage ≤ 2 without Plus disease) and severe ROP (defined as stage ≥3 or Plus disease). Main Outcome Measures Pearson and Kendall rank correlation coefficients between IVFA and LSCI metrics; Student t test P values comparing LSCI metrics between "severe" and "moderate" ROP groups. Results Pearson correlations between IVFA and LSCI included arterial-venous transit time (AVTT) and peak BFVi (pBFVi; r = -0.917; P = 0.004), AVTT and dip BFVi (dBFVi; r = -0.920; P = 0.003), AVTT and mean BFVi (r = -0.927- P = 0.003), and AVTT and volumetric rise index (r = -0.779; P = 0.039). Kendall rank correlation between AVTT and dBFVi was r = -0.619 (P = 0.051). pBFVi was higher in severe ROP than in moderate ROP (8.4 ± 0.6 and 4.4 ± 1.8, respectively; P = 0.0045 using the 2-sample t test with pooled variance and P = 0.0952 using the Wilcoxon rank-sum test). Conclusions Correlation was found between blood flow metrics obtained by IVFA and noninvasive LSCI techniques. We demonstrate the feasibility of obtaining quantitative metrics using LSCI in infants with ROP in this pilot study; however, further investigation is needed to evaluate its potential use in clinical assessment of ROP severity. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Daniel Shats
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tara Balasubramanian
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Danielle Sidelnikov
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Urjita Das
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ndidi-Amaka Onyekaba
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - He E. Forbes
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Noela Lu
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kristin Williams
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Moran R. Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sripriya Sundararajan
- Department of Neonatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shitiz Vij
- Vasoptic Medical, Inc., Columbia, Maryland
| | | | | | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Victoria Chen
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Janet L. Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
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16
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Cho E, Das U, Sidelnikov D, Balasubramanian T, Shats D, Mansoor S, Forbes HE, Zhou J, Kapoor R, Chase S, Kore M, Williams K, Saeedi O, Sundararajan S, Levin MR, Magder L, Alexander JL. Retinal blood flow association with age and weight in infants at risk for retinopathy of prematurity. Sci Rep 2024; 14:12790. [PMID: 38834830 PMCID: PMC11150459 DOI: 10.1038/s41598-024-63534-6] [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: 01/29/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
This prospective study evaluated the relationship between laser speckle contrast imaging (LSCI) ocular blood flow velocity (BFV) and five birth parameters: gestational age (GA), postmenstrual age (PMA) and chronological age (CA) at the time of measurement, birth weight (BW), and current weight (CW) in preterm neonates at risk for retinopathy of prematurity (ROP). 38 Neonates with BW < 2 kg, GA < 32 weeks, and PMA between 27 and 47 weeks underwent 91 LSCI sessions. Correlation tests and regression analysis were performed to quantify relationships between birth parameters and ocular BFV. Mean ocular BFV index in this cohort was 8.8 +/- 4.0 IU. BFV positively correlated with PMA (r = 0.3, p = 0.01), CA (r = 0.3, p = 0.005), and CW (r = 0.3, p = 0.02). BFV did not correlate with GA nor BW (r = - 0.2 and r = - 0.05, p > 0.05). Regression analysis with mixed models demonstrated that BFV increased by 1.2 for every kilogram of CW, by 0.34 for every week of CA, and by 0.36 for every week of PMA (p = 0.03, 0.004, 0.007, respectively). Our findings indicate that increased age and weight are associated with increased ocular BFV measured using LSCI in premature infants. Future studies investigating the associations between ocular BFV and ROP clinical severity must control for age and/or weight of the infant.
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Affiliation(s)
- Euna Cho
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Urjita Das
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Daniel Shats
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shaiza Mansoor
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - He Eun Forbes
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason Zhou
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ria Kapoor
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sera Chase
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Madi Kore
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristin Williams
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sripriya Sundararajan
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Moran Roni Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laurence Magder
- Department of Biostatistics and Epidemiology, University of Maryland, Baltimore, MD, USA
| | - Janet Leath Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
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17
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Stein JD, Zhou Y, Andrews CA, Kim JE, Addis V, Bixler J, Grove N, McMillan B, Munir SZ, Pershing S, Schultz JS, Stagg BC, Wang SY, Woreta F. Using Natural Language Processing to Identify Different Lens Pathology in Electronic Health Records. Am J Ophthalmol 2024; 262:153-160. [PMID: 38296152 PMCID: PMC11098689 DOI: 10.1016/j.ajo.2024.01.030] [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: 08/28/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Nearly all published ophthalmology-related Big Data studies rely exclusively on International Classification of Diseases (ICD) billing codes to identify patients with particular ocular conditions. However, inaccurate or nonspecific codes may be used. We assessed whether natural language processing (NLP), as an alternative approach, could more accurately identify lens pathology. DESIGN Database study comparing the accuracy of NLP versus ICD billing codes to properly identify lens pathology. METHODS We developed an NLP algorithm capable of searching free-text lens exam data in the electronic health record (EHR) to identify the type(s) of cataract present, cataract density, presence of intraocular lenses, and other lens pathology. We applied our algorithm to 17.5 million lens exam records in the Sight Outcomes Research Collaborative (SOURCE) repository. We selected 4314 unique lens-exam entries and asked 11 clinicians to assess whether all pathology present in the entries had been correctly identified in the NLP algorithm output. The algorithm's sensitivity at accurately identifying lens pathology was compared with that of the ICD codes. RESULTS The NLP algorithm correctly identified all lens pathology present in 4104 of the 4314 lens-exam entries (95.1%). For less common lens pathology, algorithm findings were corroborated by reviewing clinicians for 100% of mentions of pseudoexfoliation material and 99.7% for phimosis, subluxation, and synechia. Sensitivity at identifying lens pathology was better for NLP (0.98 [0.96-0.99] than for billing codes (0.49 [0.46-0.53]). CONCLUSIONS Our NLP algorithm identifies and classifies lens abnormalities routinely documented by eye-care professionals with high accuracy. Such algorithms will help researchers to properly identify and classify ocular pathology, broadening the scope of feasible research using real-world data.
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Affiliation(s)
- Joshua D Stein
- From the W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA (J.D.S., Y.Z., C.A.A., J.B.); Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA (J.D.S.).
| | - Yunshu Zhou
- From the W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA (J.D.S., Y.Z., C.A.A., J.B.)
| | - Chris A Andrews
- From the W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA (J.D.S., Y.Z., C.A.A., J.B.)
| | - Judy E Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA (J.E.K.)
| | - Victoria Addis
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA (V.A.)
| | - Jill Bixler
- From the W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA (J.D.S., Y.Z., C.A.A., J.B.)
| | - Nathan Grove
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA (N.G.)
| | - Brian McMillan
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, West Virginia, USA (B.M.)
| | - Saleha Z Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA (S.Z.M.)
| | - Suzann Pershing
- Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University, Stanford, California, USA (S.P., S.Y.W.); VA Palo Alto Health Care System, Palo Alto, California, USA (S.P.)
| | - Jeffrey S Schultz
- Department of Ophthalmology, Montefiore Medical Center, New York, New York, USA (J.S.S.)
| | - Brian C Stagg
- Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA (B.C.S.)
| | - Sophia Y Wang
- Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University, Stanford, California, USA (S.P., S.Y.W.)
| | - Fasika Woreta
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (F.W.)
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18
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Minturn R, Hartigan K, Vegunta S, Boente C, Golzarri-Arroyo L, Hynes E, Laughlin E, Haider K, Kua KL. Efficacy of supplemental oxygen in reducing the need for laser or intravitreal bevacizumab in preterm infants with stage 2 retinopathy of prematurity. BMC Ophthalmol 2024; 24:220. [PMID: 38790043 PMCID: PMC11127286 DOI: 10.1186/s12886-024-03483-w] [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: 11/14/2023] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a disease that affects preterm infants born younger than 30 weeks of gestation. The pathophysiology of ROP involves an initial vaso-obliterative phase followed by vaso-proliferative phase that leads to disease progression. The use of supplemental oxygen during the vaso-proliferative phase of ROP has been associated with reduced disease progression, but how this impacts the need for ROP treatment is unclear. The goal of this study was to compare the rate of laser or intravitreal bevacizumab after implementation of a new supplemental oxygen therapy protocol in preterm infants with stage 2 ROP. METHODS This is a retrospective chart review of preterm infants diagnosed with stage 2 ROP at Riley Hospital for Children between 1/2017 and 12/2022. Patients diagnosed between 1/2017 and 6/2020 were classified as Cohort A, preprotocol implementation. Patients diagnosed from 8/2020 to 12/2022 were classified as Cohort B, postprotocol implementation. In Cohort A, oxygen saturation was kept at 91-95% through the entire hospitalization. In Cohort B, oxygen saturation was increased to 97-99% as soon as Stage 2 ROP was diagnosed. Statistical analyses were performed using chi-square and Student's T test, followed by multivariate analyses to determine the impact of the oxygen protocol on the need for ROP treatment. RESULTS A total of 211 patients were diagnosed with stage 2 ROP between 1/2017 and 12/2022. Of those patients, 122 were before protocol implementation therapy (Cohort A), and 89 were after implementation of supplemental oxygen protocol (Cohort B). Gestational age was slightly higher in Cohort B (Cohort A 25.3 ± 1.9, Cohort B 25.8 ± 1.84, p = 0.04). There was no difference in birth weight, NEC, BPD, or survival. Cohort B had lesser need for invasive mechanical ventilation and higher days on CPAP during hospitalization. Notably, Cohort A had 67 (55%) patients treated with laser photocoagulation or intravitreal bevacizumab versus 20 (22%) patients in Cohort B (OR 0.19, 0.08-0.40). CONCLUSION The need for laser photocoagulation or intravitreal bevacizumab was significantly decreased in high-risk patients treated with the supplemental oxygen protocol. This result supports the idea that targeted supplemental oxygen therapy to keep saturations between 97 and 99% can reduce disease progression in infants with stage 2 ROP and potentially decrease the burden of additional procedures.
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Affiliation(s)
- Robert Minturn
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kelly Hartigan
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sravanthi Vegunta
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Charline Boente
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Bloomington, Bloomington, IN, USA
| | - Elizabeth Hynes
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elleen Laughlin
- Department of Pediatrics, Division of Neonatal- Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathryn Haider
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Kok Lim Kua
- Herman B Wells Center for Pediatric Research, Indianapolis, IN, USA.
- Department of Pediatrics, Division of Neonatal- Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
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Moss HE, Wiener L, Rizy C, Baxi S, Kocher M, Torres AZ, Mbagwu M. Multi-registry analysis of patients with multiple sclerosis and neuromyelitis optica to improve capture of demographic data and compare visual outcomes. Mult Scler Relat Disord 2024; 84:105499. [PMID: 38387161 PMCID: PMC10978241 DOI: 10.1016/j.msard.2024.105499] [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: 11/01/2023] [Revised: 01/19/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024]
Abstract
IMPORTANCE The American Academy of Neurology Axon Registry® provides real-world data for patients with multiple sclerosis and neuro-myelitis optica. However, some data are incomplete (e.g. demographics) and some relevant outcomes are not systematically captured in neurology documentation (e.g. visual acuity). The American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) contains demographic and visual function data that may complement Axon Registry-derived data to enhance understanding of real-world visual outcomes in neurological disease. OBJECTIVE To combine Axon Registry and IRIS Registry data to reduce missingness of demographic information and characterize visual outcomes in patients with multiple sclerosis and neuro-myelitis optica. DESIGN Cross-sectional study. SETTING Outpatient neurology and ophthalmology clinical practices. PARTICIPANTS Patients participating in both registries between January 1, 2014 through December 10, 2021 were included if they had repeat ICD-9/10 codes for with multiple sclerosis or neuro-myelitis optica in the Axon registry. EXPOSURE Diagnosis (multiple sclerosis or neuro-myelitis optica). MAIN OUTCOME AND MEASURE Age, sex, race and ethnicity were assessed in the individual registries and classified as conflicting, missing, or not missing in the combined data set. The IRIS Registry contributed visual acuity data. RESULTS Among 60,316 patients with multiple sclerosis and 1,068 patients with neuro-myelitis optica in the Axon Registry, 14,085 and 252 had temporal overlap in the IRIS Registry. Combining data reduced missing or conflicting data for race and ethnicity by 15-19 % (absolute reduction, all p ≤ 0.0005), but not age (p = 1.0) or gender (p = 0.08). 10,907 patients with MS and 142 with NMO had visual acuity data in the IRIS Registry. Visual acuity averaged between eyes was worse in patients with NMO after adjusting for age and gender (0.17 logMAR, 95 %CI 0.12,0.21, p < 0.0005). CONCLUSION AND RELEVANCE Using data from two registries reduced missing data for race and ethnicity and enabled examination of outcomes captured in the IRIS Registry for conditions that are diagnosed more frequently in the Axon Registry, demonstrating the utility of a multi-registry analysis.
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Affiliation(s)
- Heather E Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States; Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, United States.
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20
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Meyer C, Moshfeghi DM. Management of Icteric Vitreous, Retinal Opacification, and Atypical Retinopathy of Prematurity. Ophthalmic Surg Lasers Imaging Retina 2024; 55:164-167. [PMID: 38270566 DOI: 10.3928/23258160-20231206-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
A dichorionic, diamniotic twin born at 24-0/7 weeks and 740 g developed hyperbilirubinemia, necrotizing enterocolitis, and sepsis. Photographic imaging documented vitreous opacification, which was absent in the fellow twin. Retinal opacification was presumed secondary to embolic sepsis and responded to systemic antibiotics. Subsequent dropout of vascularized retina corresponded to areas of retinal opacification. Type 1 retinopathy of prematurity (ROP)-Zone I, Stage 3 ROP bilateral-demonstrated a rapid and durable response to off-label intravitreal bevacizumab 0.625 mg. Retinal opacification resolved between 39 and 40 weeks postmenstrual age. Systemic comorbidities may alter the appearance, course, and management of ROP. [Ophthalmic Surg Lasers Imaging Retina 2024;55:164-167.].
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21
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Cho E, Das U, Sidelnikov D, Balasubramanian T, Shats D, Mansoor S, Forbes HE, Zhou J, Kapoor R, Chase S, Kore M, Williams K, Saeedi O, Sundararajan S, Levin MR, Magder L, Alexander J. Retinal blood flow association with age and weight in infants at risk for retinopathy of prematurity. RESEARCH SQUARE 2024:rs.3.rs-3909449. [PMID: 38464120 PMCID: PMC10925429 DOI: 10.21203/rs.3.rs-3909449/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This prospective study evaluated the relationship between laser speckle contrast imaging (LSCI) ocular blood flow velocity (BFV) and five birth parameters: gestational age (GA), postmenstrual age (PMA), and chronological age (CA) at the time of measurement, birth weight (BW), and current weight (CW) in preterm neonates at risk for retinopathy of prematurity (ROP).38 Neonates with BW < 2 kg, GA < 32 weeks, and PMA between 27-47 weeks underwent 91 LSCI sessions. Correlation tests and regression analysis were performed to quantify relationships between birth parameters and ocular BFV. Mean ocular BFV index in this cohort was 8.8 +/- 4.0 IU. BFV positively correlated with PMA (r = 0.3, p = 0.01), CA (r = 0.3, p = 0.005), and CW (r = 0.3, p = 0.02). BFV did not correlate with GA nor BW (r=-0.2 and r=-0.05, p > 0.05). Regression analysis with mixed models demonstrated that BFV increased by 1.2 for every kilogram of CW, by 0.34 for every week of CA, and by 0.36 for every week of PMA (p = 0.03, 0.004, 0.007, respectively). Our findings indicate that increased age and weight are associated with increased ocular BFV measured using LSCI in premature infants. Future studies investigating the associations between ocular BFV and ROP clinical severity must control for age and/or weight of the infant.
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Affiliation(s)
- Euna Cho
- University of Maryland School of Medicine
| | - Urjita Das
- University of Maryland School of Medicine
| | | | | | | | | | | | - Jason Zhou
- University of Maryland School of Medicine
| | - Ria Kapoor
- University of Maryland School of Medicine
| | - Sera Chase
- University of Maryland School of Medicine
| | - Madi Kore
- University of Maryland School of Medicine
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Xie EF, Hilkert Rodriguez S, Xie B, D’Souza M, Reem G, Sulakhe D, Skondra D. Identifying novel candidate compounds for therapeutic strategies in retinopathy of prematurity via computational drug-gene association analysis. Front Pediatr 2023; 11:1151239. [PMID: 37492605 PMCID: PMC10365641 DOI: 10.3389/fped.2023.1151239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose Retinopathy of prematurity (ROP) is the leading cause of preventable childhood blindness worldwide. Although interventions such as anti-VEGF and laser have high success rates in treating severe ROP, current treatment and preventative strategies still have their limitations. Thus, we aim to identify drugs and chemicals for ROP with comprehensive safety profiles and tolerability using a computational bioinformatics approach. Methods We generated a list of genes associated with ROP to date by querying PubMed Gene which draws from animal models, human studies, and genomic studies in the NCBI database. Gene enrichment analysis was performed on the ROP gene list with the ToppGene program which draws from multiple drug-gene interaction databases to predict compounds with significant associations to the ROP gene list. Compounds with significant toxicities or without known clinical indications were filtered out from the final drug list. Results The NCBI query identified 47 ROP genes with pharmacologic annotations present in ToppGene. Enrichment analysis revealed multiple drugs and chemical compounds related to the ROP gene list. The top ten most significant compounds associated with ROP include ascorbic acid, simvastatin, acetylcysteine, niacin, castor oil, penicillamine, curcumin, losartan, capsaicin, and metformin. Antioxidants, NSAIDs, antihypertensives, and anti-diabetics are the most common top drug classes derived from this analysis, and many of these compounds have potential to be readily repurposed for ROP as new prevention and treatment strategies. Conclusion This bioinformatics analysis creates an unbiased approach for drug discovery by identifying compounds associated to the known genes and pathways of ROP. While predictions from bioinformatic studies require preclinical/clinical studies to validate their results, this technique could certainly guide future investigations for pathologies like ROP.
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Affiliation(s)
- Edward F. Xie
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, United States
| | - Sarah Hilkert Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
| | - Bingqing Xie
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Mark D’Souza
- Center for Research Informatics, The University of Chicago, Chicago, IL, United States
| | - Gonnah Reem
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
| | - Dinanath Sulakhe
- Center for Research Informatics, The University of Chicago, Chicago, IL, United States
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, United States
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