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Yamashita T, Terasaki H, Asaoka R, Iwase A, Sakai H, Sakamoto T, Araie M. Age prediction using fundus parameters of normal eyes from the Kumejima population study. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06471-4. [PMID: 38819490 DOI: 10.1007/s00417-024-06471-4] [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: 02/18/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Artificial intelligence can predict the age of an individual using color fundus photographs (CFPs). This study aimed to investigate the accuracy of age prediction in the Kumejima study using fundus parameters and to clarify age-related changes in the fundus. METHODS We used nonmydriatic CFPs obtained from the Kumejima population study, including 1,646 right eyes of healthy participants with reliable fundus parameter measurements. The tessellation fundus index was calculated as R/(R + G + B) using the mean value of the red-green-blue intensity in eight locations around the optic disc and foveal region. The optic disc ovality ratio, papillomacular angle, and retinal vessel angle were quantified as previously described. Least absolute shrinkage and selection operator regression with leave-one-out cross-validation was used to predict age. The relationship between the actual and predicted ages was investigated using Pearson's correlation coefficient. RESULTS The mean age of included participants (834 males and 812 females) was 53.4 ± 10.1 years. The mean predicted age based on fundus parameters was 53.4 ± 8.9 years, with a mean absolute error of 3.64 years, and the correlation coefficient between actual and predicted age was 0.88 (p < 0.001). Older patients had greater red and green intensities and weaker blue intensities in the peripapillary area (p < 0.001). CONCLUSIONS Age could be predicted using the CFP parameters, and there were notable age-related changes in the peripapillary color intensity. The age-related changes in the fundus may aid the understanding of the mechanism of fundus diseases such as age-related macular degeneration.
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Affiliation(s)
- Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | | | | | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - Makoto Araie
- Department of Ophthalmology, Kanto Central Hospital, Tokyo, Japan
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Bak E, Kim M, Kim SH, Lee KM. Optic nerve head factors associated with initial central visual field defect in primary open-angle glaucoma. Sci Rep 2024; 14:8000. [PMID: 38580736 PMCID: PMC10997601 DOI: 10.1038/s41598-024-58749-6] [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: 10/24/2023] [Accepted: 04/02/2024] [Indexed: 04/07/2024] Open
Abstract
We investigated optic nerve head factors associated with initial parafoveal scotoma (IPFS) in primary open-angle glaucoma. Eighty (80) patients with an IPFS and 84 patients with an initial nasal step (INS) were compared. Central retinal vascular trunk (CRVT) deviation from the Bruch's membrane opening (BMO) center was measured as a surrogate of lamina cribrosa (LC)/BMO offset, and its obliqueness was defined as the absolute value of angular deviation from the fovea-BMO axis. Proximity of retinal nerve fiber layer defect (RNFLD) was defined as the angular deviation of the inner RNFLD margin from the fovea-BMO axis. Microvasculature dropout (MvD) was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. Factors associated with IPFS, as compared with INS, were assessed using logistic regression analyses and conditional inference tree analysis. The IPFS group had more oblique CRVT offset (P < 0.001), RNFLD closer to the fovea (P < 0.001), more MvD (P < 0.001), and more LC defects (P < 0.001) compared to the INS group. In logistic regression analyses, obliqueness of CRVT offset (P = 0.002), RNFLD proximity (P < 0.001), and MvD (P = 0.001) were significant factors influencing the presence of IPFS. Conditional inference tree analysis showed that RNFLD closer to the fovea (P < 0.001) in the upper level, more oblique CRVT offset (P = 0.013) and presence of MvD (P = 0.001) in the lower level were associated with the probability of having IPFS. IPFS was associated with closer RNFLD location to the fovea when assessed from the BMO. Oblique LC/BMO offset may not only mask RNFLD proximity to the fovea due to a deviated funduscopic disc appearance, but also potentiate IPFS via focal LC defect and MvD.
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Affiliation(s)
- Eunoo Bak
- Department of Ophthalmology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | | | - Kyoung Min Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Ophthalmology, Seoul National University Boramae Medical Center, 39 Boramae Road, Dongjak-gu, Seoul, 07061, Korea.
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Shi RB, Eizenman M, Li Y, Wong W. Improving the robustness of the Sequentially Optimized Reconstruction Strategy (SORS) for visual field testing. PLoS One 2024; 19:e0301419. [PMID: 38573981 PMCID: PMC10994286 DOI: 10.1371/journal.pone.0301419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
Perimetry, or visual field test, estimates differential light sensitivity thresholds across many locations in the visual field (e.g., 54 locations in the 24-2 grid). Recent developments have shown that an entire visual field may be relatively accurately reconstructed from measurements of a subset of these locations using a linear regression model. Here, we show that incorporating a dimensionality reduction layer can improve the robustness of this reconstruction. Specifically, we propose to use principal component analysis to transform the training dataset to a lower dimensional representation and then use this representation to reconstruct the visual field. We named our new reconstruction method the transformed-target principal component regression (TTPCR). When trained on a large dataset, our new method yielded results comparable with the original linear regression method, demonstrating that there is no underfitting associated with parameter reduction. However, when trained on a small dataset, our new method used on average 22% fewer trials to reach the same error. Our results suggest that dimensionality reduction techniques can improve the robustness of visual field testing reconstruction algorithms.
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Affiliation(s)
- Runjie Bill Shi
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Moshe Eizenman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Yan Li
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, Canada
| | - Willy Wong
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, Canada
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Yamaguchi K, Tomita R, Koyanagi Y, Kawase K, Asaoka R, Terasaki H, Iwase T, Nishiguchi KM. Abilities of circumpapillary retinal nerve fiber layer thickness and vascular density to discriminate stages in primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2024; 262:1221-1229. [PMID: 37921882 DOI: 10.1007/s00417-023-06302-y] [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: 05/19/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/05/2023] Open
Abstract
PURPOSE To clarify the abilities of circumpapillary retinal nerve fiber layer thickness (cpRNFLT) obtained by optical coherence tomography (OCT) and circumpapillary vessel density (cpVD) measured by OCT-angiography to distinguish different stages in primary open-angle glaucoma determined by 24-2 or 30-2 static visual field (VF) testing. METHODS This retrospective study includes 25 healthy normal eyes of 25 subjects and 87 primary open-angle glaucoma eyes of 87 patients. Areas under the receiver operating characteristic curves (AUROC) were evaluated for determining glaucoma stages using cpRNFLT and cpVD. The absolute errors of the estimated mean total deviation (mTD) using optimal models with cpRNFLT and cpVD were also compared. RESULTS The AUROCs for discriminating glaucomatous eyes from normal eyes was significantly higher for cpRNFLT than the respective AUROCs for cpVD (0.969 [95% CI 0.939 to 0.998] vs. 0.872 [95% CI 0.806 to 0.938], p = 0.006), whereas cpVD had significantly higher AUROC for discriminating severe glaucoma eyes from moderate glaucoma eyes than cpRNFLT (0.771 [95% CI 0.655 to 0.886] vs. 0.578 [95% CI 0.420 to 0.736], p = 0.022). The mean absolute error in estimating mTD using both cpRNFLT and cpVD was significantly less than the error using cpRNFLT alone (4.56 ± 3.76 dB vs. 5.39 ± 4.00 dB, p = 0.027). CONCLUSION Our results suggest that cpVD is better for follow-ups after moderate stage. The combination of cpRNFLT and cpVD may improve VF estimation compared to cpRNFLT alone.
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Affiliation(s)
- Katsuya Yamaguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Ryo Tomita
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Yoshito Koyanagi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Kazuhide Kawase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondou, Akita, 010-8543, Japan
| | - Koji M Nishiguchi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
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Sato M, Kiyota N, Yabana T, Maekawa S, Tsuda S, Omodaka K, Himori N, Yokoyama Y, Nakazawa T. Sector-specific Association of Intraocular Pressure Dynamics in Dark-room Prone Testing and Visual Field Defect Progression in Glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00062-0. [PMID: 38554811 DOI: 10.1016/j.ogla.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To investigate sectoral differences in the relationship between intraocular pressure (IOP) dynamics during dark-room prone testing (DRPT) and visual field (VF) defect progression in primary open-angle glaucoma (POAG) patients. DESIGN Retrospective, longitudinal study. PARTICIPANTS This retrospective study included 116 eyes of 84 POAG patients who underwent DRPT and had at least 5 reliable VF tests conducted over a more than 2-year follow-up period. We excluded eyes with mean deviation worse than -20 dB or a history of intraocular surgery or laser treatment. METHODS Average total deviation (TD) was calculated in the superior, central, and inferior sectors of the Humphrey 24-2 or 30-2 program. During DRPT, IOP was measured in the sitting position, and after 60 minutes in the prone position in a dark room, IOP was measured again. The relationship between IOP change during DRPT, IOP after DRPT, and TD slope in each quadrant was analyzed with a linear mixed-effects model, adjusting for other potential confounding factors. MAIN OUTCOME MEASURES Total deviation slope in each quadrant, IOP change during DRPT, and IOP after DRPT. RESULTS Intraocular pressure after DRPT and IOP change during DRPT were 18.16 ± 3.42 mmHg and 4.92 ± 3.12 mmHg, respectively. Superior TD slope was significantly associated with both IOP after DRPT (β = -0.28, P = 0.003) and IOP change during DRPT (β = -0.21, P = 0.029), while central (β = -0.05, P = 0.595; β = -0.05; P = 0.622) and inferior (β = 0.05, P = 0.611; β = 0.01, P = 0.938) TD slopes were not. CONCLUSION Dark-room prone testing might be a useful test to predict the risk of superior VF defect progression in eyes with POAG. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Masataka Sato
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Takeshi Yabana
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shigeto Maekawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan; Department of Aging Vision Healthcare, Tohoku University Graduate School of Biomedical Engineering, Miyagi, Japan
| | - Yu Yokoyama
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan; Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan; Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Miyagi, Japan; Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan.
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Joo CW, Choi YJ, Kim HU, Park SP, Na KI. Morphological differences of the neuroretinal rim between temporally tilted and non-tilted optic discs in healthy eyes. Sci Rep 2024; 14:6070. [PMID: 38480784 PMCID: PMC10937920 DOI: 10.1038/s41598-024-54116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
This study aimed to compare morphological differences of the neuroretinal rim between the temporally tilted and non-tilted optic discs in healthy eyes. We prospectively enrolled participants aged 20-40 years with temporally tilted or non-tilted optic discs. The optic nerve head parameters were analyzed using spectral domain-optical coherence tomography. The angle between the Bruch's membrane opening (BMO) plane and BMO-minimum rim width (BMO-MRW) was termed "BMO-MRW angle". Peripapillary retinal nerve fiber layer thickness (pRNFLT) and BMO-based parameters were compared between the temporally tilted and non-tilted disc groups. As a result, 55 temporally tilted disc eyes and 38 non-tilted disc eyes were analyzed. Global pRNFLT, global BMO-MRW, and total BMO-minimum rim area (BMO-MRA) were similar between the two groups (p = 0.138, 0.161, and p = 0.410, respectively). In the sectoral analysis, temporally tilted disc group exhibited thicker BMO-MRW in the temporal sector (p = 0.032) and thinner in the nasal superior and nasal sectors (p = 0.025 and p = 0.002, respectively). Temporally tilted disc group showed larger BMO-MRA in the temporal, temporal superior, and temporal inferior sectors (p < 0.001, p < 0.001, and p < 0.016, respectively), alongside a higher BMO-MRW angle in the temporal sector and lower in the nasal superior and nasal sectors. In conclusion, the neuroretinal rim, represented by BMO-MRW and BMO-MRA, showed morphological differences between temporally tilted and non-tilted optic discs in healthy eyes. BMO-MRW and BMO-MRA showed temporalization in the same manner as pRNFLT in the temporally tilted disc eyes. The BMO-MRW angle showed that in temporally tilted disc eyes, optic nerve fibers met the BMO plane steeply in the nasal sector and gently in the temporal sector than in non-tilted disc eyes, suggesting potential stress region of optic nerve fibers in temporally tilted disc eyes.
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Affiliation(s)
- Chan Woong Joo
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Youn Joo Choi
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Han Ul Kim
- Department of Ophthalmology, Armed Forces Seoul District Hospital, Seoul, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Kyeong Ik Na
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, #150 Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea.
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Li-Han LY, Eizenman M, Shi RB, Buys YM, Trope GE, Wong W. Using Fused Data from Perimetry and Optical Coherence Tomography to Improve the Detection of Visual Field Progression in Glaucoma. Bioengineering (Basel) 2024; 11:250. [PMID: 38534524 DOI: 10.3390/bioengineering11030250] [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: 01/24/2024] [Revised: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Perimetry and optical coherence tomography (OCT) are both used to monitor glaucoma progression. However, combining these modalities can be a challenge due to differences in data types. To overcome this, we have developed an autoencoder data fusion (AEDF) model to learn compact encoding (AE-fused data) from both perimetry and OCT. The AEDF model, optimized specifically for visual field (VF) progression detection, incorporates an encoding loss to ensure the interpretation of the AE-fused data is similar to VF data while capturing key features from OCT measurements. For model training and evaluation, our study included 2504 longitudinal VF and OCT tests from 140 glaucoma patients. VF progression was determined from linear regression slopes of longitudinal mean deviations. Progression detection with AE-fused data was compared to VF-only data (standard clinical method) as well as data from a Bayesian linear regression (BLR) model. In the initial 2-year follow-up period, AE-fused data achieved a detection F1 score of 0.60 (95% CI: 0.57 to 0.62), significantly outperforming (p < 0.001) the clinical method (0.45, 95% CI: 0.43 to 0.47) and the BLR model (0.48, 95% CI: 0.45 to 0.51). The capacity of the AEDF model to generate clinically interpretable fused data that improves VF progression detection makes it a promising data integration tool in glaucoma management.
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Affiliation(s)
- Leo Yan Li-Han
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON M5S 3G4, Canada
| | - Moshe Eizenman
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON M5T 3A9, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Runjie Bill Shi
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3E2, Canada
| | - Yvonne M Buys
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON M5T 3A9, Canada
| | - Graham E Trope
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON M5T 3A9, Canada
| | - Willy Wong
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON M5S 3G4, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3E2, Canada
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Tong J, Alonso-Caneiro D, Kugelman J, Phu J, Khuu SK, Kalloniatis M. Characterisation of the normal human ganglion cell-inner plexiform layer using widefield optical coherence tomography. Ophthalmic Physiol Opt 2024; 44:457-471. [PMID: 37990841 DOI: 10.1111/opo.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To describe variations in ganglion cell-inner plexiform layer (GCIPL) thickness in a healthy cohort from widefield optical coherence tomography (OCT) scans. METHODS Widefield OCT scans spanning 55° × 45° were acquired from 470 healthy eyes. The GCIPL was automatically segmented using deep learning methods. Thickness measurements were extracted after correction for warpage and retinal tilt. Multiple linear regression analysis was applied to discern trends between global GCIPL thickness and age, axial length and sex. To further characterise age-related change, hierarchical and two-step cluster algorithms were applied to identify locations sharing similar ageing properties, and rates of change were quantified using regression analyses with data pooled by cluster analysis outcomes. RESULTS Declines in widefield GCIPL thickness with age, increasing axial length and female sex were observed (parameter estimates -0.053, -0.436 and -0.464, p-values <0.001, <0.001 and 0.02, respectively). Cluster analyses revealed concentric, slightly nasally displaced, horseshoe patterns of age-related change in the GCIPL, with up to four statistically distinct clusters outside the macula. Linear regression analyses revealed significant ageing decline in GCIPL thickness across all clusters, with faster rates of change observed at central locations when expressed as absolute (slope = -0.19 centrally vs. -0.04 to -0.12 peripherally) and percentage rates of change (slope = -0.001 centrally vs. -0.0005 peripherally). CONCLUSIONS Normative variations in GCIPL thickness from widefield OCT with age, axial length and sex were noted, highlighting factors worth considering in further developments. Widefield OCT has promising potential to facilitate quantitative detection of abnormal GCIPL outside standard fields of view.
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Affiliation(s)
- Janelle Tong
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - David Alonso-Caneiro
- School of Science, Technology and Engineering, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jason Kugelman
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jack Phu
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Concord Clinical School, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
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Mohammadzadeh V, Li L, Fei Z, Davis T, Morales E, Wu K, Lee Ma E, Afifi A, Nouri-Mahdavi K, Caprioli J. Efficacy of Smoothing Algorithms to Enhance Detection of Visual Field Progression in Glaucoma. OPHTHALMOLOGY SCIENCE 2024; 4:100423. [PMID: 38192682 PMCID: PMC10772822 DOI: 10.1016/j.xops.2023.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/27/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024]
Abstract
Purpose To evaluate and compare the effectiveness of nearest neighbor (NN)- and variational autoencoder (VAE)-smoothing algorithms to reduce variability and enhance the performance of glaucoma visual field (VF) progression models. Design Longitudinal cohort study. Subjects 7150 eyes (4232 patients), with ≥ 5 years of follow-up and ≥ 6 visits. Methods Vsual field thresholds were smoothed with the NN and VAE algorithms. The mean total deviation (mTD) and VF index rates, pointwise linear regression (PLR), permutation of PLR (PoPLR), and the glaucoma rate index were applied to the unsmoothed and smoothed data. Main Outcome Measures The proportion of progressing eyes and the conversion to progression were compared between the smoothed and unsmoothed data. A simulation series of noiseless VFs with various patterns of glaucoma damage was used to evaluate the specificity of the smoothing models. Results The mean values of age and follow-up time were 62.8 (standard deviation: 12.6) years and 10.4 (standard deviation: 4.7) years, respectively. The proportion of progression was significantly higher for the NN and VAE smoothed data compared with the unsmoothed data. VF progression occurred significantly earlier with both smoothed data compared with unsmoothed data based on mTD rates, PLR, and PoPLR methods. The ability to detect the progressing eyes was similar for the unsmoothed and smoothed data in the simulation data. Conclusions Smoothing VF data with NN and VAE algorithms improves the signal-to-noise ratio for detection of change, results in earlier detection of VF progression, and could help monitor glaucoma progression more effectively in the clinical setting. 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)
- Vahid Mohammadzadeh
- David Geffen School of Medicine, Glaucoma Division, Jules Stein Eye Institute, Los Angeles, California
| | - Leyan Li
- University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California
- Biostatistics, University of California Los Angeles, Los Angeles, California
| | - Zhe Fei
- University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California
- Biostatistics, University of California Los Angeles, Los Angeles, California
- Department of Statistics, University of California, Riverside, California
| | - Tyler Davis
- Computer Science, University of California Los Angeles, Los Angeles, California
| | - Esteban Morales
- David Geffen School of Medicine, Glaucoma Division, Jules Stein Eye Institute, Los Angeles, California
| | - Kara Wu
- University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California
- Biostatistics, University of California Los Angeles, Los Angeles, California
| | - Elise Lee Ma
- David Geffen School of Medicine, Glaucoma Division, Jules Stein Eye Institute, Los Angeles, California
| | - Abdelmonem Afifi
- University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California
| | - Kouros Nouri-Mahdavi
- David Geffen School of Medicine, Glaucoma Division, Jules Stein Eye Institute, Los Angeles, California
| | - Joseph Caprioli
- David Geffen School of Medicine, Glaucoma Division, Jules Stein Eye Institute, Los Angeles, California
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Chen Z, Shen X, Zhang Y, Yang W, Ye J, Ouyang Z, Zheng G, Yang Y, Yu M. Development and Validation of an Internet-Based Remote Perimeter (Perimouse). Transl Vis Sci Technol 2024; 13:16. [PMID: 38506801 PMCID: PMC10959190 DOI: 10.1167/tvst.13.3.16] [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: 09/11/2023] [Accepted: 01/13/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose We sought to validate the feasibility of Perimouse, an internet-based remote perimeter that allows for natural fixation and can be performed on most computers via a web page. Methods In this cross-sectional study, Perimouse evaluated the visual field of 45 healthy people and 27 patients with primary open-angle glaucoma on a laptop. Participants used a mouse cursor to locate new dots on the screen that were determined by preset saccade vectors. A "click and confirm" strategy was used to eliminate the unwanted visual search. Dot brightness was either fixed at 12 dB in the suprathreshold program (screening program) or variable in the threshold program. We compared Perimouse outcomes with the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Testing Algorithm standard program. Results In the screening program, Perimouse showed moderate to high concordance with HFA. The intraclass coefficient ranged from 0.58 to 0.86 in different areas of Garway-Heath mapping. In the threshold program, normal subjects had threshold ranging from 19 to 16 dB, presenting sensitivity changes according to the "hill of vision". The test-retest difference was 0.09 dB. Habitual spectacle correction and environmental luminance (2-337 lux) had little impact on the central or peripheral threshold (P > 0.05). The correlation between Perimouse and HFA threshold sensitivity was strong (R = 0.950), although Perimouse mean defect was 4.40 dB higher than the HFA mean defect. Conclusions Perimouse is a reliable visual field test that correlates strongly with HFA. It shows potential for population screening and monitoring visual field defects. Translational Relevance Perimouse assesses the visual field using saccade vectors without eye trackers, enhancing its accessibility via a web page.
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Affiliation(s)
- Zidong Chen
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Xiaoyuan Shen
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Yuning Zhang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Wenxin Yang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Jiexin Ye
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Zhiqiang Ouyang
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Guifeng Zheng
- Sun Yat-Sen University, School of Computer Science and Engineering, Guangzhou, PR China
| | - Yangfan Yang
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
| | - Minbin Yu
- Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, PR China
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Friedel EBN, Tebartz van Elst L, Schäfer M, Maier S, Runge K, Küchlin S, Reich M, Lagrèze WA, Kornmeier J, Ebert D, Endres D, Domschke K, Nickel K. Retinal Thinning in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1143-1156. [PMID: 36550331 PMCID: PMC10907434 DOI: 10.1007/s10803-022-05882-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Since the retina shares its embryological origin with the central nervous system, optical coherence tomography (OCT), an imaging technique frequently employed in ophthalmology to analyze the macula and intraretinal layer thicknesses and volumes, has recently become increasingly important in psychiatric research. We examined 34 autistic and 31 neurotypical adults (NT) using OCT. Autistic adults had reduced overall macular and outer nuclear layer (ONL) thickness and volume compared to NT. Both macular and ONL thickness showed significant inverse associations with the severity of autistic symptoms measured with the Social Responsiveness Scale 2 (SRS-2). Longitudinal studies across different age groups are required to clarify whether retinal changes may represent a possible trait marker.
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Affiliation(s)
- Evelyn B N Friedel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Schäfer
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Küchlin
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Reich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A Lagrèze
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Kornmeier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| | - Dieter Ebert
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Ninomiya T, Kiyota N, Sharma P, Omodaka K, Himori N, Yasuda M, Kunikata H, Nakazawa T. The Relationship Between Artificial Intelligence-Assisted OCT Angiography-Derived Foveal Avascular Zone Parameters and Visual-Field Defect Progression in Eyes with Open-Angle Glaucoma. OPHTHALMOLOGY SCIENCE 2024; 4:100387. [PMID: 38524379 PMCID: PMC10960060 DOI: 10.1016/j.xops.2023.100387] [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: 02/27/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 03/26/2024]
Abstract
Purpose To investigate clinical factors associated with foveal avascular zone (FAZ) parameters obtained using OCT angiography (OCTA) with assistance from a previously developed artificial intelligence (AI) platform in eyes with open-angle glaucoma (OAG). Design Retrospective longitudinal. Participants This study followed up 885 eyes of 558 patients with OAG for ≥ 2 years; all eyes underwent ≥ 5 Humphrey visual-field (VF) tests and had 3.0 × 3.0 mm macular OCTA scans available. Methods Average total deviation (TD) in the superior, superocentral, inferocentral, and inferior sectors of the Humphrey 24-2 program was calculated. We collected 3.0 × 3.0 mm macular OCTA images from each patient and used a previously developed AI platform with these images to obtain FAZ parameters, including FAZ area, FAZ circularity index (CI), and FAZ perimeter. Multivariable linear mixed-effects models were used to analyze the relationship between FAZ parameters, TD or TD slope in each quadrant, and systemic factors, adjusting for potential confounding factors, including axial length. Main Outcome Measures Ophthalmic and systemic variables, FAZ parameters, and TD or TD slope in each quadrant. Results The multivariable model showed that FAZ parameters were correlated with both TD and TD slope in the inferocentral quadrant (β = -0.244 - 0.168, P < 0.001). Both upper-half and lower-half FAZ parameters were better associated with TD-inferocentral and TD-inferocentral slope than TD-superocentral or TD-superocentral slope in terms of β size and statistical significance, indicating that there was no evident vertical anatomical correspondence between TD in the central quadrant and FAZ parameters. Foveal avascular zone area enlargement was associated with female gender (β = 0.242, P = 0.003). Loss of FAZ circularity was associated with both aging and comorbid sleep apnea syndrome (SAS) (yes: 1, no: 0) (β = -0.188, P < 0.001; β = -0.261, P = 0.031, respectively). Foveal avascular zone perimeter elongation was associated with aging and female gender (β = 0.084, P = 0.040; β = 0.168, P = 0.042, respectively). Conclusions Artificial intelligence-assisted OCTA-measured FAZ enlargement and irregular shape might be good markers of ocular hypoperfusion and associated inferocentral VF defect progression in eyes with OAG. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Takahiro Ninomiya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Parmanand Sharma
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Aging Vision Healthcare, Tohoku University Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
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13
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Chen L, Tseng VS, Tsung TH, Lu DW. A multi-label transformer-based deep learning approach to predict focal visual field progression. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06393-1. [PMID: 38334809 DOI: 10.1007/s00417-024-06393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Tracking functional changes in visual fields (VFs) through standard automated perimetry remains a clinical standard for glaucoma diagnosis. This study aims to develop and evaluate a deep learning (DL) model to predict regional VF progression, which has not been explored in prior studies. METHODS The study included 2430 eyes of 1283 patients with four or more consecutive VF examinations from the baseline. A multi-label transformer-based network (MTN) using longitudinal VF data was developed to predict progression in six VF regions mapped to the optic disc. Progression was defined using the mean deviation (MD) slope and calculated for all six VF regions, referred to as clusters. Separate MTN models, trained for focal progression detection and forecasting on various numbers of VFs as model input, were tested on a held-out test set. RESULTS The MTNs overall demonstrated excellent macro-average AUCs above 0.884 in detecting focal VF progression given five or more VFs. With a minimum of 6 VFs, the model demonstrated superior and more stable overall and per-cluster performance, compared to 5 VFs. The MTN given 6 VFs achieved a macro-average AUC of 0.848 for forecasting progression across 8 VF tests. The MTN also achieved excellent performance (AUCs ≥ 0.86, 1.0 sensitivity, and specificity ≥ 0.70) in four out of six clusters for the eyes already with severe VF loss (baseline MD ≤ - 12 dB). CONCLUSION The high prediction accuracy suggested that multi-label DL networks trained with longitudinal VF results may assist in identifying and forecasting progression in VF regions.
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Affiliation(s)
- Ling Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Vincent S Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ta-Hsin Tsung
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei, Taiwan
| | - Da-Wen Lu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec.2, Chenggong Rd., Neihu District, Taipei, Taiwan.
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Yamaguchi C, Kiyota N, Takahashi N, Takeda Y, Omodaka K, Tsuda S, Nakazawa T. Factors associated with intrachoroidal cavitation and sinkhole formation in eyes with glaucomatous visual-field defects. Graefes Arch Clin Exp Ophthalmol 2024; 262:557-566. [PMID: 37792069 PMCID: PMC10844383 DOI: 10.1007/s00417-023-06247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE To investigate factors associated with intrachoroidal cavitation (ICC) and sinkhole formation in eyes with glaucomatous visual-field defects. METHODS This retrospective, cross-sectional study enrolled a total of 2808 eyes of 1482 patients who were diagnosed/treated for glaucoma and underwent swept-source optical coherence tomography (OCT). We first determined the prevalence of ICCs and sinkholes and their locations. Next, we selected one eye from each patient and compared the clinical characteristics of eyes with and without ICCs. Finally, in eyes with ICCs, we compared the clinical characteristics of eyes with and without sinkholes. Blood flow (BF), represented by laser speckle flowgraphy-measured tissue-area mean blur rate (MBR), was measured in the temporal optic nerve head (ONH), temporal peripapillary chorioretinal atrophy (PPA) zone, and in the ICC zone. ICC area and angle were analyzed in OCT en-face images. Mean deviation and total deviation in the central area (TD-central) were measured with Humphrey visual-field testing. RESULTS A total of 86 eyes (3.1%) had ICCs and 52 eyes (1.9%) had sinkholes. ICC eyes had a lower spherical equivalent and longer axial length (AL) than non-ICC eyes (P < 0.05). Patients with eyes with sinkholes were more elderly and had worse best-corrected visual acuity, worse TD-central, a larger ICC, and lower tissue-area MBR in the temporal ONH, temporal PPA zone, and ICC zone (P < 0.05). CONCLUSION In eyes with glaucoma, AL elongation might be linked to ICC formation. Sinkhole formation might be associated with ICC enlargement, impaired ocular BF, and impaired retinal structure and function involving the central area.
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Affiliation(s)
- Chiaki Yamaguchi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Naoki Takahashi
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Yoko Takeda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Satoru Tsuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
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15
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Meng L, Chen L, Zhang C, Chen H, Yang J, Wang Y, Zhang W, Cheng S, Zhao Q, Zhao X, Chen Y. Quantitative assessment of retinal vasculature changes in systemic lupus erythematosus using wide-field OCTA and the correlation with disease activity. Front Immunol 2024; 15:1340224. [PMID: 38348025 PMCID: PMC10859513 DOI: 10.3389/fimmu.2024.1340224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose To assess the retinal vasculature changes quantitatively using wide-field optical coherence tomography angiography (OCTA) in systemic lupus erythematosus (SLE), and explore its correlation with systemic clinical features. Design Prospective, cross-sectional, observational study. Participants and controls Patients with SLE who presented to the Ophthalmology Department of Peking Union Medical College Hospital from November 2022 to April 2023 were collected. The subjects were divided into retinopathy and without retinopathy groups. Age and gender-matched healthy subjects were selected as controls. Methods Patients with SLE and control subjects were imaged with 24×20 mm OCTA scans centered on the fovea and 6×6 mm OCTA scans centered on the optic disc. The sub-layers of OCTA images were stratified by the built-in software of the device and then the retinal thickness and vessel density were measured automatically. The characteristics of retinal OCTA parameters of SLE and its correlation with systemic clinical indicators of patients without retinopathy were analyzed. Main outcome measures OCTA parameters, visual acuity, intraocular pressure, and systemic clinical indicators of patients such as disease activity index, autoimmune antibodies, and inflammatory marker levels were collected. Results A total of 102 SLE patients were included, 24 of which had retinopathy, and 78 had unaffected retina. Wide-field OCTA could effectively detect retinal vascular obstruction, non-perfusion area, and morphological abnormalities in patients with lupus retinopathy. SLE patients without retinopathy had significantly higher retinal superficial vessel density (SVD) in foveal (P=0.02), para-foveal temporal (P=0.01), nasal (P=0.01), peripheral foveal temporal (P=0.02), and inferior areas (P=0.02), as well as subregion temporal (P=0.01) and inferior areas (P=0.03) when compared with healthy controls (n=65 eyes from 65 participants). The area under curve (AUC) value of subregion inferior SVD combined parafoveal temporal SVD was up to 0.70. There was a significantly positive correlation between SVD and disease activity in SLE without retinopathy group. Patients with severe activity had the most significant increase in SVD. Conclusion Wide-field OCTA can provide a relatively comprehensive assessment of the retinal vasculature in SLE. In the absence of pathological changes of the retina, the SVD was significantly increased and was positively correlated with the disease activity of SLE.
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Affiliation(s)
- Lihui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lulu Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenxi Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenfei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiyu Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Song WK, Lee A, Yoon J, Kim KE, Kook MS. Comparison of the Circumpapillary Structure-Function and Vasculature-Function Relationships at Different Glaucoma Stages Using Longitudinal Data. Invest Ophthalmol Vis Sci 2024; 65:30. [PMID: 38231526 PMCID: PMC10795580 DOI: 10.1167/iovs.65.1.30] [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: 10/23/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose This study investigated the global and regional correlations between longitudinal structure-function (S-F) and vasculature-function (V-F) data using circumpapillary retinal nerve fiber layer thickness (cpRNFLT) measurements from optical coherence tomography (OCT), circumpapillary vessel density (cpVD) from OCT angiography (OCTA), and the corresponding visual field mean sensitivities at different glaucoma stages. Methods A total of 107 eyes from 107 glaucoma patients with progressive visual field (VF) changes followed up for an average of 3.33 ± 1.39 years were enrolled, including early-to-moderate (51 eyes) and advanced (56 eyes) stages. The rates of longitudinal change in the VF mean deviation (MD), cpRNFLT, and cpVD were evaluated using linear mixed-effects models and compared between different glaucoma stages. Longitudinal global and regional S-F and V-F relationships were assessed by repeated measures correlation analysis by glaucoma stage. Results No significant differences were found in the rates of VF MD and cpVD changes (P > 0.05) between the two glaucoma stage groups. CpRNFLT decreased more rapidly in the early-to-moderate stage group (P < 0.001) in which significant longitudinal global and regional correlations were found in both S-F and V-F relationships (all P < 0.05), except for the nasal sector. Significant global and regional correlations were only found in V-F relationship in advanced stage cases (all P < 0.05). Conclusions Significant longitudinal V-F relationships exist globally and regionally regardless of glaucoma stage but no longitudinal S-F relationship is present in advanced glaucoma. Longitudinal follow-up of cpVD parameters may be useful for monitoring glaucomatous VF progression at all disease stages.
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Affiliation(s)
- Woo Keun Song
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anna Lee
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jooyoung Yoon
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ko Eun Kim
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Michael S. Kook
- Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Sigut J, Fumero F, Estévez J, Alayón S, Díaz-Alemán T. In-Depth Evaluation of Saliency Maps for Interpreting Convolutional Neural Network Decisions in the Diagnosis of Glaucoma Based on Fundus Imaging. SENSORS (BASEL, SWITZERLAND) 2023; 24:239. [PMID: 38203101 PMCID: PMC10781365 DOI: 10.3390/s24010239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
Glaucoma, a leading cause of blindness, damages the optic nerve, making early diagnosis challenging due to no initial symptoms. Fundus eye images taken with a non-mydriatic retinograph help diagnose glaucoma by revealing structural changes, including the optic disc and cup. This research aims to thoroughly analyze saliency maps in interpreting convolutional neural network decisions for diagnosing glaucoma from fundus images. These maps highlight the most influential image regions guiding the network's decisions. Various network architectures were trained and tested on 739 optic nerve head images, with nine saliency methods used. Some other popular datasets were also used for further validation. The results reveal disparities among saliency maps, with some consensus between the folds corresponding to the same architecture. Concerning the significance of optic disc sectors, there is generally a lack of agreement with standard medical criteria. The background, nasal, and temporal sectors emerge as particularly influential for neural network decisions, showing a likelihood of being the most relevant ranging from 14.55% to 28.16% on average across all evaluated datasets. We can conclude that saliency maps are usually difficult to interpret and even the areas indicated as the most relevant can be very unintuitive. Therefore, its usefulness as an explanatory tool may be compromised, at least in problems such as the one addressed in this study, where the features defining the model prediction are generally not consistently reflected in relevant regions of the saliency maps, and they even cannot always be related to those used as medical standards.
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Affiliation(s)
- Jose Sigut
- Department of Computer Science and Systems Engineering, Universidad de La Laguna, Camino San Francisco de Paula, 19, La Laguna, 38203 Santa Cruz de Tenerife, Spain; (F.F.); (J.E.); (S.A.)
| | - Francisco Fumero
- Department of Computer Science and Systems Engineering, Universidad de La Laguna, Camino San Francisco de Paula, 19, La Laguna, 38203 Santa Cruz de Tenerife, Spain; (F.F.); (J.E.); (S.A.)
| | - José Estévez
- Department of Computer Science and Systems Engineering, Universidad de La Laguna, Camino San Francisco de Paula, 19, La Laguna, 38203 Santa Cruz de Tenerife, Spain; (F.F.); (J.E.); (S.A.)
| | - Silvia Alayón
- Department of Computer Science and Systems Engineering, Universidad de La Laguna, Camino San Francisco de Paula, 19, La Laguna, 38203 Santa Cruz de Tenerife, Spain; (F.F.); (J.E.); (S.A.)
| | - Tinguaro Díaz-Alemán
- Department of Ophthalmology, Hospital Universitario de Canarias, Carretera Ofra S/N, La Laguna, 38320 Santa Cruz de Tenerife, Spain;
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Huh MG, Shin YI, Jeong Y, Kim YK, Jeoung JW, Park KH. Papillomacular bundle defect (PMBD) in glaucoma patients with high myopia: frequency and risk factors. Sci Rep 2023; 13:21958. [PMID: 38081858 PMCID: PMC10713584 DOI: 10.1038/s41598-023-48687-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Little is known about the papillomacular bundle defect (PMBD) in glaucoma. As such, we investigated the frequency of PMBD in glaucoma patients with high myopia, and its risk factors. In this retrospective, cross-sectional study, retinal nerve fiber layer (RNFL) defect was analyzed in 92 glaucomatous eyes with high myopia (axial length of 26.0 mm or more or an average spherical value of - 6.0 diopters or less). After dividing them into two groups with and without PMBD, the clinical characteristics of the groups were compared and analyzed. The mean age of the patients was 52.1 ± 10.5 years, and there were 53 males and 39 females. PMBD were observed in 55 eyes (59.8%). There was no significant intergroup difference in baseline or follow-up intraocular pressure (IOP). Parapapillary atrophy (PPA)-to-disc-area ratio (OR 3.83, CI: 1.58-10.27, p = 0.010), lamina cribrosa defect (LCD; OR 2.92, CI: 1.14-8.13, p = 0.031) and central visual field defect (CVFD; OR 3.56, CI: 1.38-9.58, p = 0.010) were significantly associated with the PMBD..
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Affiliation(s)
- Min Gu Huh
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young In Shin
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jeong
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Nishida T, Weinreb RN, Arias J, Vasile C, Moghimi S. Comparison of the TEMPO binocular perimeter and Humphrey field analyzer. Sci Rep 2023; 13:21189. [PMID: 38040803 PMCID: PMC10692178 DOI: 10.1038/s41598-023-48105-5] [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: 08/21/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
This study compared between TEMPO, a new binocular perimeter, with the Humphrey Field Analyzer (HFA). Patients were tested with both TEMPO 24-2 Ambient Interactive Zippy Estimated by Sequential Testing (AIZE)-Rapid and HFA 24-2 Swedish Interactive Threshold Algorithm (SITA)-Fast in a randomized sequence on the same day. Using a mixed-effects model, visual field (VF) parameters and reliability indices were compared. Retinal nerve fiber layer (RNFL) thickness was measured using Cirrus optical coherence tomography (OCT), and coefficient of determinations for VF and OCT parameters were calculated and compared using Akaike information criteria. 740 eyes (including 68 healthy, 262 glaucoma suspects, and 410 glaucoma) of 370 participants were evaluated. No significant differences were seen in mean deviation and visual field index between the two perimeters (P > 0.05). A stronger association between VF mean sensitivity (dB or 1/L) and circumpapillary RNFL was found for TEMPO (adjusted R2 = 0.25; Akaike information criteria [AIC] = 5235.5 for dB, and adjusted R2 = 0.29; AIC = 5200.8 for 1/L, respectively) compared to HFA (adjusted R2 = 0.22; AIC = 5263.9 for dB, and adjusted R2 = 0.22; AIC = 5262.7 for 1/L, respectively). Measurement time was faster for TEMPO compared to HFA (261 s vs. 429 s, P < 0.001). Further investigations are needed to assess the long-term monitoring potential of this binocular VF test.
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Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA
| | - Juan Arias
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA
| | - Cristiana Vasile
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, 9500 Campus Point Drive, La Jolla, CA, 92093-0946, USA.
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Yamashita T, Asaoka R, Terasaki H, Yoshihara N, Kakiuchi N, Sakamoto T. Three-year changes in sex judgment using color fundus parameters in elementary school students. PLoS One 2023; 18:e0295123. [PMID: 38033010 PMCID: PMC10688721 DOI: 10.1371/journal.pone.0295123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
PURPOSE In a previous cross-sectional study, we reported that the sexes can be distinguished using known factors obtained from color fundus photography (CFP). However, it is not clear how sex differences in fundus parameters appear across the human lifespan. Therefore, we conducted a cohort study to investigate sex determination based on fundus parameters in elementary school students. METHODS This prospective observational longitudinal study investigated 109 right eyes of elementary school students over 4 years (age, 8.5 to 11.5 years). From each CFP, the tessellation fundus index was calculated as red/red + green + blue (R/[R+G+B]) using the mean value of red-green-blue intensity in eight locations around the optic disc and macular region. Optic disc area, ovality ratio, papillomacular angle, and retinal vessel angles and distances were quantified according to the data in our previous report. Using 54 fundus parameters, sex was predicted by L2 regularized binomial logistic regression for each grade. RESULTS The right eyes of 53 boys and 56 girls were analyzed. The discrimination accuracy rate significantly increased with age: 56.3% at 8.5 years, 46.1% at 9.5 years, 65.5% at 10.5 years and 73.1% at 11.5 years. CONCLUSIONS The accuracy of sex discrimination by fundus photography improved during a 3-year cohort study of elementary school students.
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Affiliation(s)
- Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima-shi, Kagoshima, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
- School of Nursing, Seirei Christopher University, Hamamatsu, Shizuoka, Japan
- Nanovision Research Division, Research Institute of Electronics, Shizuoka University, Hamamatsu, Shizuoka, Japan
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Shizuoka, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima-shi, Kagoshima, Japan
| | - Naoya Yoshihara
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima-shi, Kagoshima, Japan
| | - Naoko Kakiuchi
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima-shi, Kagoshima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima-shi, Kagoshima, Japan
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21
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Xydaki F, Arribas-Pardo P, Burgos-Blasco B, Garcia-Feijoo J, Mendez-Hernandez C. Peripapillary Vascular Density in Childhood Glaucoma: A Pilot Comparative Study with Age and Sex Matched Healthy Subjects. J Clin Med 2023; 12:6982. [PMID: 38002598 PMCID: PMC10672179 DOI: 10.3390/jcm12226982] [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: 10/19/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE The aim of this study concerns the evaluation of peripapillary vessel indices in childhood glaucoma (CG) and healthy subjects. MATERIAL AND METHODS In this prospective, unicenter, observational cross-sectional study, patients with CG and age and sex-matched healthy subjects were included. We compared retinal nerve fiber layer (RNFL) measurements in optical coherence tomography (OCT), peripapillary vessel density (PVD), and the flux index (FI) of the superficial vascular plexus from OCT angiography (OCT-A) between CG patients and control groups. RESULTS We included 39 patients (68 eyes) with CG and 50 (95 eyes) healthy subjects. The peripapillary RNFL thickness, vessel density, and flux index were significantly lower in the CG group than in the control group. The mean PVD of CG patients was 0.52 ± 0.043%, compared with 0.55 ± 0.014%, p < 0.0001 in healthy subjects. The mean FI was 0.32 ± 0.054 versus 0.37 ± 0.028, p < 0.0001, in CG patients and healthy subjects, respectively. PVD and FI in the superior, inferior, and temporal sectors were significantly lower in CG. The peripapillary RNFL thickness showed a higher area under the ROC curve (AUROC) for discriminating healthy and CG eyes and was significantly different than the PVD (0.797, 95%CI 0.726-0.869; p < 0.0001 vs. 0.664, 95%CI 0.574-0.752; p 0.00037), p 0.012. CONCLUSIONS PVD and FI show lower values in CG and correlate with RNFL thickness measurement but have lower diagnostic ability than RNFL thickness measurement. Our results reveal possible differences in the pathogenesis of microvascular compromise in childhood glaucoma patients.
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Affiliation(s)
- Flora Xydaki
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
| | - Paula Arribas-Pardo
- Ophthalmology Department, Central Defense Hospital “Gomez Ulla”, 28047 Madrid, Spain
| | - Barbara Burgos-Blasco
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
| | - Julian Garcia-Feijoo
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
| | - Carmen Mendez-Hernandez
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
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22
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Yamada Y, Kiyota N, Yoshida M, Omodaka K, Nakazawa T. The Relationship Between Kiritsu-Meijin-Derived Autonomic Function Parameters and Visual-Field Defects in Eyes with Open-Angle Glaucoma. Curr Eye Res 2023; 48:1006-1013. [PMID: 37405397 DOI: 10.1080/02713683.2023.2234105] [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: 04/14/2023] [Accepted: 07/04/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE This retrospective cross-sectional study aimed to investigate the association between autonomic parameters measured using the Kiritsu-Meijin device and visual-field defects in patients with open-angle glaucoma. METHODS A total of 79 eyes of 42 patients with open-angle glaucoma were enrolled in this study. Kiritsu-Meijin testing comprised three phases: sitting, standing, and sitting again (2 min, 2 min, and 1 min, respectively). Continuous electrocardiograms were recorded for five minutes. Autonomic parameters were extracted from the resulting data and analyzed, including activity, balance, reaction, switchover, and recovery; these are five representative parameters derived from Kiritsu-Meijin testing. Correlations between these parameters and mean deviation from Humphrey visual field testing were determined. Additionally, we used a linear mixed-effects model to observe sectoral differences in the relationship between total deviation and the Kiritsu-Meijin parameters. In this study, we focused on superior, central, and inferior total deviations. RESULTS Significant positive correlations were observed between activity, balance, and recovery and mean deviation values (β = 0.29-0.38, p < .05). The β value between activity and inferior total deviation was higher than that between activity and superior total deviation (β = 0.22, p < .05). Balance did not show any sectoral differences (p > .05). Recovery was more strongly associated with central to inferior total deviation than superior total deviation (β = 0.17-0.25, p < .05). CONCLUSION Our findings suggest that in patients with open-angle glaucoma, lower activity and recovery are associated with more severe central and/or inferior visual field defects in the superior quadrant. These results imply that measurements of autonomic function made with the Kiritsu-Meijin device may have clinical utility in the management of glaucoma.
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Affiliation(s)
- Yurina Yamada
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Kiyota
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mitsuhide Yoshida
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuko Omodaka
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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23
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Ehongo A, Dugauquier A, Kisma N, De Maertelaer V, Nana Wandji B, Tchatchou Tomy W, Alaoui Mhammedi Y, Coppens K, Leroy K, Bremer F. Myopic (Peri)papillary Changes and Visual Field Defects. Clin Ophthalmol 2023; 17:3295-3306. [PMID: 37933329 PMCID: PMC10625749 DOI: 10.2147/opth.s404167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose Myopic eyes combining gamma peripapillary atrophy and peripapillary staphyloma were sorted according to the presence of intrachoroidal cavitation (PICCs) or its absence (combinations). Visual field defects (VFDs) and factors discriminating these groups were analyzed. Methods These groups were sorted by optical coherence tomography. VFDs were assessed using the Humphrey® Field Analyzer 3, SITA standard. Ovality index (OI) was the ratio between the shortest and longest diameters of the disc. The proportions of PICCs, lamina cribrosa defects (LCDs) and clusters in each Garway-Heath's sector (A-F) were analyzed. All variables were compared between PICCs and combinations. A multivariate logistic regression analysis was performed ultimately. Results Of the 93 eyes, we obtained, 20 PICCs and 73 combinations. The prevalence of VFDs and LCDs in PICCs were 65% (13/20) and 30% (6/20), respectively. PICCs 85% (17/20) and LCDs 12% (11/93) predominated in sector B (inferotemporal) and clusters 9.7% (9/93) in the corresponding sector. The proportion of VFDs was significantly higher in PICCs than combinations (p < 0.001). In sector B, the proportion of LCDs was significantly higher in PICCs than combinations (p = 0.011). The mean OI was significantly lower (p < 0.001) in PICCs than combinations. Multivariate logistic regression analysis concluded that mean OI (p < 0.001) was the only statistically significant factor discriminating PICCs and combinations. Conclusion Mean OI discriminating PICCs from combinations is further evidence of a gradation of structural changes between them. It could be related to the higher proportion of VFDs in PICCs. The predominant distribution of PICCs infero-temporally supports PICC as a cause of uncertainty in glaucoma diagnosis in high myopia. Furthermore, the highest proportion of PICCs and LCDs in this sector highlights its vulnerability to damage in myopic eyes and deserves further investigation as it is also primarily involved in glaucoma.
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Affiliation(s)
- Adèle Ehongo
- Ophthalmology Department, Erasmus Hospital, Brussels, 1070, Belgium
| | | | - Nacima Kisma
- Ophthalmology Department, Erasmus Hospital, Brussels, 1070, Belgium
| | | | | | | | | | - Kevin Coppens
- Cosma consulting Sijsjesdreef 13, Enghien, 7850, Belgium
| | - Karelle Leroy
- Laboratory of Histology, Université Libre de Bruxelles, Bruxelles, 1070, Belgium
| | - Francoise Bremer
- Ophthalmology Department, Erasmus Hospital, Brussels, 1070, Belgium
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24
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Ibrahim Y, Xie J, Macerollo A, Sardone R, Shen Y, Romano V, Zheng Y. A Systematic Review on Retinal Biomarkers to Diagnose Dementia from OCT/OCTA Images. J Alzheimers Dis Rep 2023; 7:1201-1235. [PMID: 38025800 PMCID: PMC10657718 DOI: 10.3233/adr-230042] [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: 06/06/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background Traditional methods for diagnosing dementia are costly, time-consuming, and somewhat invasive. Since the retina shares significant anatomical similarities with the brain, retinal abnormalities detected via optical coherence tomography (OCT) and OCT angiography (OCTA) have been studied as a potential non-invasive diagnostic tool for neurodegenerative disorders; however, the most effective retinal changes remain a mystery to be unraveled in this review. Objective This study aims to explore the relationship between retinal abnormalities in OCT/OCTA images and cognitive decline as well as evaluating biomarkers' effectiveness in detecting neurodegenerative diseases. Methods A systematic search was conducted on PubMed, Web of Science, and Scopus until December 2022, resulted in 64 papers using agreed search keywords, and inclusion/exclusion criteria. Results The superior peripapillary retinal nerve fiber layer (pRNFL) is a trustworthy biomarker to identify most Alzheimer's disease (AD) cases; however, it is inefficient when dealing with mild AD and mild cognitive impairment (MCI). The global pRNFL (pRNFL-G) is another reliable biomarker to discriminate frontotemporal dementia from mild AD and healthy controls (HCs), moderate AD and MCI from HCs, as well as identifing pathological Aβ42/tau in cognitively healthy individuals. Conversely, pRNFL-G fails to realize mild AD and the progression of AD. The average pRNFL thickness variation is considered a viable biomarker to monitor the progression of AD. Finally, the superior and average pRNFL thicknesses are considered consistent for advanced AD but not for early/mild AD. Conclusions Retinal changes may indicate dementia, but further research is needed to confirm the most effective biomarkers for early and mild AD.
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Affiliation(s)
- Yehia Ibrahim
- Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK
| | - Jianyang Xie
- Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK
| | - Antonella Macerollo
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rodolfo Sardone
- Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK
- Statistics and Epidemiology Unit, Local Healthcare Authority of Taranto, Taranto, Italy
| | - Yaochun Shen
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, UK
| | - Vito Romano
- Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Yalin Zheng
- Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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25
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Montesano G, Garway-Heath DF, Rabiolo A, De Moraes CG, Ometto G, Crabb DP. Validating Trend-Based End Points for Neuroprotection Trials in Glaucoma. Transl Vis Sci Technol 2023; 12:20. [PMID: 37906055 PMCID: PMC10619697 DOI: 10.1167/tvst.12.10.20] [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: 05/04/2023] [Accepted: 10/08/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the power of trend-based visual field (VF) progression end points against long-term development of event-based end points accepted by the US Food and Drug Administration (FDA). Methods One eye from 3352 patients with ≥10 24-2 VFs (median = 11 years) follow-up were analyzed. Two FDA-compatible criteria were applied to these series to label "true-progressed" eyes: ≥5 locations changing from baseline by more than 7 dB (FDA-7) or by more than the expected test-retest variability (GPA-like) in 2 consecutive tests. Observed rates of progression (RoP) were used to simulate trial-like series (2 years) randomly assigned (1000 times) to a "placebo" or a "treatment" arm. We simulated neuroprotective "treatment" effects by changing the proportion of "true progressed" eyes in the two arms. Two trend-based methods for mean deviation (MD) were assessed: (1) linear mixed model (LMM), testing average difference in RoP between the two arms, and (2) time-to-progression (TTP), calculated by linear regression as time needed for MD to decline by predefined cutoffs from baseline. Power curves with 95% confidence intervals were calculated for trend and event-based methods on the simulated series. Results The FDA-7 and GPA-like progression was achieved by 45% and 55% of the eyes in the clinical database. LMM and TTP had similar power, significantly superior to the event-based methods, none of which reached 80% power. All methods had a 5% false-positive rate. Conclusions The trend-based methods can efficiently detect treatment effects defined by long-term FDA-compatible progression. Translational Relevance The assessment of the power of trend-based methods to detect clinically relevant progression end points.
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Affiliation(s)
- Giovanni Montesano
- City, University of London, Optometry and Visual Sciences, London, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - David F Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Alessandro Rabiolo
- Department of Health Sciences, Università del Piemonte Orientale "A. Avogadro," Novara, Italy
- Eye Clinic, University Hospital Maggiore della Carità, Novara, Italy
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Giovanni Ometto
- City, University of London, Optometry and Visual Sciences, London, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - David P Crabb
- City, University of London, Optometry and Visual Sciences, London, UK
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26
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Asaoka R, Murata H. Prediction of visual field progression in glaucoma: existing methods and artificial intelligence. Jpn J Ophthalmol 2023; 67:546-559. [PMID: 37540325 DOI: 10.1007/s10384-023-01009-3] [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: 12/26/2022] [Accepted: 04/13/2023] [Indexed: 08/05/2023]
Abstract
Timely treatment is essential in the management of glaucoma. However, subjective assessment of visual field (VF) progression is not recommended, because it can be unreliable. There are two types of artificial intelligence (AI) strong and weak (machine learning). Weak AIs can perform specific tasks. Linear regression is a method of weak AI. Using linear regression in the real-world clinic has enabled analyzing and predicting VF progression. However, caution is still required when interpreting the results, because whenever the number of VF data sets investigated is small, the predictions can be inaccurate. Several other non-ordinal, or modern AI methods have been constructed to improve prediction accuracy, such as clustering and more modern AI methods of Analysis with Non-Stationary Weibull Error Regression and Spatial Enhancement (ANSWERS), Variational Bayes Linear Regression (VBLR), Kalman Filter and sparse modeling (The least absolute shrinkage and selection operator regression: Lasso). It is also possible to improve the prediction performance using retinal thickness measured with optical coherence tomography by using machine learning methods, such as multitask learning.
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Grants
- 19H01114 ministry of education, culture, sports, science, and technology of Japan
- 18KK0253 ministry of education, culture, sports, science and technology of Japan
- 20K09784 ministry of education, culture, sports, science and technology of Japan
- 80635748 ministry of education, culture, sports, science and technology of Japan
- TR-SPRINT japan agency for medical reserach and development
- Grant the Japan Glaucoma Society Project Support Program
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Affiliation(s)
- Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, Japan.
- Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Shizuoka, Japan.
| | - Hiroshi Murata
- Department of Ophthalmology, National Center for Global health and Medicine, Tokyo, Japan
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27
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Soares I, Gravito-Soares M, Gravito-Soares E, Vaz S, Almeida V. Comparison of different measuring methods in the assessment of the ISNT rule and its variants in a normal population: A cross-sectional study. Ophthalmic Physiol Opt 2023; 43:1190-1202. [PMID: 37243449 DOI: 10.1111/opo.13171] [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: 11/25/2022] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE The aim of this study was to compare five different neuroretinal rim (NRR) measurement methods, based on quadrants and NRR widths, in the assessment of the ISNT (inferior (I) > superior (S) > nasal (N) > temporal (T)) rule, and its variants IST (inferior (I) > superior (S) > temporal (S)) rule, IS (inferior (I) > superior (S)) rule and T (temporal is the thinnest) rule in a normal population. Factors influencing compliance with this rule and its variants were also evaluated. METHODS Stereoscopic fundus images were analysed through a dichoptic viewing system. Two graders labelled the optic disc and cup, as well as the fovea. Custom-made software automatically determined the limits of the optic disc and cup and examined the ISNT rule and its variants using several NRR measurement methods. RESULTS Sixty-nine subjects with normal eyes were enrolled. For the various NRR measuring methods, the percentage of eyes following the rules, that is, validity ranges were 0.0%-15.9% for the ISNT rule, 31.9%-59.4% for the IST rule, 46.4%-59.4% for the IS rule and 50.7%-100.0% for the T rule. Significant intra-measurement agreement ranges were IST (κ = 0.50-0.85), IS (κ = 0.68-1.00) and T (κ = 0.24-0.77). Only the IST and IS rules achieved significant inter-measurement agreement (κ = 0.47-1.00). After multivariate and receiver operating characteristic (ROC) curve analyses, the vertical cup position cupy (area under the ROC curve (AUROC) = 0.60-0.96; cut-off = |0.005|) was the most important predictor for virtually all NRR measurement agreements for the ISNT, IST and IS rules. The horizontal cup position (AUROC = 0.50-0.92; cut-off = -0.028 to 0.05) was the most important predictive factor for the majority of the NRR measurement agreements for the T rule. CONCLUSIONS Only the IST and IS rules are valid for the same normal subjects. The most important factor affecting the validity of the ISNT rule and its variants was the anatomical cup position. NRR measurement agreements based on NRR quadrants exhibited larger validity and better agreement. The IST and IS rules can be combined with the alternative SIT (superior (S) > inferior (I) > temporal (T)) and SI (superior (S) > inferior (I)) rules to detect almost all normal subjects.
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Affiliation(s)
- Ivo Soares
- Department of Physics, University of Beira Interior, Covilhã, Portugal
- Health Sciences Research Centre (CICS-UBI), University of Beira Interior, Covilhã, Portugal
- Clinical and Experimental Centre in Vision Sciences (CCECV), University of Beira Interior, Covilhã, Portugal
| | - Marta Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Elisa Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sandra Vaz
- Centre of Mathematics and Applications (CMA-UBI), Department of Mathematics, University of Beira Interior, Covilhã, Portugal
| | - Vasco Almeida
- Department of Physics, University of Beira Interior, Covilhã, Portugal
- Clinical and Experimental Centre in Vision Sciences (CCECV), University of Beira Interior, Covilhã, Portugal
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Kim JA, Lee EJ, Kim TW. Impact of peripapillary retinoschisis on visual field test results in glaucomatous eyes. Br J Ophthalmol 2023; 107:1281-1285. [PMID: 35728936 DOI: 10.1136/bjophthalmol-2021-320509] [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: 09/23/2021] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To investigate the influence of peripapillary retinoschisis (PRS) on visual field (VF) test results in patients with primary open angle glaucoma (POAG). METHODS Thirty eyes of 30 patients with POAG who had PRS at least once were included. All eyes were followed-up for a minimum 5 years at 4-6-month intervals. The occurrence of PRS was determined by circumpapillary retinal nerve fibre layer B-scan on spectral-domain optical coherence tomography (OCT). The global and regional VF deviations just prior to and immediately after PRS formation, or just prior to and immediately after PRS resolution (if it occurred), were compared. VF sensitivity within the region corresponding to the OCT sector where PRS occurred was determined according to the Garway-Heath map. RESULTS Global MD (p=0.345) and regional VF deviations (p=0.255) did not differ significantly between immediately after and just prior to PRS formation. Global MD (p=0.846) and regional VF deviations (p=0.758) were also similar between immediately after and just prior to PRS resolution. CONCLUSION PRS has no short-term effect on the VF sensitivity. Therefore, VF test can still be useful for evaluating glaucomatous damage even in the presence of PRS compared with OCT.
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Affiliation(s)
- Ji-Ah Kim
- Department of Ophthalmology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Jiang J, Song Y, Kong K, Wang P, Lin F, Gao X, Wang Z, Jin L, Chen M, Lam DSC, Weinreb RN, Jonas JB, Ohno-Matsui K, Chen S, Zhang X. Optic Nerve Head Abnormalities in Nonpathologic High Myopia and the Relationship With Visual Field. Asia Pac J Ophthalmol (Phila) 2023; 12:460-467. [PMID: 37851563 DOI: 10.1097/apo.0000000000000636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/27/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE To describe the optic nerve head (ONH) abnormalities in nonpathologic highly myopic eyes based on swept-source optical coherence tomography (OCT) and the relationship with visual field (VF). DESIGN Secondary analysis from a longitudinal cohort study. METHODS Highly myopic patients without myopic maculopathy of category 2 or higher were enrolled. All participants underwent a swept-source OCT examination focused on ONH. We differentiated between 3 major types (optic disc morphologic abnormality, papillary/peripapillary tissue defect, and papillary/peripapillary schisis) and 12 subtypes of ONH abnormalities. The prevalence and characteristics of ONH abnormalities and the relationship with VF were analyzed. RESULTS A total of 857 participants (1389 eyes) were included. Among the 1389 eyes, 91.86%, 68.61%, and 34.92% of them had at least 1, 2, or 3 ONH abnormalities, respectively, which corresponded to 29.55%, 31.79%, and 35.67% of VF defects, respectively. Among the 12 subtypes of the 3 major types, peripapillary hyperreflective ovoid mass-like structure, visible retrobulbar subarachnoid space, and prelaminar schisis were the most common, respectively. Perimetric defects corresponding to OCT abnormalities were more commonly found in eyes with peripapillary retinal detachment, peripapillary retinoschisis, and peripapillary hyperreflective ovoid mass-like structure. Glaucoma-like VF defects were more common in eyes with deep optic cups (28.17%) and with optic disc pit/pit-like change (18.92%). CONCLUSIONS We observed and clarified the ONH structural abnormalities in eyes with nonpathologic high myopia. These descriptions may be helpful to differentiate changes in pathologic high myopia or glaucoma.
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Affiliation(s)
- Jingwen Jiang
- 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, China
| | - Yunhe Song
- 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, China
| | - Kangjie Kong
- 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, China
| | - Peiyuan Wang
- 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, China
| | - Fengbin Lin
- 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, China
| | - Xinbo Gao
- 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, China
| | - Zhenyu Wang
- 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, China
| | - Ling Jin
- 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, China
| | - Meiling Chen
- 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, China
| | - Dennis S C Lam
- The C-MER Dennis Lam and Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Robert N Weinreb
- Department of Ophthalmology, Hamilton Glaucoma Center, Viterbi Family and Shiley Eye Institute, University of California San Diego, La Jolla, CA, US
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Shida Chen
- 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, China
| | - 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, China
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Nishida T, Weinreb R, Arias J, Vasile C, Moghimi S. Comparison of the TEMPO Binocular Perimeter and Humphrey Field Analyzer. RESEARCH SQUARE 2023:rs.3.rs-3283528. [PMID: 37693597 PMCID: PMC10491334 DOI: 10.21203/rs.3.rs-3283528/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This study compared between TEMPO, a new binocular perimeter, with the Humphrey Field Analyzer (HFA). Patients were tested with both TEMPO 24 - 2 AIZE-Rapid and HFA 24 - 2 SITA-Fast in a randomized sequence on the same day. Using a mixed-effects model, visual field (VF) parameters and reliability indices were compared. Retinal nerve fiber layer (RNFL) thickness was measured using Cirrus OCT, and coefficient of determinations for visual field and OCT parameters were calculated and compared using Akaike information criteria. 740 eyes (including 68 healthy, 262 glaucoma suspects, and 410 glaucoma) of 370 participants were evaluated. No significant differences were seen in mean deviation and visual field index between the two perimeters (P > 0.05). A stronger association between VF mean deviation and circumpapillary RNFL was found for TEMPO (adjusted R2 = 0.28; AIC = 5210.9) compared to HFA (adjusted R2 = 0.26; AIC = 5232.0). TEMPO had better reliability indices (fixation loss, false positive, and false negative) compared to HFA (all P < 0.05). Measurement time was faster for TEMPO compared to HFA (261sec vs. 429sec, P < 0.001). Further investigations are needed to assess the long-term monitoring potential of this binocular VF test.
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Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
| | - Robert Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
| | - Juan Arias
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
| | - Cristiana Vasile
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego
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31
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Yamashita T, Asaoka R, Iwase A, Sakai H, Terasaki H, Sakamoto T, Araie M. Sex determination using color fundus parameters in older adults of Kumejima population study. Graefes Arch Clin Exp Ophthalmol 2023; 261:2411-2419. [PMID: 36856844 DOI: 10.1007/s00417-023-06024-1] [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: 11/05/2022] [Revised: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Deep learning artificial intelligence can determine the sex using only fundus photographs. However, the factors used by deep learning to determine the sex are not visible. Therefore, the purpose of the study was to determine whether the sex of an older individual can be determined by regression analysis of their color fundus photographs (CFPs). METHODS Forty-two parameters were analyzed by regression analysis using 1653 CFPs of normal subjects in the Kumajima study. The parameters included the mean values of red, green, and blue intensities; the tessellation fundus index; the optic disc ovality ratio; the papillomacular angle; and the retinal vessel angles. Finally, the L2 regularized binomial logistic regression was used to predict the sex using all the parameters, and the diagnostic ability was assessed through the leave-one-cross-validation. RESULTS The mean age of the 838 men and 815 women were 52.8 and 54.0 years, respectively. The ovality ratio and retinal artery angles in women were significantly smaller than that in men. The green intensity at all locations for the women were significantly higher than that of men (P < 0.001). The discrimination accuracy rate assessed by the area-under-the-curve was 80.4%. CONCLUSIONS Our methods can determine the sex from the CFPs of the adult with an accuracy of 80.4%. The ovality ratio, retinal vessel angles, tessellation, and the green intensities of the fundus are important factors to identify the sex in individuals over 40 years old.
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Affiliation(s)
- Takehiro Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | | | | | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
| | - Makoto Araie
- Department of Ophthalmology, Kanto Central Hospital, Tokyo, Japan
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32
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Kim H, Lee J, Moon S, Kim S, Kim T, Jin SW, Kim JL, Shin J, Lee SU, Jang G, Hu Y, Park JR. Visual field prediction using a deep bidirectional gated recurrent unit network model. Sci Rep 2023; 13:11154. [PMID: 37429862 DOI: 10.1038/s41598-023-37360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
Although deep learning architecture has been used to process sequential data, only a few studies have explored the usefulness of deep learning algorithms to detect glaucoma progression. Here, we proposed a bidirectional gated recurrent unit (Bi-GRU) algorithm to predict visual field loss. In total, 5413 eyes from 3321 patients were included in the training set, whereas 1272 eyes from 1272 patients were included in the test set. Data from five consecutive visual field examinations were used as input; the sixth visual field examinations were compared with predictions by the Bi-GRU. The performance of Bi-GRU was compared with the performances of conventional linear regression (LR) and long short-term memory (LSTM) algorithms. Overall prediction error was significantly lower for Bi-GRU than for LR and LSTM algorithms. In pointwise prediction, Bi-GRU showed the lowest prediction error among the three models in most test locations. Furthermore, Bi-GRU was the least affected model in terms of worsening reliability indices and glaucoma severity. Accurate prediction of visual field loss using the Bi-GRU algorithm may facilitate decision-making regarding the treatment of patients with glaucoma.
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Grants
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HI19C0481 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- HC19C0276 Ministry of Health & Welfare, Republic of Korea
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1I1A1A01057767 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2021R1A2B5B03087097 Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2017R1A5A1015722M Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
- NRF-2022R1A5A1033624 Korean government
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Affiliation(s)
- Hwayeong Kim
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Jiwoong Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sangwoo Moon
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Sangil Kim
- Department of Mathematics, Pusan National University, Busan, Republic of Korea
| | - Taehyeong Kim
- Department of Mathematics, Pusan National University, Busan, Republic of Korea
| | - Sang Wook Jin
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Jung Lim Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jonghoon Shin
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Seung Uk Lee
- Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea
| | - Geunsoo Jang
- Nonlinear Dynamics and Mathematical Application Center, Kyungpook National University, Daegu, Korea
| | - Yuanmeng Hu
- Department of Mathematics, Pusan National University, Busan, Republic of Korea
| | - Jeong Rye Park
- Department of Mathematics, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea.
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Montesano G, Ometto G, Ahmed IIK, Ramulu PY, Chang DF, Crabb DP, Gazzard G. Five-Year Visual Field Outcomes of the HORIZON Trial. Am J Ophthalmol 2023; 251:143-155. [PMID: 36813144 DOI: 10.1016/j.ajo.2023.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To compare visual field (VF) progression between glaucoma patients receiving cataract surgery alone (CS) or with a Hydrus microstent (CS-HMS). DESIGN Post hoc analysis of VF data from the HORIZON multicenter randomized controlled trial. METHODS A total of 556 patients with glaucoma and cataract were randomized 2:1 to either CS-HMS (369) or CS (187) and followed up for 5 years. VF was performed at 6 months and then every year after surgery. We analyzed data for all participants with at least 3 reliable VFs (false positives < 15%). Average between-group difference in rate of progression (RoP) was tested using a Bayesian mixed model and a 2-sided Bayesian P value <.05 (main outcome). A multivariable model measured the effect of intraocular pressure (IOP). A survival analysis compared the probability of global VF sensitivity dropping by predefined cutoffs (2.5, 3.5, 4.5, and 5.5 dB) from baseline. RESULTS Data from 352 eyes in the CS-HMS arm and 165 in the CS arm were analyzed (2966 VFs). The mean RoP was -0.26 dB/y (95% credible interval -0.36, -0.16) for CS-HMS and -0.49 dB/y (95% credible interval -0.63, -0.34) for CS. This difference was significant (P = .0138). The difference in IOP only explained 17% of the effect (P < .0001). Five-year survival analysis showed an increased probability of VF worsening by 5.5 dB (P = .0170), indicating a greater proportion of fast progressors in the CS arm. CONCLUSIONS CS-HMS has a significant effect on VF preservation in glaucoma patients compared with CS alone, reducing the proportion of fast progressors.
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Affiliation(s)
- Giovanni Montesano
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (G.M., G.O., G.G.), London, United Kingdom; City, University of London-Optometry and Visual Sciences (G.M., G.O., D.P.C.), London, United Kingdom.
| | - Giovanni Ometto
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (G.M., G.O., G.G.), London, United Kingdom; City, University of London-Optometry and Visual Sciences (G.M., G.O., D.P.C.), London, United Kingdom
| | - Iqbal Ike K Ahmed
- John Moran Eye Center, University of Utah (I.I.K.A.), Salt Lake City, Utah; University of Toronto (I.I.K.A.), Toronto, Ontario, Canada
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University (P.Y.R.), Baltimore, Maryland, USA
| | - David F Chang
- Altos Eye Physicians (D.F.C.), Los Altos, California, USA
| | - David P Crabb
- City, University of London-Optometry and Visual Sciences (G.M., G.O., D.P.C.), London, United Kingdom
| | - Gus Gazzard
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (G.M., G.O., G.G.), London, United Kingdom.
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Rafla D, Khuu SK, Kashyap S, Kalloniatis M, Phu J. Visualising structural and functional characteristics distinguishing between newly diagnosed high-tension and low-tension glaucoma patients. Ophthalmic Physiol Opt 2023; 43:771-787. [PMID: 36964934 PMCID: PMC10946885 DOI: 10.1111/opo.13129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE To determine whether there are quantifiable structural or functional differences that can distinguish between high-tension glaucoma (HTG; intraocular pressure [IOP] > 21 mm Hg) and low-tension glaucoma (LTG; IOP ≤ 21 mm Hg) at diagnosis. METHOD This was a retrospective, cross-sectional study. Clinical results of one eye from 90 newly diagnosed HTG and 319 newly diagnosed LTG patients (117 with very-low-tension glaucoma [vLTG; ≤15 mm Hg] and 202 with middling LTG [mLTG; >15 mm Hg, ≤21 mm Hg]) were extracted, which included relevant demographic covariates of glaucoma, quantitative optical coherence tomography (including the optic nerve head, retinal nerve fibre layer and ganglion cell-inner plexiform layer) measurements and standard automated perimetry global metrics. We used binary logistic regression analysis to identify statistically significant clinical parameters distinguishing between phenotypic groups for inclusion in principal component (PC) (factor) analysis (PCA). The separability between each centroid for each cohort was calculated using the Euclidean distance (d(x,y)). RESULTS The binary logistic regression comparing HTG and all LTG identified eight statistically significant clinical parameters. Subsequent PCA results included three PCs with an eigenvalue >1. PCs 1 and 2 accounted for 21.2% and 20.2% of the model, respectively, with a d(x,y) = 0.468, indicating low separability between HTG and LTG. The analysis comparing vLTG, mLTG and HTG identified 15 significant clinical parameters, which were subsequently grouped into five PCs. PCs 1 and 2 accounted for 24.1% and 17.8%, respectively. The largest separation was observed between vLTG and HTG (d(x,y) = 0.581), followed by vLTG and mLTG (d(x,y) = 0.435) and lastly mLTG and HTG (d(x,y) = 0.210). CONCLUSION Conventional quantitative structural or functional parameters could not distinguish between pressure-defined glaucoma phenotypes at the point of diagnosis and are therefore not contributory to separating cohorts. The overlap in findings highlights the heterogeneity of the primary open-angle glaucoma clinical presentations among pressure-defined groups at the cohort level.
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Affiliation(s)
- Daniel Rafla
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesSydneyNew South WalesAustralia
| | - Sieu K. Khuu
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
| | - Sahana Kashyap
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesSydneyNew South WalesAustralia
| | - Michael Kalloniatis
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesSydneyNew South WalesAustralia
- School of Medicine (Optometry)Deakin UniversityVictoriaGeelongAustralia
| | - Jack Phu
- Centre for Eye HealthThe University of New South WalesSydneyNew South WalesAustralia
- School of Optometry and Vision ScienceThe University of New South WalesSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneyNew South WalesCamperdownAustralia
- Concord Clinical SchoolConcord Repatriation General HospitalNew South WalesConcordAustralia
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Hsia Y, Wang TH, Huang JY, Su CC. Relationship between the Macular Microvasculature and Central Visual Field Sensitivity in Patients with Advanced Glaucoma. Ophthalmol Glaucoma 2023; 6:413-421. [PMID: 36801261 DOI: 10.1016/j.ogla.2023.02.002] [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: 10/24/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE To evaluate the relationship between central visual field sensitivity (cVFS) and the structural parameters in patients with advanced glaucoma. DESIGN Cross-sectional study. METHODS In total, 226 eyes of 226 patients with advanced glaucoma were classified into the "minor central defect" (mean deviation on 10-2 visual field test [MD10] > -10 dB) and "significant central defect" (MD10 ≤ -10 dB) groups. We examined the structural parameters using RTVue OCT and angiography, including the retinal nerve fiber layer, ganglion cell complex, peripapillary vessel density (VD), and superficial and deep macular VD (mVD). The assessment of cVFS included MD10 and the mean deviation of the central 16 points on the 10-2 VF test (MD16). We used Pearson correlation and segmented regression to assess the global and regional relationships between the structural parameters and cVFS. MAIN OUTCOME MEASURES Correlation between structural parameters and cVFS. RESULTS In the minor central defect group, the best global correlations existed between the superficial macular and parafoveal mVD and MD16 (r = 0.52 and 0.54, P < 0.001). In the significant central defect group, superficial mVD best correlated with MD10 (r = 0.47, P < 0.001). Segmented regression between superficial mVD and cVFS revealed no breakpoint was found as MD10 declined, but a breakpoint was identified at -5.95 dB for MD16, which was statistically significant (P < 0.001). The regional correlations between the grid VD and sectors of the central 16 points were significant (r = 0.20-0.53, P= 0.010 ∼P < 0.001). CONCLUSIONS The fair global and regional relationships between mVD and cVFS suggest that mVD may be beneficial for monitoring cVFS in patients with advanced glaucoma. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Yun Hsia
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsing-Hong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jehn-Yu Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Chia Su
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
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Zangalli CS, Jammal AA, Reis ASC, Ayub G, Diniz-Filho A, Paranhos A, Paula JS, Costa VP. Minimum Rim Width and Peripapillary Retinal Nerve Fiber Layer Thickness for Diagnosing Early to Moderate Glaucoma. J Glaucoma 2023; 32:526-532. [PMID: 36730041 DOI: 10.1097/ijg.0000000000002156] [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: 03/14/2022] [Accepted: 11/16/2022] [Indexed: 02/03/2023]
Abstract
PRCIS In a cross-sectional study from a Brazilian multiracial population, minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness measurements from OCT showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes. PURPOSE The purpose of this study is to compare the ability of MRW and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements in discriminating early to moderate glaucoma from healthy eyes in a Brazilian population. METHODS A total of 155 healthy controls and 118 patients with mild to moderate glaucoma (mean deviation >-12 dB) underwent MRW and RNFLT measurements with optical coherence tomography. Only 1 eye per patient was included in the analysis. A receiver operating characteristic (ROC) regression model was used to evaluate the diagnostic accuracy of MRW and RNFLT, whereas adjusting for age and Bruch membrane opening area. Sensitivities at fixed specificities of 95% were calculated for each parameter. RESULTS Global RNFLT and MRW showed comparable area under the ROC curves [0.93 (0.91-0.96) and 0.93 (0.89-0.96), respectively; P =0.973]. Both parameters had similar sensitivities (75% vs. 74%, respectively; P =0.852) at a fixed specificity of 95%. The best sector for diagnosing glaucoma for both parameters was the temporal inferior sector, which showed an area under the ROC curve of 0.93 (0.87-0.96) for RNFLT and 0.91 (0.86-0.95) for MRW ( P =0.320). The temporal inferior sector showed similar sensitivities for RNFLT and MRW measurements (83% vs. 77%, respectively) at a fixed specificity of 95% (P =0.230). CONCLUSIONS MRW and RNFLT measurements showed comparable diagnostic performance in discriminating early to moderate glaucoma from healthy eyes in a Brazilian multiracial population.
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Chen Z, Shemuelian E, Wollstein G, Wang Y, Ishikawa H, Schuman JS. Segmentation-Free OCT-Volume-Based Deep Learning Model Improves Pointwise Visual Field Sensitivity Estimation. Transl Vis Sci Technol 2023; 12:28. [PMID: 37382575 PMCID: PMC10318595 DOI: 10.1167/tvst.12.6.28] [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: 12/19/2022] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
Purpose The structural changes measured by optical coherence tomography (OCT) are related to functional changes in visual fields (VFs). This study aims to accurately assess the structure-function relationship and overcome the challenges brought by the minimal measurable level (floor effect) of segmentation-dependent OCT measurements commonly used in prior studies. Methods We developed a deep learning model to estimate the functional performance directly from three-dimensional (3D) OCT volumes and compared it to the model trained with segmentation-dependent two-dimensional (2D) OCT thickness maps. Moreover, we proposed a gradient loss to utilize the spatial information of VFs. Results Our 3D model was significantly better than the 2D model both globally and pointwise regarding both mean absolute error (MAE = 3.11 + 3.54 vs. 3.47 ± 3.75 dB, P < 0.001) and Pearson's correlation coefficient (0.80 vs. 0.75, P < 0.001). On a subset of test data with floor effects, the 3D model showed less influence from floor effects than the 2D model (MAE = 5.24 ± 3.99 vs. 6.34 ± 4.58 dB, P < 0.001, and correlation 0.83 vs. 0.74, P < 0.001). The gradient loss improved the estimation error for low-sensitivity values. Furthermore, our 3D model outperformed all prior studies. Conclusions By providing a better quantitative model to encapsulate the structure-function relationship more accurately, our method may help deriving VF test surrogates. Translational Relevance DL-based VF surrogates not only benefit patients by reducing the testing time of VFs but also allow clinicians to make clinical judgments without the inherent limitations of VFs.
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Affiliation(s)
- Zhiqi Chen
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Eitan Shemuelian
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Center for Neural Science, NYU College of Arts and Sciences, New York, NY, USA
| | - Yao Wang
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Hiroshi Ishikawa
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Joel S. Schuman
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
- Center for Neural Science, NYU College of Arts and Sciences, New York, NY, USA
- Wills Eye Hospital, Philadelphia, PA, USA
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Li Y, Eizenman M, Shi RB, Buys YM, Trope GE, Wong W. A Data-Driven Model for Simulating Longitudinal Visual Field Tests in Glaucoma. Transl Vis Sci Technol 2023; 12:27. [PMID: 37382576 PMCID: PMC10318593 DOI: 10.1167/tvst.12.6.27] [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: 12/27/2022] [Accepted: 06/08/2023] [Indexed: 06/30/2023] Open
Abstract
Purpose To develop a simulation model for glaucomatous longitudinal visual field (VF) tests with controlled progression rates. Methods Longitudinal VF tests of 1008 eyes from 755 patients with glaucoma were used to learn the statistical characteristics of VF progression. The learned statistics and known anatomic correlations between VF test points were used to automatically generate progression patterns for baseline fields of patients with glaucoma. VF sequences were constructed by adding spatially correlated noise templates to the generated progression patterns. The two one-sided test (TOST) procedure was used to analyze the equivalence between simulated data and data from patients with glaucoma. VF progression detection rates in the simulated VF data were compared to those in patients with glaucoma using mean deviation (MD), cluster, and pointwise trend analysis. Results VF indices (MD, pattern standard deviation), MD linear regression slopes, and progression detection rates for the simulated and patients' data were practically equivalent (TOST P < 0.01). In patients with glaucoma, the detection rates in 7 years using MD, cluster, and pointwise trend analysis were 24.4%, 26.2%, and 38.4%, respectively. In the simulated data, the mean detection rates (95% confidence interval) for MD, cluster, and pointwise trend analysis were 24.7% (24.1%-25.2%), 24.9% (24.2%-25.5%), and 35.7% (34.9%-36.5%), respectively. Conclusions A novel simulation model generates glaucomatous VF sequences that are practically equivalent to longitudinal VFs from patients with glaucoma. Translational Relevance Simulated VF sequences with controlled progression rates can support the evaluation and optimization of methods to detect VF progression and can provide guidance for the interpretation of longitudinal VFs.
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Affiliation(s)
- Yan Li
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Moshe Eizenman
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Runjie B. Shi
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Yvonne M. Buys
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Graham E. Trope
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Willy Wong
- The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Asaoka R, Murata H, Fujino Y, Aoki S, Hirasawa K, Shoji N. Comparing the structure-function relationship between the visual fields measured with variational Bayes linear regression and SITA standard. PLoS One 2023; 18:e0282638. [PMID: 36877701 PMCID: PMC9987807 DOI: 10.1371/journal.pone.0282638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
PURPOSE We recently constructed an algorithm to measure visual field (VF) using the variational Bayes linear regression (VBLR). This algorithm enabled a faster VF measurement than the Swedish interactive thresholding algorithm (SITA) standard while maintaining the test-retest reproducibility (Murata H, et al. Br J Ophthalmol 2021). The current study aimed to compare the structure-function relationship between the SITA standard and VBLR. METHOD In 78 eyes of 56 patients with primary open-angle glaucoma, VF measurements were conducted using both SITA standard and VBLR VF, as well as spectral-domain optical coherence tomography. The structure-function relationship was investigated between visual sensitivity and circumpapillary retinal nerve fiber layer in the whole VF. This analysis was repeated for each of the 12 sectors (30 degrees). The strength of the structure-function relationship was evaluated using the second-order bias-corrected Akaike Information Criterion (AICc) index. RESULT In the whole VF, AICc values of SITA standard and VBLR were 601.6 and 597.3, respectively. The relative likelihood that VBLR had a better structure-function relationship than the SITA standard was 88.2% (when the entire field was averaged) or 99.9% (when all test points were analyzed in the pointwise manner). With the sector-wise analysis, SITA standard had a better structure-function relationship than VBLR in 1 sector (Superior sector in the retina), whereas VBLR had a better structure-function relationship than SITA standard in 4 sectors (Supero-Nasal, Infero-Nasal, Inferior, and Infero-Temporal sectors) with >95% relative likelihood. CONCLUSION Although it depends on locations and similar between SITA standard and VBLR-VF, but VBLR-VF had a better structure-function relationship than the SITA standard overall.
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Affiliation(s)
- Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Seirei Christopher University, Hamamatsu, Shizuoka, Japan
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Shizuoka Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, National Center for Global health and Medicine, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Seirei Christopher University, Hamamatsu, Shizuoka, Japan
- Department of Ophthalmology, Shimane University, Matsue, Shimane, Japan
| | - Shuichiro Aoki
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Ye J, Zhu H, Yan W, Tu Y, Hu X, Wu W. Retinal peripapillary microvasculature in indirect traumatic optic neuropathy predicted prognosis of endoscopic trans-ethmosphenoid optic canal decompression. Acta Ophthalmol 2023; 101:e226-e235. [PMID: 36053015 DOI: 10.1111/aos.15243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022]
Abstract
PURPOSES The purpose of this study is to quantify the alteration of retinal peripapillary microvasculature and structure in unilateral indirect traumatic optic neuropathy (ITON) and figure out predicted factors of visual improvement for ITON patients with endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) after one month. METHODS Twenty healthy controls and 72 unilateral ITON patients were included. Optical coherence tomography angiography was used to analyse radial peripapillary capillary (RPC) density, peripapillary retinal nerve fibre layer (pRNFL) thickness, superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP) density. Associations between preoperative parameters and postoperative best-corrected visual acuity (BCVA) were determined. The receiver operating characteristic (ROC) curves were used to figure out predicted factors of visual improvement for ITON after ETOCD one month. RESULTS In ITON eyes, the preoperative global RPC density, pRNFL thickness and SRCP density were reduced compared with unaffected eyes (p ≤ 0.001). Multivariate linear regression showed that preoperative global RPC density (Standardized β = -0.273), SRCP density (Standardized β = -0.183), DRCP density (Standardized β = -0.098) and preoperative BCVA (Standardized β = 0.795) were associated with the postoperative BCVA (All p < 0.001). The area under the curve (AUC) of preoperative global RPC density to predict visual improvement after ETOCD was 0.816, while the AUCs of preoperative BCVA, global pRNFL thickness, SRCP and DRCP density were 0.575, 0.756, 0.516 and 0.615, respectively. CONCLUSIONS The alteration of peripapillary area, especially the reduced RPC density, occurred in ITON eyes. The preoperative RPC density was associated with postoperative BCVA and was shown to be highly predictive for visual improvement after ETOCD one month.
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Affiliation(s)
- Jie Ye
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hui Zhu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wentao Yan
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yunhai Tu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiaozhou Hu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wencan Wu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Hosni Mahmoud HA, Alabdulkreem E. Bidirectional Neural Network Model for Glaucoma Progression Prediction. J Pers Med 2023; 13:390. [PMID: 36983572 PMCID: PMC10052760 DOI: 10.3390/jpm13030390] [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] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/30/2023] Open
Abstract
Deep learning models are usually utilized to learn from spatial data, only a few studies are proposed to predict glaucoma time progression utilizing deep learning models. In this article, we present a bidirectional recurrent deep learning model (Bi-RM) to detect prospective progressive visual field diagnoses. A dataset of 5413 different eyes from 3321 samples is utilized as the learning phase dataset and 1272 eyes are used for testing. Five consecutive diagnoses are recorded from the dataset as input and the sixth progressive visual field diagnosis is matched with the prediction of the Bi-RM. The precision metrics of the Bi-RM are validated in association with the linear regression algorithm (LR) and term memory (TM) technique. The total prediction error of the Bi-RM is significantly less than those of LR and TM. In the class prediction, Bi-RM depicts the least prediction error in all three methods in most of the testing cases. In addition, Bi-RM is not impacted by the reliability keys and the glaucoma degree.
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Affiliation(s)
- Hanan A. Hosni Mahmoud
- Department of Computer Sciences, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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Zhou W, Sabel BA. Vascular dysregulation in glaucoma: retinal vasoconstriction and normal neurovascular coupling in altitudinal visual field defects. EPMA J 2023; 14:87-99. [PMID: 36866155 PMCID: PMC9971397 DOI: 10.1007/s13167-023-00316-6] [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: 10/25/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
Purpose Vision loss in glaucoma is not only associated with elevated intraocular pressure and neurodegeneration, but vascular dysregulation (VD) is a major factor. To optimize therapy, an improved understanding of concepts of predictive, preventive, and personalized medicine (3PM) is needed which is based on a more detailed understanding of VD pathology. Specifically, to learn if the root cause of glaucomatous vision loss is of neuronal (degeneration) or vascular origin, we now studied neurovascular coupling (NVC) and vessel morphology and their relationship to vision loss in glaucoma. Methods In patients with primary open angle glaucoma (POAG) (n = 30) and healthy controls (n = 22), NVC was studied using dynamic vessel analyzer to quantify retinal vessel diameter before, during, and after flicker light stimulation to evaluate the dilation response following neuronal activation. Vessel features and dilation were then related to branch level and visual field impairment. Results Retinal arterial and venous vessels had significantly smaller diameters in patients with POAG in comparison to controls. However, both arterial and venous dilation reached normal values during neuronal activation despite their smaller diameters. This was largely independent of visual field depth and varied among patients. Conclusions Because dilation/constriction is normal, VD in POAG can be explained by chronic vasoconstriction which limits energy supply to retinal (and brain) neurons with subsequent hypo-metabolism ("silent" neurons) or neuronal cell death. We propose that the root cause of POAG is primarily of vascular and not neuronal origin. This understanding can help to better personalize POAG therapy of not only targeting eye pressure but also vasoconstriction to prevent low vision, slowing its progression and supporting recovery and restoration. Trial registration ClinicalTrials.gov, # NCT04037384 on July 3, 2019.
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Affiliation(s)
- Wanshu Zhou
- grid.5807.a0000 0001 1018 4307Institute of Medical Psychology, Medical Faculty, Otto-Von-Guericke University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Bernhard A. Sabel
- grid.5807.a0000 0001 1018 4307Institute of Medical Psychology, Medical Faculty, Otto-Von-Guericke University of Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
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Montesano G, Ometto G, King A, Garway-Heath DF, Crabb DP. Two-Year Visual Field Outcomes of the Treatment of Advanced Glaucoma Study (TAGS). Am J Ophthalmol 2023; 246:42-50. [PMID: 36228777 DOI: 10.1016/j.ajo.2022.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE to compare visual field (VF) progression between the 2 arms of the Treatment of Advanced Glaucoma Study (TAGS). DESIGN Post hoc analysis of VF data from a 2-arm, multicenter, randomized controlled clinical trial. METHODS A total of 453 patients with newly diagnosed advanced open-angle glaucoma in at least 1 eye from 27 centers in the United Kingdom were randomized to either trabeculectomy (n = 227) or medication in their index eye (n = 226) and followed-up for 2 years with 2 24-2 VF tests at baseline, 4, 12, and 24 months. Data were analyzed for participants with a reliable VF (false positive rate < 15%) at baseline and at least 2 other time points. Average difference in rate of progression (RoP) was analyzed using a hierarchical Bayesian model. Time for each eye to progress from baseline beyond specific cut-offs (0.5, 1, 1.5, and 2 dB) was compared using survival analysis. RESULTS This study analyzed 211 eyes in the trabeculectomy first arm and 203 eyes in the medication first arm. The average RoP (estimate [95% credible intervals]) was -0.59 [-0.88, -0.31] dB/year in the medication first arm and -0.40 [-0.67, -0.13] dB/year in the trabeculectomy first arm. The difference was not significant (Bayesian P-value = .353). More eyes progressed in the medication first arm, but this difference was not significant. CONCLUSIONS There was no significant difference in the average RoP at 2 years.
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Affiliation(s)
- Giovanni Montesano
- From City, University of London, Optometry and Visual Sciences, London, UK (G.M., G.O., D.P.C.); NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK (G.M., D.F.G-H.)
| | - Giovanni Ometto
- From City, University of London, Optometry and Visual Sciences, London, UK (G.M., G.O., D.P.C.)
| | - Anthony King
- Department of Ophthalmology, Nottingham University Hospital, Nottingham, UK (A.K.)
| | - David F Garway-Heath
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK (G.M., D.F.G-H.)
| | - David P Crabb
- From City, University of London, Optometry and Visual Sciences, London, UK (G.M., G.O., D.P.C.).
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Pugazhendhi S, Yu M, Zhou G, Chen Y, Wang R, Liao YJ. Peripapillary and macular microvasculature features of non-arteritic anterior ischemic optic neuropathy. Front Med (Lausanne) 2023; 9:1033838. [PMID: 36714135 PMCID: PMC9877420 DOI: 10.3389/fmed.2022.1033838] [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: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose The hallmark of non-arteritic anterior ischemic optic neuropathy (NAION) is vascular compromise to the anterior optic nerve and thinning of the retinal nerve fiber layer (RNFL) and secondary degeneration of the retinal ganglion cell body or thinning of the ganglion cell complex (GCC). This study investigates optical coherence tomography (OCT) and OCT Angiography (OCTA) changes in chronic NAION and identifies imaging biomarkers that best predict disease. Methods We performed a retrospective case-control study of 24 chronic NAION eyes (18 patients) and 70 control eyes (45 patients) to compare both whole-eye and regional OCT, OCTA, static perimetry measurements. OCT measurements were quantified automatically using commercial software, and OCTA was analyzed using custom MATLAB script with large vessel removal to measure 154 total parameters per eye. Results We confirmed that static perimetry mean deviation (MD) was significantly worse in chronic NAION (-13.53 ± 2.36) than control (-0.47 ± 0.72; P < 0.001) eyes, and NAION eyes had 31 μm thinner RNFL (control: 95.9 ± 25.8 μm; NAION: 64.5 ± 18.0, P < 0.001), and 21.8 μm thinner GCC compared with controls (control: 81.5 ± 4.4 μm; NAION: 59.7 ± 10.5, P < 0.001). Spearman correlation analysis of OCTA parameters reveal that vessel area density (VAD) and flux are highly correlated with visual field MD and OCT measurements. Hierarchical clustering two distinct groups (NAION and control), where standardized measurements of NAION eyes were generally lower than controls. Two-way mixed ANOVAs showed significant interaction between patient status (control and chronic NAION) and structure (optic disk and macula) for annulus VAD and flux values and mean RNFL and GCC thickness. Post-hoc tests showed this effect stems from lower peripapillary values in NAION compared to controls. Separate logistic regression models with LASSO regularization identified VAD and flux are one of the best OCTA parameters for predicting NAION. Conclusion Ischemic insult to the optic disk is more severe likely from primary degeneration of the affected peripapillary region while macula is affected by secondary retrograde degeneration and loss of retinal ganglion cells. In addition to OCT measurements, peripapillary and macular vascular parameters such as VAD and flux are good predictors of optic nerve and retinal changes in NAION.
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Affiliation(s)
| | - Miaomiao Yu
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Gabriella Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Yuxuan Chen
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Ruikang Wang
- Department of Bioengineering, University of Washington, Seattle, WA, United States,Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Yaping Joyce Liao
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, United States,Department of Neurology, School of Medicine, Stanford University, Stanford, CA, United States,*Correspondence: Yaping Joyce Liao,
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Soares RM, Braga JF, da Silva Fernandes J, Ferreira CC, Ribeiro L, Alves H, Meira D. Automated macular segmentation can distinguish glaucomatous from compressive optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:1701-1712. [PMID: 36625929 DOI: 10.1007/s00417-022-05962-6] [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: 09/06/2022] [Revised: 11/30/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To compare macular damage in glaucomatous optic neuropathy (GON) and compressive optic neuropathy (CON) and assess its diagnostic accuracy in distinguishing between diseases. METHODS Observational, cross-sectional, single-center study. Patients with GON, CON, and healthy controls were included according to the eligibility criteria. An automated spectral-domain optical coherence tomography (SD-OCT) algorithm was used to segment the circumpapilary retinal nerve fiber layer (cpRNFL) and macula. The layer thickness was measured in each sector according to the Early Treatment Diabetic Retinopathy Study and the 6-sector Garway-Heath-based grids. Data was compared across all study groups, and the significance level was set at 0.05. RESULTS Seventy-five eyes of 75 participants, 25 with GON, 25 with CON, and 25 healthy controls (CG), were included. Macular thickness was diminished in the ganglion cell complex of GON and CON patients compared to CG (p<0.05). The best Garway-Heath-based grid parameters for distinguishing GON and CON were the nasal-inferior (NI) and nasal-superior sectors and the NI/temporal inferior (TI) damage ratios in the macular ganglion cell (mGCL) and inner plexiform (IPL) layers. Moreover, the combination of the NI sector and NI/TI damage ratios in both layers had higher discriminative power (AUC 0.909; 95% CI 0.830-0.988; p<0.001) than combining parameters in each layer separately. CONCLUSION Our findings suggest that the evaluation of macular segmented layers damage by SD-OCT may be a helpful add-on tool in the differential diagnosis between GON and CON.
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Affiliation(s)
- Ricardo Machado Soares
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal.
| | - Joana Figueiredo Braga
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Joana da Silva Fernandes
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Catarina Cunha Ferreira
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Lígia Ribeiro
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Hélio Alves
- Department of Biomedicine - Faculty of Medicine of University of Porto, Porto, Portugal
| | - Dália Meira
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
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Cánovas-Serrano Y, Vallés-San-Leandro L, Rodríguez-Izquierdo MÁ, López-Serrano R, Lajara-Blesa J. On the protective role of the blood vessels in glaucomatous damage: A transversal study. JOURNAL OF OPTOMETRY 2023; 16:81-87. [PMID: 34933830 PMCID: PMC9811363 DOI: 10.1016/j.optom.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/23/2021] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To corroborate whether vessels on the surface of the optic nerve head can provide protection against the loss of underlying axons in subjects with manifest glaucoma. METHODS In this pilot study, thirty-six glaucomatous eyes with a perimetric defect in the Bjerrum area were included. The retinal nerve fiber layer (RNFL) thickness was measured in each of the sectors of the clock-hour map obtained by Cirrus HD-OCT considering the presence or absence of blood vessels. These sectors were related with their corresponding areas of the retina examined in the visual field using a mathematical model of the retina introduced by Jansonius, in order to determine the values of threshold sensitivity in those areas in the presence or absence of vessels. RESULTS We corroborated the protective role of the blood vessel for peripapillary RNFL thickness of clock-hour 12 despite obtaining a p-value (p = 0.023; w = 228.5) close to the acceptance zone (p ≥ 0.05). The mean ± standard deviation with vessel and without vessel were 70.95 ± 24.35 and 88.46 ± 23.96, respectively. No differences were found between the mean values of threshold sensitivity to the presence or absence of blood vessels in each of the sectors considered. CONCLUSIONS Our findings do not allow us to affirm that there is an association between the presence of a vessel and protection against glaucomatous damage in subjects with an advanced manifestation of the disease. In the future, more extensive studies are needed to study this relationship in subjects with early glaucoma.
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Affiliation(s)
- Yaiza Cánovas-Serrano
- Health Sciences PhD program, Catholic University of Murcia (UCAM), Campus de los Jerónimos n°135, Guadalupe 30107, Murcia, Spain.
| | | | | | | | - Jerónimo Lajara-Blesa
- Clinical Research Department, Vista Ircovisión, Murcia, Spain; Faculty of Health Sciences, Catholic University of Murcia (UCAM), Spain
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Chuangsuwanich T, Tun TA, Braeu FA, Wang X, Chin ZY, Panda SK, Buist M, Strouthidis N, Perera S, Nongpiur M, Aung T, Girard MJA. Differing Associations between Optic Nerve Head Strains and Visual Field Loss in Patients with Normal- and High-Tension Glaucoma. Ophthalmology 2023; 130:99-110. [PMID: 35964710 DOI: 10.1016/j.ophtha.2022.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To study the associations between optic nerve head (ONH) strains under intraocular pressure (IOP) elevation with retinal sensitivity in patients with glaucoma. DESIGN Clinic-based cross-sectional study. PARTICIPANTS Two hundred twenty-nine patients with primary open-angle glaucoma (subdivided into 115 patients with high-tension glaucoma [HTG] and 114 patients with normal-tension glaucoma [NTG]). METHODS For 1 eye of each patient, we imaged the ONH using spectral-domain OCT under the following conditions: (1) primary gaze and (2) primary gaze with acute IOP elevation (to approximately 35 mmHg) achieved through ophthalmodynamometry. A 3-dimensional strain-mapping algorithm was applied to quantify IOP-induced ONH tissue strain (i.e., deformation) in each ONH. Strains in the prelaminar tissue (PLT), the retina, the choroid, the sclera, and the lamina cribrosa (LC) were associated (using linear regression) with measures of retinal sensitivity from the 24-2 Humphrey visual field test (Carl Zeiss Meditec). This was performed globally, then locally according to a previously published regionalization scheme. MAIN OUTCOME MEASURES Associations between ONH strains and values of retinal sensitivity from visual field testing. RESULTS For patients with HTG, we found (1) significant negative linear associations between ONH strains and retinal sensitivity (P < 0.001; on average, a 1% increase in ONH strains corresponded to a decrease in retinal sensitivity of 1.1 decibels [dB]), (2) that high-strain regions colocalized with anatomically mapped regions of high visual field loss, and (3) that the strongest negative associations were observed in the superior region and in the PLT. In contrast, for patients with NTG, no significant associations between strains and retinal sensitivity were observed except in the superotemporal region of the LC. CONCLUSIONS We found significant negative associations between IOP-induced ONH strains and retinal sensitivity in a relatively large glaucoma cohort. Specifically, patients with HTG who experienced higher ONH strains were more likely to exhibit lower retinal sensitivities. Interestingly, this trend in general was less pronounced in patients with NTG, which could suggest a distinct pathophysiologic relationship between the two glaucoma subtypes.
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Affiliation(s)
- Thanadet Chuangsuwanich
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Republic of Singapore.
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Fabian A Braeu
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Xiaofei Wang
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Zhi Yun Chin
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Republic of Singapore
| | - Satish Kumar Panda
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore, Republic of Singapore
| | - Martin Buist
- Department of Biomedical Engineering, National University of Singapore, Singapore, Republic of Singapore
| | - Nicholas Strouthidis
- National Institute of Health Research, Biomedical Sciences Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Monisha Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory, Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore; Institute for Molecular and Clinical Ophthalmology, Basel, Switzerland.
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Erichev VP, Antonov AA, Vitkov AA, Grigoryan LA. [Static automated perimetry in the diagnosis of glaucoma. Assessment of disease progression]. Vestn Oftalmol 2023; 139:96-104. [PMID: 37942603 DOI: 10.17116/oftalma202313905196] [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] [Indexed: 11/10/2023]
Abstract
There are several ways to assess glaucoma progression using standard automated perimetry. Most often, ophthalmologists evaluate the stability of visual functions manually when comparing several study protocols. The advantages of clinical assessment are ease of implementation and the ability to interpret data from any device. The main disadvantage of this method is its subjectivity. There are many available automated methods for assessing disease progression involving Humphrey Field Analyzer and Octopus perimeters. Event analysis allows determining glaucoma progression at the time of examination, with consideration of the possible physiological fluctuations in light sensitivity. Trend analysis of perimetric indices makes it possible to assess the rate of glaucoma progression and forecast the trend of changes in visual functions over the next five years. All these methods for assessing progression have certain advantages and disadvantages and cannot be considered ideal. Pointwise and cluster trend analysis are more sensitive in early glaucoma and are being actively researched and developed. These methods have great potential, although they are not yet sufficiently available in clinical practice.
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Affiliation(s)
- V P Erichev
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A A Antonov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A A Vitkov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - L A Grigoryan
- MedTech Innovation - Skolkovo Research Center, Moscow, Russia
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Vasculature-function relationship in open-angle glaucomatous eyes with a choroidal microvasculature dropout. Sci Rep 2022; 12:19507. [PMID: 36376372 PMCID: PMC9663513 DOI: 10.1038/s41598-022-23109-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Identifying biomarkers associated with functional impairment is important in monitoring glaucoma patients. This retrospective cross-sectional study investigated the vasculature-function relationship in open-angle glaucoma (OAG) eyes with choroidal microvasculature dropout (CMvD) versus in OAG eyes without. Optical coherence tomography (OCT) angiography-derived circumpapillary (cpVD) and macular vessel densities (mVD) were measured in 159 early-stage OAG eyes (mean deviation > -6 dB) in accordance with the presence or not of a CMvD. OCT-derived circumpapillary retinal nerve fibre layer thickness (cpRNFLT) and macular ganglion cell-inner plexiform layer thicknesses (mGCIPLT) were also measured as reference standards. The vasculature (cpVD and mVD)-function [24-2 visual field mean sensitivity (VFMS) and central 10° VFMS (cVFMS)] and structure (cpRNFLT and mGCIPLT)-function (24-2 VFMS and cVFMS) relationships were compared using global and sectoral maps between OAG eyes with (CMvD+) and without CMvD (CMvD-). The CMvD+ eyes showed significantly steeper cpVD-24-2 VFMS and mVD-cVFMS correlations (P < 0.05). In contrast, there were no significant differences in the cpRNFLT-24-2 VFMS and mGCIPLT-cVFMS relationships between the two groups (P > 0.05). In conclusion, OAG eyes with a CMvD have significantly stronger vasculature-function relationships than eyes without. Vessel density parameters may be useful biomarkers of disease progression in early-stage OAG patients with a CMvD.
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Solli E, Doshi H, Elze T, Pasquale LR, Branco J, Wall M, Kupersmith M. Archetypal analysis of visual fields in optic neuritis reveals functional biomarkers associated with outcome and treatment response. Mult Scler Relat Disord 2022; 67:104074. [PMID: 35940021 DOI: 10.1016/j.msard.2022.104074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/21/2022] [Accepted: 07/24/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Archetypal analysis (AA), a form of unsupervised machine learning, can identify quantifiable visual field (VF) patterns seen in optic neuritis (ON), known as archetypes (ATs). We hypothesized that AT weight changes over time would reflect the course of recovery and the effects of therapy in ON. We explored whether baseline AT weights would be associated with VF status at the clinical trial outcome and if ATs would indicate residual VF defects in eyes with mean deviation (MD) ≥ -2.00 at six months. METHODS We used a published 16-AT model derived from 3892 Optic Neuritis Treatment Trial VFs (456 eyes) for all analyses. We measured AT weight changes over the six-month study period and used asymptotic regression to analyze the rate of change. We compared AT weights at six months between treatment groups. We evaluated associations between baseline AT weight thresholds and VF outcome or treatment effect. We calculated residual AT weights in eyes with MD ≥ -2.00 dB at six months. RESULTS Over six months, AT1 (a normal VF pattern) demonstrated the greatest median weight change, increasing from 0.00% (IQR 0.00-0.00%) at baseline to 60.0% (IQR 38.3-70.8%) at six months (p < 0.001). At outcome, the intravenous methylprednisolone (IVMP) group had the highest median AT1 weight (IVMP: 63.3%, IQR 51.3-72.8%; placebo: 56.2%, IQR 35.1-71.6%; prednisone 58.3%, IQR 35.1-71.6%; p = 0.019). Eyes with AT1 weight ≥ 19% at baseline had superior median MD values (-0.91 vs. -2.07 dB, p < 0.001) and AT1 weights (70.8% vs. 57.8% p < 0.001) at six months. Only eyes with AT1 weight < 19% at baseline showed a treatment benefit for IVMP, with a higher six-month median AT1 weight compared to placebo (p = 0.015) and prednisone (p = 0.016), and a higher median MD compared to placebo (p = 0.027). At six months, 182 (80.2%) VFs with MD ≥ -2.00 had at least one abnormal AT. DISCUSSION Changes in quantifiable, archetypal patterns of VF loss reflect recovery in ON. Machine learning analysis of the VFs in optic neuritis reveals associations with response to therapy and VF outcome, and uncovers residual deficits, not readily seen with standard evaluations.
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Affiliation(s)
- Elena Solli
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 17E 102 St 8th Floor, New York, NY 10029, United States
| | - Hiten Doshi
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tobias Elze
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joseph Branco
- New York Medical College, Valhalla, NY, United States
| | - Michael Wall
- Departments of Neurology and Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States
| | - Mark Kupersmith
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 17E 102 St 8th Floor, New York, NY 10029, United States; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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