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Yang H, Rees JP, Sanchez FG, Gardiner SK, Mansberger SL. OCT Segmentation Errors with Bruch's Membrane Opening-Minimum Rim Width as Compared with Retinal Nerve Fiber Layer Thickness. Ophthalmol Glaucoma 2024; 7:308-315. [PMID: 38104770 DOI: 10.1016/j.ogla.2023.12.002] [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: 08/04/2023] [Revised: 11/15/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To compare the magnitude and location of automated segmentation errors of the Bruch's membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT). DESIGN Cross-sectional study. PARTICIPANTS We included 162 glaucoma suspect or open-angle glaucoma eyes from 162 participants. METHODS We used spectral-domain optic coherence tomography (Spectralis 870 nm, Heidelberg Engineering) to image the optic nerve with 24 radial optic nerve head B-scans and a 12-degree peripapillary circle scan, and exported the native "automated segmentation only" results for BMO-MRW and RNFLT. We also exported the results after "manual refinement" of the measurements. MAIN OUTCOME MEASURES We calculated the absolute and proportional error globally and within the 12 30-degree sectors of the optic disc. We determined whether the glaucoma classifications were different between BMO-MRW and RNFLT as a result of manual and automatic segmentation. RESULTS The absolute error mean was larger for BMO-MRW than for RNFLT (10.8 μm vs. 3.58 μm, P < 0.001). However, the proportional errors were similar (4.3% vs. 4.4%, P = 0.47). In a multivariable regression model, errors in BMO-MRW were not significantly associated with age, location, magnitude, or severity of glaucoma loss (all P ≥ 0.05). However, larger RNFLT errors were associated with the superior and inferior sector location, thicker nerve fiber layer, and worse visual field (all P < 0.05). Errors in BMO-MRW and RNFLT were not likely to occur in the same sector location (R2 = 0.001; P = 0.15). With manual refinement, the glaucoma classification changed in 7.8% and 6.2% of eyes with BMO-MRW and RNFLT, respectively. CONCLUSIONS Both BMO-MRW and RNFLT measurements included segmentation errors, which did not seem to have a common location, and may result in differences in glaucoma classification. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Hongli Yang
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon
| | - Jack P Rees
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon
| | - Facundo G Sanchez
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon
| | - Stuart K Gardiner
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon
| | - Steven L Mansberger
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon.
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Hong S, Yang H, Gardiner SK, Luo H, Sharpe GP, Caprioli J, Demirel S, Girkin CA, Mardin CY, Quigley HA, Scheuerle AF, Fortune B, Jiravarnsirikul A, Zangalli C, Chauhan BC, Burgoyne CF. Optical Coherence Tomographic Optic Nerve Head Morphology in Myopia III: The Exposed Neural Canal Region in Healthy Eyes-Implications for High Myopia. Am J Ophthalmol 2024; 258:55-75. [PMID: 37673378 PMCID: PMC10841091 DOI: 10.1016/j.ajo.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE To determine the prevalence and magnitude of optical coherence tomography (OCT) exposed neural canal (ENC), externally oblique choroidal border tissue (EOCBT), and exposed scleral flange (ESF) regions in 362 non-highly myopic (spherical equivalent -6.00 to 5.75 diopters) eyes of 362 healthy subjects. DESIGN Cross-sectional study. METHODS After OCT optic nerve head (ONH) imaging, Bruch membrane opening (BMO), the anterior scleral canal opening (ASCO), and the scleral flange opening (SFO) were manually segmented. BMO, ASCO, and SFO points were projected to the BMO reference plane. The direction and magnitude of BMO/ASCO offset as well as the magnitude of ENC, EOCBT, and ESF was calculated within 30° sectors relative to the foveal-BMO axis. Hi-ESF eyes demonstrated an ESF ≥100 µm in at least 1 sector. Sectoral peri-neural canal choroidal thickness (pNC-CT) was measured and correlations between the magnitude of sectoral ESF and proportional pNC-CT were assessed. RESULTS Seventy-three Hi-ESF (20.2%) and 289 non-Hi-ESF eyes (79.8%) were identified. BMO/ASCO offset as well as ENC, EOCBT, and ESF prevalence and magnitude were greatest inferior temporally where the pNC-CT was thinnest. Among Hi-ESF eyes, the magnitude of each ENC region correlated with the BMO/ASCO offset magnitude, and the sectors with the longest ESF correlated with the sectors with proportionally thinnest pNC-CT. CONCLUSIONS ONH BMO/ASCO offset, either as a cause or result of ONH neural canal remodeling, corresponds with the sectoral location of maximum ESF and minimum pNC-CT in non-highly myopic eyes. Longitudinal studies to characterize the development and clinical implications of ENC Hi-ESF regions in non-highly myopic and highly myopic eyes are indicated.
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Affiliation(s)
- Seungwoo Hong
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Yebon Eye Clinic (S.H.), Seoul, Korea
| | - Hongli Yang
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Haomin Luo
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Department of Ophthalmology, Hunan Provincial People's Hospital, Hunan Normal University (H.L.), Changsha, Hunan Province, China
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University (G.P.S., B.C.C.), Halifax, Nova Scotia, Canada
| | - Joseph Caprioli
- Jules Stein Eye Institute, David Geffen School of Medicine at UCLA (J.C.), Los Angeles, California, USA
| | - Shaban Demirel
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham (C.A.G.), Birmingham, Alabama, USA
| | - Christian Y Mardin
- Department of Ophthalmology, University of Erlangen (C.Y.M.), Erlangen, Germany
| | - Harry A Quigley
- Wilmer Eye Institute, Johns Hopkins University (H.A.Q.), Baltimore, Maryland, USA
| | | | - Brad Fortune
- Devers Eye Institute, Discoveries in Sight Research Laboratories, Legacy Research Institute (S.K.G., S.D., B.F.), Portland, Oregon, USA
| | - Anuwat Jiravarnsirikul
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA; Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University (A.J.), Bangkok, Thailand
| | - Camila Zangalli
- Department of Glaucoma, Hospital de Olhos Niteroi (C.Z.), Rio de Janeiro, Brazil
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University (G.P.S., B.C.C.), Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- From the Devers Eye Institute, Optic Nerve Head Research Laboratory, Legacy Research Institute (S.H., H.Y., H.L., A.J., C.F.B.), Portland, Oregon, USA.
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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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Czerpak CA, Ling YTT, Jefferys JL, Quigley HA, Nguyen TD. The Curvature, Collagen Network Structure, and Their Relationship to the Pressure-Induced Strain Response of the Human Lamina Cribrosa in Normal and Glaucoma Eyes. J Biomech Eng 2023; 145:101005. [PMID: 37382629 PMCID: PMC10405282 DOI: 10.1115/1.4062846] [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: 03/07/2022] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
The lamina cribrosa (LC) is a connective tissue in the optic nerve head (ONH). The objective of this study was to measure the curvature and collagen microstructure of the human LC, compare the effects of glaucoma and glaucoma optic nerve damage, and investigate the relationship between the structure and pressure-induced strain response of the LC in glaucoma eyes. Previously, the posterior scleral cups of 10 normal eyes and 16 diagnosed glaucoma eyes were subjected to inflation testing with second harmonic generation (SHG) imaging of the LC and digital volume correlation (DVC) to calculate the strain field. In this study, we applied a custom microstructural analysis algorithm to the maximum intensity projection of SHG images to measure features of the LC beam and pore network. We also estimated the LC curvatures from the anterior surface of the DVC-correlated LC volume. Results showed that the LC in glaucoma eyes had larger curvatures p≤0.03), a smaller average pore area (p = 0.001), greater beam tortuosity (p < 0.0001), and more isotropic beam structure (p = 0.01) than in normal eyes. The difference measured between glaucoma and normal eyes may indicate remodeling of the LC with glaucoma or baseline differences that contribute to the development of glaucomatous axonal damage.
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Affiliation(s)
- Cameron A Czerpak
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, MD 21218
| | - Yik Tung Tracy Ling
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, MD 21218
| | - Joan L Jefferys
- Wilmer Ophthalmological Institute, School of Medicine, The Johns Hopkins University, Baltimore, MD 21287
| | - Harry A Quigley
- Wilmer Ophthalmological Institute, School of Medicine, The Johns Hopkins University, Baltimore, MD 21287
| | - Thao D Nguyen
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, MD 21218; Wilmer Ophthalmological Institute, School of Medicine, The Johns Hopkins University, Baltimore, MD 21287
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Lam AKC, Lai HC, Sung YK, Lam WH, Tiu CM. Performance of neuroretinal rim thickness measurement by Cirrus high-definition optical coherence tomography in myopic eyes. Sci Rep 2023; 13:12714. [PMID: 37543611 PMCID: PMC10404224 DOI: 10.1038/s41598-023-39701-6] [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: 01/06/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023] Open
Abstract
Neuroretinal rim (NRR) measurement can aid the diagnosis of glaucoma. A few studies reported that Cirrus optical coherence tomography (OCT) had NRR segmentation errors. The current study investigated segmentation success of NRR in myopic eyes using the Cirrus built-in software and to determine the number of acquisitions required to identify NRR thinning. Right eye of 87 healthy adult myopes had an optic disc scanned using Cirrus HD-OCT for five successive acquisitions. A masked examiner evaluated 36 radial line images of each scan to screen for segmentation errors using the built-in software at the Bruch's membrane opening (BMO) and/or internal limiting membrane (ILM). Participants with three accurate NRR acquisitions had their average NRR thickness determined. This result was compared with average of the two acquisitions and the first acquisition. Among 435 OCT scans of the optic disc (87 eyes × 5 acquisitions), 129 (29.7%) scans had segmentation errors that occurred mainly at the ILM. The inferior-temporal and superior meridians had slightly more segmentation errors than other meridians, independent of axial length, amount of myopia, or presence of peripapillary atrophy. Sixty-five eyes (74.7%) had at least three accurate NRR measurements. The three acquisitions had high reliability in NRR thickness in the four quadrants (intraclass correlation coefficient > 0.990, coefficient of variation < 3.9%). NRR difference between the first acquisition and the average of three acquisitions was small (mean difference 2 ± 13 μm, 95% limits of agreement within ± 30 μm) among the four quadrants. Segmentation errors in NRR measurements appeared regardless of axial length, amount of myopia, or presence of peripapillary atrophy. Cirrus segmentation lines should be manually inspected when measuring NRR thickness.
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Affiliation(s)
- Andrew K C Lam
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
- School of Optometry, Centre for Myopia Research, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Shatin, Hong Kong SAR, China.
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
| | - H C Lai
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Y K Sung
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - W H Lam
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - C M Tiu
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Burgoyne CF, Wang YX, Jeoung JW, Hong S, Gardiner S, Reynaud J, Fortune B, Girard MJA, Sharpe G, Nicolela M, Chauhan BC, Yang H. OCT Optic Nerve Head Morphology in Myopia II: Peri-Neural Canal Scleral Bowing and Choroidal Thickness in High Myopia-An American Ophthalmological Society Thesis. Am J Ophthalmol 2023; 252:225-252. [PMID: 36906092 PMCID: PMC10492898 DOI: 10.1016/j.ajo.2023.03.002] [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] [Received: 12/31/2022] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE To use optical coherence tomography (OCT) to characterize optic nerve head (ONH) peri-neural canal (pNC) scleral bowing (pNC-SB) and pNC choroidal thickness (pNC-CT) in 69 highly myopic and 138 healthy, age-matched, control eyes. DESIGN Cross-sectional, case control study. METHODS Within ONH radial B-scans, Bruch membrane (BM), BM opening (BMO), anterior scleral canal opening (ASCO), and pNC scleral surface were segmented. BMO and ASCO planes and centroids were determined. pNC-SB was characterized within 30° foveal-BMO (FoBMO) sectors by 2 parameters: pNC-SB-scleral slope (pNC-SB-SS), measured within 3 pNC segments (0-300, 300-700, and 700-1000 μm from the ASCO centroid); and pNC-SB-ASCO depth relative to a pNC scleral reference plane (pNC-SB-ASCOD). pNC-CT was calculated as the minimum distance between the scleral surface and BM at 3 pNC locations (300, 700, and 1100 μm from the ASCO). RESULTS pNC-SB increased and pNC-CT decreased with axial length (P < .0133; P < .0001) and age (P < .0211; P < .0004) among all study eyes. pNC-SB was increased (P < .001) and pNC-CT was decreased (P < .0279) in the highly myopic compared to control eyes, and these differences were greatest in the inferior quadrant sectors (P < .0002). Sectoral pNC-SB was not related to sectoral pNC-CT in control eyes, but was inversely related to sectoral pNC-CT (P < .0001) in the highly myopic eyes. CONCLUSIONS Our data suggest that pNC-SB is increased and pNC-CT is decreased in highly myopic eyes and that these phenomena are greatest in the inferior sectors. They support the hypothesis that sectors of maximum pNC-SB may predict sectors of greatest susceptibility to aging and glaucoma in future longitudinal studies of highly myopic eyes. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Claude F Burgoyne
- From the Devers Eye Institute Optic Nerve Head Research Laboratory (C.F., J.R., H.Y.), Legacy Research Institute, Portland, Oregon, USA; Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA.
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology (Y.X.W.), Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing, China
| | - Jin Wook Jeoung
- Department of Ophthalmology (J.W.J.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Stuart Gardiner
- Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA
| | - Juan Reynaud
- Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA
| | - Brad Fortune
- Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA
| | - Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory (M.J.A.G.), Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Glen Sharpe
- Department of Ophthalmology and Visual Sciences (G.S., M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcelo Nicolela
- Department of Ophthalmology and Visual Sciences (G.S., M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Balwantray C Chauhan
- Department of Ophthalmology and Visual Sciences (G.S., M.N., B.C.C.), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hongli Yang
- Devers Eye Institute Discoveries in Sight Research Laboratories (C.F.B., S.G., J.R., B.F., H.Y.), Legacy Research Institute, Portland, Oregon, USA
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Kong JH, Park SP, Na KI. Differences in optic nerve head structure between acute angle-closure glaucoma and open-angle glaucoma. Sci Rep 2023; 13:7935. [PMID: 37193817 DOI: 10.1038/s41598-023-35020-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
This study aimed to compare the optic nerve head (ONH) structure in acute angle-closure glaucoma (AACG) and open-angle glaucoma (OAG) to investigate the differences in glaucomatous damage. The AACG and OAG eyes were matched with regard to global retinal nerve fiber layer thickness (RNFLT). AACG eyes were divided into two subgroups based on the presence of ONH swelling at the onset of AACG. RNFLT, Bruch's membrane opening-minimum rim width (BMO-MRW), and Bruch's membrane opening-minimum rim area (BMO-MRA) were analyzed. Global RNFLT values were similar in AACG and OAG groups, but lower than in the healthy group (P < 0.001). The global BMO-MRW and total BMO-MRA were significantly higher in AACG than in OAG group (P < 0.001, respectively). AACG showed similar global BMO-MRW and total BMO-MRA, irrespective of the presence or absence of ONH swelling, while AACG with ONH swelling was associated with significantly thinner global RNFLT compared to AACG without ONH swelling (P < 0.006). The result of differences in ONH structure between the OAG and AACG, especially the AACG with ONH swelling at the onset of AACG, suggests that the mechanisms of optic nerve damage in the two diseases are different.
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Affiliation(s)
- Jeong Han Kong
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea
| | - Kyeong Ik Na
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, South Korea.
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Jiang J, Ye C, Zhang C, Lin Z, Tang Y, Ye W, Xu X, Zhang S, Lu F, Liang Y. The Patterns of Visual Field Defects in Primary Angle-Closure Glaucoma Compared to High-Tension Glaucoma and Normal-Tension Glaucoma. Ophthalmic Res 2023; 66:940-948. [PMID: 37062276 DOI: 10.1159/000530175] [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: 05/01/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION The aim of this study was to compare the patterns of visual field (VF) defects in primary angle-closure glaucoma (PACG) to control groups of eyes with high-tension glaucoma (HTG) and normal-tension glaucoma (NTG). METHODS Forty-eight eyes with PACG were enrolled, and control eyes with HTG and NTG matched for age, sex, and mean deviation of VF defect were selected. VF tests were performed using the 24-2 program of the Humphrey field analyzer. VF defects were classified into six patterns with the Ocular Hypertension Treatment Study classification system and were categorized into three stages (early, moderate, and advanced). Each hemifield was divided into five regions according to the Glaucoma Hemifield Test (GHT). The mean total deviation (TD) of each GHT region was calculated. RESULTS Compared with HTG and NTG groups, the partial arcuate VF defects were more common in the PACG group. In the PACG group, the nasal GHT region in the inferior hemifield had the worst mean TD (-8.48 ± 8.62 dB), followed by the arcuate 1 (-7.81 ± 7.91 dB), arcuate 2 (-7.46 ± 7.43 dB), paracentral (-7.19 ± 7.98 dB), and central (-5.14 ± 6.24 dB) regions; the mean TD of the central region was significantly better than those for all other regions (all p < 0.05). A similar trend was observed in the superior hemifield in the PACG group but not the VF hemifields of the HTG and NTG groups. CONCLUSION Patterns of VF defect in PACG patients differ from those with HTG and NTG. This discrepancy might be due to the differences in the pathogenic mechanisms of glaucomatous optic neuropathy.
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Affiliation(s)
- Junhong Jiang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Cong Ye
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Cong Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Zhong Lin
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Yihua Tang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Wenqing Ye
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Xiang Xu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Shaodan Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
- Glaucoma Institute, Wenzhou Medical University, Wenzhou, China
| | - Fan Lu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Yuanbo Liang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Disease, Wenzhou, China
- Glaucoma Institute, Wenzhou Medical University, Wenzhou, China
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Ganglion Cell Complex Analysis: Correlations with Retinal Nerve Fiber Layer on Optical Coherence Tomography. Diagnostics (Basel) 2023; 13:diagnostics13020266. [PMID: 36673076 PMCID: PMC9858609 DOI: 10.3390/diagnostics13020266] [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: 11/13/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of this review is to analyze the correlations between the changes in the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL) on optical coherence tomography in different possible situations, especially in eyes with glaucoma. For glaucoma evaluation, several studies have suggested that in the early stages, GCC analysis, especially the thickness of the infero and that of the inferotemporal GCC layers, is a more sensitive examination than circumpapillary RNFL (pRNFL). In the moderate stages of glaucoma, inferior pRNFL thinning is better correlated with the disease than in advanced cases. Another strategy for glaucoma detection is to find any asymmetry of the ganglion cell-inner plexiform layers (GCIPL) between the two macular hemifields, because this finding is a valuable indicator for preperimetric glaucoma, better than the RNFL thickness or the absolute thickness parameters of GCIPL. In preperimetric and suspected glaucoma, GCC and pRNFL have better specificity and are superior to the visual field. In advanced stages, pRNFL and later, GCC reach the floor effect. Therefore, in this stage, it is more useful to evaluate the visual field for monitoring the progression of glaucoma. In conclusion, GCC and pRNFL are parameters that can be used for glaucoma diagnosis and monitoring of the progression of the disease, with each having a higher accuracy depending on the stage of the disease.
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Köse HC, Tekeli O. Comparison of microvascular parameters and diagnostic ability of optical coherence tomography angiography between eyes with primary angle closure glaucoma and primary open angle glaucoma. Photodiagnosis Photodyn Ther 2022; 40:103114. [PMID: 36096437 DOI: 10.1016/j.pdpdt.2022.103114] [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: 05/30/2022] [Revised: 08/21/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To investigate and compare the peripapillary and macular microvascular parameters between eyes with primary angle closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). METHODS Seventy-nine eyes of 43 patients with primary angle closure glaucoma (PACG), 78 eyes of 43 patients with primary open-angle glaucoma (POAG), 64 eyes of 35 patients with primary angle closure (PAC), and 73 eyes of 40 control subjects underwent imaging with OCTA. Perfusion density (PD) and vessel density (VD) for the macular area, and PD and flux index (FI) for the peripapillary area were calculated automatically. The area under receiver operator characteristic curves (AUC) were constructed to distinguish PACG and POAG eyes from healthy control eyes. RESULTS The peripapillary FI in all quadrants and PD and VD of the macular outer circle in superior and inferior quadrants were significantly lower in PACG and POAG eyes than in control eyes. The peripapillary FI in the inferior quadrant was significantly lower in the POAG group than in the PACG group (0.348 ± 0.06 vs. 0.369 ± 0.06, p = 0.04). The remaining OCTA parameters in the peripapillary and macular area did not show a significant difference between the POAG and PACG groups. Eyes with PAC presented significantly lower PD and VD than healthy control eyes at the superior and inferior quadrant of the macular outer circle, while retinal nerve fiber layer and ganglion cell inner complex thickness were not significantly different from than control eyes. The best diagnostic parameter was peripapillary FI in both PACG (AUC: 0.922) and POAG (AUC: 0.938) eyes. CONCLUSIONS We found significantly lower peripapillary FI in the inferior quadrant in POAG eyes compared to the PACG eyes, which may indicate the different underlying pathogenesis between POAG and PACG. The PAC eyes had lower macular PD and VD than normal eyes. This suggests that retinal vascular impairment may develop earlier than structural damage in PAC eyes.
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Affiliation(s)
- Helin Ceren Köse
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.
| | - Oya Tekeli
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Lešták J, Fůs M, Král J. The Relationship Between the Thickness of cpRNFL in Segments and Intraocular Pressure. Clin Ophthalmol 2022; 16:3673-3679. [PMID: 36389642 PMCID: PMC9657260 DOI: 10.2147/opth.s388936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study was to investigate whether the retinal nerve fibre layer (RNFL) in some segments of the optic nerve disc in pathological intraocular pressure is more damaged in eyes without antiglaucoma treatment. Patients and Methods The cohort consisted of 69 subjects (122 eyes), 32 males (6x one, 26x both eyes) aged 21 to 76 years and 37 females (4x one and 30x both eyes) aged 22 to 75 years, who were measured to have IOP greater than 21 mmHg (21–36) in routine ambulatory care. Measurements were performed using the Ocular Response Analyser, taking into account corneal hysteresis. RNFL thickness was measured using the Avanti RTVue XR and was assessed in 8 segments (1-IT, 2-TI, 3-TS, 4-ST, 5-SN, 6-NS, 7-NI, 8-IN). The visual field was examined with a fast threshold glaucoma program using the Medmont M700. The overall defect (OD) was evaluated. Pearson’s correlation coefficient r was used to assess the dependence between the selected parameters. Results The largest peripapillary changes in RNFL were observed in segments 1, 4, 5 and 8. It should be emphasized that segments 1 and 4 have been temporarily shifted. Segments 5 and 8 then corresponded to the upper (at no. 12) and lower (at no. 6) sectors. Conclusion The most important result of this study is the finding that the greatest changes in the RNFL layer were observed in pathological IOP at segment 5 (r=−0.3) and 8 (r=−0.28), at the point where the fibres of the magnocellular retinal ganglion cells enter the retina.
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Affiliation(s)
- Jan Lešták
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
- Correspondence: Jan Lešták, Faculty of Biomedical Engineering, Czech Technical University in Prague, nám. Sítná 3105, Kladno, 272 01, Czech Republic, Tel +420 602 336 770, Email
| | - Martin Fůs
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Jakub Král
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
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El-Nimri NW, Moghimi S, Nishida T, Yarmohammadi A, Zangwill LM, Hou H, Proudfoot J, Walker E, Fazio MA, Girkin CA, Liebmann JM, Weinreb RN. Racial Differences in Detection of Glaucoma Using Retinal Nerve Fiber Layer Thickness and Bruch Membrane Opening Minimum Rim Width. Am J Ophthalmol 2022; 246:223-235. [PMID: 36662535 DOI: 10.1016/j.ajo.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE To compare the sensitivities and specificities of the retinal nerve fiber layer thickness (RNFLT) and Bruch membrane opening minimum rim width (BMO-MRW) reference database-based criteria for detection of glaucoma in individuals of European descent (ED) and individuals of African descent (AD). DESIGN Comparative diagnostic analysis by race METHODS: 382 eyes of 255 glaucoma patients (ED = 170, AD = 85) and 94 eyes of 50 healthy individuals (ED = 30, AD = 20) with global and sectoral RNFLT and BMO-MRW measured with Spectralis optical coherence tomography (OCT) were included. Six diagnostic criteria were evaluated: global measurement below the 5th or 1st percentile, ≥1 of the 6 sector measurements below the 5th or 1st percentile, and superotemporal (ST) and/or inferotemporal (IT) measurement below the 5th or 1st percentile. The sensitivities and specificities of these measurements for detection of glaucoma were compared using bootstrapping methods. RESULTS ST and/or IT RNFLT below the 5th percentile has the best performance for detection of glaucoma among RNFLT classifications with a sensitivity (95% CI) of 89.5% (86.1, 92.5) and specificity of 87.2% (77.8, 95.1). In AD individuals, sensitivities of ST and IT RNFLT and BMO-MRW measurements below the 5th percentile criteria were lower than in ED individuals (RNFLT: 83.7% vs 92.5%, and BMO-MRW: 72.1% vs 88.5%, respectively), as well as specificities (AD RNFLT: 73.7% and BMO-MRW: 89.5% vs ED RNFLT: 96.4% and BMO-MRW: 98.2%, respectively). CONCLUSIONS RNFLT and BMO-MRW had consistently lower diagnostic performance in AD individuals compared with ED individuals. BMO-MRW criteria might fail to detect as many as one-third of eyes with glaucoma, specifically in AD individuals. With the current reference database, RNFLT, and especially BMO-MRW, criteria are not adequate for diagnosing glaucoma in AD individuals.
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Affiliation(s)
- Nevin W El-Nimri
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.).
| | - Takashi Nishida
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Adeleh Yarmohammadi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Huiyuan Hou
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - James Proudfoot
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Evan Walker
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (M.A.F., C.A.G.) and
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (M.A.F., C.A.G.) and
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York (J.M.L.), USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
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Karimi A, Razaghi R, Rahmati SM, Girkin CA, Downs JC. Relative Contributions of Intraocular and Cerebrospinal Fluid Pressures to the Biomechanics of the Lamina Cribrosa and Laminar Neural Tissues. Invest Ophthalmol Vis Sci 2022; 63:14. [PMID: 36255364 PMCID: PMC9587471 DOI: 10.1167/iovs.63.11.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The laminar region of the optic nerve head (ONH), thought to be the site of damage to the retinal ganglion cell axons in glaucoma, is continuously loaded on its anterior and posterior surfaces by dynamic intraocular pressure (IOP) and orbital cerebrospinal fluid pressure (CSFP), respectively. Thus, translaminar pressure (TLP; TLP = IOP-CSFP) has been proposed as a glaucoma risk factor. Methods Three eye-specific finite element models of the posterior human eye were constructed, including full 3D microstructures of the load-bearing lamina cribrosa (LC) with interspersed laminar neural tissues (NTs), and heterogeneous, anisotropic, hyperelastic material formulations for the surrounding peripapillary sclera and adjacent pia. ONH biomechanical responses were simulated using three combinations of IOP and CSFP loadings consistent with posture change from sitting to supine. Results Results show that tensile, compressive, and shear stresses and strains in the ONH were higher in the supine position compared to the sitting position (P < 0.05). In addition, LC beams bear three to five times more TLP-driven stress than interspersed laminar NT, whereas laminar NT exhibit three to five times greater strain than supporting LC (P < 0.05). Compared with CSFP, IOP drove approximately four times greater stress and strain in the LC, NT, and peripapillary sclera, normalized per mm Hg pressure change. In addition, IOP drove approximately three-fold greater scleral canal expansion and anterior-posterior laminar deformation than CSFP per mm Hg (P < 0.05). Conclusions Whereas TLP has been hypothesized to play a prominent role in ONH biomechanics, the IOP and CSFP effects are not equivalent, as IOP-driven stress, strain, and deformation play a more dominant role than CSFP effects.
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Affiliation(s)
- Alireza Karimi
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Reza Razaghi
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | | | - Christopher A. Girkin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - J. Crawford Downs
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Tong YX, Zhang XY, He Y, Chen ZL, Jiang B. Optical coherence tomography evaluation of retinal nerve fiber layer thickness in non-arteritic anterior ischemic optic neuropathy and primary open angle glaucoma: a systematic review and Meta-analysis. Int J Ophthalmol 2022; 15:1370-1380. [PMID: 36017036 DOI: 10.18240/ijo.2022.08.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the differences in average and sectoral peripapillary retinal nerve fiber layer (pRNFL) thickness using spectral domain optical coherence tomography (SD-OCT) in patients with non-arteritic anterior ischemic neuropathy (NAION) compared with those with primary open angle glaucoma (POAG). METHODS A comprehensive literature search of the PubMed, Cochrane Library, and Embase databases were performed prior to October, 2021. Studies that compared the pRNFL thickness in NAION eyes with that in POAG eyes with matched mean deviation of the visual fields were included. The weighted mean difference (WMD) with 95% confidence interval (CI) was used to pool continuous outcomes. RESULTS Ten cross-sectional studies (11 datasets) comprising a total of 625 eyes (278 NAION eyes, 347 POAG eyes) were included in the qualitative and quantitative analyses. The pooled results demonstrated that the superior pRNFL was significantly thinner in NAION eyes than in POAG eyes (WMD=-6.40, 95%CI: -12.22 to -0.58, P=0.031), whereas the inferior pRNFL was significant thinner in POAG eyes than in NAION eyes (WMD=11.10, 95%CI: 7.06 to 15.14, P≤0.001). No difference was noted concerning the average, nasal, and temporal pRNFL thickness (average: WMD=1.45, 95%CI: -0.75 to 3.66, P=0.196; nasal: WMD=-2.12, 95%CI: -4.43 to 0.19, P=0.072; temporal: WMD=-1.24, 95%CI: -3.96 to 1.47, P=0.370). CONCLUSION SD-OCT based evaluation of inferior and superior pRNFL thickness can be potentially utilized to differentiate NAION from POAG, and help to understand the different pathophysiological mechanisms between these two diseases. Further longitudinal studies and studies using eight-quadrant or clock-hour classification method are required to validate the obtained findings.
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Affiliation(s)
- Yu-Xin Tong
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Xin-Yu Zhang
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Yi He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Zong-Lin Chen
- Department of General Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Bing Jiang
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
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Kim JA, Lee EJ, Kim TW, Woo SJ. Difference in topographic morphology of optic nerve head and neuroretinal rim between normal tension glaucoma and central retinal artery occlusion. Sci Rep 2022; 12:10895. [PMID: 35764667 PMCID: PMC9240046 DOI: 10.1038/s41598-022-14943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022] Open
Abstract
Although central retinal artery occlusion (CRAO) has its own defining pathomechanism and clinical characteristics, morphologic feature of the optic nerve head (ONH) during its later stage is not diagnostic, which makes it difficult to differentiate CRAO from other optic neuropathies. This cross-sectional study was performed to investigate the differences in the topographic morphology of the ONH in eyes with normal-tension glaucoma (NTG) and CRAO. Thirty-one eyes with NTG; 31 eyes with CRAO; and 31 healthy fellow eyes of the subjects with CRAO were included. ONH morphology was evaluated by measuring horizontal rim width (HRW), minimal rim width in the selected horizontal image (MRW), and lamina cribrosa curvature index (LCCI) in horizontal B-scan images obtained using enhanced depth-imaging optical coherence tomography. HRW was smaller and LCCI was larger in NTG eyes than in both CRAO and healthy fellow eyes (both P < 0.001), while both were comparable between CRAO and healthy fellow eyes. MRW differed significantly among the three groups, being smallest in NTG eyes followed by CRAO and healthy fellow eyes (P < 0.001). NTG and CRAO eyes with a similar degree of RNFL loss differed in ONH morphology, indicating that mechanisms of ONH damage differ between these two conditions.
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Affiliation(s)
- Ji-Ah Kim
- Department of Ophthalmology, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, Korea.
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, 463-707, Gyeonggi-do, Korea
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Bartlett RL, Frost BE, Mortlock KE, Fergusson JR, White N, Morgan JE, North RV, Albon J. Quantifying biomarkers of axonal degeneration in early glaucoma to find the disc at risk. Sci Rep 2022; 12:9366. [PMID: 35672326 PMCID: PMC9174204 DOI: 10.1038/s41598-022-12036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
To evaluate regional axonal-related parameters as a function of disease stage in primary open angle glaucoma (POAG) and visual field (VF) sensitivity. Spectral domain optical coherence tomography was used to acquire 20° scans of POAG (n = 117) or healthy control (n = 52) human optic nerve heads (ONHs). Region specific and mean nerve fibre layer (NFL) thicknesses, border NFL and peripapillary NFL, minimum rim width (MRW)/ area (MRA) and prelamina thickness; and volume were compared across POAG disease stages and with visual field sensitivity. Differences identified between early glaucoma (EG), preperimetric glaucoma (PG) and control (C) ONHs included thinner PG prelamina regions than in controls (p < 0.05). Mean border NFL was thinner in EG (p < 0.001) and PG (p = 0.049) compared to control eyes; and EG mean, and inferior and ST, border NFL was thinner than in PG (p < 0.01). Mean, superior and inferior PG peripapillary NFL were thinner than in controls (p < 0.05), and EG ST peripapillary NFL was thinner than in PG (p = 0.023). MRW differences included: PG SN and inferior less than in controls (p < 0.05); thinner EG mean regional, inferior, nasal, and ST MRW versus PG MRW (p < 0.05). Regional border NFL, peripapillary NFL, MRW, MRA, prelamina thickness (except centre, p = 0.127) and prelamina volume (p < 0.05) were significantly associated with VF mean deviation (MD). Novel axon-derived indices hold potential as biomarkers to detect early glaucoma and identify ONHs at risk.
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Affiliation(s)
- R L Bartlett
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - B E Frost
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- School of Biosciences, Cardiff University, Cardiff, UK
| | - K E Mortlock
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J R Fergusson
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - N White
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J E Morgan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - R V North
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK
| | - J Albon
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
- Cardiff Institute for Tissue Engineering and Repair, Cardiff University, Cardiff, UK.
- Vivat Scientia Bioimaging Laboratories, Cardiff University, Cardiff, UK.
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de Paula A, Perdicchi A, Pocobelli A, Fragiotta S, Scuderi G. The “Topography” of Glaucomatous Defect Using OCT and Visual Field Examination. J Curr Glaucoma Pract 2022; 16:31-35. [PMID: 36060037 PMCID: PMC9385384 DOI: 10.5005/jp-journals-10078-1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim To describe the modifications in the superior and inferior retinal nerve fiber layer (RNFL) thickness regarding the distribution of the VF defects for the horizontal meridians in glaucomatous patients and the differences in the RNFL thickness topography between glaucomatous and healthy subjects. Methods One hundred twenty eyes of 91 patients affected by glaucoma and 94 eyes of 51 normal patients were retrospectively reviewed. Computerized 30°VF (Octopus G1 Dynamic strategy) and optical coherence tomography (OCT) ONH and 3D disk analysis were performed in all cases. The RNFL thickness measures analyzed in both groups were superior-nasal (SN), superior-temporal (ST), inferior-nasal (IN), and inferior temporal (IT) sectors. The VFs were classified according to the distribution of the VF defect as for the horizontal meridian in the pattern deviation plot as superior, inferior, predominantly superior, or predominantly inferior. Result In the glaucomatous group, 78 eyes (65%) showed a predominantly superior VF defect, while 38 eyes (32%) showed a predominantly inferior VF defect. Fifty-six eyes (46.7%) presented an exclusively superior, and 27/120 eyes (22.5%) presented an exclusively inferior VF defect. In the control group, the thickest RNFL sector was IT. The ST sector showed the thickest RNFL in presence of an exclusive superior VF defect. In case of an exclusive inferior VF defect, the thickest RNFL was the IT sector. VF showing superior defect presented a more altered MD than the VF with an inferior defect. Conclusion Glaucomatous damage affects both the superior and inferior neural rim almost simultaneously. However, the neural rim loss seems to be asymmetric, involving the inferior or superior rim depending on the predominant involvement of the superior or inferior hemifield at the VF test. Particularly, the IT sector appears to be the most compromised in glaucomatous eyes. Therefore, the asymmetry between superior and inferior RNFL could support the diagnosis of glaucoma. How to cite this article de Paula A, Perdicchi A, Pocobelli A, et al. The “Topography” of Glaucomatous Defect Using OCT and Visual Field Examination. J Curr Glaucoma Pract 2022;16(1):31-35.
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Affiliation(s)
- Alessandro de Paula
- Department of Head-neck, San Giovanni Addolorata Hospital, Uoc Oftalmologia - Banca Degli Occhi, Rome, Italy
- Alessandro de Paula, Department of Head-neck, San Giovanni Addolorata Hospital, Uoc Oftalmologia - Banca Degli Occhi, Rome, Italy, Phone: +39 0677052950, e-mail:
| | - Andrea Perdicchi
- Department of NESMOS, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Augusto Pocobelli
- Department of Head-neck, San Giovanni Addolorata Hospital, Uoc Oftalmologia - Banca Degli Occhi, Rome, Italy
| | - Serena Fragiotta
- Department of NESMOS, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Gianluca Scuderi
- Department of NESMOS, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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Superior segmental optic nerve hypoplasia: A review. Surv Ophthalmol 2022; 67:1467-1475. [DOI: 10.1016/j.survophthal.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
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Cheung CY, Ling Li S, Chan N, Chan PP, Wang Y, Wong M, Lai I, Tham CC. Intraocular Pressure Control Predicts Retinal Nerve Fiber Layer Thinning in Primary Angle Closure Disease: The CUPAL Study. Am J Ophthalmol 2022; 234:205-214. [PMID: 34416183 DOI: 10.1016/j.ajo.2021.08.004] [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: 12/29/2020] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the relationship of intraocular pressure (IOP) control with subsequent retinal nerve fiber layer (RNFL) thinning in patients with primary angle closure disease (PACD). DESIGN Prospective cohort study. METHODS The study monitored 517 treated PACD eyes from 280 Chinese patients at least 24 months. IOP was measured every 3 months using Goldmann applanation tonometry, and RNFLs were measured by spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering) every 6 months. IOP mean and fluctuation were calculated as the average and the coefficient of variation of IOP measurements during the first 18 months of the study period. The relationship between IOP and subsequent RNFL changes over time were examined using multivariable linear mixed models. Intraclass correlations at the patient and eye levels were also controlled using nested random intercepts in the models. RESULTS IOP mean (β = -1.20 µm/y per 1 mm Hg, P < .001) and IOP fluctuation (β = -3.10 µm/y per 10% unit change in the coefficient of variation, P < .001) were independently negatively associated with subsequent progressive global RNFL changes, after adjustment for age, sex, and baseline RNFL thickness. In the sectoral analysis, both higher mean IOP and IOP fluctuation predicted progressive RNFL thinning in the inferotemporal, superotemporal, superonasal, and temporal sectors in the order of strength of association. In the subgroup analysis by disease category, IOP fluctuation showed greater association with global RNFL thinning in eyes with primary angle closure glaucoma (P = .010) than in eyes without glaucomatous changes (P = .07). CONCLUSIONS In treated PACD eyes, large IOP fluctuation is an independent predictor for subsequent progressive RNFL thinning in addition to high mean IOP during follow-up.
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Karimi A, Rahmati SM, Grytz RG, Girkin CA, Downs JC. Modeling the biomechanics of the lamina cribrosa microstructure in the human eye. Acta Biomater 2021; 134:357-378. [PMID: 34245889 DOI: 10.1016/j.actbio.2021.07.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022]
Abstract
Glaucoma is among the leading causes of blindness worldwide that is characterized by irreversible damage to the retinal ganglion cell axons in the lamina cribrosa (LC) region of the optic nerve head (ONH), most often associated with elevated intraocular pressure (IOP). The LC is a porous, connective tissue structure that provides mechanical support to the axons as they exit the eye and the biomechanics of the LC microstructure likely play a crucial role in protecting the axons passing through it. There is a limited knowledge of the IOP-driven biomechanics of the LC microstructure, primarily due to its small size and the difficulty with imaging the LC both in vitro and in vivo. We present finite element (FE) models of three human eye posterior poles that include the LC microstructure and interspersed neural tissues (NT) composed of retinal axons that are constructed directly from segmented, binary images of the LC. These models were used to estimate the stresses and strains in the LC and NT for an acute IOP elevation from 0 to 45 mmHg and compared with identical models except that the LC was represented as a homogenized continuum material with either homogeneous isotropic neo-Hookean properties or heterogeneous properties derived from local connective tissue volume fraction (CTVF) and predominant LC beam orientation. Stresses and strains in the LC and NT microstructure were investigated, and results were compared against those from the models wherein the LC was represented as a homogenized continuum. The regionalized volumetric average stresses and strains showed that the microstructural model yielded similar patterns to our prior approach using an LC continuum representation with mapped LC CTVF/anisotropy, but the microstructural modeling approach allows analysis of the stresses and strains in the LC and NT separately. As expected, the LC beams carried most of the IOP load in the microstructural models but exhibited less strain, while the encapsulated NT exhibited lower stresses and much higher strains. Results also revealed that the continuum models underestimate the maximum strains in the LC beams and NT by a factor of 2-3. Microstructural modeling should provide greater insight into the biomechanical factors driving damage to the axons (NT) and LC connective tissue remodeling that occur in glaucoma. The methods presented are ideal for modeling any structure with a complex microstructure composed of different materials, such as trabecular bone, lung, and tissue engineering scaffolds such as decellularized LC. Matlab code for mesh generation from a segmented image stack of the microstructure is included as Supplemental Material. STATEMENT OF SIGNIFICANCE: Glaucoma is among the leading causes of blindness worldwide that is characterized by axon damage in the lamina cribrosa (LC) region of the eye. We present a new approach for finite element modeling the entire eye-specific 3D LC microstructure and the interspersed neural tissues, incorporated into an eye-specific posterior eye model that provides appropriate boundary and loading conditions. Results are presented for three human donor eyes, showing that prior modeling approaches underestimate the stresses and strains in the laminar microstructure. We constructed models from image stacks of the segmented microstructure (Matlab code included) using an approach that is ideal for modeling any structure with a complex microstructure composed of different materials, such as trabecular bone, lung, and tissue engineering scaffolds.
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21
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Lin Y, Chen S, Zhang M. Peripapillary vessel density measurement of quadrant and clock-hour sectors in primary angle closure glaucoma using optical coherence tomography angiography. BMC Ophthalmol 2021; 21:328. [PMID: 34503457 PMCID: PMC8428096 DOI: 10.1186/s12886-021-02093-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate diagnostic ability of peripapillary vessel density of primary angle closure glaucoma (PACG) eyes in quadrant and clock-hour sectors by optical coherence tomography angiography (OCTA). METHODS This was a cross-sectional study on forty-one PACG patients (41eyes) and twenty-seven healthy subjects (27 eyes). All subjects underwent OCTA (DRI OCT Triton; Topcon Corporation, Tokyo, Japan) and peripapillary retinal nerve fiber layer (RNFL) thickness imaging with swept-source optical coherence tomography (OCT). The peripapillary vessel density of quadrant and clock-hour sectors was quantified by imageJ software. The diagnostic capability of OCTA and OCT parameters was evaluated by the areas under the receiver operating characteristics curves (AUCs). Pearson correlation analysis or Spearman correlation test was used to evaluate the correlation between vessel density parameters and related factors. RESULTS Compared with the control group, the peripapillary vessel density of glaucomatous group was lower to different degrees in the four quadrants and each clock-hour sectors, and vessel density reduced most at 7 o'clock. The difference between the diagnostic ability of peripapillary vessel density and peripapillary RNFL thickness was not statistically significant, except 4 o'clock and inferior quadrant. The inferior quadrant peripapillary vessel density had the best diagnostic value (AUC0.969), followed by the 7 o'clock vessel density (AUC0.964), average vessel density (AUC0.939) and the 7 o'clock RNFL thickness (AUC0.919). The average peripapillary vessel density was correlated with average RNFL and visual field (VF) mean deviation (P < 0.001). CONCLUSIONS In PACG, the diagnostic ability of the peripapillary vessel density is equivalent to the peripapillary RNFL thickness. Understanding spatial characteristics of the peripapillary vessel density in PACG may be helpful for clinical diagnosis and monitoring the progress of diseases.
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Affiliation(s)
- Yongdong Lin
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Dong xia Road, Shantou, Guangdong Province, People's Republic of China
| | - Shirong Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Dong xia Road, Shantou, Guangdong Province, People's Republic of China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Dong xia Road, Shantou, Guangdong Province, People's Republic of China.
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22
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Park IK, Kim KW, Moon NJ, Shin JH, Chun YS. Comparison of Superior and Inferior Visual Field Asymmetry Between Normal-tension and High-tension Glaucoma. J Glaucoma 2021; 30:648-655. [PMID: 34008532 DOI: 10.1097/ijg.0000000000001872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/18/2021] [Indexed: 11/25/2022]
Abstract
PRECIS Increased severity of glaucoma heightened the hemispherical asymmetry in normal-tension and high-tension glaucoma (NTG/HTG), especially NTG. NTG showed localized superior defects in the central and paracentral areas whereas HTG showed mild asymmetry with diffuse defects. PURPOSE The purpose of this study was to compare the patterns of visual field (VF) defects according to glaucoma severity in NTG and HTG. MATERIALS AND METHODS A total of 1458 eyes with NTG (936) and HTG (522) were classified by mean deviation values into mild, moderate, and severe. The mean total deviation (mTD) values for each nasal, central, paracentral, arcuate 1, and arcuate 2 region of the Glaucoma Hemifield Test (GHT) were calculated. The differences in mTD between the superior and inferior hemifields of NTG and HTG were compared, and the degree of hemifield asymmetry was plotted. RESULTS In NTG and HTG, the mTDs of the 5 regions of the superior GHT were significantly worse than those of the corresponding regions of the inferior GHT at all severity levels except for mild HTG. However, NTG showed significantly greater asymmetry than HTG in 2 regions at mild, 3 at moderate, and all 5 at severe. Moderate and severe NTG showed severe asymmetry with localized superior field defects concentrated at the central and paracentral areas with >8 dB asymmetry. However, in all HTG groups showed mild asymmetry with diffuse defects. CONCLUSIONS The superior hemifield was more severely affected than the inferior hemifield in NTG and HTG. As the severity of glaucoma increased, so did the asymmetry in both groups, with NTG showing more profound asymmetric VF defects in the central and paracentral areas whereas HTG did not. Different VF patterns suggest differing pathologic mechanisms and possible need for different therapeutic strategies in NTG and HTG.
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Affiliation(s)
- In Ki Park
- Department of Ophthalmology, Kyung Hee University College of Medicine, Kyung Hee University Hospital
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital
| | - Nam Ju Moon
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital
| | - Jae-Ho Shin
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital
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Thompson AC, Li A, Asrani S. Agreement Between Trend-Based and Qualitative Analysis of the Retinal Nerve Fiber Layer Thickness for Glaucoma Progression on Spectral-Domain Optical Coherence Tomography. Ophthalmol Ther 2021; 10:629-642. [PMID: 34212312 PMCID: PMC8319289 DOI: 10.1007/s40123-021-00355-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION To evaluate the agreement between trend-based analysis and qualitative assessment of the retinal nerve fiber layer (RNFL) thickness for glaucomatous progression on spectral-domain optical coherence tomography (SDOCT). METHODS Retrospective review of 190 eyes from 103 patients with glaucoma or suspected glaucoma that underwent SDOCT imaging during four consecutive clinic visits. Trend-based progression was characterized by a significantly negative slope. Progression by qualitative analysis was determined by review of raw SDOCT B-scans. RESULTS The slope was significantly greater in those with progression than without progression for both trend-based and qualitative analysis (p < 0.001). However, the qualitative grading classified a significantly greater proportion of eyes as progressing compared to trend-based analysis in both the superotemporal (ST) (23.2% vs. 10.5%, p = 0.001) and inferotemporal (IT) RNFL (27.4% vs 8.4%, p < 0.001). The trend-based and qualitative classifications of progression showed poor agreement in both the ST (kappa = 0.0135) and IT RNFL (kappa = 0.1222). The agreement between trend-based and qualitative analysis was lower for eyes with artifacts (ST = 58.11%; IT = 68.7%) than those without artifacts (ST = 80.2%; IT = 74.8%). Moreover, among eyes with artifacts, there was no significant difference in slope between those qualitatively categorized as progressing versus not progressing (p > 0.05). CONCLUSIONS Poor agreement was found between a trend-based and qualitative analysis of change in RNFL on SDOCT. Careful qualitative review of SDOCT imaging may identify specific areas of glaucoma progression not captured by trend-based methods, especially in the presence of artifacts. Such an approach may also prove useful for detecting glaucoma progression in a clinical setting when there are few data points available.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke University, Box 3802, Durham, NC, 27710, USA
| | - Ang Li
- Cleveland Clinic, Cleveland, OH, USA
| | - Sanjay Asrani
- Department of Ophthalmology, Duke University, Box 3802, Durham, NC, 27710, USA.
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24
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Celebi ARC, Park EA, Verticchio Vercellin AC, Tsikata E, Lee R, Shieh E, Antar H, Freeman M, Zhang J, Que C, Simavli H, McClurkin M, Guo R, Elze T, de Boer JF, Chen TC. Structure-Function Mapping Using a Three-Dimensional Neuroretinal Rim Parameter Derived From Spectral Domain Optical Coherence Tomography Volume Scans. Transl Vis Sci Technol 2021; 10:28. [PMID: 34019635 PMCID: PMC8142720 DOI: 10.1167/tvst.10.6.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the structure-function relationship in glaucoma using Humphrey visual field (HVF) perimetry and a three-dimensional neuroretinal rim parameter derived from spectral domain optical coherence tomography (SD-OCT) volume scans. Methods Structure-function correlation was analyzed globally and regionally (four quadrants and four sectors). Structural data included peripapillary retinal nerve fiber layer (RNFL) thickness and minimum distance band (MDB) neuroretinal rim thickness, defined as the shortest distance between the inner cup surface and the outer retinal pigment epithelium/Bruch's membrane complex. Logarithmic regression analyses were performed and Pearson correlation coefficients determined to assess relationship strength. Results The study consisted of 102 open-angle glaucoma patients and 58 healthy subjects. The Pearson correlation coefficient for global MDB thickness (R = 0.585) was higher than for global RNFL thickness (R = 0.492), but the difference was not statistically significant (P = 0.18). The correlation coefficients for regional MDB thicknesses and corresponding HVF sensitivities were higher than those for regional RNFL thicknesses and HVF in six out of eight regions (P = 0.08 to 0.47). In the remaining two out of eight regions, the correlation coefficients were higher for RNFL thickness than for MDB thickness (P = 0.15 to 0.20). Conclusions Three-dimensional MDB neuroretinal rim thickness relates to visual function as strongly as the most commonly used SD-OCT parameter for glaucoma, two-dimensional peripapillary RNFL thickness. Translational Relevance This paper illustrates the potential for 3D OCT algorithms to improve in vivo imaging in glaucoma.
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Affiliation(s)
- Ali Riza Cenk Celebi
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Ophthalmology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Elli A Park
- Boston University School of Medicine, Boston, MA, USA
| | - Alice Chandra Verticchio Vercellin
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Istituto di Ricovero e Cura a Carattere Scientifico-Fondazione Bietti, Rome, Italy
| | - Edem Tsikata
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Ramon Lee
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
| | - Eric Shieh
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hussein Antar
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Madeline Freeman
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Smith College School for Social Work, Northampton, MA, USA
| | - Jing Zhang
- Peking University First Hospital, Beijing, China
| | - Christian Que
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Ophthalmology, University of East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Huseyin Simavli
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA.,Kudret Eye Hospital, Istanbul, Turkey
| | | | - Rong Guo
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tobias Elze
- Harvard Medical School, Boston, MA, USA.,Schepens Eye Research Institute, Boston, MA, USA
| | - Johannes F de Boer
- LaserLaB Amsterdam, Department of Physics and Astronomy, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Teresa C Chen
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear, Boston, MA, USA
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Mrad Y, Elloumi Y, Akil M, Bedoui MH. A fast and accurate method for glaucoma screening from smartphone-captured fundus images. Ing Rech Biomed 2021. [DOI: 10.1016/j.irbm.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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26
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Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. The global prevalence of glaucoma in people aged 40 to 80 years is estimated to be 3.5%. With the growing number and proportion of older persons in the population, it is projected that 111.8 million people will have glaucoma in 2040. Currently available treatments cannot reverse glaucomatous damage to the visual system; however, early diagnosis and treatment can prevent progression of the disease. In most cases, glaucoma is a chronic condition that requires lifelong management. This article reviews the pathophysiology, classification, clinical manifestations, diagnosis, and management of glaucoma.
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Affiliation(s)
- Jessica Minjy Kang
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Angelo P Tanna
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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27
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Sawada Y, Araie M, Shibata H, Iwase T. Nasal displacement of retinal vessels on the optic disc in glaucoma associated with a nasally angled passage through lamina cribrosa. Sci Rep 2021; 11:4176. [PMID: 33603146 PMCID: PMC7892818 DOI: 10.1038/s41598-021-83720-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
To investigate nasal displacement of central retinal vessel (CRV) on the optic nerve head (ONH) in glaucoma in association with its passage through lamina cribrosa (LC). This cross-sectional study included 113 eyes with glaucoma and 60 normal eyes. Horizontal spectral-domain optical coherence tomography (SD-OCT) scans of the ONH were acquired, and point where CRV emerged on the ONH surface was defined as the position of the CRV. Next, radial scans of the ONH were acquired, and angle of the CRV passing through the LC was measured. These parameters were compared between glaucomatous and normal eyes by t-test, and their relationship with possible confounders was assessed by multiple regression analyses. In glaucoma, CRV was significantly more nasally displaced than it was in normal eyes (66.0 ± 8.6 vs. 54.3 ± 9.5, P < 0.0001), and eyes with more vessel displacement exhibited significantly worse glaucomatous visual field defects (P = 0.0004). Greater nasal displacement of the CRV was significantly associated with a more nasally angled path through the LC (rs = 0.569, P < 0.0001). By using SD-OCT, we confirmed that nasal displacement of the CRV on the ONH was associated with glaucoma and was induced by its nasally angled path through the LC.
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Affiliation(s)
- Yu Sawada
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Makoto Araie
- Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Hitomi Shibata
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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28
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Li A, Thompson AC, Asrani S. Impact of Artifacts From Optical Coherence Tomography Retinal Nerve Fiber Layer and Macula Scans on Detection of Glaucoma Progression. Am J Ophthalmol 2021; 221:235-245. [PMID: 32818450 DOI: 10.1016/j.ajo.2020.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the prevalence of artifacts on segmented spectral-domain optical coherence tomography (SDOCT) images and assess their impact on the interpretation of glaucomatous progression in the retinal nerve fiber layer (RNFL) profile and macular thickness map. DESIGN Retrospective reliability analysis. METHODS Retrospective review of glaucoma and glaucoma suspect eyes imaged with SDOCT during a 1-month period. All cases had at least 4 sets of RNFL and macular images at 6-month intervals. SDOCT raw B-scans were examined to determine true progression and whether artifacts impacted the original interpretation of progression based on auto-segmented change maps. The co-prevalence of artifacts in the RNFL and macula was assessed, as well as the association of clinical factors with the likelihood of artifacts. RESULTS A total of 190 eyes with 760 sets of OCT RNFL and macular scans were included. Fifty percent (96/190) of eyes had artifacts, either in the circumpapillary RNFL (83/190; 43.68%) or the macula (57/190; 30.0%). Epiretinal membrane and vitreomacular traction were the most common artifacts. True progression was present on 39.5% (75/190) of scans overall. Among scans with artifacts, 23.9% (23/96) of artifacts masked true progression (ie, false-negative), 36.5% (35/96) led to an interpretation of false progression (ie, false-positive), and 39.6% (38/96) had no effect on the interpretation of progression. The presence of true progression on the RNFL scan was significantly associated with the presence of true progression on the macular scan (P < .001). Similarly, the presence of artifacts on the RNFL scan was significantly associated with artifacts on the macular scan (P < .001). In multivariable analysis, severe glaucoma, hypertension, and age were significantly associated with the presence of artifacts on RNFL (P < .05). CONCLUSIONS Artifacts are highly prevalent on both circumpapillary RNFL and macular scans on SDOCT images acquired in a glaucoma clinic. Artifacts can lead to false-positive and false-negative interpretation of progression when using only the auto-segmentation change maps. Thus, careful examination of the raw B-scan images of both the RNFL and macula is critical to identify artifacts and true glaucoma progression.
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Affiliation(s)
- Ang Li
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Atalie C Thompson
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Sanjay Asrani
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA.
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29
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Wang YX, Panda-Jonas S, Jonas JB. Optic nerve head anatomy in myopia and glaucoma, including parapapillary zones alpha, beta, gamma and delta: Histology and clinical features. Prog Retin Eye Res 2020; 83:100933. [PMID: 33309588 DOI: 10.1016/j.preteyeres.2020.100933] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022]
Abstract
The optic nerve head can morphologically be differentiated into the optic disc with the lamina cribrosa as its basis, and the parapapillary region with zones alpha (irregular pigmentation due to irregularities of the retinal pigment epithelium (RPE) and peripheral location), beta zone (complete RPE loss while Bruch's membrane (BM) is present), gamma zone (absence of BM), and delta zone (elongated and thinned peripapillary scleral flange) within gamma zone and located at the peripapillary ring. Alpha zone is present in almost all eyes. Beta zone is associated with glaucoma and may develop due to a IOP rise-dependent parapapillary up-piling of RPE. Gamma zone may develop due to a shift of the non-enlarged BM opening (BMO) in moderate myopia, while in highly myopic eyes, the BMO enlarges and a circular gamma zone and delta zone develop. The ophthalmoscopic shape and size of the optic disc is markedly influenced by a myopic shift of BMO, usually into the temporal direction, leading to a BM overhanging into the intrapapillary compartment at the nasal disc border, a secondary lack of BM in the temporal parapapillary region (leading to gamma zone in non-highly myopic eyes), and an ocular optic nerve canal running obliquely from centrally posteriorly to nasally anteriorly. In highly myopic eyes (cut-off for high myopia at approximately -8 diopters or an axial length of 26.5 mm), the optic disc area enlarges, the lamina cribrosa thus enlarges in area and decreases in thickness, and the BMO increases, leading to a circular gamma zone and delta zone in highly myopic eyes.
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Affiliation(s)
- Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| | - Songhomitra Panda-Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
| | - Jost B Jonas
- Institute for Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany
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30
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Lim ZW, Chee ML, Lim SH, Thakur S, Majithia S, Soh ZD, Teo ZL, Rim TH, Sabanayagam C, Tham YC, Cheng CY. Normative profiles of neuroretinal rim area in a multiethnic Asian population: the Singapore Epidemiology of Eye Diseases study. Br J Ophthalmol 2020; 106:381-387. [DOI: 10.1136/bjophthalmol-2020-317323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/08/2020] [Accepted: 11/04/2020] [Indexed: 01/20/2023]
Abstract
AimsTo evaluate the normative profiles for neuroretinal rim area (RA) in a multiethnic Asian population.MethodsSubjects were recruited from the Singapore Epidemiology of Eye Diseases (2009–2015) study and underwent standardised examinations. RA measurements were performed using Cirrus high-definition optical coherence tomography (Carl Zeiss Meditec). Multivariable linear regression with generalised estimating equation model was used to evaluate the associations between demographic, systemic and ocular factors with RA.ResultsA total of 9394 eyes from 5116 subjects (1724 Chinese, 1463 Malay, 1929 Indian) were included in the final analysis. The mean (±SD) of RA was 1.28 (±0.23) mm2for Chinese, 1.33 (±0.26) mm2for Malays, and 1.23 (±0.23) mm2for Indians. The 5th percentile value for RA was 0.94 mm2for Chinese, 0.96 mm2for Malay, and 0.89 mm2for Indian. In multivariable analysis, following adjustment for age, gender, body mass index, diabetes mellitus, hyperlipidaemia, history of cataract surgery, axial length, intraocular pressure (IOP) and disc area, Indian eyes have smaller RA when compared with Malays (β=−0.074; 95% CI −0.090 to −0.058; p<0.001) and Chinese (β=−0.035; 95% CI −0.051 to −0.019; p<0.001), respectively. Additionally, older age (per decade, β=−0.022), male gender (β=−0.031), longer axial length (per mm, β=−0.025), spherical equivalent (per negative dioptre, β=−0.005), higher IOP (per mm Hg, β=−0.009) were associated with smaller RA (all p≤0.004).ConclusionIn this multiethnic population-based study, we observed significantly smaller RA in Indian eyes, compared with Chinese and Malays. This indicates the need of a more refined ethnic-specific RA normative databases among Asians.
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Seo SB, Cho HK. Deep learning classification of early normal-tension glaucoma and glaucoma suspects using Bruch's membrane opening-minimum rim width and RNFL. Sci Rep 2020; 10:19042. [PMID: 33149191 PMCID: PMC7643070 DOI: 10.1038/s41598-020-76154-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022] Open
Abstract
We aimed to classify early normal-tension glaucoma (NTG) and glaucoma suspect (GS) using Bruch’s membrane opening-minimum rim width (BMO-MRW), peripapillary retinal nerve fiber layer (RNFL), and the color classification of RNFL based on a deep-learning model. Discriminating early-stage glaucoma and GS is challenging and a deep-learning model may be helpful to clinicians. NTG accounts for an average 77% of open-angle glaucoma in Asians. BMO-MRW is a new structural parameter that has advantages in assessing neuroretinal rim tissue more accurately than conventional parameters. A dataset consisted of 229 eyes out of 277 GS and 168 eyes of 285 patients with early NTG. A deep-learning algorithm was developed to discriminate between GS and early NTG using a training set, and its accuracy was validated in the testing dataset using the area under the curve (AUC) of the receiver operating characteristic curve (ROC). The deep neural network model (DNN) achieved highest diagnostic performance, with an AUC of 0.966 (95%confidence interval 0.929–1.000) in classifying either GS or early NTG, while AUCs of 0.927–0.947 were obtained by other machine-learning models. The performance of the DNN model considering all three OCT-based parameters was the highest (AUC 0.966) compared to the combinations of just two parameters. As a single parameter, BMO-MRW (0.959) performed better than RNFL alone (0.914).
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Affiliation(s)
- Sat Byul Seo
- Department of Mathematics Education, School of Education, Kyungnam University, Changwon, Republic of Korea
| | - Hyun-Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon, Gyeongsangnam-do, 51472, Republic of Korea. .,Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea.
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Sun S, Ha A, Kim YK, Yoo BW, Kim HC, Park KH. Dual-input convolutional neural network for glaucoma diagnosis using spectral-domain optical coherence tomography. Br J Ophthalmol 2020; 105:1555-1560. [PMID: 32920530 DOI: 10.1136/bjophthalmol-2020-316274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/15/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS To evaluate, with spectral-domain optical coherence tomography (SD-OCT), the glaucoma-diagnostic ability of a deep-learning classifier. METHODS A total of 777 Cirrus high-definition SD-OCT image sets of the retinal nerve fibre layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) of 315 normal subjects, 219 patients with early-stage primary open-angle glaucoma (POAG) and 243 patients with moderate-to-severe-stage POAG were aggregated. The image sets were divided into a training data set (252 normal, 174 early POAG and 195 moderate-to-severe POAG) and a test data set (63 normal, 45 early POAG and 48 moderate-to-severe POAG). The visual geometry group (VGG16)-based dual-input convolutional neural network (DICNN) was adopted for the glaucoma diagnoses. Unlike other networks, the DICNN structure takes two images (both RNFL and GCIPL) as inputs. The glaucoma-diagnostic ability was computed according to both accuracy and area under the receiver operating characteristic curve (AUC). RESULTS For the test data set, DICNN could distinguish between patients with glaucoma and normal subjects accurately (accuracy=92.793%, AUC=0.957 (95% CI 0.943 to 0.966), sensitivity=0.896 (95% CI 0.896 to 0.917), specificity=0.952 (95% CI 0.921 to 0.952)). For distinguishing between patients with early-stage glaucoma and normal subjects, DICNN's diagnostic ability (accuracy=85.185%, AUC=0.869 (95% CI 0.825 to 0.879), sensitivity=0.921 (95% CI 0.813 to 0.905), specificity=0.756 (95% CI 0.610 to 0.790)]) was higher than convolutional neural network algorithms that trained with RNFL or GCIPL separately. CONCLUSION The deep-learning algorithm using SD-OCT can distinguish normal subjects not only from established patients with glaucoma but also from patients with early-stage glaucoma. The deep-learning model with DICNN, as trained by both RNFL and GCIPL thickness map data, showed a high diagnostic ability for discriminatingpatients with early-stage glaucoma from normal subjects.
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Affiliation(s)
- Sukkyu Sun
- Interdisciplinary Program in Bioengineering, Graduate school, Seoul National University, Seoul, South Korea
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Jeju National University Hospital, Jeju-si, South Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | | | - Hee Chan Kim
- Interdisciplinary Program in Bioengineering, Graduate school, Seoul National University, Seoul, South Korea .,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, South Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
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Midgett D, Liu B, Ling YTT, Jefferys JL, Quigley HA, Nguyen TD. The Effects of Glaucoma on the Pressure-Induced Strain Response of the Human Lamina Cribrosa. Invest Ophthalmol Vis Sci 2020; 61:41. [PMID: 32343781 PMCID: PMC7401932 DOI: 10.1167/iovs.61.4.41] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose To measure the ex vivo pressure-induced strain response of the human optic nerve head and analyze for variations with glaucoma diagnosis and optic nerve axon damage. Methods The posterior sclera of 16 eyes from 8 diagnosed glaucoma donors and 10 eyes from 6 donors with no history of glaucoma were inflation tested between 5 and 45 mm Hg. The optic nerve from each donor was examined for degree of axon loss. The posterior volume of the lamina cribrosa (LC) was imaged with second harmonic generation and analyzed using volume correlation to calculate LC strains between 5 and 10 and 5 and 45 mm Hg. Results Eye length and LC area were larger in eyes diagnosed with glaucoma (P≤ 0.03). Nasal-temporal EXX and circumferential Eθθ strains were lower in the LC of diagnosed glaucoma eyes at 10 mm Hg (P≤ 0.05) and 45 mm Hg (P≤ 0.07). EXX was smaller in the LC of glaucoma eyes with <25% axon loss compared with undamaged normal eyes (P = 0.01, 45 mm Hg). In general, the strains were larger in the peripheral than central LC. The ratio of the maximum principal strain Emax in the peripheral to central LC was larger in glaucoma eyes with >25% axon loss than in glaucoma eyes with milder damage (P = 0.004, 10 mm Hg). Conclusions The stiffness of the LC pressure-strain response was greater in diagnosed glaucoma eyes and varied with glaucomatous axon damage. Lower LC strains in glaucoma eyes with milder damage may represent baseline biomechanical behavior that contributes to axon loss, whereas greater LC strain and altered radial LC strain variation in glaucoma eyes with more severe damage may be caused by glaucoma-related remodeling.
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Diagnostic Capability of 3D Peripapillary Retinal Volume for Glaucoma Using Optical Coherence Tomography Customized Software. J Glaucoma 2020; 28:708-717. [PMID: 31180936 PMCID: PMC6727946 DOI: 10.1097/ijg.0000000000001291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PRéCIS:: The diagnostic capability of peripapillary retinal volume is similar to peripapillary retinal nerve fiber layer thickness for diagnosing glaucoma, but with fewer artifacts. PURPOSE To compare the diagnostic capability of 3-dimensional peripapillary retinal volume (RV) versus 2-dimensional peripapillary retinal nerve fiber layer (RNFL) thickness for open-angle glaucoma. PATIENTS AND METHODS A retrospective cross-sectional analysis was conducted. A total of 180 subjects (113 open-angle glaucoma, 67 normal participants) had spectral domain optical coherence tomography volume scans and RNFL thickness measurements. Peripapillary RV values were calculated using a custom-designed program with 4 circumpapillary annuli (CA): CA1 had circle diameters of 2.5 and 3.5 mm; CA2, 3 and 4 mm; CA3, 3.5 and 4.5 mm; and CA4, 4 and 5 mm. Area under the receiver operating characteristic curves were calculated for global, quadrant, and octant regions for RV (CA1 to CA4) and RNFL thickness. Pair-wise comparisons were conducted. Artifacts rates were determined. RESULTS Mean age was 62.7±15.4 years, and 47.8% (86/180) were male. Among RV measurements, best diagnostic performances were for the smallest 2 annuli for inferior RV (CA1: 0.964, CA2: 0.955). Of the 4 annuli, CA1 had the highest diagnostic performance. Of specific regions, the inferior RV quadrant had the highest performance across CA1 to CA4. Peripapillary RV had similar diagnostic capability compared with RNFL thickness (P>0.05). The artifact rate per B-scan for RV was 6.0%, which was significantly lower compared with 2-dimensional RNFL thickness in the same patient population (32.2%, P<0.0001). CONCLUSIONS The diagnostic capability of RV is similar to RNFL thickness for perimetric open-angle glaucoma, but RV had fewer artifacts compared with RNFL thickness.
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Mendez-Hernandez C, Wang S, Arribas-Pardo P, Salazar-Quiñones L, Güemes-Villahoz N, Fernandez-Perez C, Garcia-Feijoo J. Diagnostic validity of optic nerve head colorimetric assessment and optical coherence tomography angiography in patients with glaucoma. Br J Ophthalmol 2020; 105:957-963. [PMID: 32703781 PMCID: PMC8237198 DOI: 10.1136/bjophthalmol-2020-316455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/07/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
Background/Aims The aim of this study was to assess the optic nerve head (ONH) and macular vessel density with optical coherence tomography angiography (OCT-A) and the ONH haemoglobin (ONH Hb) amount with Laguna ONhE program in open-angle glaucoma (OAG) patients. Methods In this prospective observational cross-sectional study, 67 OAG patients and 41 healthy age-sex frequency matched subjects were examined with OCT-A and retinal photos. The circumpapillary (wcpVD), optic nerve head (iVD) and macular (wmVD) capillary vessel density of OCT-A and ONH colorimetric assessment to determine the ONH Hb amount using the Laguna ONhE program were evaluated. Results Significant differences between normal subjects and glaucoma patients in the wcpVD (22.18±3.42 vs 16.03±2.89%; p<0.001), iVD (18.31±5.56 vs 12.52±4.67%; p<0.001), wmVD (15.60±2.34 vs 13.34±2.32%; p<0.001) and amount of ONH Hb (71.10±1.67 vs 68.86±2.46%; p<0.001) and in the papillary cup (68.14±5.25 vs 64.77±5.08%; p=0.001) were found. The Laguna ONhE glaucoma discriminant function (GDF) index had a negative value in the OAG patients and normal values in healthy subjects (−18.76±13.31 vs 7.98±14.09; p<0.001). The area under the receiver operating characteristic (ROC) curve (AUROC) for discriminating between healthy and glaucomatous eyes was highest for wcpVD (0.93; 95% CI 0.86 to 0.97, p<0.0001), followed by GDF (0.92; 95% CI 0.86 to 0.97, p<0.0001), iVD (0.79; 95% CI 0.70 to 0.86; p<0.0001) and ONH Hb (0.78; 95% CI 0.69 to 0.85, p<0.0001). Pair wise comparisons showed that the AUROC of wcpVD (0.93) was not significantly different than GDF (0.92) (p=0.855). Conclusion Laguna ONhE program and OCT-A have similar diagnostic validity in open-angle glaucoma patients.
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Affiliation(s)
- Carmen Mendez-Hernandez
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain .,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain.,OFTARED, Madrid, Spain
| | - Surina Wang
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | | | - Liseth Salazar-Quiñones
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | - Noemi Güemes-Villahoz
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain
| | - Cristina Fernandez-Perez
- Medicina Preventiva, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Julian Garcia-Feijoo
- Ophthalmology, Hospital Universitario Clinico San Carlos, Madrid, Spain.,Inmunología, Oftalmología y ORL, Facultad de Medicina., Universidad Complutense, Madrid, Spain.,OFTARED, Madrid, Spain
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Park K, Kim J, Lee J. A deep learning approach to predict visual field using optical coherence tomography. PLoS One 2020; 15:e0234902. [PMID: 32628672 PMCID: PMC7337305 DOI: 10.1371/journal.pone.0234902] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 06/04/2020] [Indexed: 11/01/2022] Open
Abstract
We developed a deep learning architecture based on Inception V3 to predict visual field using optical coherence tomography (OCT) imaging and evaluated its performance. Two OCT images, macular ganglion cell-inner plexiform layer (mGCIPL) and peripapillary retinal nerve fibre layer (pRNFL) thicknesses, were acquired and combined. A convolutional neural network architecture was constructed to predict visual field using this combined OCT image. The root mean square error (RMSE) between the actual and predicted visual fields was calculated to evaluate the performance. Globally (the entire visual field area), the RMSE for all patients was 4.79 ± 2.56 dB, with 3.27 dB and 5.27 dB for the normal and glaucoma groups, respectively. The RMSE of the macular region (4.40 dB) was higher than that of the peripheral region (4.29 dB) for all subjects. In normal subjects, the RMSE of the macular region (2.45 dB) was significantly lower than that of the peripheral region (3.11 dB), whereas in glaucoma subjects, the RMSE was higher (5.62 dB versus 5.03 dB, respectively). The deep learning method effectively predicted the visual field 24-2 using the combined OCT image. This method may help clinicians determine visual fields, particularly for patients who are unable to undergo a physical visual field exam.
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Affiliation(s)
- Keunheung Park
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jinmi Kim
- Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jiwoong Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- * E-mail:
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Visualizing the Consistency of Clinical Characteristics that Distinguish Healthy Persons, Glaucoma Suspect Patients, and Manifest Glaucoma Patients. ACTA ACUST UNITED AC 2020; 3:274-287. [DOI: 10.1016/j.ogla.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 11/18/2022]
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Yang H, Luo H, Hardin C, Wang Y, Jeoung JW, Albert C, Vianna JR, Sharpe GP, Reynaud J, Demirel S, Mansberger SL, Fortune B, Nicolela M, Gardiner SK, Chauhan BC, Burgoyne CF. Optical Coherence Tomography Structural Abnormality Detection in Glaucoma Using Topographically Correspondent Rim and Retinal Nerve Fiber Layer Criteria. Am J Ophthalmol 2020; 213:203-216. [PMID: 31899204 PMCID: PMC7214190 DOI: 10.1016/j.ajo.2019.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE This study evaluated the ability of topographically correspondent (TC) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) criteria to detect optical coherence tomography (OCT) structural abnormality in glaucoma (GL) and glaucoma suspect (GLS) eyes. DESIGN Retrospective cross-sectional study. METHODS A total of 196 GL eyes, 150 GLS eyes, and 303 heathy eyes underwent pRNFL and 24 radial optic nerve head OCT imaging and manual correction of the internal limiting membrane, Bruch's membrane opening (BMO), and outer pRNFL segmentations. MRW and pRNFLT were quantified in 6 Garway-Heath or 12 30-degree (clock-hour) sectors. OCT abnormality for each parameter was defined to be less than the 5th percentile of the healthy eye distribution. OCT abnormality for individual eyes was defined using global, sectoral, and combined parameter criteria that achieved ≥95% specificity in the healthy eyes. TC combination criteria required the sectoral location of MRW and pRNFLT abnormality to be topographically aligned and included comMR (a previously reported TC combination consisting of MRW and pRNFLT parameter: [MRW + pRNFLT × (average MRW healthy eyes/average pRNFLT healthy eyes) MRW]. RESULTS TC sectoral criteria (1 Garway-Heath MRW + corresponding Garway-Heath RNFLT), (one 30-degree MRW + any 1 corresponding or adjacent 30-degree pRNFLT), 30-degree and Garway-Heath comMR-TI and global comMR were the best performing criteria, demonstrating (96%-99% specificity), 86%-91% sensitivity for GL, 80%-84% sensitivity for early GL (MD ≥ -4.0 dB) and 93%-96% sensitivity for moderate-to-advanced GL (MD < -4.0 dB). CONCLUSIONS Clinically intuitive TC MRW and pRNFLT combination criteria identified the sectoral location of OCT abnormality in GL eyes with high diagnostic precision.
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Affiliation(s)
- Hongli Yang
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Haomin Luo
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Department of Ophthalmology, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Christy Hardin
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Yaxing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, Beijing, China
| | - Jin Wook Jeoung
- Department of Ophthalmology, Medical College, the Catholic University of Korea, Seoul, South Korea
| | - Cindy Albert
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Jayme R Vianna
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glen P Sharpe
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Juan Reynaud
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Shaban Demirel
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Steven L Mansberger
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Marcelo Nicolela
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stuart K Gardiner
- Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA
| | - Balwantray C Chauhan
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Claude F Burgoyne
- Optic Nerve Head Research Laboratory, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA; Discoveries in Sight Research Laboratories, Devers Eye Institute, Legacy Research Institute, Portland, Oregon, USA.
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Hou TY, Kuang TM, Ko YC, Chang YF, Liu CJL, Chen MJ. Optic Disc and Macular Vessel Density Measured by Optical Coherence Tomography Angiography in Open-Angle and Angle-Closure Glaucoma. Sci Rep 2020; 10:5608. [PMID: 32221379 PMCID: PMC7101395 DOI: 10.1038/s41598-020-62633-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/11/2020] [Indexed: 12/22/2022] Open
Abstract
There is distinct pathogenesis between primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Although elevated intraocular pressure (IOP) is the major risk factor for glaucoma, non-IOP risk factors such as vascular abnormalities and lower systolic/diastolic perfusion pressure may play a role in the pathogenic process. This study aimed to compare the vessel density (VD) in the optic disc and macula using optical coherence tomography angiography (OCTA) between POAG and PACG eyes. Thirty-two POAG eyes, 30 PACG eyes, and 39 control eyes were included. All the optic disc VD parameters except the inside disc VD were significantly lower in glaucomatous eyes than in control eyes. Compared with PACG eyes, only the inferior temporal peripapillary VD was significantly lower in POAG eyes. The parafoveal VD was significantly lower in each quadrant in glaucomatous eyes than in control eyes. The central macular and parafoveal VD did not differ between POAG and PACG eyes. In conclusion, the inferior temporal peripapillary VD was significantly reduced in POAG eyes compared with PACG eyes, while PACG eyes showed a more evenly distributed reduction in the peripapillary VD. The distinct patterns of VD change may be associated with the different pathogenesis between POAG and PACG.
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Affiliation(s)
- Tzu-Yu Hou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tung-Mei Kuang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Fan Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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Optical Coherence Tomography Angiography of Optic Disc in Eyes With Primary Open-angle Glaucoma and Normal-tension Glaucoma. J Glaucoma 2020; 28:243-251. [PMID: 30624391 DOI: 10.1097/ijg.0000000000001184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To examine vessel density (VD) properties of the optic nerve head in eyes with ocular hypertension (OHT), high-tension glaucoma (HTG), and normal-tension glaucoma (NTG) and to evaluate associations on structural parameters of retinal nerve fiber layer (RNFL). METHODS Three groups of patients with OHT (n=15), HTG (n=36), and NTG (n=22), and a healthy control group (n=23) were included in this study. Peripapillary VD and optic disc flow area were measured using optical coherence tomography angiography, and peripapillary RNFL (pRNFL) thickness was determined. Global and sectoral analysis of optic nerve head vasculature and pRNFL thickness were measured. RESULTS Glaucomatous eyes had lower global peripapillary VD (HTG: 54.04±5.11, NTG: 54.74±6.37) compared with nonglaucomatous eyes (OHT: 59.72±1.63, controls: 61.35±2.47). VD parameters of the optic disc were comparable between the control and OHT group and between the HTG and NTG group. In the HTG and NTG groups we found significant correlations between average peripapillary VD and global pRNFL thickness (HTG ρ=0.71, P<0.001; NTG ρ=0.65, P=0.001). This was true for all sectors except for the temporal position. CONCLUSIONS Overall, glaucomatous eyes had lower peripapillary VD compared with normal and OHT eyes. There is a strong relationship between the peripapillary structure of RNFL and its vasculature.
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Monitoring Glaucomatous Functional Loss Using an Artificial Intelligence-Enabled Dashboard. Ophthalmology 2020; 127:1170-1178. [PMID: 32317176 DOI: 10.1016/j.ophtha.2020.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 03/03/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To develop an artificial intelligence (AI) dashboard for monitoring glaucomatous functional loss. DESIGN Retrospective, cross-sectional, longitudinal cohort study. PARTICIPANTS Of 31 591 visual fields (VFs) on 8077 subjects, 13 231 VFs from the most recent visit of each patient were included to develop the AI dashboard. Longitudinal VFs from 287 eyes with glaucoma were used to validate the models. METHOD We entered VF data from the most recent visit of glaucomatous and nonglaucomatous patients into a "pipeline" that included principal component analysis (PCA), manifold learning, and unsupervised clustering to identify eyes with similar global, hemifield, and local patterns of VF loss. We visualized the results on a map, which we refer to as an "AI-enabled glaucoma dashboard." We used density-based clustering and the VF decomposition method called "archetypal analysis" to annotate the dashboard. Finally, we used 2 separate benchmark datasets-one representing "likely nonprogression" and the other representing "likely progression"-to validate the dashboard and assess its ability to portray functional change over time in glaucoma. MAIN OUTCOME MEASURES The severity and extent of functional loss and characteristic patterns of VF loss in patients with glaucoma. RESULTS After building the dashboard, we identified 32 nonoverlapping clusters. Each cluster on the dashboard corresponded to a particular global functional severity, an extent of VF loss into different hemifields, and characteristic local patterns of VF loss. By using 2 independent benchmark datasets and a definition of stability as trajectories not passing through over 2 clusters in a left or downward direction, the specificity for detecting "likely nonprogression" was 94% and the sensitivity for detecting "likely progression" was 77%. CONCLUSIONS The AI-enabled glaucoma dashboard, developed using a large VF dataset containing a broad spectrum of visual deficit types, has the potential to provide clinicians with a user-friendly tool for determination of the severity of glaucomatous vision deficit, the spatial extent of the damage, and a means for monitoring the disease progression.
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Tai TY, Ko YC, Chang YF, Liu CJL, Chen MJ. Diagnostic utility of neuroretinal rim thickness, measured in clock-hour sectors with HD optical coherence tomography, in preperimetric glaucoma. J Chin Med Assoc 2020; 83:307-312. [PMID: 31972833 DOI: 10.1097/jcma.0000000000000257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We evaluated the usefulness of neuroretinal rim (NRR) thicknesses, measured in clock-hour sectors with Cirrus HD optical coherence tomography, for diagnosing preperimetric glaucoma (PPG). METHODS This prospective study included 39 eyes of 39 patients with PPG and 39 eyes of 39 controls that were matched to patients for age and refractive error. We measured the circumpapillary retinal nerve fiber layer (cpRNFL) thickness, macular ganglion cell-inner plexiform layer (GCIPL) thickness, and optic nerve head (ONH) parameters with optical coherence tomography. The clock-hour NRR thicknesses were derived from a 360° circumferential rim thickness curve. We analyzed the area under the receiver operating characteristics curve (AUROC), cutoff values, and sensitivities at specificities of 90% and 95%. RESULTS The largest area under the receiver operating characteristics curves were observed for the NRR thickness at 6 o'clock (0.823), the inferior RNFL thickness (0.821), the average RNFL thickness (0.819), and the NRR thickness at 7 o'clock (0.818). The performance of the NRR thickness at 6 o'clock was comparable to the best performances of the cpRNFL, GCIPL, and ONH parameters (all p > 0.05). CONCLUSION The ability of the clock-hour NRR thickness assessment to diagnose PPG was comparable to the diagnostic abilities of cpRNFL, GCIPL, and ONH parameters. The best indicator of PPG was the NRR thickness parameter that was at 6 o'clock. This finding could play a role in detecting early structural changes in PPG.
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Affiliation(s)
- Tzu-Yang Tai
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Ophthalmology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Fan Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Ophthalmology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Ophthalmology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Tham YC, Chee ML, Dai W, Lim ZW, Majithia S, Siantar R, Thakur S, Rim T, Cheung CY, Sabanayagam C, Aung T, Wong TY, Cheng CY. Profiles of Ganglion Cell-Inner Plexiform Layer Thickness in a Multi-Ethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study. Ophthalmology 2020; 127:1064-1076. [PMID: 32197910 DOI: 10.1016/j.ophtha.2020.01.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/31/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To examine the normative profile and determinants of macular ganglion cell-inner plexiform layer (GCIPL) thickness based on spectral-domain OCT (SD-OCT) in a nonglaucoma, multi-ethnic Asian population. DESIGN Population-based, cross-sectional study. PARTICIPANTS Ethnic Chinese, Malay, and Indian adults aged ≥40 years recruited from the Singapore Epidemiology of Eye Diseases Study. METHODS All participants underwent standardized examinations. The GCIPL thickness was measured using Cirrus HD-OCT (Carl Zeiss Meditec, Dublin, CA). Participants with glaucoma or poor-quality scans were excluded. Eye-specific data were used. Associations of ocular and systemic factors with GCIPL thickness parameters were investigated using multivariable linear regression with generalized estimating equation models to account for correlation between both eyes. MAIN OUTCOME MEASURES GCIPL thickness. RESULTS A total of 4464 participants (7520 eyes) consisting of 1625 Chinese, 1212 Malay, and 1627 Indian adults contributed to this analysis. Average GCIPL thickness was 82.6±6.1 μm in Chinese, 81.5±6.8 μm in Malays, and 78.0±6.9 μm in Indians (P < 0.001 by analysis of variance). The 5th percentile limit of average GCIPL thickness was 72 μm in Chinese, 70 μm in Malays, and 67 μm in Indians. In multivariable analysis adjusting for age, gender, axial length, presence of cataract, OCT signal strength, disc area, hypertension, diabetes, and hyperlipidemia, eyes of Indians were observed to have 3.43 μm thinner GCIPL on average compared with Chinese (P < 0.001) and 3.36 μm thinner GCIPL compared with Malays (P < 0.001). In addition, older age (per decade; β = -2.51), female (β = -1.57), longer axial length (per mm; β = -1.54), and presence of chronic kidney disease (β = -1.49) were significantly associated with thinner average GCIPL (all P ≤ 0.008). Larger optic disc area (per mm2; β = 0.78; P < 0.001) was associated with thicker GCIPL. These factors were consistently observed to be significant for superior and inferior hemisphere GCIPL thickness. CONCLUSIONS GCIPL thickness profiles were significantly thinner in Indians compared with Chinese and Malays. Our findings further highlight the need of a more refined, ethnic-specific normative database for GCIPL thickness, which in turn may improve the detection and diagnosis of glaucoma in Asians.
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Affiliation(s)
- Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Wei Dai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Zhi Wei Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tyler Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Lee EJ, Han JC, Park DY, Kee C. A neuroglia-based interpretation of glaucomatous neuroretinal rim thinning in the optic nerve head. Prog Retin Eye Res 2020; 77:100840. [PMID: 31982595 DOI: 10.1016/j.preteyeres.2020.100840] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Neuroretinal rim thinning (NRR) is a characteristic glaucomatous optic disc change. However, the precise mechanism of the rim thinning has not been completely elucidated. This review focuses on the structural role of the glioarchitecture in the formation of the glaucomatous NRR thinning. The NRR is a glia-framed structure, with honeycomb geometry and mechanically reinforced astrocyte processes along the transverse plane. When neural damage selectively involves the neuron and spares the glia, the gross structure of the tissue is preserved. The disorganization and loss of the glioarchitecture are the two hallmarks of optic nerve head (ONH) remodeling in glaucoma that leads to the thinning of NRR tissue upon axonal loss. This is in contrast to most non-glaucomatous optic neuropathies with optic disc pallor where hypertrophy of the glioarchitecture is associated with the seemingly absent optic disc cupping. Arteritic anterior ischemic optic neuropathy is an exception where pan-necrosis of ONH tissue leads to NRR thinning. Milder ischemia indicates selective neuronal loss that spares glia in non-arteritic anterior ischemic optic neuropathy. The biological reason is the heterogeneous glial response determined by the site, type, and severity of the injury. The neuroglial interpretation explains how the cellular changes underlie the clinical findings. Updated understandings on glial responses illustrate the mechanical, microenvironmental, and microglial modulation of activated astrocytes in glaucoma. Findings relevant to the possible mechanism of the astrocyte death in advanced glaucoma are also emerging. Ultimately, a better understanding of glaucomatous glial response may lead to glia-targeting neuroprotection in the future.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
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Lee EJ, Han JC, Park DY, Kee C. Difference in Topographic Pattern of Prelaminar and Neuroretinal Rim Thinning Between Nonarteritic Anterior Ischemic Optic Neuropathy and Glaucoma. Invest Ophthalmol Vis Sci 2019; 60:2461-2467. [PMID: 31163088 DOI: 10.1167/iovs.19-26891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the local distribution of prelaminar and neuroretinal rim (NRR) thickness between eyes with nonarteritic anterior ischemic optic neuropathy (NAION) and normal tension glaucoma (NTG) using enhanced depth imaging spectral-domain optical coherence tomography (OCT). Methods This cross-sectional study included pairs of NAION and NTG patients, and controls. We measured the central prelaminar thickness; Bruch's membrane opening (BMO)-horizontal (HRW), minimal (MRW), and vertical rim widths (VRW), and vertical/horizontal thicknesses at knee of curve at rising curvature of the cup wall. HV ratio was calculated as BMO-HRW/BMO-VRW. The six thicknesses and their differences were compared. Results We had 12 pairs, with comparable visual field loss and retinal nerve fiber layer (RNFL) thickness between NAION and NTG. Within the optic nerve head (ONH), BMO-MRW, BMO-HRW, horizontal width at the knee of curve, and central prelaminar tissue showed significantly larger values in NAION compared to NTG (P < 0.05). The difference of NRR thickness between NAION and NTG increased in a centripetal manner, being maximum at the knee of curve. The mean HV ratio was 1.63 in NAION, 0.83 in NTG, and 1.06 in controls (P < 0.001). OCT showed disproportionately less altered prelaminar tissue in NAION. Conclusions NAION and NTG showed significantly different distributions of prelaminar and NRR tissue thicknesses despite similar RNFL thicknesses, with the maximal difference being the horizontal cup wall thickness at the knee of curve. Sparing of prelaminar tissue loss characterized the ONH in NAION. OCT might aid in differential diagnosis based on local variation in thinning patterns.
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Affiliation(s)
- Eun Jung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Young Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ling YTT, Shi R, Midgett DE, Jefferys JL, Quigley HA, Nguyen TD. Characterizing the Collagen Network Structure and Pressure-Induced Strains of the Human Lamina Cribrosa. Invest Ophthalmol Vis Sci 2019; 60:2406-2422. [PMID: 31157833 PMCID: PMC6545820 DOI: 10.1167/iovs.18-25863] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The purpose of this study was to measure the 2D collagen network structure of the human lamina cribrosa (LC), analyze for the correlations with age, region, and LC size, as well as the correlations with pressure-induced strains. Methods The posterior scleral cups of 10 enucleated human eyes with no known ocular disease were subjected to ex vivo inflation testing from 5 to 45 mm Hg. The optic nerve head was imaged by using second harmonic generation imaging (SHG) to identify the LC collagen structure at both pressures. Displacements and strains were calculated by using digital volume correlation of the SHG volumes. Nine structural features were measured by using a custom Matlab image analysis program, including the pore area fraction, node density, and beam connectivity, tortuosity, and anisotropy. Results All strain measures increased significantly with higher pore area fraction, and all but the radial-circumferential shear strain (Erθ) decreased with higher node density. The maximum principal strain (Emax) and maximum shear strain (Γmax) also increased with larger beam aspect ratio and tortuosity, respectively, and decreased with higher connectivity. The peripheral regions had lower node density and connectivity, and higher pore area fraction, tortuosity, and strains (except for Erθ) than the central regions. The peripheral nasal region had the lowest Emax, Γmax, radial strain, and pore area fraction. Conclusions Features of LC beam network microstructure that are indicative of greater collagen density and connectivity are associated with lower pressure-induced LC strain, potentially contributing to resistance to glaucomatous damage.
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Affiliation(s)
- Yik Tung Tracy Ling
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Ran Shi
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States.,Department of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Dan E Midgett
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Joan L Jefferys
- Wilmer Ophthalmological Institute, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Harry A Quigley
- Wilmer Ophthalmological Institute, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Thao D Nguyen
- Department of Mechanical Engineering, The Johns Hopkins University, Baltimore, Maryland, United States
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Keel S, Wu J, Lee PY, Scheetz J, He M. Visualizing Deep Learning Models for the Detection of Referable Diabetic Retinopathy and Glaucoma. JAMA Ophthalmol 2019; 137:288-292. [PMID: 30570648 DOI: 10.1001/jamaophthalmol.2018.6035] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Convolutional neural networks have recently been applied to ophthalmic diseases; however, the rationale for the outputs generated by these systems is inscrutable to clinicians. A visualization tool is needed that would enable clinicians to understand important exposure variables in real time. Objective To systematically visualize the convolutional neural networks of 2 validated deep learning models for the detection of referable diabetic retinopathy (DR) and glaucomatous optic neuropathy (GON). Design, Setting, and Participants The GON and referable DR algorithms were previously developed and validated (holdout method) using 48 116 and 66 790 retinal photographs, respectively, derived from a third-party database (LabelMe) of deidentified photographs from various clinical settings in China. In the present cross-sectional study, a random sample of 100 true-positive photographs and all false-positive cases from each of the GON and DR validation data sets were selected. All data were collected from March to June 2017. The original color fundus images were processed using an adaptive kernel visualization technique. The images were preprocessed by applying a sliding window with a size of 28 × 28 pixels and a stride of 3 pixels to crop images into smaller subimages to produce a feature map. Threshold scales were adjusted to optimal levels for each model to generate heat maps highlighting localized landmarks on the input image. A single optometrist allocated each image to predefined categories based on the generated heat map. Main Outcomes and Measures Visualization regions of the fundus. Results In the GON data set, 90 of 100 true-positive cases (90%; 95% CI, 82%-95%) and 15 of 22 false-positive cases (68%; 95% CI, 45%-86%) displayed heat map visualization within regions of the optic nerve head only. Lesions typically seen in cases of referable DR (exudate, hemorrhage, or vessel abnormality) were identified as the most important prognostic regions in 96 of 100 true-positive DR cases (96%; 95% CI, 90%-99%). In 39 of 46 false-positive DR cases (85%; 95% CI, 71%-94%), the heat map displayed visualization of nontraditional fundus regions with or without retinal venules. Conclusions and Relevance These findings suggest that this visualization method can highlight traditional regions in disease diagnosis, substantiating the validity of the deep learning models investigated. This visualization technique may promote the clinical adoption of these models.
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Affiliation(s)
- Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jinrong Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Pei Ying Lee
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jane Scheetz
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
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Reduced Retinal Vessel Density in Primary Angle Closure Glaucoma: A Quantitative Study Using Optical Coherence Tomography Angiography. J Glaucoma 2019; 27:322-327. [PMID: 29419642 DOI: 10.1097/ijg.0000000000000900] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article is to investigate the changes in the retinal vasculature in different parts of the fundus in eyes with primary angle closure glaucoma (PACG). METHODS Healthy subjects and those with PACG were enrolled. Optical coherence tomography and a split-spectrum amplitude decorrelation angiography algorithm were used to quantify the retinal vessel densities in the parafoveal and peripapillary areas. RESULTS Thirty-nine eyes from 24 PACG patients and 39 eyes from 20 age-matched and sex-matched healthy subjects were included. The retinal vessel densities in the parafoveal and peripapillary areas and every sector of the 2 areas were significantly lower in the PACG eyes than in the healthy eyes. The difference was greater in the peripapillary area (11.75%) than in the parafoveal area (7.55%, P<0.05). In the PACG eyes, the vessel density in the peripapillary area correlated closely with the intraocular pressure, but that in the parafoveal area did not. When the PACG eyes were divided into groups with well-controlled and not well-controlled intraocular pressure (≤21 mm Hg or not), the vessel density and retinal nerve fiber layer thickness in the peripapillary area were much lower in the not well-controlled eyes (P<0.05), whereas the vessel density in the parafovea and the ganglion cell complex thickness were similar in the 2 subgroups. CONCLUSION Retinal vessel density was significantly reduced in PACG eyes. The magnitude of this difference varied between the fundus areas, and was greater in the peripapillary area.
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A Sectoral Analysis of Vessel Density Measurements in Perimetrically Intact Regions of Glaucomatous Eyes: An Optical Coherence Tomography Angiography Study. J Glaucoma 2019; 27:525-531. [PMID: 29557826 DOI: 10.1097/ijg.0000000000000950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To study sectoral vessel density (VD) and structural alterations in the peripapillary and parafoveal hemiretina corresponding to perimetrically intact regions of glaucomatous eyes with hemifield defects and to compare these with healthy eyes using optical coherence tomography. METHODS This cross-sectional study included 37 eyes with open-angle glaucoma having visual fields defects restricted to 1 hemifield and 45 age-matched controls. Peripapillary VD and retinal nerve fiber layer (RNFL) thickness were measured in 8 sectors. Parafoveal VD and ganglion cell complex thickness were measured in the superior and inferior hemispheres of the macula. These parameters were compared between the intact hemiretinae of glaucomatous eyes and corresponding sectors of healthy eyes using the t test. RESULTS Within the perimetrically intact regions of glaucomatous eyes, the mean VD and RNFL thickness were significantly reduced in inferotemporal, superonasal, and nasal upper peripapillary sectors as compared with healthy eyes (P<0.008). The temporal upper sector had reduced mean VD (60.3% vs. 62.9%, P=0.04) despite similar mean RNFL thickness (P=0.18). The superotemporal sector had decreased mean RNFL thickness (121 vs. 138 µm, P=0.0001) despite similar VD (P=0.06). At the macula, ganglion cell complex thickness was reduced in the superior and inferior hemispheres, but mean VD was reduced in the superior parafoveal region only. CONCLUSIONS Peripapillary and parafoveal vascular changes precede functional decline. The extent of VD reduction and RNFL thinning varies in different peripapillary sectors and longitudinal studies are required to better understand the temporal relationship of vascular and RNFL loss.
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Lee YP, Ro JW, Yi K, Choi DG. ISNT rule satisfaction in Korean non-glaucomatous subjects. Eur J Ophthalmol 2019; 31:125-129. [PMID: 31530190 DOI: 10.1177/1120672119876824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the efficacy of the ISNT rule in normal eyes of Koreans. METHODS We retrospectively reviewed medical records of 890 subjects with fundus photographs and evaluated the presence of the cup and ISNT rule satisfaction. If the ISNT rule was violated, the quadrants in which the neuroretinal rim was thinnest and thickest, respectively, were evaluated. RESULTS Among 890 eyes, 84.7% showed the cup. The subjects without the cup were significantly younger and more hyperopic. Among 754 eyes with the cup, 53.5% showed ISNT rule satisfaction. In 351 eyes violating the ISNT rule, the most common quadrant showing the thickest neuroretinal rim was the inferior (65.5%), and the thinnest, the temporal (98.3%). CONCLUSION The cup was absent in 15% of the assessed eyes. Only about half of eyes with the cup showed ISNT rule satisfaction. Even in eyes violating ISNT rule, the inferior was the most common quadrant with the thickest neuroretinal rim and the temporal, the thinnest.
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Affiliation(s)
- Yoon Pyo Lee
- Department of Ophthalmology, Chung-Yang-gun Medical Center, Chungcheongnam-do, South Korea
| | - Jin Woo Ro
- Department of Physical Examination Division, Gyeong-In Regional Military Manpower Administration, Suwon, South Korea
| | - Kayoung Yi
- Department of Ophthalmology, College of Medicine and Kangnam Sacred Heart Hospital, Hallym University, Seoul, South Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, College of Medicine and Kangnam Sacred Heart Hospital, Hallym University, Seoul, South Korea
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