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Guo PY, Zhang X, Li F, Lin C, Nguyen A, Sakata R, Higashita R, Okamoto K, Yu M, Aihara M, Aung T, Lin S, Leung CKS. Diagnostic criteria of anterior segment swept-source optical coherence tomography to detect gonioscopic angle closure. Br J Ophthalmol 2024:bjo-2023-323860. [PMID: 38594062 DOI: 10.1136/bjo-2023-323860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 11/27/2023] [Indexed: 04/11/2024]
Abstract
AIMS To compare the diagnostic performance of 360° anterior segment optical coherence tomography assessment by applying normative percentile cut-offs versus iris trabecular contact (ITC) for detecting gonioscopic angle closure. METHODS In this multicentre study, 394 healthy individuals were included in the normative dataset to derive the age-specific and angle location-specific normative percentiles of angle open distance (AOD500) and trabecular iris space area (TISA500) which were measured every 10° for 360°. 119 healthy participants and 170 patients with angle closure by gonioscopy were included in the test dataset to investigate the diagnostic performance of three sets of criteria for detection of gonioscopic angle closure: (1) the 10th and (2) the 5th percentiles of AOD500/TISA500, and (3) ITC (ie, AOD500/TISA500=0 mm/mm2). The number of angle locations with angle closure defined by each set of the criteria for each eye was used to generate the receiver operating characteristic (ROC) curve for the discrimination between gonioscopic angle closure and open angle. RESULTS Of the three sets of diagnostic criteria examined, the area under the ROC curve was greatest for the 10th percentile of AOD500 (0.933), whereas the ITC criterion AOD500=0 mm showed the smallest area under the ROC (0.852) and the difference was statistically significant with or without adjusting for age and axial length (p<0.001). The criterion ≥90° of AOD500 below the 10th percentile attained the best sensitivity 87.6% and specificity 84.9% combination for detecting gonioscopic angle closure. CONCLUSIONS Applying the normative percentiles of angle measurements yielded a higher diagnostic performance than ITC for detecting angle closure on gonioscopy.
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Affiliation(s)
- Philip Yawen Guo
- Department of Ophthalmology, The University of Hong Kong, Pok Fu Lam, People's Republic of China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Chen Lin
- Shenzhen Aier Eye Hospital, Shenzhen, China
| | - Anwell Nguyen
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Rei Sakata
- Ophthalmology, The University of Tokyo, Bunkyo-ku, Japan
| | | | | | - Marco Yu
- Singapore Eye Research Institute, Singapore
| | - Makoto Aihara
- Ophthalmology, Tokyo Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Tokyo, Japan
| | - Tin Aung
- Glaucoma, Singapore National Eye Centre, Singapore
| | - Shan Lin
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
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Mathew DJ, Sivak JM. Lipid mediators in glaucoma: Unraveling their diverse roles and untapped therapeutic potential. Prostaglandins Other Lipid Mediat 2024; 171:106815. [PMID: 38280539 DOI: 10.1016/j.prostaglandins.2024.106815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Glaucoma is a complex neurodegenerative disease characterized by optic nerve damage and visual field loss, and remains a leading cause of irreversible blindness. Elevated intraocular pressure (IOP) is a critical risk factor that requires effective management. Emerging research underscores dual roles of bioactive lipid mediators in both IOP regulation, and the modulation of neurodegeneration and neuroinflammation in glaucoma. Bioactive lipids, encompassing eicosanoids, specialized pro-resolving mediators (SPMs), sphingolipids, and endocannabinoids, have emerged as crucial players in these processes, orchestrating inflammation and diverse effects on aqueous humor dynamics and tissue remodeling. Perturbations in these lipid mediators contribute to retinal ganglion cell loss, vascular dysfunction, oxidative stress, and neuroinflammation. Glaucoma management primarily targets IOP reduction via pharmacological agents and surgical interventions, with prostaglandin analogues at the forefront. Intriguingly, additional lipid mediators offer promise in attenuating inflammation and providing neuroprotection. Here we explore these pathways to shed light on their intricate roles, and to unveil novel therapeutic avenues for glaucoma management.
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Affiliation(s)
- D J Mathew
- Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Ophthalmology and Vision Science, University of Toronto School of Medicine, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto School of Medicine, Toronto, Canada
| | - J M Sivak
- Donald K Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Ophthalmology and Vision Science, University of Toronto School of Medicine, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto School of Medicine, Toronto, Canada.
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Yuan Y, Xiong R, Wang W, Xu BY, Liao C, Yang S, Li C, Zhang J, Yin Q, Zheng Y, Friedman DS, Foster PJ, He M. Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect. JAMA Ophthalmol 2024; 142:216-223. [PMID: 38236591 PMCID: PMC10797526 DOI: 10.1001/jamaophthalmol.2023.5286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 01/19/2024]
Abstract
Importance Identifying primary angle closure suspect (PACS) eyes at risk of angle closure is crucial for its management. However, the risk of progression and its prediction are still understudied in long-term longitudinal studies about PACS. Objective To explore baseline predictors and develop prediction models for the 14-year risk of progression from PACS to primary angle closure (PAC). Design, Setting, and Participants This cohort study involved participants from the Zhongshan Angle Closure Prevention trial who had untreated eyes with PACS. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under both light and dark conditions. Primary angle closure was defined as peripheral anterior synechiae in 1 or more clock hours, intraocular pressure (IOP) greater than 24 mm Hg, or acute angle closure. Based on baseline covariates, logistic regression models were built to predict the risk of progression from PACS to PAC during 14 years of follow-up. Results The analysis included 377 eyes from 377 patients (mean [SD] patient age at baseline, 58.28 [4.71] years; 317 females [84%]). By the 14-year follow-up visit, 93 eyes (25%) had progressed from PACS to PAC. In multivariable models, higher IOP (odds ratio [OR], 1.14 [95% CI, 1.04-1.25] per 1-mm Hg increase), shallower central anterior chamber depth (ACD; OR, 0.81 [95% CI, 0.67-0.97] per 0.1-mm increase), and shallower limbal ACD (OR, 0.96 [95% CI, 0.93-0.99] per 0.01 increase in peripheral corneal thickness) at baseline were associated with an increased 14-year risk of progression from PACS to PAC. As for AS-OCT measurements, smaller light-room trabecular-iris space area (TISA) at 500 μm from the scleral spur (OR, 0.86 [95% CI, 0.77-0.96] per 0.01-mm2 increase), smaller light-room angle recess area (ARA) at 750 μm from the scleral spur (OR, 0.93 [95% CI, 0.88-0.98] per 0.01-mm2 increase), and smaller dark-room TISA at 500 μm (OR, 0.89 [95% CI, 0.80-0.98] per 0.01-mm2 increase) at baseline were identified as predictors for the 14-year risk of progression. The prediction models based on IOP and central and limbal ACDs showed moderate performance (area under the receiver operating characteristic curve, 0.69; 95% CI, 0.63-0.75) in predicting progression from PACS to PAC, and inclusion of AS-OCT metrics did not improve the model's performance. Conclusions and Relevance This cohort study suggests that higher IOP, shallower central and limbal ACDs, and smaller TISA at 500 μm and light-room ARA at 750 μm may serve as baseline predictors for progression to PAC in PACS eyes. Evaluating these factors can aid in customizing PACS management.
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Affiliation(s)
- Yixiong Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ruilin Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China
| | - Benjamin Y. Xu
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Chimei Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Qiuxia Yin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - David S. Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Paul J. Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Experimental Ophthalmology, The Hong Kong Polytechnic University, Hong Kong, China
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Liao C, Quigley H, Jiang Y, Huang S, Huang W, Friedman D, Foster PJ, He M. Iris volume change with physiologic mydriasis to identify development of angle closure: the Zhongshan Angle Closure Prevention Trial. Br J Ophthalmol 2024; 108:366-371. [PMID: 37236768 DOI: 10.1136/bjo-2022-322981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/05/2023] [Indexed: 05/28/2023]
Abstract
AIMS To assess dynamic change of iris area (Iarea) and volume (VOL) with physiologic pupil dilation for progression of primary angle closure suspects. METHODS Participants underwent baseline examinations including gonioscopy and anterior segment OCT (AS-OCT) as part of the Zhongshan Angle Closure Prevention Trial. The AS-OCT images were obtained both in the dark and light. Progression was defined as development of primary angle closure or an acute angle closure attack. Static ocular biometrics and dynamic changes were compared between progressors and non-progressors and multivariable logistic regression was developed to assess risk factors for progression. RESULTS A mean 16.8% decrease in Iarea and a mean 6.26% decrease in VOL occurred with pupil dilation, while 22.96% non-progressors and 40% progressors presented VOL increases with pupil dilation. Iarea in light and dark and VOL in light were significantly smaller in progressors. In a multivariable logistic model, older age (p=0.008), narrower horizontal angle opening distance (AOD) 250 µm from the scleral spur (AOD250, p=0.001), flatter iris curvature (IC, p=0.006) and lower loss of iris volume (ΔVOL, p=0.04) were significantly associated with progression. With receiver operating characteristic analysis, the area under the curve for ΔVOL alone was 0.621, while that for the combined index (age, AOD250, IC and ΔVOL) was 0.824. Eyes with elevated intraocular pressure had less VOL loss compared with progressors developing peripheral anterior synechiae alone (p=0.055 for ΔVOL adjusted for pupil enlargement). CONCLUSION A smaller change in ΔVOL is an additive risk factor to identify eyes more likely to develop angle closure disease. TRIAL REGISTRATION NUMBER ISRCTN45213099.
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Affiliation(s)
- Chimei Liao
- Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, China
| | - Harry Quigley
- Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Yuzhen Jiang
- Ophthalmology, National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Shengsong Huang
- Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
| | - Wenyong Huang
- Ophthalmology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - David Friedman
- Ophthalmology, Harvard University, Boston, Massachusetts, USA
| | - Paul J Foster
- Division of Epidemiology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mingguang He
- Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
- Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Soh ZD, Tan M, Nongpiur ME, Xu BY, Friedman D, Zhang X, Leung C, Liu Y, Koh V, Aung T, Cheng CY. Assessment of angle closure disease in the age of artificial intelligence: A review. Prog Retin Eye Res 2024; 98:101227. [PMID: 37926242 DOI: 10.1016/j.preteyeres.2023.101227] [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: 05/31/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
Primary angle closure glaucoma is a visually debilitating disease that is under-detected worldwide. Many of the challenges in managing primary angle closure disease (PACD) are related to the lack of convenient and precise tools for clinic-based disease assessment and monitoring. Artificial intelligence (AI)- assisted tools to detect and assess PACD have proliferated in recent years with encouraging results. Machine learning (ML) algorithms that utilize clinical data have been developed to categorize angle closure eyes by disease mechanism. Other ML algorithms that utilize image data have demonstrated good performance in detecting angle closure. Nonetheless, deep learning (DL) algorithms trained directly on image data generally outperformed traditional ML algorithms in detecting PACD, were able to accurately differentiate between angle status (open, narrow, closed), and automated the measurement of quantitative parameters. However, more work is required to expand the capabilities of these AI algorithms and for deployment into real-world practice settings. This includes the need for real-world evaluation, establishing the use case for different algorithms, and evaluating the feasibility of deployment while considering other clinical, economic, social, and policy-related factors.
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Affiliation(s)
- Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, 169856, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, 119077, Singapore.
| | - Mingrui Tan
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*Star), 1 Fusionopolis Way, 138632, Singapore.
| | - Monisha Esther Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Programme, Academic Medicine, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
| | - Benjamin Yixing Xu
- Roski Eye Institute, Keck School of Medicine, University of Southern California, 1450 San Pablo St #4400, Los Angeles, CA, 90033, USA.
| | - David Friedman
- Department of Ophthalmology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Massachusetts Eye and Ear, Mass General Brigham, 243 Charles Street, Boston, MA, 02114, USA.
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat Sen University, No. 54 Xianlie South Road, Yuexiu District, Guangzhou, China.
| | - Christopher Leung
- Department of Ophthalmology, School of Clinical Medicine, The University of Hong Kong, Cyberport 4, 100 Cyberport Road, Hong Kong; Department of Ophthalmology, Queen Mary Hospital, 102 Pok Fu Lam Road, Hong Kong.
| | - Yong Liu
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*Star), 1 Fusionopolis Way, 138632, Singapore.
| | - Victor Koh
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, 119077, Singapore; Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228, Singapore.
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Programme, Academic Medicine, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road, 169856, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, 119077, Singapore; Ophthalmology & Visual Sciences Academic Clinical Programme, Academic Medicine, Duke-NUS Medical School, 8 College Road, 169857, Singapore; Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228, Singapore.
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Soh ZD, Tan M, Nongpiur ME, Yu M, Qian C, Tham YC, Koh V, Aung T, Xu X, Liu Y, Cheng CY. Deep Learning-based Quantification of Anterior Segment OCT Parameters. OPHTHALMOLOGY SCIENCE 2024; 4:100360. [PMID: 37869016 PMCID: PMC10587633 DOI: 10.1016/j.xops.2023.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 10/24/2023]
Abstract
Objective To develop and validate a deep learning algorithm that could automate the annotation of scleral spur (SS) and segmentation of anterior chamber (AC) structures for measurements of AC, iris, and angle width parameters in anterior segment OCT (ASOCT) scans. Design Cross-sectional study. Subjects Data from 2 population-based studies (i.e., the Singapore Chinese Eye Study and Singapore Malay Eye Study) and 1 clinical study on angle-closure disease were included in algorithm development. A separate clinical study on angle-closure disease was used for external validation. Method Image contrast of ASOCT scans were first enhanced with CycleGAN. We utilized a heat map regression approach with coarse-to-fine framework for SS annotation. Then, an ensemble network of U-Net, full resolution residual network, and full resolution U-Net was used for structure segmentation. Measurements obtained from predicted SSs and structure segmentation were measured and compared with measurements obtained from manual SS annotation and structure segmentation (i.e., ground truth). Main Outcome Measures We measured Euclidean distance and intraclass correlation coefficients (ICC) to evaluate SS annotation and Dice similarity coefficient for structure segmentation. The ICC, Bland-Altman plot, and repeatability coefficient were used to evaluate agreement and precision of measurements. Results For SS annotation, our algorithm achieved a Euclidean distance of 124.7 μm, ICC ≥ 0.95, and a 3.3% error rate. For structure segmentation, we obtained Dice similarity coefficient ≥ 0.91 for cornea, iris, and AC segmentation. For angle width measurements, ≥ 95% of data points were within the 95% limits-of-agreement in Bland-Altman plot with insignificant systematic bias (all P > 0.12). The ICC ranged from 0.71-0.87 for angle width measurements, 0.54 for IT750, 0.83-0.85 for other iris measurements, and 0.89-0.99 for AC measurements. Using the same SS coordinates from a human expert, measurements obtained from our algorithm were generally less variable than measurements obtained from a semiautomated angle assessment program. Conclusion We developed a deep learning algorithm that could automate SS annotation and structure segmentation in ASOCT scans like human experts, in both open-angle and angle-closure eyes. This algorithm reduces the time needed and subjectivity in obtaining ASOCT measurements. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mingrui Tan
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore
| | - Monisha Esther Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Chaoxu Qian
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Victor Koh
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Xinxing Xu
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore
| | - Yong Liu
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Zhang X, Guo PY, Lin C, Li F, Nguyen A, Sakata R, Higashita R, Okamoto K, Yu M, Aihara M, Aung T, Lin S, Leung CKS. Assessment of Iris Trabecular Contact in Eyes with Gonioscopic Angle-Closure. Ophthalmology 2023; 130:111-119. [PMID: 36652194 DOI: 10.1016/j.ophtha.2022.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/24/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the extent of iris trabecular contact (ITC) measured by anterior segment OCT (AS-OCT) and its association with primary angle-closure (PAC) and PAC glaucoma (PACG) in eyes with gonioscopic angle-closure and to determine the diagnostic performance of ITC for detection of gonioscopic angle-closure. DESIGN Multicenter, prospective study. PARTICIPANTS A total of 119 healthy participants with gonioscopic open-angle and 170 patients with gonioscopic angle-closure (94 with PAC suspect and 76 with PAC/PACG) were included. METHODS One eye of each subject was randomly selected for AS-OCT imaging. Angle-opening distance (AOD500) and trabecular iris space area (TISA500) were measured every 10° for 360°. Two criteria of ITC500 were examined: (1) AOD500 = 0 mm and (2) TISA500 = 0 mm2. The association between the extent of ITC500 and PAC/PACG in eyes with gonioscopic angle-closure was analyzed with logistic regression analysis. MAIN OUTCOME MEASURES Sensitivity and specificity of ITC500 for detection of gonioscopic angle-closure; odds ratio (OR) of PAC/PACG. RESULTS The sensitivity of ITC500 ≥ 10° for detection of gonioscopic angle-closure ranged from 82.4% (AOD500 = 0 mm) to 84.7% (TISA500 = 0 mm2), and the specificity was 85.7% (for both AOD500 = 0 mm and TISA500 = 0 mm2). The extent of ITC500 determined by AS-OCT, not cumulative gonioscopy score (i.e., the sum of the modified Shaffer grades over 4 quadrants), was associated with the odds of PAC/PACG in eyes with gonioscopic angle-closure; the odds of PAC/PACG increased by 5% for every 10° increase in ITC500 (OR, 1.051, 95% confidence interval [CI], 1.022-1.080 for AOD500 = 0 mm; OR, 1.049, 95% CI, 1.022-1.078 for TISA500 = 0 mm2). Axial length and anterior chamber depth were not associated with PAC/PACG in eyes with gonioscopic angle-closure (P ≥ 0.574). CONCLUSIONS A greater extent of ITC measured by AS-OCT, not angle-closure determined by gonioscopy, was associated with a greater odds of PAC/PACG in eyes with gonioscopic angle-closure.
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Affiliation(s)
- Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, PRC
| | - Philip Yawen Guo
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, PRC
| | - Chen Lin
- Department of Ophthalmology, Shenzhen People's hospital, Shenzhen, PRC
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, PRC
| | - Anwell Nguyen
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Rei Sakata
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | | | | | - Marco Yu
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore; National University of Singapore, Singapore
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore; National University of Singapore, Singapore
| | - Shan Lin
- Department of Ophthalmology, University of California San Francisco, San Francisco, California; Glaucoma Center of San Francisco, San Francisco, California
| | - Christopher Kai-Shun Leung
- Hong Kong Eye Hospital, Hong Kong, PRC; Department of Ophthalmology, The University of Hong Kong, Hong Kong, PRC; Department of Ophthalmology, Queen Mary Hospital, Hong Kong, PRC.
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Mukhopadhyay D, Patel K, Huda S. Increase in anterior chamber angle depth after topical pilocarpine measured by spectral domain optical coherence tomography: A possible additional indicator for laser peripheral iridotomy in primary angle-closure suspects in an opportunistic set-up. Indian J Ophthalmol 2022; 70:4174-4179. [PMID: 36453309 PMCID: PMC9940567 DOI: 10.4103/ijo.ijo_764_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Indication of laser peripheral iridotomy (LPI) is often conjectural due to dependency on gonioscopy and strict dichotomous classification of occludability. Indentation gonioscopy is the gold standard but is under-utilized for various reasons. The prevalence of primary angle closure disease (PACD) in eastern India is 1.5-1.9%, with a 22% five-year progression rate. Many angle closure patients may go blind without timely diagnosis and iridotomy. General ophthalmologists need alternate, validated methods for diagnoses. Pilocarpine eye drop causes miosis, and flattens the iris, producing angle changes detectable by spectral domain optical coherence tomography (SD-OCT). We hypothesized that the amount of angle change may be a suitable indicator for iridotomy. Methods Our prospective cross-sectional single-masked observational study evaluated pilocarpine-induced changes in angle parameters detected by SD-OCT. Out of 372 patients enrolled, 273 patients (539 eyes) remained, with a mean age of 48.6 years (SD = 10.36). All eyes were graded by the Van Herick (VH) method, gonioscopy, and anterior segment (AS) SD-OCT and reassessed after pilocarpine drops. Results The sensitivity and specificity of tomography measurements against gonioscopy grades were 61% and 85%, respectively. The receiver operating characteristic (ROC) curve was 0.85. Pilocarpine-induced angle widening was significant in gonioscopically narrower angles. Low Van Herick grades (217 eyes), narrow gonioscopy grades (238 eyes), and a narrow OCT angle value (165 eyes) were candidates for iridotomy. Conclusion Our study results showed that pilocarpine-induced angle widening detected by SD-OCT could be a strong objective indicator for LPI.
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Affiliation(s)
- Debdas Mukhopadhyay
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India,Correspondence to: Prof. Debdas Mukhopadhyay, BKG Eye Institute, Gour Road, Mokdompur, Malda - 732 103, West Bengal, India. E-mail:
| | - Khevna Patel
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India
| | - Sadaf Huda
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India
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9
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Hao L, Hu Y, Xu Y, Fu H, Miao H, Zheng C, Liu J. Dynamic analysis of iris changes and a deep learning system for automated angle-closure classification based on AS-OCT videos. EYE AND VISION 2022; 9:41. [PMID: 36333758 PMCID: PMC9636810 DOI: 10.1186/s40662-022-00314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Background To study the association between dynamic iris change and primary angle-closure disease (PACD) with anterior segment optical coherence tomography (AS-OCT) videos and develop an automated deep learning system for angle-closure screening as well as validate its performance.
Methods A total of 369 AS-OCT videos (19,940 frames)—159 angle-closure subjects and 210 normal controls (two datasets using different AS-OCT capturing devices)—were included. The correlation between iris changes (pupil constriction) and PACD was analyzed based on dynamic clinical parameters (pupil diameter) under the guidance of a senior ophthalmologist. A temporal network was then developed to learn discriminative temporal features from the videos. The datasets were randomly split into training, and test sets and fivefold stratified cross-validation were used to evaluate the performance. Results For dynamic clinical parameter evaluation, the mean velocity of pupil constriction (VPC) was significantly lower in angle-closure eyes (0.470 mm/s) than in normal eyes (0.571 mm/s) (P < 0.001), as was the acceleration of pupil constriction (APC, 3.512 mm/s2vs. 5.256 mm/s2; P < 0.001). For our temporal network, the areas under the curve of the system using AS-OCT images, original AS-OCT videos, and aligned AS-OCT videos were 0.766 (95% CI: 0.610–0.923) vs. 0.820 (95% CI: 0.680–0.961) vs. 0.905 (95% CI: 0.802–1.000) (for Casia dataset) and 0.767 (95% CI: 0.620–0.914) vs. 0.837 (95% CI: 0.713–0.961) vs. 0.919 (95% CI: 0.831–1.000) (for Zeiss dataset). Conclusions The results showed, comparatively, that the iris of angle-closure eyes stretches less in response to illumination than in normal eyes. Furthermore, the dynamic feature of iris motion could assist in angle-closure classification. Supplementary Information The online version contains supplementary material available at 10.1186/s40662-022-00314-1.
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Apolo G, Lazkani N, Zhou S, Song AE, Pardeshi AA, Torossian L, Nguyen K, Weinreb RN, Xu BY. Age-Related Changes in Dynamic Iris Behavior Assessed Using a Programmable Closed-Loop Iris Control System. Transl Vis Sci Technol 2022; 11:9. [PMID: 36374485 PMCID: PMC9669806 DOI: 10.1167/tvst.11.11.9] [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: 05/23/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to develop and test a programmable closed-loop system for tracking, modulating, and assessing dynamic iris behavior, including in the mid-dilated position. Methods A programmable closed-loop iris control system was developed by customizing an ANTERION OCT device (Heidelberg Engineering, Heidelberg, Germany). Custom software was developed to store camera and optical coherence tomography (OCT) images, track pupillary diameter (PD), control a light-emitting diode (LED), and modulate ambient lighting to maintain the iris in a dilated, constricted, or mid-dilated position in real-time. Study participants underwent 3 consecutive 65-second scan sessions. Dynamic iris behavior in the form of peak constriction velocity (PCV) and mid-dilated iris activity (MDIA) were calculated and analyzed offline. Results Among 58 participants, 56 (96.6%) were eligible for analysis based on achieving and maintaining mean PD within ±10% of the calculated mid-dilated PD. Mean participant age was 49.8 ± 18.9 years. Mean PCV was 3.92 ± 0.83 mm/s, and mean MDIA was 0.37 ± 0.15 mm. The mean difference between the calculated and achieved mid-dilated PD was 0.166 ± 0.192 mm. There were significant negative correlations between PCV and age (slope = -0.022, P < 0.001) and MDIA and age (slope = -0.004, P < 0.001). Success rates were lower (69.0%) but relationships between dynamic iris behavior and age were similar based on achieving and maintaining mean PD within ±5% of the calculated mid-dilated PD. Conclusions A programmable closed-loop iris control system can modulate dynamic iris behavior and maintain the iris in a mid-dilated position. Pupillary constriction velocity and iris activity in the mid-dilated position decrease with age. Translational Relevance This system can be applied to study dynamic disease processes involving the iris and establish novel biometric measures that could serve as risk factors for acute and chronic primary angle closure glaucoma (PACG).
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Affiliation(s)
- Galo Apolo
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Naim Lazkani
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Sarah Zhou
- Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Abe E Song
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Anmol A Pardeshi
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Lernik Torossian
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Kent Nguyen
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Center and Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Benjamin Y Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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11
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Lifton J, Burkemper B, Jiang X, Pardeshi AA, Richter G, McKean-Cowdin R, Varma R, Xu BY. Ocular Biometric Determinants of Dark-to-Light Change in Angle Width: The Chinese American Eye Study. Am J Ophthalmol 2022; 237:183-192. [PMID: 34736951 PMCID: PMC9035021 DOI: 10.1016/j.ajo.2021.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess ocular biometric determinants of dark-to-light change in anterior chamber angle width and identify dynamic risk factors in primary angle closure disease (PACD). DESIGN Population-based cross-sectional study. METHODS Chinese American Eye Study (CHES) participants underwent anterior segment optical coherence tomography imaging in the dark and light. Static dark and light biometric parameters, including angle opening distance, 750 µm (AOD750), anterior chamber width (ACW), lens vault (LV), and pupillary diameter (PD) were measured, and dynamic dark-to-light changes were calculated. Contributions by static and dynamic parameters to dark-to-light changes in AOD750 were assessed using multivariable linear regression models with standardized regression coefficients (SRCs) and semipartial correlation coefficients squared (SPCC2). PACD was defined as ≥3 quadrants of gonioscopic angle closure. RESULTS The analysis included 1011 participants. All biometric parameters differed between dark and light (P < .05). On multivariable regression analysis, change in ACW (SRC = -0.35, SPCC2 = 0.081) and PD (SRC = -0.46, SPCC2 = 0.072) were the strongest determinants of dark-to-light change in AOD750 (overall R2 = 0.40). Dark-to-light increase in AOD750 was less in eyes with than without PACD (0.081 mm and 0.111 mm, respectively; P < .001). ACW increased in eyes with PACD and decreased in eyes without PACD from dark to light (P < .025), whereas change in PD was similar (P = .28). CONCLUSIONS Beneficial angle widening effects of transitioning from dark to light are attenuated in eyes with PACD, which appears related to aberrant dark-to-light change in ACW. These findings highlight the importance of assessing the angle in both dark and light to identify potential dynamic mechanisms of angle closure.
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Ye S, Bao C, Chen Y, Shen M, Lu F, Zhang S, Zhu D. Identification of Peripheral Anterior Synechia by Corneal Deformation Using Air-Puff Dynamic Anterior Segment Optical Coherence Tomography. Front Bioeng Biotechnol 2022; 10:856531. [PMID: 35433648 PMCID: PMC9011042 DOI: 10.3389/fbioe.2022.856531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Indentation gonioscopy is commonly used in the clinic to evaluate peripheral anterior synechia (PAS) of angle closure glaucoma (ACG). The examination requires contacting with the cornea, resulting in an uncomfortable feeling for patients, and it only provides qualitative outcomes which may be affected by subjective judgment of the clinicians. Previous studies had reported to identify the presence of PAS by measuring the changes of morphological parameters of the anterior chamber angle (ACA) under the pupillary light reflex, by anterior segment optical coherence tomography (AS-OCT). However, this method was invalid for some subjects who had low sensitiveness to light. This article describes an air-puff dynamic anterior segment optical coherence tomography (DAS-OCT) system that can evaluate the presence of PAS in a non-contact approach. The peripheral cornea is deformed by an air puff jetted from the DAS-OCT, causing a transfer of force to the ACA, just as how indentation gonioscopy works. The dynamic changes of the ACA before and after the air puff are recorded by OCT. Ten eyes of normal subjects were enrolled in this study to validate the repeatability and availability of the measurements. Then, ten samples of the ACA from five subjects with ACG were recruited and were assigned into two groups, the non PAS group (NPAS) and PAS group, according to the results of gonioscopy. The ACA structural parameters including the angle opening distance at 750 μm to the scleral spur (AOD750) and the trabecular-iris space area at 750 μm anterior to the scleral spur (TISA750) were then calculated automatically by a custom-written algorithm. The intraclass correlation coefficient (ICC) of measured parameters was all above 0.85 for normal subjects, exhibiting good repeatability. For patients, both parameters showed significant differences between the two groups after the air puff, while no differences were observed before the air puff. AOD750dif and TISA750dif between two groups showed more significant differences, indicating that they could be used as indicators to identify the presence of PAS. In conclusion, the DAS-OCT system proposed in this study is demonstrated effective to identify the presence of PAS by measuring the changes of the ACA via a noncontact approach. It shows great potential for applications in guidance for diagnosis of angle closure glaucoma.
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Affiliation(s)
- Shuling Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | | | - Yulei Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Shaodan Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Shaodan Zhang, ; Dexi Zhu,
| | - Dexi Zhu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Shaodan Zhang, ; Dexi Zhu,
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Hao J, Li F, Hao H, Fu H, Xu Y, Higashita R, Zhang X, Liu J, Zhao Y. Hybrid Variation-Aware Network for Angle-Closure Assessment in AS-OCT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:254-265. [PMID: 34487491 DOI: 10.1109/tmi.2021.3110602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Automatic angle-closure assessment in Anterior Segment OCT (AS-OCT) images is an important task for the screening and diagnosis of glaucoma, and the most recent computer-aided models focus on a binary classification of anterior chamber angles (ACA) in AS-OCT, i.e., open-angle and angle-closure. In order to assist clinicians who seek better to understand the development of the spectrum of glaucoma types, a more discriminating three-class classification scheme was suggested, i.e., the classification of ACA was expended to include open-, appositional- and synechial angles. However, appositional and synechial angles display similar appearances in an AS-OCT image, which makes classification models struggle to differentiate angle-closure subtypes based on static AS-OCT images. In order to tackle this issue, we propose a 2D-3D Hybrid Variation-aware Network (HV-Net) for open-appositional-synechial ACA classification from AS-OCT imagery. Specifically, taking into account clinical priors, we first reconstruct the 3D iris surface from an AS-OCT sequence, and obtain the geometrical characteristics necessary to provide global shape information. 2D AS-OCT slices and 3D iris representations are then fed into our HV-Net to extract cross-sectional appearance features and iris morphological features, respectively. To achieve similar results to those of dynamic gonioscopy examination, which is the current gold standard for diagnostic angle assessment, the paired AS-OCT images acquired in dark and light illumination conditions are used to obtain an accurate characterization of configurational changes in ACAs and iris shapes, using a Variation-aware Block. In addition, an annealing loss function was introduced to optimize our model, so as to encourage the sub-networks to map the inputs into the more conducive spaces to extract dark-to-light variation representations, while retaining the discriminative power of the learned features. The proposed model is evaluated across 1584 paired AS-OCT samples, and it has demonstrated its superiority in classifying open-, appositional- and synechial angles.
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Repeatability and Agreement of Two Swept-source Optical Coherence Tomographers for Anterior Segment Parameter Measurements. J Glaucoma 2022; 31:602-608. [DOI: 10.1097/ijg.0000000000001989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022]
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15
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Rekha PS, Jaseena K. Agreement of gonioscopy and anterior segment-optical coherence tomography in the assessment of the anterior chamber angle: A cross-sectional study. KERALA JOURNAL OF OPHTHALMOLOGY 2022. [DOI: 10.4103/kjo.kjo_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Primary Angle-Closure Disease Preferred Practice Pattern®. Ophthalmology 2021; 128:P30-P70. [PMID: 34933744 DOI: 10.1016/j.ophtha.2020.10.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023] Open
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17
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Xu BY, Friedman DS, Foster PJ, Jiang Y, Pardeshi AA, Jiang Y, Munoz B, Aung T, He M. Anatomic Changes and Predictors of Angle Widening after Laser Peripheral Iridotomy: The Zhongshan Angle Closure Prevention Trial. Ophthalmology 2021; 128:1161-1168. [PMID: 33497730 DOI: 10.1016/j.ophtha.2021.01.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess anatomic changes after laser peripheral iridotomy (LPI) and predictors of angle widening based on anterior segment (AS) OCT and angle opening based on gonioscopy. DESIGN Prospective observational study. PARTICIPANTS Primary angle-closure suspects (PACSs) 50 to 70 years of age. METHODS Participants of the Zhongshan Angle Closure Prevention (ZAP) Trial underwent gonioscopy and AS-OCT imaging at baseline and 2 weeks after LPI. Primary angle-closure suspect was defined as the inability to visualize pigmented trabecular meshwork in 2 or more quadrants on static gonioscopy. Laser peripheral iridotomy was performed on 1 eye per patient in superior (between 11 and 1 o'clock) or temporal or nasal locations (at or below 10:30 or 1:30 o'clock). Biometric parameters in horizontal and vertical AS-OCT scans were measured and averaged. Linear and logistic regression modeling were performed to determine predictors of angle widening, defined as change in mean angle opening distance measured at 750 μm from the scleral spur (AOD750); poor angle widening, defined as the lowest quintile of change in mean AOD750; and poor angle opening, defined as residual PACS after LPI based on gonioscopy. MAIN OUTCOME MEASURES Anatomic changes and predictors of angle widening and opening after LPI. RESULTS Four hundred fifty-four patients were included in the analysis. Two hundred nineteen underwent superior LPI and 235 underwent temporal or nasal LPI. Significant changes were found among most biometric parameters (P < 0.006) after LPI, including greater AOD750 (P < 0.001). One hundred twenty eyes (26.4%) showed residual PACS after LPI. In multivariate regression analysis, superior LPI location (P = 0.004), smaller AOD750 (P < 0.001), and greater iris curvature (P < 0.001), were predictive of greater angle widening. Temporal or nasal LPI locations (odds ratio [OR], 2.60, P < 0.001) was predictive of poor angle widening. Smaller mean gonioscopy grade (OR, 0.34, 1-grade increment) was predictive of poor angle opening. CONCLUSIONS Superior LPI location results in significantly greater angle widening compared with temporal or nasal locations in a Chinese population with PACS. This supports consideration of superior LPI locations to optimize anatomic changes after LPI.
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Affiliation(s)
- Benjamin Y Xu
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - David S Friedman
- Glaucoma Center of Excellence, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Yu Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Anmol A Pardeshi
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yuzhen Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Beatriz Munoz
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
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Anterior chamber angle imaging with swept-source optical coherence tomography: comparison between CASIAII and ANTERION. Sci Rep 2020; 10:18771. [PMID: 33127944 PMCID: PMC7603499 DOI: 10.1038/s41598-020-74813-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/07/2020] [Indexed: 11/08/2022] Open
Abstract
This study compared the test-retest variabilities and measurement agreement of anterior chamber angle (ACA) dimensions measured by two anterior segment swept-source optical coherence tomography (SS-OCT)-the ANTERION (Heidelberg Engineering, Heidelberg, Germany) and CASIAII (Tomey, Nagoya, Japan). Thirty-eight subjects, 18 patients with primary angle closure and 20 healthy participants with open angles, were included. The mean age was 54.7 ± 15.8 years (range: 26-75 years). One eye of each subject was randomly selected for anterior segment imaging by ANTERION and CASIAII, using the same scan pattern (6 evenly spaced radial scans across the anterior segment for three times) in the same visit. The between- and within-instrument agreement and repeatability coefficients of angle open distance (AOD500), trabecular-iris space area (TISA500), lens vault (LV), scleral spur-scleral spur distance (SSD), anterior chamber depth (ACD), and pupil diameter (PD) were measured. The anterior and posterior boundaries of the cornea, iris, and lens were automatically segmented by the SS-OCT instruments; the scleral spur was manually located by a single masked observer. There were significant differences between ANTERION and CASIAII measurements; the SSD, PD, and ACD were smaller whereas AOD500 and TISA500 were greater in ANTERION compared with CASIAII (P < 0.001). Anterior segment measurements obtained from the two SS-OCT instruments showed strong associations (R2 ranged between 0.866 and 0.998) although the between-instrument agreement was poor; the spans of 95% limits of between-instrument agreement were ≥ 1.5-folds than the within-instrument agreement for either instrument. Whereas both SS-OCT instruments showed low test-retest measurement variabilities, the repeatability coefficients of AOD500, TISA500, ACD, and PD were slightly smaller for CASIAII than ANTERION (P ≤ 0.012).
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Pardeshi AA, Song AE, Lazkani N, Xie X, Huang A, Xu BY. Intradevice Repeatability and Interdevice Agreement of Ocular Biometric Measurements: A Comparison of Two Swept-Source Anterior Segment OCT Devices. Transl Vis Sci Technol 2020; 9:14. [PMID: 32879770 PMCID: PMC7442878 DOI: 10.1167/tvst.9.9.14] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose To assess the repeatability and agreement of ocular biometric parameters measured using the Tomey CASIA SS-1000 and Heidelberg ANTERION anterior segment optical coherence tomography (AS-OCT) devices. Methods Both eyes of subjects 18 years of age or older were scanned three times with the CASIA and ANTERION under standardized dark lighting. One AS-OCT image along the horizontal (temporal-nasal) meridian was analyzed per eye and per scan. Pupillary diameter (PD) was within 15% for all pairwise comparisons. Anterior chamber depth, lens vault, anterior chamber width, angle opening distance, trabecular iris space area, and scleral spur angle (SSA500) were measured using manufacturer-provided image analysis software. Intraclass correlation (ICC), Wilcoxon signed-rank, and Bland-Altman analyses were performed to assess intradevice repeatability and interdevice agreement of measurements. Results Thirty-two eyes of 21 subjects were analyzed. There was excellent agreement (ICC >0.98) and no significant difference (P > 0.05) in PD across all comparisons. Intradevice measurement repeatability was excellent for both the CASIA (ICC range 0.93–0.99) and ANTERION (ICC range 0.97–0.99). Interdevice measurement agreement was also excellent (ICC range 0.85–0.96). Measurements within and between devices were similar (P > 0.06) for all parameters except SSA500 (P = 0.03). Linear regression and Bland-Altman plots showed the relationship was consistent across the entire range of measurements. Conclusions Intradevice measurement repeatability is excellent for the CASIA and ANTERION. Interdevice measurement agreement between the two devices exceeds metrics reported by previous comparison studies. Translational Relevance Modern swept-source AS-OCT devices produce highly repeatable measurements of ocular biometric parameters that are nearly interchangeable across devices.
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Affiliation(s)
- Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Abe E Song
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Naim Lazkani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Xiaobin Xie
- Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, China.,Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Alex Huang
- Doheny Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
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Zhang XF, Li M, Shi Y, Wan XH, Wang HZ. Repeatability and agreement of two anterior segment OCT in myopic patients before implantable collamer lenses implantation. Int J Ophthalmol 2020; 13:625-631. [PMID: 32399415 DOI: 10.18240/ijo.2020.04.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/11/2019] [Indexed: 12/27/2022] Open
Abstract
AIM To evaluate the intra-operator repeatability of time domain and swept-source Fourier domain anterior segment optical coherence tomography (AS-OCT), namely, Visante AS-OCT and Casia SS-1000 OCT, in measuring the preoperative parameters of implantable collamer lens (ICL) in myopic eyes, as well as the agreement between the two devices. METHODS A total of 97 eyes from 49 myopes were investigated in this prospective case series study. The anterior chamber depth (ACD), angle-to-angle distance (ATA), pupil diameter (PD) and crystalline lens rise (CLR) in all subjects were measured for three times during one session by the same operator. The repeatability was evaluated using the within-subject standard deviation (Sw), repeatability limits and intraclass correlation coefficients (ICC). The agreement between the two systems was evaluated using the Bland-Altman plots and 95% limits of agreement (LoA). RESULTS The repeatability limits of Visante AS-OCT in measuring ACD, ATA, PD and CLR were 0.099, 0.141, 0.304, and 0.079 mm, respectively. The repeatability limits of Casia SS-1000 OCT in measuring ACD, ATA, PD, and CLR were 0.105, 0.127, 0.357, and 0.082 mm, respectively. Excellent repeatability could be attained in both devices, with the ICC>0.8 for all the measured variables. The interdevice agreement was excellent (P>0.05) for ACD and ATA, but poor (P<0.05) for PD and CLR. CONCLUSION Good repeatability can be attained by time domain and swept-source Fourier-domain OCT for all the measured variables. Moreover, interdevice agreement analysis suggests that interchangeable measurements between two devices can be achieved for ACD and ATA, but not for PD and CLR; but the differences in measurements were not clinically significant.
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Affiliation(s)
- Xi-Fang Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Meng Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Yan Shi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xiu-Hua Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Huai-Zhou Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
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Ha A, Kim YK, Jeoung JW, Kim DM, Park KH. Association of Angle Width With Progression of Normal-Tension Glaucoma: A Minimum 7-Year Follow-up Study. JAMA Ophthalmol 2019; 137:13-20. [PMID: 30326036 DOI: 10.1001/jamaophthalmol.2018.4333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Glaucoma has been dichotomically classified as open or closed angle, and accordingly, distinct therapies have been administered. In this study, the issue of narrow-angle normal-tension glaucoma (NTG), which may be an intermediate-stage or hybrid-stage disease entity, was addressed. Objective To determine whether anterior chamber (AC) angle width plays any role in NTG progression. Design, Setting, and Participants Retrospective analysis of prospectively collected data at Seoul National University Hospital between January 2004 and December 2009. Fifty-two eyes of narrow-angle NTG and 52 wide-angle NTG eyes matched for age, untreated intraocular pressure, and mean deviation of visual field. Nonindentation gonioscopy was used to grade AC angles: narrow angle was defined as a partially invisible (invisible in ≥90° and <180°) pigmented posterior trabecular meshwork, and wide angle was defined as a fully visible pigmented posterior trabecular meshwork. Data were analyzed in September 2017. Main Outcomes and Measures Optic disc/retinal nerve fiber layer defect and visual field progression. Results Of the narrow-angle NTG cohort, the mean (SD) age was 49.5 (9.1) years and 15 individuals (28.8%) were women; of the wide-angle NTG cohort, the mean (SD) age was 48.7 (9.5) years and 19 (36.5%) were women. All participants were Korean. Over the course of the mean (SD) 7.6 (0.4)-year follow-up period, 25 of 52 narrow-angle eyes (48.1%) and 13 of 52 wide-angle eyes (25.0%) showed structural progression (odds ratio [OR], 2.78; 95% CI, 1.21-6.37; P = .02). Meanwhile, 21 of 52 narrow-angle eyes (40.3%) and 9 of 52 wide-angle eyes (17.3%) showed functional progression (OR, 3.24; 95% CI, 1.31-8.00; P = .009). The cumulative probability of both structural and functional progression was significantly greater in the narrow-angle than in the wide-angle group (mean [SD] 5-year survival rates, 0.56 [0.07] vs 0.83 [0.05]; P = .006 and 0.60 [0.07] vs 0.87 [0.05]; P = .007, respectively). The baseline diurnal intraocular pressure's SD was approximately 1.38-times greater in the narrow-angle than in the wide-angle group (1.8 [0.6] vs 1.3 [0.3] mm Hg; mean difference, 0.52; 95% CI, 0.32-0.72; P < .001). For the follow-up intraocular pressure fluctuation, the narrow-angle group showed an approximately 1.75-times greater SD (2.1 [0.5] vs 1.2 [0.3] mm Hg; mean difference, 0.93; 95% CI, 0.77-1.09; P < .001). Conclusions and Relevance Narrow-angle NTG showed a greater probability of disease progression than did wide-angle NTG. Further studies determining whether augmented or differentiated treatment strategies would be beneficial for patients with narrow-angle NTG are warranted.
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Affiliation(s)
- Ahnul Ha
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Young Kook Kim
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Jeoung
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Dong Myung Kim
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Ki Ho Park
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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Normal tension glaucoma-like degeneration of the visual system in aged marmosets. Sci Rep 2019; 9:14852. [PMID: 31619716 PMCID: PMC6795850 DOI: 10.1038/s41598-019-51281-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/27/2019] [Indexed: 01/25/2023] Open
Abstract
The common marmoset (Callithrix jacchus) is a non-human primate that provides valuable models for neuroscience and aging research due to its anatomical similarities to humans and relatively short lifespan. This study was carried out to examine whether aged marmosets develop glaucoma, as seen in humans. We found that 11% of the aged marmosets presented with glaucoma-like characteristics; this incident rate is very similar to that in humans. Magnetic resonance imaging showed a significant volume loss in the visual cortex, and histological analyses confirmed the degeneration of the lateral geniculate nuclei and visual cortex in the affected marmosets. These marmosets did not have elevated intraocular pressure, but showed an increased oxidative stress level, low cerebrospinal fluid (CSF) pressure, and low brain-derived neurotrophic factor (BDNF) and TrkB expression in the retina, optic nerve head and CSF. Our findings suggest that marmosets have potential to provide useful information for the research of eye and the visual system.
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Diurnal Variation of Optical Coherence Tomography Measurements of Static and Dynamic Anterior Segment Parameters. J Glaucoma 2019; 27:16-21. [PMID: 29194197 DOI: 10.1097/ijg.0000000000000832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the diurnal variation of static and dynamic anterior segment parameters in young, healthy eyes by comparing anterior segment optical coherence tomography (AS-OCT) measurements obtained in the morning and evening and also in the light and dark. METHODS Twenty-two subjects ranging from 19 to 47 years of age with no past ocular history were selected. Imaging was performed with the Tomey CASIA2 AS-OCT device in 2 fixed lighting environments, light and dark, between the hours of 08:30 to 10:00 and 17:30 to 19:00. Four AS-OCT images were analyzed per eye. Pupil diameter (PD), iris area (IA), iris curvature (IC), anterior chamber depth (ACD), lens vault (LV), anterior chamber width (ACW), anterior chamber area (ACA), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were measured. RESULTS Pupil diameter was similar between the AM and PM groups in the light (P=0.89) and dark (P=0.51). There was no significant difference between AM and PM measurement values for any of the static or dynamic parameters in the light (P>0.39) and dark (P>0.31). Intraclass correlation coefficients (ICC) demonstrated excellent agreement between AM and PM measurement values in the light (ICC>0.81) and dark (ICC>0.93). In addition, there was no significant difference between AM and PM angle opening distance at 500 µm measurement values in the light (P>0.34) and dark (P>0.40) when each of 8 angle sectors was analyzed individually. CONCLUSIONS No significant diurnal variation of static or dynamic anterior segment parameter measurements was detected in the light and dark. Diurnal variation of these parameters does not regularly occur in young, healthy eyes.
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Xu BY, Pardeshi AA, Burkemper B, Richter GM, Lin SC, McKean-Cowdin R, Varma R. Differences in Anterior Chamber Angle Assessments Between Gonioscopy, EyeCam, and Anterior Segment OCT: The Chinese American Eye Study. Transl Vis Sci Technol 2019; 8:5. [PMID: 30941263 PMCID: PMC6438105 DOI: 10.1167/tvst.8.2.5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/12/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To quantify interquadrant differences in anterior chamber angle (ACA) configuration assessed on gonioscopy, EyeCam, and anterior segment optical coherence tomography (AS-OCT) in a cohort of Chinese Americans. Methods Subjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES), a population-based epidemiologic study in Los Angeles, CA. Each subject underwent a complete ocular exam, including gonioscopy, EyeCam, and AS-OCT, under dark ambient lighting. Gonioscopy and AS-OCT imaging and EyeCam image grading were performed by trained ophthalmologists. Results Seven hundred nine eyes from 709 subjects were analyzed. Less anatomic variation among the quadrants was detected on gonioscopy and EyeCam compared with AS-OCT (P < 0.05). The mean gonioscopy grade, EyeCam grade, and AS-OCT measurement for each quadrant varied by up to 10.3%, 6.4%, and 46.2% of the superior quadrant value, respectively. There were significant interquadrant differences (P < 0.05) among mean AOD750 measurements when grouping by quadrant and gonioscopy or EyeCam grade. Mean AOD750 measurements were smallest for the superior quadrant by between 14.3% and 38.1% and 17.4% and 37.9% on gonioscopy and EyeCam, respectively, compared with other quadrants. Conclusions Gonioscopy and EyeCam significantly underrepresent anatomic variations of the ACA compared with AS-OCT. Gonioscopy or EyeCam grades from different quadrants do not appear to be comparable or interchangeable, which supports reconsideration of current definitions and methods used to diagnose and manage primary angle closure disease. Translational Relevance AS-OCT imaging raises concerns about current clinical definitions and methods that rely gonioscopy or EyeCam to assess the ACA.
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Affiliation(s)
- Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Bruce Burkemper
- Southern California Eyecare and Vision Research Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Grace M Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Shan C Lin
- Beckman Vision Center, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Rohit Varma
- Southern California Eyecare and Vision Research Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
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Choudhari NS, Chanda S, Khanna R, Senthil S, Garudadri CS. Diagnostic Accuracy of Van Herick Technique to Detect Pre-Disease States of Primary Angle Closure Glaucoma in a Resource Constraint Region. Ophthalmic Epidemiol 2019; 26:175-182. [PMID: 30616435 DOI: 10.1080/09286586.2018.1562083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To critically evaluate diagnostic accuracy of the van Herick (vH) technique in detection of gonioscopically occludable angle in a rural population and to explore ways to improve accuracy of the technique Methods: The study cohort was formed by two-stage cluster random sampling. Peripheral anterior chamber depth grading was performed, using both traditional and modified (photographic comparison) vH techniques, under dark adapted and standard lighting conditions by a comprehensive ophthalmologist masked to the clinical features. The cut-off criterion for vH test was 25% of peripheral corneal thickness. The reference standard was dark room 4-mirror indentation gonioscopy performed by an experienced glaucoma specialist. This study adhered to the STARD guidelines for reporting diagnostic accuracy studies. RESULTS We studied 111 eyes of 111 participants. The median age was 62 years. The angle was occludable by gonioscopy in 69 (62%) eyes; 58 eyes were primary angle closure suspects and 11 were primary angle closure patients. The likelihood ratio (95% confidence interval (CI)) of the positive (LR+) and negative (LR‒) result by the traditional vH technique was 5.17 (2.43, 11) and 0.30 (0.20, 0.46), respectively. The LR+ by reducing and LR‒ by elevating the cut-off grade of the traditional vH technique were 9.4 (2.3, 37.4) and 0.08 (0.02, 0.31), respectively. The area under receiver operating characteristic curve did not differ significantly by photographic comparison or lighting condition (p = 0.13). CONCLUSIONS vH grading can be considered as a triage test before gonioscopy. The value of the vH technique to the diagnostic strategy is discussed.
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Affiliation(s)
- Nikhil S Choudhari
- a V S T Glaucoma Centre, Kallam Anji Reddy Campus , L V Prasad Eye Institute , Hyderabad , India.,b Edward and Soona Brown Eye Centre , L V Prasad Eye Institute , Sattenapalle , India
| | - Sanjay Chanda
- b Edward and Soona Brown Eye Centre , L V Prasad Eye Institute , Sattenapalle , India
| | - Rohit Khanna
- c Allen Foster Community Eye Health Research Centre , Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute , Hyderabad , India
| | - Sirisha Senthil
- a V S T Glaucoma Centre, Kallam Anji Reddy Campus , L V Prasad Eye Institute , Hyderabad , India
| | - Chandra Sekhar Garudadri
- a V S T Glaucoma Centre, Kallam Anji Reddy Campus , L V Prasad Eye Institute , Hyderabad , India
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Pupil Size Associated with the Largest Iris Volume in Normal Chinese Eyes. J Ophthalmol 2018; 2018:8058951. [PMID: 30687548 PMCID: PMC6327274 DOI: 10.1155/2018/8058951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/22/2018] [Accepted: 12/05/2018] [Indexed: 12/03/2022] Open
Abstract
Background To determine the range of pupil size that has the largest iris volume in normal eyes. Methods 31 healthy adult Chinese volunteers underwent swept-source anterior segment OCT examination in both eyes. Pilocarpine 1% was instilled in a randomly selected eye (eye with induced miosis (ME)) of each participant to obtain iris volume (IV) measurements over a range of pupil sizes. OCT was performed prior to and one hour after pilocarpine in both ME and fellow eye (FE). Iris volume (IV), anterior chamber volume (ACV), anterior chamber depth (ACD), and pupil size (PS) were recorded. A scatter plot was used to depict the association between each pupil size and IV. Results The pupillary sizes for which IV was recorded in ME and FE ranged from 1.161 mm to 6.665 mm. The mean IV increased with miosis in both ME and FE; in 13 eyes, IV decreased with a decrease in pupillary size. PS between 3.812 and 6.665 mm was associated with an increase in IV, while PS between 3.159 and 5.54 mm was associated with a decrease. The relationship between PS and IV was in the shape of a downward parabola and was modeled using a quadratic equation (y = −1.3121x2 + 8.8429x + 16.423, R2 = 0.26886). The largest IV occurred at PS between 3 and 4 mm. Conclusions The relationship between PS and IV in this study was in the shape of a downward parabola. The largest IV was recorded at a pupillary size between 3 and 4 mm. This trial is registered with ChiCTR-ROC-17013572.
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27
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Xu BY, Burkemper B, Lewinger JP, Jiang X, Pardeshi AA, Richter G, Torres M, McKean-Cowdin R, Varma R. Correlation between Intraocular Pressure and Angle Configuration Measured by OCT: The Chinese American Eye Study. Ophthalmol Glaucoma 2018; 1:158-166. [PMID: 31025032 PMCID: PMC6475915 DOI: 10.1016/j.ogla.2018.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To characterize the relationship between angle configuration measured by anterior segment optical coherence tomography (AS-OCT) and intraocular pressure (IOP). DESIGN Cross-sectional study. PARTICIPANTS Subjects aged 50 years or older were identified from the Chinese American Eye Study (CHES), a population-based epidemiological study in Los Angeles, CA. METHODS Each subject underwent a complete ocular exam including Goldmann applanation tonometry, gonioscopy, and AS-OCT imaging. Four AS-OCT images were analyzed per eye and parameters describing angle configuration were measured, including angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), and scleral spur angle (SSA). The relationship between AS-OCT measurements and IOP was assessed using locally-weighted scatterplot smoothing (LOWESS) regression and change-point analyses. MAIN OUTCOME MEASURES Correlation between AS-OCT measurements and IOP. RESULTS 702 eyes (382 closed angle and 320 open angle) from 555 subjects were analyzed. Mean IOP for angle closure eyes was 16.3 ± 3.9 mmHg and open angle eyes was 15.3 ± 2.7 mmHg. Mean IOP increased as AS-OCT measurements decreased for all parameters except TIA750. Once measurement values dropped below parameter-specific threshold values, AS-OCT measurements and IOP were significantly correlated (p < 0.05) for AOD500 (r = -0.416), AOD750 (r = -0.213), ARA500 (r = -0.669), ARA750 (r = -0.680), TISA500 (r = -0.655), TISA750 (r = -0.641), SSA500 (r = -0.538), and SSA750 (r = -0.208). There was no correlation between AS-OCT measurements and IOP in open angle eyes (p > 0.40). CONCLUSIONS There is an anatomic threshold for angle configuration below which IOP is strongly related to the degree of angle closure. This finding suggests reconsideration of current definitions of angle closure and may be relevant for developing new OCT-based methods to identify patients at higher risk for elevated IOP and glaucoma.
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Affiliation(s)
- Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Bruce Burkemper
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Juan Pablo Lewinger
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Xuejuan Jiang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Grace Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Mina Torres
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Rohit Varma
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
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Ang M, Baskaran M, Werkmeister RM, Chua J, Schmidl D, Aranha dos Santos V, Garhöfer G, Mehta JS, Schmetterer L. Anterior segment optical coherence tomography. Prog Retin Eye Res 2018; 66:132-156. [DOI: 10.1016/j.preteyeres.2018.04.002] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/20/2018] [Accepted: 04/04/2018] [Indexed: 02/03/2023]
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Dastiridou A, Marion K, Niemeyer M, Francis B, Sadda S, Chopra V. Pilot Study of the Effects of Ambient Light Level Variation on Spectral Domain Anterior Segment OCT-Derived Angle Metrics in Caucasians versus Asians. Curr Eye Res 2018; 43:955-959. [PMID: 29641953 DOI: 10.1080/02713683.2018.1464192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the effects of ambient light level variation on spectral domain anterior segment optical coherence tomography (SD-ΟCT)-derived anterior chamber angle metrics in Caucasians versus Asians. MATERIALS AND METHODS Caucasian (n = 24) and Asian participants of Chinese ancestry (n = 24) with open angles on gonioscopy had one eye imaged twice at five strictly controlled, ambient light levels. Ethnicity was self-reported. Light levels were strictly controlled using a light meter at 1.0, 0.75, 0.5, 0.25, and 0 foot candle illumination levels. SD-OCT 5-line raster scans at the inferior 270° irido-corneal angle were measured by two trained, masked graders from the Doheny Image Reading Center using customized Image-J software. Schwalbe's line-angle opening distance (SL-AOD) and SL-trabecular iris space area (SL-TISA) in different light meter readings (LMRs) between the two groups were compared. RESULTS Baseline light SL-AOD and SL-TISA measured 0.464 ± 0.115mm/0.351 ± 0.110mm2 and 0.344 ± 0.118mm/0.257 ± 0.092mm2, respectively, in the Caucasian and the Asian group. SL-AOD and SL-TISA in each LMR were significantly larger in the Caucasian group compared to the Asian group (p < 0.05). Despite this difference in angle size between the groups, there were no statistically significant differences in the degree of change in angle parameters from light to dark (% changes in SL-AOD or SL-TISA between the two groups were statistically similar with all p-values >0.3). CONCLUSION SL-based angle dimensions using SD-OCT are sensitive to changes in ambient illumination in participants with Caucasian and Asian ancestry. Although Caucasian eyes had larger baseline angle opening under bright light conditions, the light-to-dark change in angle dimensions was similar in the two groups.
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Affiliation(s)
- Anna Dastiridou
- a Doheny Image Reading Center , Doheny Eye Institute , Los Angeles , CA , USA
| | - Kenneth Marion
- a Doheny Image Reading Center , Doheny Eye Institute , Los Angeles , CA , USA
| | - Moritz Niemeyer
- a Doheny Image Reading Center , Doheny Eye Institute , Los Angeles , CA , USA
| | - Brian Francis
- a Doheny Image Reading Center , Doheny Eye Institute , Los Angeles , CA , USA.,b Department of Ophthalmology , David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - Srinivas Sadda
- a Doheny Image Reading Center , Doheny Eye Institute , Los Angeles , CA , USA.,b Department of Ophthalmology , David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - Vikas Chopra
- a Doheny Image Reading Center , Doheny Eye Institute , Los Angeles , CA , USA.,b Department of Ophthalmology , David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
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Porporato N, Baskaran M, Aung T. Role of anterior segment optical coherence tomography in angle-closure disease: a review. Clin Exp Ophthalmol 2017; 46:147-157. [DOI: 10.1111/ceo.13120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Natalia Porporato
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
| | - Tin Aung
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
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Reproducibility and Agreement of Anterior Segment Parameter Measurements Obtained Using the CASIA2 and Spectralis OCT2 Optical Coherence Tomography Devices. J Glaucoma 2017; 26:974-979. [PMID: 28930883 DOI: 10.1097/ijg.0000000000000788] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the reproducibility and agreement of measurement values obtained from the Tomey CASIA2 and Heidelberg Spectralis OCT2 anterior segment optical coherence tomographic devices. METHODS Twenty eyes from 10 subjects ranging from age 28 to 45 years with no history of eye conditions or intraocular surgery were included. Two scans were obtained with each device in a standardized dark room environment after a period of dark adaptation. One anterior segment optical coherence tomography image along the horizontal (temporal nasal) meridian was analyzed per eye and per scan. Lens vault, pupil diameter, anterior chamber width, angle opening distance, trabecular iris space area, and scleral spur angle were measured using manufacturer-provided image analysis programs. Intraclass correlation coefficient (ICC) values, coefficients of variation, and Bland-Altman plots were computed to assess the intradevice correlation and interdevice agreement of measurement values. RESULTS There was excellent intradevice reproducibility of measurement values for both the CASIA (ICC range, 0.86 to 0.99) and Spectralis (ICC range, 0.79 to 1.00). There was also excellent interdevice correlation of measurement values (ICC range, 0.78 to 0.93) for all parameters except anterior chamber width (ICC 0.20). Linear regression models and Bland-Altman plots showed that this relationship was strongest when measurement values were small. CONCLUSIONS There is excellent intradevice reproducibility and good interdevice agreement of anterior segment parameter measurement values for the CASIA2 and Spectralis OCT2. However, the measurements obtained with each device should not be considered interchangeable.
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Lin J, Wang Z, Chung C, Xu J, Dai M, Huang J. Dynamic changes of anterior segment in patients with different stages of primary angle-closure in both eyes and normal subjects. PLoS One 2017; 12:e0177769. [PMID: 28542344 PMCID: PMC5436810 DOI: 10.1371/journal.pone.0177769] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 05/03/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare changes in anterior segment parameters under light and dark (light-to-dark) conditions among eyes with chronic primary angle-closure glaucoma (CPACG), fellow eyes with confirmed or suspect primary angle-closure (PAC or PACS), and age-matched healthy eyes. Methods Consecutive patients with CPACG in one eye and PAC/PACS in the fellow eye, as well as age-matched healthy subjects were recruited. Anterior segment optical coherence tomography measurements were conducted under light and dark conditions, and anterior chamber, lens, and iris parameters compared. Demographic and biometric factors associated with light-to-dark change in iris area were analyzed by linear regression. Results Fifty-seven patients (mean age 59.6±8.9 years) and 30 normal subjects matched for age (60.6±9.3 years) and sex ratio were recruited. In regards to differences under light–to-dark conditions, angle opening distance at 500 μm (AOD500μm) and iris area during light-to-dark transition were smaller in CPACG eyes than fellow PACS/PAC eyes and normal eyes (P<0.017). Pupil diameter change was largest in normal eyes, and larger in PACS/PAC eyes than CPACG eyes (P<0.017). There was an average reduction of 0.145 mm2 in iris area for each millimeter of pupil diameter increase in CPACG eyes, 0.161 mm2 in fellow PAC/PACS eyes, and 0.165 mm2 in normal eyes. Larger iris curvature in the dark and diagnosis of PACG were significantly associated with less light-to-dark iris area changes. Conclusions Dynamic changes in iris parameters with light-to-dark transition differed significantly among CPACG eyes, fellow PAC/PACS eyes, and normal eyes. Greater iris curvature under dark conditions was correlated with reduced light-to-dark change in iris area and pupil diameter, which may contribute to disease progression.
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Affiliation(s)
- Jialiu Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhonghao Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chuchen Chung
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jianan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Miaomiao Dai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- * E-mail:
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Kwon J, Sung KR, Han S, Moon YJ, Shin JW. Subclassification of Primary Angle Closure Using Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopic Parameters. Ophthalmology 2017; 124:1039-1047. [PMID: 28385302 DOI: 10.1016/j.ophtha.2017.02.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To classify eyes with primary angle closure (PAC) in terms of the features visualized using anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). DESIGN Retrospective, observational study. PARTICIPANTS A total of 73 eyes of 73 patients with PAC. METHODS Participants' eyes that had undergone laser peripheral iridotomy (LPI) were imaged using AS-OCT and UBM under the same lighting conditions. Anterior chamber depth, anterior chamber width, iris cross-sectional area, peripheral iris thickness, iris curvature, lens vault (LV), and angle opening distance 500 μm from the scleral spur (SS) were determined using the AS-OCT image; trabecular-ciliary process angle (TCA), trabecular-ciliary process distance (TCPD), and ciliary body (CB) thickness 1 mm posterior to the SS were estimated on the UBM image using ImageJ software (Wayne Rasband, National Institutes of Health, Rockville, MD). Iris insertion, iris angulation, iris convexity, presence of ciliary sulcus, irido-angle contact, and CB orientation assessed on the UBM image were included. Partitioning around the medoids algorithm was used for cluster analysis based on the parameters obtained using AS-OCT and UBM. Axial length and pupil diameter were incorporated into statistical models. MAIN OUTCOME MEASURES Clinical and anatomic characteristics were compared between the clusters, as classified using the partitioning around medoids algorithm method. RESULTS Cluster analysis revealed that 2-group clustering produced the best results. The 2 clusters, which were defined in terms of parameters obtained using AS-OCT and UBM, showed differences in iris curvature (0.16±0.08 vs. 0.11±0.04 mm), TCA (91.0°±13.4° vs. 63.7°±6.2°), TCPD (0.99±0.22 vs. 0.78±0.16 mm), CB orientation (neutral/anterior, 35/13 vs. 0/25), and iris insertion (basal/middle/apical, 37/9/2 vs. 12/11/2). Pre-LPI intraocular pressure (IOP) (18.8±5.4 vs. 16.2±4.5 mmHg; P = 0.037) and percentage of IOP reduction after LPI (22.3%±17.9% vs. 8.3%±19.5%; P < 0.003) showed a significant difference between the 2 clusters. CONCLUSIONS The most distinct difference between the 2 subgroups in the cluster analysis was TCA, suggesting that the position of the CB is important in subclassifying PAC. By using UBM, clinicians may obtain more clues about the mechanisms of PAC; in turn, they may learn to predict the IOP-lowering effects of LPI.
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Affiliation(s)
- Junki Kwon
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Kyung Rim Sung
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam-Si, Gyeonggi-do, South Korea
| | - Ye Ji Moon
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Joong Won Shin
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea
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Akil H, Dastiridou A, Marion K, Francis BA, Chopra V. Effects of diurnal, lighting, and angle-of-incidence variation on anterior segment optical coherence tomography (AS-OCT) angle metrics. BMC Ophthalmol 2017; 17:31. [PMID: 28335747 PMCID: PMC5364610 DOI: 10.1186/s12886-017-0425-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND First reported study to assess the effect of diurnal variation on anterior chamber angle measurements, as well as, to re-test the effects of lighting and angle-of-incidence variation on anterior chamber angle (ACA) measurements acquired by time-domain anterior segment optical coherence tomography (AS-OCT). METHODS A total of 30 eyes from 15 healthy, normal subjects underwent anterior chamber imaging using a Visante time-domain AS-OCT according to an IRB-approved protocol. For each eye, the inferior angle was imaged twice in the morning (8 am - 10 am) and then again in the afternoon (3 pm - 5 pm), under light meter-controlled conditions with ambient room lighting 'ON' and lights 'OFF', and at 5° angle of incidence increments. The ACA metrics measured for each eye were: angle opening distance (AOD, measured 500 and 750 μm anterior from scleral spur), the trabecular-iris-space area (TISA, measured 500 and 750 μm anterior from scleral spur), and scleral spur angle. Measurements were performed by masked, certified Reading Center graders using the Visante's Internal Measurement Tool. Differences in measurements between morning and afternoon, lighting variations, and angle of incidence were compared. RESULTS Mean age of the participants was 31.2 years (range 23-58). Anterior chamber angle metrics did not differ significantly from morning to afternoon imaging, or when the angle of incidence was offset by 5° in either direction away from the inferior angle 6 o'clock position. (p-value 0.13-0.93). Angle metrics at the inferior corneal limbus, 6 o'clock position (IC270), with room lighting 'OFF', showed a significant decrease (p < 0.05) compared to room lighting 'ON'. CONCLUSIONS There does not appear to be significant diurnal variation in AS-OCT parameters in normal individuals, but lighting conditions need to be strictly controlled since variation in lighting led to significant variability in AS-OCT parameters. No changes in ACA parameters were noted by varying the angle-of-incidence, which gives confidence in being able to perform longitudinal studies in approximately the same area (plus/minus 5° of original scan location).
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Affiliation(s)
- Handan Akil
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Anna Dastiridou
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Kenneth Marion
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA
| | - Brian A Francis
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA.,Department of Ophthalmology, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Vikas Chopra
- Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA. .,Department of Ophthalmology, David Geffen School of Medicine, Los Angeles, CA, USA.
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Sun X, Dai Y, Chen Y, Yu DY, Cringle SJ, Chen J, Kong X, Wang X, Jiang C. Primary angle closure glaucoma: What we know and what we don’t know. Prog Retin Eye Res 2017; 57:26-45. [DOI: 10.1016/j.preteyeres.2016.12.003] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/18/2016] [Accepted: 12/07/2016] [Indexed: 01/25/2023]
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DYNAMIC CHANGES OF THE ANTERIOR CHAMBER ANGLE PRODUCED BY INTRAVITREAL ANTI-VASCULAR GROWTH FACTOR INJECTIONS. Retina 2016; 36:1874-81. [DOI: 10.1097/iae.0000000000001018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marion KM, Dastiridou A, Niemeyer M, Francis BA, Sadda SR, Chopra V. Anterior Chamber Angle Morphometry Measurement Changes to Ambient Illumination Scaling in Visante Time Domain Optical Coherence Tomography. Curr Eye Res 2016; 42:386-393. [PMID: 27420338 DOI: 10.1080/02713683.2016.1190847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To test the effect of ambient illumination scaling on the reproducibility and reliability anterior chamber metrics using the Visante time domain optical coherence tomography (TD-OCT) instrument. MATERIALS AND METHODS The inferior irido-corneal angles of 25 normal, healthy eyes were imaged twice with the Zeiss Visante TD-OCT under five strictly controlled ambient light conditions (foot candles (fc) measured with a light meter at camera/eye interface). Each eye was imaged 10 times totaling 250 assessments. Angle opening distance (AOD500/750), trabecular iris space area (TISA500/750), and scleral spur (SS) angle were graded twice by masked, trained graders at the Doheny Imaging Reading Center using the Visante's intrinsic tools. Lighting effects on measurements, intra-/inter-grader and acquisition analyses, and Bland-Altman plots were computed using Statistical Package for Social Science (SPSS Inc. version 18.0, Armonk, NY). RESULTS With a near linear relationship of angle metrics to lights levels (R2 = 0.8-0.95), the analysis examines the differences from the brightest to darkest light levels. Decreasing ambient light levels from 1.0 to 0.0 fc decreased the average AOD500 measurement from 407 ± 136 µm to 315 ± 114 µm (mean percent difference (MPD) 29%, p < 0.001), AOD750 from 587 ± 184 µm to 496 ± 155 µm (MPD 18%, p < 0.001), TISA500 from 136 ± 43 µm2 to 101 ± 37 µm2 (MPD 35%, p < 0.001), TISA750 from 269 ± 81 µm2 to 212 ± 68 µm2 (MPD 27%, p < 0.001), and SS angle from 38.3% ± 9% to 32.1% ± 9% (MPD 19%, p < 0.001). Intra-/inter-grader results showed good reproducibility for each grader (MPD = 0.7-3%; coefficient of variation (CV) = 3.2-8.3%; R2 = 0.8-0.95; p < 0.001 for all metrics) and between graders (MPD = 1.4-5.9%; CV = 6.7-14.2%; R2 = 0.81-0.89; Pearson Correlation Coefficient (PCC) = 0.8-0.97 (p<0.001)). Bland-Altman plots did not demonstrate any apparent bias, with similar repeatability and agreement. CONCLUSIONS The results of this study show the high sensitivity of the anterior chamber to changes in the illumination. The slight decrease in light had a corresponding large decrease in Anterior Chamber Angle (ACA) metrics. With clinical diagnoses and treatments of eye diseases relying on these angle measurements, these findings emphasize the importance of strictly controlling light conditions in order to obtain reproducible measurements of anterior chamber geometry.
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Affiliation(s)
- Kenneth M Marion
- a Doheny Eye Institute, Doheny Image Reading Center , Los Angeles , CA , USA
| | - Anna Dastiridou
- a Doheny Eye Institute, Doheny Image Reading Center , Los Angeles , CA , USA
| | - Moritz Niemeyer
- a Doheny Eye Institute, Doheny Image Reading Center , Los Angeles , CA , USA
| | - Brian A Francis
- a Doheny Eye Institute, Doheny Image Reading Center , Los Angeles , CA , USA
| | - Srinivas R Sadda
- a Doheny Eye Institute, Doheny Image Reading Center , Los Angeles , CA , USA
| | - Vikas Chopra
- a Doheny Eye Institute, Doheny Image Reading Center , Los Angeles , CA , USA
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Abstract
Foreword It gives me pleasure to introduce the 4th edition of the EGS Guidelines. The Third edition proved to be extremely successful, being translated into 7 languages with over 70000 copies being distributed across Europe; it has been downloadable, free, as a pdf file for the past 4 years. As one of the main objectives of the European Glaucoma Society has been to both educate and standardize glaucoma practice within the EU, these guidelines were structured so as to play their part. Glaucoma is a living specialty, with new ideas on causation, mechanisms and treatments constantly appearing. As a number of years have passed since the publication of the last edition, changes in some if not all of these ideas would be expected. For this new edition of the guidelines a number of editorial teams were created, each with responsibility for an area within the specialty; updating where necessary, introducing new diagrams and Flowcharts and ensuring that references were up to date. Each team had writers previously involved with the last edition as well as newer and younger members being co-opted. As soon as specific sections were completed they had further editorial comment to ensure cross referencing and style continuity with other sections. Overall guidance was the responsibility of Anders Heijl and Carlo Traverso. Tribute must be made to the Task Force whose efforts made the timely publication of the new edition possible. Roger Hitchings Chairman of the EGS Foundation www.eugs.org The Guidelines Writers and Contributors Augusto Azuara Blanco Luca Bagnasco Alessandro Bagnis Keith Barton Christoph Baudouin Boel Bengtsson Alain Bron Francesca Cordeiro Barbara Cvenkel Philippe Denis Christoph Faschinger Panayiota Founti Stefano Gandolfi David Garway Heath Francisco Goni Franz Grehn Anders Heijl Roger Hitchings Gabor Hollo Tony Hommer Michele Iester Jost Jonas Yves Lachkar Giorgio Marchini Frances Meier Gibbons Stefano Miglior Marta Misiuk-Hojo Maria Musolino Jean Philippe Nordmann Norbert Pfeiffer Luis Abegao Pinto Luca Rossetti John Salmon Leo Schmetterer Riccardo Scotto Tarek Shaarawy Ingeborg Stalmans Gordana Sunaric Megevand Ernst Tamm John Thygesen Fotis Topouzis Carlo Enrico Traverso Anja Tuulonen Ananth Viswanathan Thierry Zeyen The Guidelines Task Force Luca Bagnasco Anders Heijl Carlo Enrico Traverso Augusto Azuara Blanco Alessandro Bagnis David Garway Heath Michele Iester Yves Lachkar Ingeborg Stalmans Gordana Sunaric Mégevand Fotis Topouzis Anja Tuulonen Ananth Viswanathan The EGS Executive Committee Carlo Enrico Traverso (President) Anja Tuulonen (Vice President) Roger Hitchings (Past President) Anton Hommer (Treasurer) Barbara Cvenkel Julian Garcia Feijoo David Garway Heath Norbert Pfeiffer Ingeborg Stalmans The Board of the European Glaucoma Society Foundation Roger Hitchings (Chair) Carlo E. Traverso (Vice Chair) Franz Grehn Anders Heijl John Thygesen Fotis Topouzis Thierry Zeyen The EGS Committees CME and Certification Gordana Sunaric Mégevand (Chair) Carlo Enrico Traverso (Co-chair) Delivery of Care Anton Hommer (Chair) EU Action Thierry Zeyen (Chair) Carlo E. Traverso (Co-chair) Education John Thygesen (Chair) Fotis Topouzis (Co-chair) Glaucogene Ananth Viswanathan (Chair) Fotis Topouzis (Co-chair) Industry Liaison Roger Hitchings (Chair) Information Technology Ingeborg Stalmans (Chair) Carlo E. Traverso (Co-chair) National Society Liaison Anders Heijl (Chair) Program Planning Fotis Topouzis (Chair) Ingeborg Stalmans (Co-chair) Quality and Outcomes Anja Tuulonen (Chair) Augusto Azuara Blanco (Co-chair) Scientific Franz Grehn (Chair) David Garway Heath (Co-chair)
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Affiliation(s)
- Alireza Mashaghi
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Jiaxu Hong
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil K Chauhan
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Dana
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Comparing Gonioscopy With Visante and Cirrus Optical Coherence Tomography for Anterior Chamber Angle Assessment in Glaucoma Patients. J Glaucoma 2016; 25:177-83. [PMID: 24844543 DOI: 10.1097/ijg.0000000000000076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare gonioscopy with Visante and Cirrus optical coherence tomography (OCT) for identifying angle structures and the presence of angle closure in patients with glaucoma. A secondary objective was to assess interrater agreement for gonioscopy grading among 3 independent examiners. METHODS Gonioscopy grading using Spaeth Classification and determination of angle-closure risk was performed on 1 randomly selected eye for 50 phakic patients. Images of the same eye using both Visante and Cirrus OCT were obtained in both light and dark conditions. Agreement of angle closure among 3 devices and interrater agreement for gonioscopy were determined using Cohen's κ (K) or Kendall's coefficient of concordance (W). RESULTS Of the 50 patients, 60% were female, 64% were white, and the mean age was 62 years. Angle closure was detected in 18%, 16%, and 48% of quadrants with Visante, Cirrus, and gonioscopy, respectively. The scleral spur was identified in 56% and 50% of quadrants with Visante and Cirrus OCT, respectively. Visante and Cirrus OCT showed moderate agreement in detecting angle closure (K=0.42 light, K=0.53 dark) but slight-to-fair agreement with gonioscopy (Visante K=0.25, Cirrus K=0.15). Gonioscopy demonstrated substantial agreement in angle closure (K=0.65 to 0.68) and angle-closure risk assessment (W=0.83) among 3 examiners. CONCLUSIONS Visante and Cirrus OCT imaging may have limited ability to identify angle closure because of difficulty identifying angle structures. Gonioscopy by well-trained clinicians had remarkably consistent agreement for identifying angle-closure risk.
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Effect of Angle of Incidence on Anterior Chamber Angle Metrics From Optical Coherence Tomography. J Glaucoma 2016; 25:e19-23. [PMID: 25265000 DOI: 10.1097/ijg.0000000000000169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the local variability of anterior chamber angle (ACA) metrics obtained by time domain (TD) and spectral domain (SD) optical coherence tomography (OCT). MATERIALS AND METHODS Anterior-segment OCT imaging was performed on 30 normal eyes using Visante TD-OCT and 40 normal eyes using Cirrus SD-OCT. For Visante OCT, a single 16-mm line scan of the inferior angle with 3 slightly different rotations of 265, 270, and 275 degrees was performed. For Cirrus OCT, a 5-line raster of the inferior angle was performed, centering the third scan line at the 6 o'clock position, with 0.25 mm between lines. ACA measurements were taken for angle-opening distance (AOD) and trabecular iris space area (TISA) at 500/750 μm from the scleral spur for Visante OCT and at Schwalbe's line (SL) for Cirrus OCT. RESULTS For Visante OCT, AOD500 was 0.406 mm (SD=0.143 mm) and TISA500 was 0.139 mm (0.054 mm). There was no difference in AOD500, AOD750, TISA500, or TISA750 between the 3 scan orientations (P>0.1 for all comparisons). For Cirrus OCT, AOD500 was 0.850±0.318 mm and TISA500 was 0.325±0.145 mm. No difference was found in SL-AOD and SL-TISA between the 3 scan positions. CONCLUSIONS These findings suggest that small local changes in the position of the OCT line scan spaced up to 1.0 mm apart on Cirrus, or 10-degree apart on Visante, did not significantly alter the inferior ACA metrics in achieving reliable measurements in young healthy eyes. Given the absence of tracking and registration for current anterior-segment OCT instruments, this observation is of relevance for longitudinal and dynamic studies of angle geometry.
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Prakash G, Srivastava D. Single session, intrauser repeatability of anterior chamber biometric and corneal pachy-volumetric parameters using a new Scheimpflug+Placido device. JOURNAL OF OPTOMETRY 2016; 9:85-92. [PMID: 26338543 PMCID: PMC4812002 DOI: 10.1016/j.optom.2015.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/23/2015] [Indexed: 05/13/2023]
Abstract
PURPOSE To analyze single session, intrauser reliability of a Scheimpflug device for anterior chamber (AC) and corneal parameters. METHODS In this observational study, 100 normal candidates underwent Scheimpflug analysis with Sirius 3D Rotating Scheimpflug Camera and Topography System (Costruzione Strumenti Oftalmici, Italy). Two scans in dark room conditions were performed by the same experienced user. The candidates were asked to keep both eyes closed for 5min before the scans. Exclusion criteria were previous ocular surgery, corneal scarring and anterior segment/posterior segment anomalies. Only the right eyes were used for the analysis. Both corneal (central, minimum, and apical thickness, volume, horizontal visible iris diameter, and apical curvature) and anterior chamber (volume, depth, angle, horizontal diameter) measurements were evaluated. RESULTS There was no difference in the means of repeated measurements (p>0.05, ANOVA). Intraclass correlations between the measures were high and ranged from 0.995-0.997 for corneal to 0.964-0.997 for anterior chamber (AC) parameters. The precision of repeatability measures (1.96×Sw) was approximately 5μ for the central and minimum corneal thickness, 8μ for the apical corneal thickness, 0.06mm for AC (anterior chamber) depth and less than 2° for the AC angle. CONCLUSIONS Sirius Scheimpflug system has high repeatability for both corneal and AC parameters in normal eyes.
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Affiliation(s)
- Gaurav Prakash
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates.
| | - Dhruv Srivastava
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates
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Marion KM, Niemeyer M, Francis B, Sadda SR, Chopra V. Effects of light variation on Schwalbe's line-based anterior chamber angle metrics measured with cirrus spectral domain optical coherence tomography. Clin Exp Ophthalmol 2016; 44:455-64. [PMID: 26753527 DOI: 10.1111/ceo.12700] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evaluate the impact of variations in ambient lighting conditions on the reproducibility/reliability of Schwalbe's Line (SL)-based anterior chamber angle (ACA) metrics using spectral domain optical coherence tomography (SD-OCT). DESIGN Images were taken at Doheny Eye Centers-UCLA clinic, which were randomized, masked and graded twice by dual reading centre graders. PARTICIPANTS Twenty-five normal/healthy participants with open angles METHODS Inferior angles were imaged using Cirrus SD-OCT under five light levels (foot-candles (fc) measured at camera-eye interface with Sper light-meter) with the instrument's corneal illumination function set to default level of 50 (CIdef) and low 5 (CIlow). Each eye was imaged 20 times, totaling 500 assessments. MAIN OUTCOME MEASURES SL-angle-opening-distance (SL-AOD) and SL-trabecular-iris-space-area (SL-TISA) measured using custom ImageJ software. Intra-/inter-grader variability analyses were completed using Statistical-Package-for-Social-Science and Bland-Altman plots demonstrated limits of agreement for comparisons. RESULTS Light level demonstrated a linear relationship with angle size, thus differences from highest to lowest light levels were compared. Decreasing light from 1.0 → 0.0fc at CIdef decreased SL-AOD from 394 µm +/- 137 µm → 356 µm +/- 137 µm (mean percent difference (MPD) = 10.71%,P < 0.001) and SL-TISA from 297 µm(2) +/- 114 µm(2) → 261 µm(2) +/- 109 µm(2) (MPD = 13.7%, P < 0.001). Decreasing from 1.0 → 0.0fc at CIlow decreased SL-AOD from 366 µm +/- 136 µm → 329 µm +/- 122 µm (MPD = 10.9%, P < 0.001) and SL-TISA from 271 µm(2) +/- 113 µm(2) → 234 µm(2) +/- 98 µm(2) (MPD = 15.8%, P < 0.001). There was 7.9/11.4% (both P < 0.001) difference for SL-AOD/SL-TISA between CIdef → CIlow at 1.0fc, and 7.7/9.4% (both P < 0.001) difference at 0.0fc. Intra-/inter-grader results showed high reproducibility for all metrics (MPD = 0.33-4.4%; CV = 0.96-1.36; PCC = 0.93-0.95(P < 0.001); R2 = 0.94-0.98). Bland-Altman plots did not demonstrate bias, with repeat-ability and agreement among measurements. CONCLUSIONS Using Cirrus SD-OCT, we found that SL-based ACA morphometrics are exquisitely sensitive to changes in ambient illumination and also corneal illumination by the OCT instrument. Consistently imaging in the darkest room possible is recommended (≤0.2 fce).
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Affiliation(s)
- Kenneth M Marion
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | - Moritz Niemeyer
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | - Brian Francis
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | - Srinivas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | - Vikas Chopra
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
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Zheng C, de Leon JMS, Cheung CY, Narayanaswamy AK, Ong SH, Tan CW, Chew PT, Perera SA, Wong TY, Aung T. Determinants of pupil diameters and pupil dynamics in an adult Chinese population. Graefes Arch Clin Exp Ophthalmol 2016; 254:929-36. [PMID: 26810838 DOI: 10.1007/s00417-016-3272-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/06/2015] [Accepted: 01/12/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND To investigate the determinants of pupil diameter (PD), amplitude of pupil diameter change (PD-change) and speed of pupil constriction (SPC) using video anterior segment optical coherence tomography (AS-OCT) in a population-based sample of Chinese adults. METHODS Chinese adults aged 40 to 80 years who were free from glaucoma were consecutively recruited from the population-based Singapore Chinese Eye Study. The SPC was measured by AS-OCT videography. Univariate and multivariate analyses were performed to examine the effects of demographic and ocular biometric factors (e.g., axial length [AL], anterior chamber depth [ACD], baseline PD, iris thickness at the area of the dilator muscle [ITDMR], iris area [IA], and iris bowing [IB]) on SPC, PD, and PD-change. RESULTS A total of 266/302 (89.5 %) AS-OCT videos of eligible eyes were available for analysis. Among these subjects, 64.3 % were women, and the mean age (± standard deviation [SD]) was 56 ± 8.3 years. SPC was not associated with sex. In multiple regression analyses, SPC was independently associated with baseline PD (β = 0.116, p = 0.006). Baseline PD was independently associated with ACD (β = 0.341, p < 0.001), TISA 500 (β = -4.513, p < 0.001), IA (β = -2.796, p < 0.001), and ITDMR (β = 6.573, p < 0.001). PD-change was independently associated with ACD (β = 0.256, p < 0.001), IA (β = -1.507, p < 0.001), IB (β = 0.630, p = 0.011), and ITDMR (β = 3.124, p < 0.001). CONCLUSIONS Among normal eyes in an adult Chinese population, SPC was associated with larger baseline PD. Larger baseline PD and greater PD change form dark to light were associated with greater ACD, with smaller IA and thicker ITDMR.
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Affiliation(s)
- Ce Zheng
- Singapore Eye Research Institute & Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228, Singapore.,Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Dong Xia North Road, Shantou, 515041, Guangdong Province, China
| | - John Mark S de Leon
- Singapore Eye Research Institute & Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Carol Y Cheung
- Singapore Eye Research Institute & Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Arun K Narayanaswamy
- Singapore Eye Research Institute & Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Sim-Heng Ong
- Department of Electrical & Computer Engineering, National University of Singapore, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Clement W Tan
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Paul T Chew
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Shamira A Perera
- Singapore Eye Research Institute & Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute & Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Tin Aung
- Singapore Eye Research Institute & Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road NUHS Tower Block, Level 11, Singapore, 119228, Singapore. .,Duke-NUS Graduate Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
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Lee RY, Lin SC, Chen RI, Barbosa DT, Lin SC. Association between light-to-dark changes in angle width and iris parameters in light, dark and changes from light-to-dark conditions. Br J Ophthalmol 2016; 100:1274-9. [DOI: 10.1136/bjophthalmol-2015-307393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/26/2015] [Indexed: 11/04/2022]
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Leung CKS. Optical Coherence Tomography Imaging for Glaucoma - Today and Tomorrow. Asia Pac J Ophthalmol (Phila) 2016; 5:11-6. [PMID: 26886114 DOI: 10.1097/apo.0000000000000179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Digital imaging technologies for glaucoma diagnostics have evolved rapidly over the recent years. From time-domain optical coherence tomography (OCT) to spectral-domain and swept-source OCTs, the application of OCT for analysis of the anterior chamber angle and the optic nerve head (ONH) is expanding. The second-generation anterior segment swept-source OCT is able to image the configuration of the anterior chamber angle in 3 dimensions in less than 1 second and perform 360-degree analysis of the anterior chamber angle width for detection of angle closure. The morphology, density, and dimensions of the crystalline lens in relation to the anterior chamber can now be examined from the anterior corneal surface to the posterior lens surface, facilitating the investigation of the involvement of the crystalline lens in primary angle closure. Spectral-domain and swept-source OCTs have improved the measurement reliability of the lamina cribrosa and the neuroretinal rim configurations. Studying the deformation of the lamina cribrosa and ONH surfaces is relevant to decipher the mechanisms of ONH damage in the development and progression of glaucoma. Software and algorithms for automatic analysis of the anterior chamber angle dimensions and deformation of the ONH and lamina cribrosa surfaces are required to process large volumetric data sets, and they are under active development. It is expected that new imaging technologies will improve the detection and risk assessment of angle-closure and open-angle glaucomas.
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Affiliation(s)
- Christopher Kai-Shun Leung
- From the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Optical Coherence Tomography as a Tool for Ocular Dynamics Estimation. BIOMED RESEARCH INTERNATIONAL 2015; 2015:293693. [PMID: 26557659 PMCID: PMC4628777 DOI: 10.1155/2015/293693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/04/2015] [Accepted: 06/11/2015] [Indexed: 12/01/2022]
Abstract
Purpose. The aim of the study is to demonstrate that the ocular dynamics of the anterior chamber of the eye can be estimated quantitatively by means of optical coherence tomography (OCT). Methods. A commercial high speed, high resolution optical coherence tomographer was used. The sequences of tomographic images of the iridocorneal angle of three subjects were captured and each image from the sequence was processed in MATLAB environment in order to detect and identify the contours of the cornea and iris. The data on pulsatile displacements of the cornea and iris and the changes of the depth of the gap between them were retrieved from the sequences. Finally, the spectral analysis of the changes of these parameters was performed. Results. The results of the temporal and spectral analysis manifest the ocular microfluctuation that might be associated with breathing (manifested by 0.25 Hz peak in the power spectra), heart rate (1–1.5 Hz peak), and ocular hemodynamics (3.75–4.5 Hz peak). Conclusions. This paper shows that the optical coherence tomography can be used as a tool for noninvasive estimation of the ocular dynamics of the anterior segment of the eye, but its usability in diagnostics of the ocular hemodynamics needs further investigations.
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Xu Y, Liu J, Cheng J, Lee BH, Wong DWK, Baskaran M, Perera S, Aung T. Automated anterior chamber angle localization and glaucoma type classification in OCT images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:7380-3. [PMID: 24111450 DOI: 10.1109/embc.2013.6611263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To identify glaucoma type with OCT (optical coherence tomography) images, we present an image processing and machine learning based framework to localize and classify anterior chamber angle (ACA) accurately and efficiently. In digital OCT photographs, our method automatically localizes the ACA region, which is the primary structural image cue for clinically identifying glaucoma type. Next, visual features are extracted from this region to classify the angle as open angle (OA) or angle-closure (AC). This proposed method has three major contributions that differ from existing methods. First, the ACA localization from OCT images is fully automated and efficient for different ACA configurations. Second, it can directly classify ACA as OA/AC based on only visual features, which is different from previous work for ACA measurement that relies on clinical features. Third, it demonstrates that higher dimensional visual features outperform low dimensional clinical features in terms of angle closure classification accuracy. From tests on a clinical dataset comprising of 2048 images, the proposed method only requires 0.26s per image. The framework achieves a 0.921 ± 0.036 AUC (area under curve) value and 84.0% ± 5.7% balanced accuracy at a 85% specificity, which outperforms existing methods based on clinical features.
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Comparison of Physiologic versus Pharmacologic Mydriasis on Anterior Chamber Angle Measurements Using Spectral Domain Optical Coherence Tomography. J Ophthalmol 2015; 2015:845643. [PMID: 25878896 PMCID: PMC4386293 DOI: 10.1155/2015/845643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/13/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To compare the effects of physiologic versus pharmacologic pupil dilation on anterior chamber angle (ACA) measurements obtained with spectral domain optical coherence tomography (SD-OCT). Methods. Forty eyes from 20 healthy, phakic individuals with open angles underwent anterior segment OCT imaging under 3 pupillary states: (1) pupil constricted under standard room lighting, (2) physiologic mydriasis in a darkened room, and (3) postpharmacologic mydriasis. Inferior angle Schwalbe's line-angle opening distance (SL-AOD) and SL-trabecular-iris-space area (SL-TISA) were computed for each eye and pupillary condition by masked, certified Reading Center graders using customized grading software. Results. SL-AOD and SL-TISA under pupillary constriction to room light were 0.87 ± 0.31 mm and 0.33 ± 0.14 mm(2), respectively; decreased to 0.75 ± 0.29 mm (P < 0.01) and 0.29 ± 0.13 mm(2) (P < 0.01), respectively, under physiologic mydriasis; and increased to 0.90 ± 0.38 mm (P < 0.01) and 0.34 ± 0.17 mm(2) (P = 0.06) under pharmacologic mydriasis compared to baseline. Conclusions. Using SD-OCT imaging, pharmacologic mydriasis yielded the widest angle opening, whereas physiologic mydriasis yielded the most angle narrowing in normal individuals with open iridocorneal angles. Accounting for the state of the pupil and standardizing the lighting condition would appear to be of importance for future studies of the angle.
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Anterior segment optical coherence tomography measurement after neodymium-yttrium-aluminum-garnet laser capsulotomy. Am J Ophthalmol 2014; 158:994-8. [PMID: 25127700 DOI: 10.1016/j.ajo.2014.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 08/06/2014] [Accepted: 08/06/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate changes in anterior chamber depth (ACD) and angle width after neodymium-yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy. DESIGN Prospective interventional case series. METHODS In a single institution, 43 eyes of 43 consecutive pseudophakic patients with symptomatic posterior capsule opacification (PCO) underwent Nd:YAG laser capsulotomy. Anterior chamber depth and angle width in pseudophakic eyes with posterior capsule opacification were measured with anterior segment optical coherence tomography (AS-OCT) before and 3 days after Nd:YAG laser capsulotomy. Preoperative and postoperative measurements of anterior chamber depth and angle width included the angle opening distance, measured as the perpendicular distance from the trabecular meshwork at 500 μm and 750 μm anterior to the scleral spur to the anterior iris surface (AOD500 and AOD750, respectively), and anterior chamber angle (ACA) in the nasal and temporal quadrants. Main outcome measures were the changes in ACD and angle width parameters. RESULTS The mean patient age was 63.4 ± 3.6 years. Before Nd:YAG laser capsulotomy, mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.71 ± 0.11 mm, 0.61 ± 0.054 mm, 0.67 ± 0.063 mm, and 34.5 ± 1.67 degrees and 34.8 ± 1.55 degrees, respectively. Three days after Nd:YAG laser capsulotomy, mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.77 ± 0.1 mm, 0.69 ± 0.06 mm, 0.73 ± 0.06 mm, and 35.51 ± 1.64 degrees and 36.17 ± 1.51 degrees, respectively (P < .01 for all). CONCLUSIONS The depth and width of the ACA in pseudophakic eyes with PCO increased significantly after Nd:YAG laser capsulotomy, as shown by AS-OCT, a reliable and noncontact method for measuring anterior ocular structures. Our study shows that the different angle parameters such as ACD, AOD500, AOD750, and ACA measurements seem highly correlated.
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Influence of anterior segment biometric parameters on the anterior chamber angle width in eyes with angle closure. J Glaucoma 2014; 24:144-8. [PMID: 25186223 DOI: 10.1097/ijg.0000000000000090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To predict angle narrowing in eyes with angle closure in a Japanese population using anterior segment optical coherence tomography (AS-OCT) quantitative parameters. PATIENTS AND METHODS AS-OCT was used to examine 118 eyes of 118 patients with angle closure and 40 eyes of 40 patients with open angle under dark conditions. After measuring the angle opening distance 500 (AOD500), anterior chamber depth, iris thickness (IT), iris convexity (IC), pupil diameter, anterior chamber width, and crystalline lens rise, multivariate regression analyses were performed for the AOD500 in each group. RESULTS With the exception of IT, significant differences were observed between the AS-OCT parameters for the angle closure and open-angle groups. Anterior chamber depth, IT, and IC were the explanatory variables associated with AOD500 for each group (P≤0.001). A significant negative association was found between IT and IC only in the angle-closure group (P<0.001). CONCLUSIONS This study quantitatively confirmed that shallow anterior chamber depth was a major mechanism of angle narrowing, and that both IT and IC had a strong impact on angle narrowing. Moreover, the negative association found between IT and IC in only the angle closure group indicated the existence of the stretch force placed on the iris by relative pupillary block.
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