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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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Espinoza G, Iglesias K, Parra JC, Rodriguez-Una I, Serrano-Gomez S, Prada AM, Galvis V. Agreement and Reproducibility of Anterior Chamber Angle Measurements between CASIA2 Built-In Software and Human Graders. J Clin Med 2023; 12:6381. [PMID: 37835024 PMCID: PMC10573880 DOI: 10.3390/jcm12196381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE This study evaluated the agreement and reproducibility of ACA measurements obtained using the built-in software of the CASIA2 (Version 3G.1) and the measurements derived from expert clinicians. METHODS Healthy volunteers underwent ophthalmological evaluation and AS-OCT examination. ACA measurements derived from automated and manual SS location were obtained using the CASIA2 automated software and clinician identification, respectively. The intraobserver, interobserver reproducibility, CASIA2-human grader reproducibility and CASIA2 repeatability were assessed using intraclass correlation coefficients (ICCs). RESULTS The study examined 58 eyes of 30 participants. The CASIA2 software showed excellent repeatability for all ACA parameters (ICC > 0.84). Intraobserver, interobserver, and CASIA2-human grader reproducibility were also excellent (ICC > 0.87). Interobserver agreement was high, except for nasal TISA500, differing between observers 1 and 2 (p < 0.05). The agreement between CASIA2 measurements and human graders was high, except for nasal TISA500, where observer 1 values were smaller (p < 0.05). CONCLUSION The CASIA2 built-in software reliably measures ACA parameters in healthy individuals, demonstrating high consistency. Although a small difference was observed in nasal TISA500 measurements, interobserver and CASIA2-human grader reproducibility remained excellent. Automated SS detection has the potential to facilitate evaluation and monitoring of primary angle closure disease.
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Affiliation(s)
- Gustavo Espinoza
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Katheriene Iglesias
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
| | - Juan C. Parra
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Ignacio Rodriguez-Una
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain;
| | - Sergio Serrano-Gomez
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Angelica M. Prada
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
| | - Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca 681004, Santander, Colombia
- Fundación Oftalmológica de Santander, Floridablanca 681004, Santander, Colombia
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga 680002, Santander, Colombia
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Yuksel Elgin C, Chen D, Al‐Aswad LA. Ophthalmic imaging for the diagnosis and monitoring of glaucoma: A review. Clin Exp Ophthalmol 2022; 50:183-197. [DOI: 10.1111/ceo.14044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 12/21/2022]
Affiliation(s)
- Cansu Yuksel Elgin
- Department of Ophthalmology, NYU Langone Health NYU Grossman School of Medicine New York New York USA
| | - Dinah Chen
- Department of Ophthalmology, NYU Langone Health NYU Grossman School of Medicine New York New York USA
| | - Lama A. Al‐Aswad
- Department of Ophthalmology, NYU Langone Health NYU Grossman School of Medicine New York New York USA
- Department of Population Health, NYU Langone Health NYU Grossman School of Medicine New York New York USA
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Pasaoglu I, Basarir B. Comparison of anterior chamber angle parameters and iris structure of juvenile open-angle glaucoma and pigmentary glaucoma. Indian J Ophthalmol 2022; 70:558-563. [PMID: 35086237 PMCID: PMC9023982 DOI: 10.4103/ijo.ijo_2012_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To compare the quantitative measurements of the anterior chamber angle (ACA) and iris parameters in patients with juvenile open-angle glaucoma (JOAG), pigmentary glaucoma (PG), and healthy controls using anterior segment optical coherence tomography (AS-OCT). Methods: This was a retrospective, cross-sectional study of 25 eyes with JOAG, 25 eyes with PG, and 25 control eyes. Anterior chamber depth, angle-opening distance 500 and 750, trabecular–iris space 500 and 750, scleral spur angle, iris thickness (IT, measured at the thickest part), and iris bowing were obtained using AS-OCT (Visante” OCT 3.0 Model 1000, Carl Zeiss Meditec, Inc). Results: The quantitative ACA parameters were found to be significantly higher in JOAG and PG patients compared to healthy controls (P < 0.001); there was no significant difference between the eyes with JOAG and PG (P > 0.05). In eyes with JOAG and PG, there was significantly backward bowing of the iris in temporal and nasal angles compared to control subjects (P < 0.001). Median iris bowing was not significantly different between the patients with JOAG and PG (P > 0.05). The temporal and nasal angle iris thickness were significantly thinner in eyes with JOAG than the eyes with PG (P < 0.001) and age-matched control subjects (P < 0.001). The median IT did not differ between the patients with PG and control subjects (P > 0.05). In patients with JOAG, the intraocular pressure (IOP) was inversely correlated with IT (r = -0.43, P < 0.05). Conclusion: AS-OCT provided quantitative data on the ACA and iris parameters in JOAG and PG. The evaluation of the ACA and iris structures using AS-OCT revealed higher ACA measurements and posterior bowing of the iris in patients with JOAG and PG. Furthermore, the patients with JOAG were found to have thinner IT than the ones with PG and healthy controls.
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Affiliation(s)
- Isil Pasaoglu
- Department of Glaucoma, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Berna Basarir
- Department of Glaucoma, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Zhao T, Zhao M, Xie Q, Fong CW, Chen J, Liu Y, Feng H, Li S, Arnold BF, Aung T, He M, Oatts JT, Han Y. Repeatability and Reproducibility of Anterior Chamber Angle Measurement with Swept-Source Optical Coherence Tomography in Patients with Primary Angle Closure Suspect. Curr Eye Res 2021; 46:1853-1860. [PMID: 34253093 DOI: 10.1080/02713683.2021.1942069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To evaluate the inter- and intra-observer reliability of anterior chamber (AC) angle measurements obtained by swept-source optical coherence tomography (SS-OCT).Methods: Forty-eight consecutive patients diagnosed with primary angle closure suspect (PACS) were included. Three masked observers at different training levels (one glaucoma specialist, one ophthalmology resident, and one pre-medical college student) measured 192 SS-OCT images of the PACS patients. One observer (the glaucoma specialist) repeated measurements 1 week later. SS-OCT parameters included: Anterior segment volume, including corneal, AC, and iris volume; anterior segment dimensions, including AC depth and width (ACD, ACW), and lens vault (LV); and angle parameters, including angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and the trabecular iris angle (TIA). Intraclass correlation coefficients (ICCs) were used to measure reliability.Results: For inter-observer reproducibility, ICCs of corneal, AC, and iris volumes were 0.952 to 0.998. ICCs of ACD at all axes were above 0.989. ICCs of ACW and LV were smallest in the 90°-270° axis (0.751 and 0.768) but not significantly different from other axes. ARA, TISA, and TIA at all angles had significantly smallest ICCs 250 µm from the scleral spur compared with 500 µm and 750 µm. The ICCs comparing observers with different training levels had similar ranges and followed similar trends. For intra-observer repeatability, the smallest ICC was 0.843. Decreasing AC depth correlated with increased inter-observer reproducibility.Conclusions: We found excellent intra-observer repeatability for all SS-OCT parameters. Angle measurements have more variation among the observers when taken 250 µm from the scleral spur. Shallow AC might lead to more variability for angle parameters. Non-expert observers may be recruited for high-quality image grading with standard training.
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Affiliation(s)
- Tong Zhao
- Department of Ophthalmology, University of California, San Francisco, California, USA.,Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Mengya Zhao
- Department of Ophthalmology, University of California, San Francisco, California, USA.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qinghong Xie
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Christopher W Fong
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Jeremy Chen
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Yingna Liu
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Hui Feng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing, People's Republic of China
| | - Shuning Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing, People's Republic of China
| | - Benjamin F Arnold
- Department of Ophthalmology, University of California, San Francisco, California, USA.,Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Clinical Research Center, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Julius T Oatts
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, California, USA
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Zheng C, Koh V, Bian F, Li L, Xie X, Wang Z, Yang J, Chew PTK, Zhang M. Semi-supervised generative adversarial networks for closed-angle detection on anterior segment optical coherence tomography images: an empirical study with a small training dataset. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1073. [PMID: 34422985 PMCID: PMC8339863 DOI: 10.21037/atm-20-7436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Semi-supervised learning algorithms can leverage an unlabeled dataset when labeling is limited or expensive to obtain. In the current study, we developed and evaluated a semi-supervised generative adversarial networks (GANs) model that detects closed-angle on anterior segment optical coherence tomography (AS-OCT) images using a small labeled dataset. METHODS In this cross-sectional study, a semi-supervised GANs model was developed for automatic closed-angle detection training on a small labeled and large unsupervised training dataset collected from the Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong (JSIEC). The closed-angle was defined as iris-trabecular contact beyond the scleral spur in AS-OCT images. We further developed two supervised deep learning (DL) models training on the same supervised dataset and the whole dataset separately. The semi-supervised GANs model and supervised DL models' performance were compared on two independent testing datasets from JSIEC (515 images) and the Department of Ophthalmology (84 images), National University Health System, respectively. The diagnostic performance was assessed by evaluation matrices, including the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS For closed-angle detection using clinician grading of AS-OCT imaging as the reference standard, the semi-supervised GANs model showed comparable performance, with AUCs of 0.97 (95% CI, 0.96-0.99) and 0.98 (95% CI, 0.94-1.00), compared with the supervised DL model (using the whole dataset) [AUCs of 0.97 (95% CI, 0.96-0.99), and 0.97 (95% CI, 0.94-1.00)]. When training on the same small supervised dataset, the semi-supervised GANs achieved performance at least as well as, if not better than, the supervised DL model [AUCs of 0.90 (95% CI: 0.84-0.96), and 0.92 (95% CI, 0.86-0.97)]. CONCLUSIONS The semi-supervised GANs method achieves diagnostic performance at least as good as a supervised DL model when trained on small labeled datasets. Further development of semi-supervised learning methods could be useful within clinical and research settings. TRIAL REGISTRATION NUMBER ChiCTR2000037892.
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Affiliation(s)
- Ce Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Shanghai, China
| | - Victor Koh
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fang Bian
- Department of Ophthalmology, Deyang People’s Hospital, Deyang, China
| | - Luo Li
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Xiaolin Xie
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Zilei Wang
- Shanghai Children’s Hospital, Shanghai, China
| | - Jianlong Yang
- Ningbo Institute of Industrial Technology, Chinese Academy of Sciences, Ningbo, China
| | - Paul Tec Kuan Chew
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
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Pham TH, Devalla SK, Ang A, Soh ZD, Thiery AH, Boote C, Cheng CY, Girard MJA, Koh V. Deep learning algorithms to isolate and quantify the structures of the anterior segment in optical coherence tomography images. Br J Ophthalmol 2020; 105:1231-1237. [PMID: 32980820 DOI: 10.1136/bjophthalmol-2019-315723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/14/2020] [Accepted: 08/03/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Accurate isolation and quantification of intraocular dimensions in the anterior segment (AS) of the eye using optical coherence tomography (OCT) images is important in the diagnosis and treatment of many eye diseases, especially angle-closure glaucoma. METHOD In this study, we developed a deep convolutional neural network (DCNN) for the localisation of the scleral spur; moreover, we introduced an information-rich segmentation approach for this localisation problem. An ensemble of DCNNs for the segmentation of AS structures (iris, corneosclera shell adn anterior chamber) was developed. Based on the results of two previous processes, an algorithm to automatically quantify clinically important measurements were created. 200 images from 58 patients (100 eyes) were used for testing. RESULTS With limited training data, the DCNN was able to detect the scleral spur on unseen anterior segment optical coherence tomography (ASOCT) images as accurately as an experienced ophthalmologist on the given test dataset and simultaneously isolated the AS structures with a Dice coefficient of 95.7%. We then automatically extracted eight clinically relevant ASOCT measurements and proposed an automated quality check process that asserts the reliability of these measurements. When combined with an OCT machine capable of imaging multiple radial sections, the algorithms can provide a more complete objective assessment. The total segmentation and measurement time for a single scan is less than 2 s. CONCLUSION This is an essential step towards providing a robust automated framework for reliable quantification of ASOCT scans, for applications in the diagnosis and management of angle-closure glaucoma.
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Affiliation(s)
- Tan Hung Pham
- Department of Biomedical Engineering, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore
| | | | - Aloysius Ang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhi-Da Soh
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Alexandre H Thiery
- Statistics and Applied Probability, National University of Singapore, Singapore
| | - Craig Boote
- Optometry and Vision Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Ching-Yu Cheng
- Ocular Epidemiology Research Group, Singapore Eye Research Institute, Singapore
| | - Michael J A Girard
- Ophthalmic Engineering and Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore
| | - Victor Koh
- Department of Ophthalmology, National University Hospital, Singapore
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Chansangpetch S, Rojanapongpun P, Lin SC. Anterior Segment Imaging for Angle Closure. Am J Ophthalmol 2018; 188:xvi-xxix. [PMID: 29352976 DOI: 10.1016/j.ajo.2018.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/01/2018] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To summarize the role of anterior segment imaging (AS-imaging) in angle closure diagnosis and management, and the possible advantages over the current standard of gonioscopy. DESIGN Literature review and perspective. METHODS Review of the pertinent publications with interpretation and perspective in relation to the use of AS-imaging in angle closure assessment focusing on anterior segment optical coherence tomography and ultrasound biomicroscopy. RESULTS Several limitations have been encountered with the reference standard of gonioscopy for angle assessment. AS-imaging has been shown to have performance in angle closure detection compared to gonioscopy. Also, imaging has greater reproducibility and serves as better documentation for long-term follow-up than conventional gonioscopy. The qualitative and quantitative information obtained from AS-imaging enables better understanding of the underlying mechanisms of angle closure and provides useful parameters for risk assessment and possible prediction of the response to laser and surgical intervention. The latest technologies-including 3-dimensional imaging-have allowed for the assessment of the angle that simulates the gonioscopic view. These advantages suggest that AS-imaging has a potential to be a reference standard for the diagnosis and monitoring of angle closure disease in the future. CONCLUSIONS Although gonioscopy remains the primary method of angle assessment, AS-imaging has an increasing role in angle closure screening and management. The test should be integrated into clinical practice as an adjunctive tool for angle assessment. It is arguable that AS-imaging should be considered first-line screening for patients at risk for angle closure.
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Affiliation(s)
- Sunee Chansangpetch
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California
| | - Prin Rojanapongpun
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California.
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Römkens HC, Beckers HJ, Schouten JS, Berendschot TT, Webers CA. Reference values for anterior chamber morphometrics with swept-source optical coherence tomography in a Caucasian population. Clin Ophthalmol 2018. [PMID: 29535498 PMCID: PMC5836660 DOI: 10.2147/opth.s147364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study is to generate reference values for anterior chamber morphometrics to facilitate the interpretation of anterior chamber images acquired with swept-source optical coherence tomography (SS-OCT) in a Caucasian population. Materials and methods Non-glaucomatous Caucasian subjects, who were newly referred to the outpatient department of the University Eye Clinic Maastricht UMC+, were asked to undergo anterior segment assessment with SS-OCT imaging prior to routine eye examination (including visual acuity and refractive error measurements, Goldmann applanation tonometry, slit lamp examination and funduscopy). Results A total of 647 Caucasian subjects, aged 40–80 years, were included. Mean age (± standard deviation) was 61.7±10.3 years, and 294 were male (45%). Mean refractive error was −0.63±3.17 D. OCT images and measurements were obtained in all cases. The mean temporal trabecular iris angle at 500 µm (TIA500) was 27.04°±12.04°, the mean nasal TIA500 was 27.43°±11.75°, the mean anterior chamber depth (ACD) was 2.75±0.39 mm and the mean lens vault (LV) was 0.44±0.30 mm. A smaller temporal TIA500, shallower ACD and higher LV were found in female and hyperopic subjects. Conclusion Reference values for anterior chamber morphometrics in Caucasians were generated, quantified and presented. These values offer tools for the interpretation of anterior segment images of Caucasians and differentiation between presumed mechanisms of angle closure.
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Affiliation(s)
- Hellen Cs Römkens
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Henny Jm Beckers
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jan Sag Schouten
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Tos Tjm Berendschot
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Carroll Ab Webers
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, the Netherlands
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10
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Quantification of trabecular-iris contact and its prevalence by optical coherence tomography in a healthy Caucasian population. Eur J Ophthalmol 2017; 27:417-422. [PMID: 28009398 DOI: 10.5301/ejo.5000919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the prevalence of trabecular-iris contact (TIC) and quantify this contact in healthy Caucasian individuals using Fourier-domain optical coherence tomography (FD-OCT). METHODS For this cross-sectional study, 2,012 eyes of 1,006 healthy subjects were recruited among individuals undergoing a routine ophthalmologic checkup. In each participant, age, sex, intraocular pressure, and spherical refractive error were first recorded along with anterior chamber depth and volume, central corneal thickness measured with the Pentacam, and axial length with the IOLMaster. Anterior chamber angle variables and the presence of TIC in the horizontal quadrants were determined by anterior segment FD-OCT (RTVue 100®). When TIC was observed, TIC length (TICL) and its percentage in relation to the length of the trabecular meshwork (TICL percentage) were also measured. RESULTS Trabecular-iris contact in the horizontal quadrants was observed in 34 eyes of 25 patients, representing 1.6% of the total number of eyes examined. In this subgroup of individuals, mean age was 55.8 years, 84% were women, and spherical refractive error ranged from -0.25 to 8.25 D. Eyes with TIC showed an angle width of less than 23.2 degrees and axial length shorter than 23.7 mm. Mean TICL was 239 ± 79 μm (103-495 μm) and mean TICL percentage was 46.9% ± 13.9% (17.2%-76.3%). CONCLUSIONS The prevalence of TIC was low in this population. Fourier-domain optical coherence tomography emerged as useful to assess its prevalence and quantify the extent of TIC.
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Beer F, Wartak A, Haindl R, Gröschl M, Baumann B, Pircher M, Hitzenberger CK. Conical scan pattern for enhanced visualization of the human cornea using polarization-sensitive OCT. BIOMEDICAL OPTICS EXPRESS 2017; 8:2906-2923. [PMID: 28663915 PMCID: PMC5480438 DOI: 10.1364/boe.8.002906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 05/13/2023]
Abstract
Conventional imaging of the human cornea with optical coherence tomography (OCT) relies on telecentric scanning optics with sampling beams that are parallel to the optical axis of the eye. Because of the shape of the cornea, the beams have in some areas considerable inclination to the corneal surface which is accompanied by low signal intensities in these areas and thus an inhomogeneous appearance of corneal structures. In addition, alterations in the polarization state of the probing light depend on the angle between the imaging beam and the birefringent axis of the sample. Therefore, changes in the polarization state observed with polarization-sensitive (PS-) OCT originate mainly from the shape of the cornea. In order to minimize the effects of the corneal shape on intensity and polarization-sensitive based data, we developed a conical scanning optics design. This design provides imaging beams that are essentially orthogonal to the corneal surface. Thus, high signal intensity throughout the entire imaged volume is obtained and the influence of the corneal shape on polarization-sensitive data is greatly reduced. We demonstrate the benefit of the concept by comparing PS-OCT imaging results of the human cornea in healthy volunteers using both scanning schemes.
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Affiliation(s)
- Florian Beer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, A-1090 Vienna,
Austria
- Institute of Applied Physics, Vienna University of Technology, Wiedner Hauptstraße 8-10/134, A-1040 Vienna,
Austria
| | - Andreas Wartak
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, A-1090 Vienna,
Austria
| | - Richard Haindl
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, A-1090 Vienna,
Austria
| | - Martin Gröschl
- Institute of Applied Physics, Vienna University of Technology, Wiedner Hauptstraße 8-10/134, A-1040 Vienna,
Austria
| | - Bernhard Baumann
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, A-1090 Vienna,
Austria
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, A-1090 Vienna,
Austria
| | - Christoph K. Hitzenberger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, AKH 4L, A-1090 Vienna,
Austria
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12
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Tun TA, Tan SS, Atalay E, Verma S, Nongpiur ME, Baskaran M, Aung T, Husain R. Investigation of the variability of anterior chamber scan protocol with Cirrus high definition optical coherence tomography. Clin Exp Ophthalmol 2017; 45:464-471. [PMID: 28098418 DOI: 10.1111/ceo.12913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
IMPORTANCE The evaluation of anterior chamber scan of Cirrus optical coherence tomography for routine clinical use. BACKGROUND To assess the variability of anterior chamber angle measurements. DESIGN This was a cross-sectional study. PARTICIPANTS Forty subjects aged 40-80 years were included. METHODS One randomly selected eye from 40 subjects was imaged with Cirrus optical coherence tomography (Carl Zeiss Meditec, Dublin, CA) by two different operators (expert vs. non-expert) with a 15-min interval for inter-observer and intra-observer variability of image acquisition. For image grading, the angle opening distance (AOD750) and the trabecular iris space area (TISA750) of nasal and temporal quadrants were measured with a customized algorithm (ImageJ, NIH, Bethesda, MD) by two different graders in a masked and random fashion. Bland Altman analysis and intraclass correlation coefficient (ICC) were calculated. MAIN OUTCOME MEASURES ICC and limit of agreements (LOA). RESULTS There were 15 (37.5%) eyes with closed angles. For inter-observer variability, the mean difference (95% LOA) of AOD750 for image acquisition and grading were -0.0039 mm (-0.0486, 0.0408) and 0.0011 mm (-0.0228, 0.025), respectively. The mean difference (95% LOA) of AOD750 for intra-observer variability for image acquisition and grading were 0.0013 mm (-0.0362, 0.0389) and -0.0013 mm (-0.0482, 0.0457), respectively. The ICCs were all ≥0.9. There was no significant difference in measurement variability between open and closed angles (P > 0.05). CONCLUSIONS AND RELEVANCE Anterior chamber scan had low inter-observer and intra-observer variability in quantitative evaluation that was not affected by the angle status or the experience of an operator.
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Affiliation(s)
- Tin A Tun
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Shayne S Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eray Atalay
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Sushma Verma
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Monisha E Nongpiur
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
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13
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Optical Coherence Tomography Assessment of Angle Anatomy Changes After Trabeculectomy in Primary Angle-Closure Glaucoma. J Glaucoma 2016; 25:244-7. [PMID: 25318576 DOI: 10.1097/ijg.0000000000000153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Using anterior chamber optical coherence tomography to evaluate changes in angle anatomy in patients with primary angle-closure glaucoma (PACG) before and after trabeculectomy. METHODS This is a prospective observational study in 38 eyes of 38 patients with PACG, who underwent trabeculectomy. We used customized software to analyze optical coherence tomography images (Visante) of all participants before and after the surgical treatment. Multivariate linear regression analysis was performed for predictors of percentage change in mean angle parameters, including scleral spur angle, angle opening distance, angle recess area, and trabecular-iris surface area. The main outcome measures were changes in angle parameters and their relationship with age, sex, refraction, MD, visual outcomes, central corneal thickness, axial length of eye, number of glaucoma bottles, baseline intraocular pressure (IOP), and percentage changes in IOP (ΔIOP). RESULTS There was a significant increase in all angle parameters at the follow-up examination compared with the baseline value (all P<0.001). After multivariate analysis, the only variable related to changes in all angle parameters was ΔIOP. CONCLUSIONS Trabeculectomy results in a significant increase in the angle width in PACG. The increase in angle parameters was significantly related to the IOP changes.
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14
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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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15
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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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16
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Fernández-Vigo JI, García-Feijóo J, Martínez-de-la-Casa JM, García-Bella J, Arriola-Villalobos P, Fernández-Pérez C, Fernández-Vigo JÁ. Fourier domain optical coherence tomography to assess the iridocorneal angle and correlation study in a large Caucasian population. BMC Ophthalmol 2016; 16:42. [PMID: 27091025 PMCID: PMC4835848 DOI: 10.1186/s12886-016-0219-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, novel anatomic parameters that can be measured by optical coherence tomography (OCT), have been identified as a more objective and accurate method of defining the iridocorneal angle. The aim of the present study is to measure the iridocorneal angle by Fourier domain (FD) OCT and to identify correlations between angle measurements and subject factors in a large healthy Caucasian population. METHODS A cross sectional study was performed in 989 left eyes of 989 healthy subjects. The iridocorneal angle measurements: trabecular-iris angle (TIA), angle opening distance (AOD500) and trabecular-iris space area (TISA500) 500 μm from the scleral spur, were made using the FD-OCT RTVue®. Iris thickness was also measured. Correlations were examined between angle measurements and demographic and ocular factors. The main determinants of angle width were identified by multivariate linear regression. RESULTS TIA could be measured in 94% of the eyes, and AOD500 and TISA500 in 92%. The means recorded were TIA 35.8 ± 12.2 degrees (range 1.5 to 76.1), AOD500 542.6 ± 285.4 μm (range 15 to 1755), and TISA500 0.195 ± 0.104 mm(2) (range 0.02 to 0.62). The correlation between the temporal and nasal quadrant was R = 0.902 for TIA. The reproducibility of measurements was excellent (intraclass correlation coefficient >0.947). Mean angle width measurements were smaller in women (p = 0.02). Correlation was detected between angle means and anterior chamber volume (ACV; R = 0.848), anterior chamber depth (ACD; R = 0.818), spherical error (R = -0.619) and age (R = -0.487), while no correlation was observed with Intraocular pressure (R = -0.052). ACV emerged as the main determinant of TIA (R(2) = 0.705; p < 0.001). CONCLUSIONS In this Caucasian population, strong correlation was detected between FD-OCT anterior angle measurements and ACV, ACD, spherical refractive error and sex, emerging the ACV as the main determinant of TIA.
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Affiliation(s)
- José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Universitario Clínico San Carlos, Instituto de Investigación sanitaria San Carlos (IdISSC), c/Profesor Martín Lagos s/n, 28100, Madrid, Spain. .,Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | - Julián García-Feijóo
- Department of Ophthalmology, Hospital Universitario Clínico San Carlos, Instituto de Investigación sanitaria San Carlos (IdISSC), c/Profesor Martín Lagos s/n, 28100, Madrid, Spain
| | - José María Martínez-de-la-Casa
- Department of Ophthalmology, Hospital Universitario Clínico San Carlos, Instituto de Investigación sanitaria San Carlos (IdISSC), c/Profesor Martín Lagos s/n, 28100, Madrid, Spain
| | - Javier García-Bella
- Department of Ophthalmology, Hospital Universitario Clínico San Carlos, Instituto de Investigación sanitaria San Carlos (IdISSC), c/Profesor Martín Lagos s/n, 28100, Madrid, Spain
| | - Pedro Arriola-Villalobos
- Department of Ophthalmology, Hospital Universitario Clínico San Carlos, Instituto de Investigación sanitaria San Carlos (IdISSC), c/Profesor Martín Lagos s/n, 28100, Madrid, Spain
| | - Cristina Fernández-Pérez
- Department of Preventive Medicine, Hospital Universitario Clínico San Carlos, Instituto de Investigación sanitaria San Carlos (IdISSC), Madrid, Spain
| | - José Ángel Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Department of Ophthalmology, Universidad de Extremadura, Badajoz, Spain
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17
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Reproducibility and Agreement Between 2 Spectral Domain Optical Coherence Tomography Devices for Anterior Chamber Angle Measurements. J Glaucoma 2016. [PMID: 26200742 PMCID: PMC4667752 DOI: 10.1097/ijg.0000000000000303] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To compare anterior chamber angle parameters based on the location of Schwalbe line (SL) from 2 spectral domain optical coherence tomography (SD-OCT) instruments and to measure their reproducibility.
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18
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Identification of anterior chamber angle parameters with a portable SD-OCT device compared to a non-portable SD-OCT. Int Ophthalmol 2016; 37:31-37. [DOI: 10.1007/s10792-016-0223-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/17/2016] [Indexed: 11/26/2022]
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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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20
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Fernández-Vigo JI, Fernández-Vigo C, Martínez de la Casa JM, Sáenz-Francés F, Santos-Bueso E, García Feijóo J, Fernández-Vigo JA. Identification of iridocorneal angle structures assessed by Fourier domain optical coherence tomography. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:74-80. [PMID: 26652971 DOI: 10.1016/j.oftal.2015.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 09/02/2015] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To study the structures of the iridocorneal angle using anterior segment optical coherence tomography (OCT) defining their tomographic characteristics and quantifying their identification frequency. MATERIAL AND METHODS A cross-sectional study was performed on 267 right eyes of 267 consecutive healthy patients. Fourier domain OCT RTVue (Optovue Inc, CA, EE. UU.) was used to examine the iridocorneal angle in the nasal and temporal sectors. The structures evaluated were: Sclerocorneal limbus, sclerocorneal transition, Schwalbe's line, trabecular meshwork, Schlemm's canal, scleral spur, and angular recess. Within and between agreements to identify structures were calculated using Cohen's kappa coefficient. RESULTS The mean age was 41.3 ± 14.3 years (range 20-80), with 57% being women. The sclerocorneal limbus, sclerocorneal transition, and Schwalbe's line were identified by 98.7, 97 and 93.4% of the images, respectively, with the trabecular meshwork and Schlemm's canal being identified in 91% of cases. The scleral spur could be identified in 85.4%, and the angular recess in 74.5%. There was no difference in the identification between the temporal and nasal sectors. Within and between agreement was k=0.92 and k=0.88, respectively, in the identification of the structures of the total images studied. CONCLUSIONS Fourier domain OCT is a reliable technique for the identification of the structures of the iridocorneal angle, among which can be highlighted are, the trabecular meshwork, Schlemm's canal, scleral spur, and Schwalbe's line.
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Affiliation(s)
- J I Fernández-Vigo
- Departamento de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Centro Internacional de Oftalmología Avanzada, Madrid, España.
| | | | - J M Martínez de la Casa
- Departamento de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - F Sáenz-Francés
- Departamento de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - E Santos-Bueso
- Departamento de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J García Feijóo
- Departamento de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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Comparative Study of Anterior Eye Segment Measurements with Spectral Swept-Source and Time-Domain Optical Coherence Tomography in Eyes with Corneal Dystrophies. BIOMED RESEARCH INTERNATIONAL 2015; 2015:805367. [PMID: 26457303 PMCID: PMC4589615 DOI: 10.1155/2015/805367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/15/2015] [Indexed: 11/22/2022]
Abstract
Purpose. To compare anterior eye segment measurements and morphology obtained with two optical coherence tomography systems (TD OCT, SS OCT) in eyes with corneal dystrophies (CDs). Methods. Fifty healthy volunteers (50 eyes) and 54 patients (96 eyes) diagnosed with CD (epithelial basement membrane dystrophy, EBMD = 12 eyes; Thiel-Behnke CD = 6 eyes; lattice CD TGFBI type = 15 eyes; granular CD type 1 = 7 eyes, granular CD type 2 = 2 eyes; macular CD = 23 eyes; and Fuchs endothelial CD = 31 eyes) were recruited for the study. Automated and manual central corneal thickness (aCCT, mCCT), anterior chamber depth (ACD), and nasal and temporal trabecular iris angle (nTIA, tTIA) were measured and compared with Bland-Altman plots. Results. Good agreement between the TD and SS OCT measurements was demonstrated for mCCT and aCCT in normal individuals and for mCCT in the CDs group. The ACD, nTIA, and tTIA measurements differed significantly in both groups. TBCD, LCD, and FECD caused increased CCT. MCD caused significant corneal thinning. FECD affected all analyzed parameters. Conclusions. Better agreement between SS OCT and TD OCT measurements was demonstrated in normal individuals compared to the CDs group. OCT provides comprehensive corneal deposits analysis and demonstrates the association of CD with CCT, ACD, and TIA measurements.
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Reproducibility of anterior segment angle metrics measurements derived from Cirrus spectral domain optical coherence tomography. J Glaucoma 2015; 24:e47-51. [PMID: 25264987 DOI: 10.1097/ijg.0000000000000136] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate the reproducibility of anterior segment angle (ACA) metrics measurements in normal subjects on Cirrus spectral domain optical coherence tomography (SD-OCT). METHODS 40 eyes from 20 healthy, normal subjects underwent anterior segment imaging using a Cirrus SD-OCT. For each eye, 2 acquisitions of 5-line raster scans were performed perpendicularly on the inferior (270 degrees) angle. The Schwalbe's line-angle opening distance (SL-AOD) and Schwalbe's line-trabecular-iris space area (SL-TISA) measurements were performed by masked certified reading center graders using customized grading software. Intra-acquisition, intergrader, and intragrader reproducibility of SL-AOD and SL-TISA measurements were evaluated by intraclass correlation coefficients (ICC), Bland-Altman plots, and computation of mean percent difference (MPD) and coefficient of variability (CV). RESULTS The mean SL-AOD (average of 2 acquisitions) was 0.75 mm (range, 0.32 mm to 1.39 mm); SL-TISA was 0.28 mm² (range, 0.082 mm² to 0.569 mm²). The repeatability of Cirrus SD-OCT was excellent for both SL-AOD (MPD 4.74%, CV=0.92, ICC=0.99) and SL-TISA (MPD 9.4%, CV=0.8, ICC=0.99). The intragrader reproducibility was high for SL-AOD (MPD 4.28%, CV=0.94, ICC=0.995) and SL-TISA (MPD 6.05%, CV=0.89, ICC=0.993). The inter-grader reproducibility was not as good but still excellent for both SL-AOD (MPD 15.47%, CV=0.95, ICC=0.94) and SL-TISA (MPD 19.43%, CV=0.99, ICC=0.93). Bland-Altman plots of all comparisons did not demonstrate any apparent bias, with similar repeatability at various SL-AOD and SL-TISA values. CONCLUSIONS In our population of young healthy adults with normal eyes, there was excellent intra-acquisition, intragrader, and intergrader reproducibility for Schwalbe's line-based ACA metrics obtained from Cirrus SD-OCT images. These SD-OCT-derived measures may serve as reliable descriptors of angle morphometry for use in clinical trials and clinical practice.
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Wang N, Wang CX, Lian XF, Duan SJ, Huang D, Zhou SY. Staging of development in Terrien’s degeneration based on corneal curvatures detected by optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2015; 253:1757-64. [DOI: 10.1007/s00417-015-3057-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
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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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Hurmeric V, Yoo SH, Mutlu FM. Optical coherence tomography in cornea and refractive surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Maruyama Y, Mori K, Ikeda Y, Ueno M, Kinoshita S. Morphological analysis of age-related iridocorneal angle changes in normal and glaucomatous cases using anterior segment optical coherence tomography. Clin Ophthalmol 2013; 8:113-8. [PMID: 24379654 PMCID: PMC3873234 DOI: 10.2147/opth.s52370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To analyze age-related morphological changes of the iridocorneal angle in normal subjects and glaucomatous cases, using anterior segment optical coherence tomography (AS-OCT). METHODS This study involved 58 eyes of 58 open-angle glaucoma cases and 72 eyes of 72 age-matched normal-open-angle control subjects. Iridocorneal angle structures in nasal and temporal regions and anterior chamber depth (ACD) were measured using AS-OCT. Axial length and refractive error were measured by use of an ocular biometer and auto refractor keratometer. Angle opening distance (AOD), angle recess area (ARA), and trabecular-iris space area (TISA), measured at 500 μm (TISA500) and 750 μm (TISA750) distant from the scleral spur, were calculated, in the nasal and temporal regions. A new index, the peripheral angle frame index (PAFI), which represents the peripheral angle structure, was proposed, and was defined as (TISA750-TISA500)/TISA500. RESULTS Refractive power in the glaucoma cases was less than in control cases (P<0.0001). Axial length (P<0.0001) and ACD (P=0.0004) were longer and deeper, respectively, in the glaucoma cases, compared with the control cases. In both control and glaucoma groups, ACD, AOD, ARA, and TISA decreased linearly in an age-dependent manner, while PAFI stayed at relatively constant values throughout the age distribution. AOD in the glaucoma group was longer than in the control group, in both the temporal and nasal regions; ARA and TISA were larger in the glaucoma than in the control group. However, no significant differences in nasal or temporal PAFI were found between the glaucoma and control groups. CONCLUSION The findings of this study show that AS-OCT is useful for the quantitative evaluation of age-related changes in peripheral angle structure in glaucoma and control cases.
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Affiliation(s)
- Yuko Maruyama
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiko Mori
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoko Ikeda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Araie M. Test-retest variability in structural parameters measured with glaucoma imaging devices. Jpn J Ophthalmol 2012; 57:1-24. [PMID: 23138681 DOI: 10.1007/s10384-012-0181-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/27/2012] [Indexed: 11/26/2022]
Abstract
In addition to classical stereo-disc photography, various glaucoma imaging devices were developed in the last two decades to quantitatively measure and record glaucoma-related structural parameters of the eye. In determining whether or not the glaucomatous damage progressed from baseline and in estimating the number of test results' optimal frequency needed to confirm disease progression, information relating to the test-retest variability of measurement results provided by each imaging device is indispensable. Such information enables the clinician to apply these devices in practice. The test-retest variability of a system is usually estimated using the Bland-Altman analysis and by calculating the coefficient of variation (CV), intraclass correlation coefficient (ICC), and minimum detectable changes (MDC). The reported CV, ICC, and MDC values for glaucoma-related structural parameter measurement results of stereo-disc photographs, confocal scanning laser ophthalmoscopes, scanning laser polarimeters, time-domain optical coherence tomography (OCT), spectral-domain OCT (SD-OCT), anterior-segment OCT, and ultrasound biomicroscope are systematically reviewed in this manuscript, which will enable the clinician to interpret measurement results provided by each glaucoma imaging devices and thus be useful in practice. Although SD-OCT systems may be currently prevailing because of the volume of information provided and the relatively better test-retest variability, these systems need improvement in their test-retest variability measurement capabilities.
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Affiliation(s)
- Makoto Araie
- Kanto Central Hospital of The Mutual Aid Association of Public School Teachers, 6-25-1 Kamiyoga, Setagaya-ku, Tokyo 158-8531, Japan.
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Riau AK, Tan NYS, Angunawela RI, Htoon HM, Chaurasia SS, Mehta JS. Reproducibility and age-related changes of ocular parametric measurements in rabbits. BMC Vet Res 2012; 8:138. [PMID: 22901963 PMCID: PMC3514359 DOI: 10.1186/1746-6148-8-138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/15/2012] [Indexed: 12/02/2022] Open
Abstract
Background The rabbit is a common animal model for ophthalmic research, especially corneal research. Ocular structures grow rapidly during the early stages of life. It is unclear when the rabbit cornea becomes mature and stabilized. We investigated the changes of keratometry, refractive state and central corneal thickness (CCT) with age. In addition, we studied the intra- and inter-observer reproducibility of anterior chamber depth (ACD) and anterior chamber width (ACW) measurements in rabbits using anterior segment-optical coherence tomography (AS-OCT). Results The growth of New Zealand White rabbits (n = 16) were monitored from age 1 to 12 months old. Corneal keratometric and refractive values were obtained using an autorefractor/keratometer, and CCT was measured using an AS-OCT. Keratometry and CCT changed rapidly from 1 to 7 months and appeared to be stabilizing after 8 months. The reduction of corneal curvature was approximately 1.36 diopter (D)/month from age 1 to 7 months, but the change decelerated to 0.30 D/month from age 8 to 12 months. An increase of 10 μm/month in CCT was observed from age 1 to 7 months, but the gain was reduced to less than 1 μm/month from age 8 to 12 months. There was a hyperopic shift over the span of 12 months, albeit the increase in spherical equivalent was slow and gradual. Rabbits of random age were then selected for 2 repeated ACD and ACW measurements by 2 independent and masked observers. Bland-Altman plots revealed a good agreement of ACD and ACW measurements inter- and intra-observer and the ranges of 95% limit of agreement were acceptable from a clinical perspective. Conclusions Corneal keratometry, spherical equivalent refraction and CCT changed significantly during the first few months of life of rabbits. Young rabbits have been used in a large number of eye research studies. In certain settings, the ocular parametric changes are an important aspect to note as they may alter the findings made in a rabbit experimental model. In this study, we have also demonstrated for the first time a good between observer reproducibility of measurements of ocular parameters in an animal model by using an AS-OCT.
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Affiliation(s)
- Andri K Riau
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
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Deokule S, Alencar L, Vizzeri G, Medeiros F, Weinreb RN. Comparison of Unenhanced and Enhanced Imaging Protocols for Angle Measurements With Anterior Segment Optical Coherence Tomography. Ophthalmic Surg Lasers Imaging Retina 2012; 43:39-44. [DOI: 10.3928/15428877-20111027-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 09/23/2011] [Indexed: 11/20/2022]
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Reproducibility of scleral spur identification and angle measurements using fourier domain anterior segment optical coherence tomography. J Ophthalmol 2012; 2012:487309. [PMID: 23209880 PMCID: PMC3503366 DOI: 10.1155/2012/487309] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/05/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate intraobserver and interobserver agreement in locating the scleral spur landmark (SSL) and anterior chamber angle measurements obtained using Fourier Domain Anterior Segment Optical Coherence Tomography (ASOCT) images. Methods. Two independent, masked observers (SR and AZC) identified SSLs on ASOCT images from 31 eyes with open and nonopen angles. A third independent reader, NPB, adjudicated SSL placement if identifications differed by more than 80 μm. Nine months later, SR reidentified SSLs. Intraobserver and interobserver agreement in SSL placement, trabecular-iris space area (TISA750), and angle opening distance (AOD750) were calculated. Results. In 84% of quadrants, SR's SSL placements during 2 sessions were within 80 μm in both the X- and Y-axes, and in 77% of quadrants, SR and AZC were within 80 μm in both axes. In adjudicated images, 90% of all quadrants were within 80 μm, 88% in nonopen-angle eyes, and 92% in open-angle eyes. The intraobserver and interobserver correlation coefficients (with and without adjudication) were above 0.9 for TISA750 and AOD750 for all quadrants. Conclusions. Reproducible identification of the SSL from images obtained with FD-ASOCT is possible. The ability to identify the SSL allows reproducible measurement of the anterior chamber angle using TISA750 and AOD750.
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Abstract
The technology of optical coherence tomography (OCT) has evolved rapidly from time-domain to spectral-domain and swept-source OCT over the recent years. OCT has become an important tool for assessment of the anterior chamber angle and detection of angle closure. Improvement in image resolution and scan speed of OCT has facilitated a more detailed and comprehensive analysis of the anterior chamber angle. It is now possible to examine Schwalbe's line and Schlemm's canal along with the scleral spur. High-speed imaging allows evaluation of the angle in 360°. With three-dimensional reconstruction, visualization of the iris profiles and the angle configurations is enhanced. This article summarizes the development and application of OCT for anterior chamber angle measurement, detection of angle closure, and investigation of the pathophysiology of primary angle closure.
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