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LeTran VH, Burkemper B, O'Fee JR, Souverein EA, Lee JC, Phillips MJ, Dinh-Dang D, Song BJ, Xu BY, Wong BJ, Richter GM. Wedge Defects on Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma: Prevalence and Associated Clinical Factors. J Glaucoma 2022; 31:242-249. [PMID: 35089892 DOI: 10.1097/ijg.0000000000001991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Among subjects with glaucoma, wedge-shaped defects on optical coherence tomography angiography (OCTA) were associated with disc hemorrhages (DH), paracentral visual field (VF) defects, increased cup-to-disc ratio (CDR), and thinner retinal nerve fiber layer (RNFL). PURPOSE To examine determinants of wedge defects on peripapillary OCTA in glaucoma. MATERIALS AND METHODS A total of 278 eyes of 186 subjects with mild to severe primary open-angle glaucoma underwent 6×6 spectral-domain OCTA imaging of the superficial peripapillary retina from 2016 to 2020 at an academic practice. Wedge defects were defined as focal microvasculature loss that extends outward from the optic nerve in an arcuate, wedge shape. Logistic regression models controlling for intereye correlation identified variables significantly associated with wedge defects. Eyes with profound microvasculature loss in both hemispheres were excluded. Candidate variables included: age, sex, race or ethnicity, diabetes, hypertension, follow-up duration, baseline untreated intraocular pressure, intraocular pressure at time of imaging, DH history, paracentral VF defects, CDR, central corneal thickness, spherical equivalent, VF mean deviation, RNFL thickness, and glaucoma stage. RESULTS Of 278 eyes, 126 (45.3%) had wedge defects in at least 1 hemisphere. In our multivariable logistic regression model, wedge defects were associated with DH history [odds ratio (OR): 3.19, 95% confidence interval (CI): 1.05-9.69, P=0.041], paracentral VF defects [OR: 4.38 (95% CI: 2.11-9.11), P<0.0001], larger CDR [OR: 1.27 (95% CI: 1.03-1.56), P=0.024, per 0.1 increase], and thinner RNFL [OR: 1.71 (95% CI: 1.25-2.34), P=0.0009, per 10 μm decrease]. CONCLUSION DH history and paracentral VF defects were independently associated with wedge defects on OCTA, which was present in 45.3% of primary open-angle glaucoma patients. These findings may provide insight into glaucoma pathogenesis.
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Affiliation(s)
- Vivian H LeTran
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Bruce Burkemper
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - John R O'Fee
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Erik A Souverein
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Jae C Lee
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Mark J Phillips
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | | - Brian J Song
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Benjamin Y Xu
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Brandon J Wong
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Grace M Richter
- Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Combined wide-field optical coherence tomography angiography density map for high myopic glaucoma detection. Sci Rep 2021; 11:22034. [PMID: 34764370 PMCID: PMC8585951 DOI: 10.1038/s41598-021-01661-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/01/2021] [Indexed: 02/01/2023] Open
Abstract
The present study aimed to evaluate the diagnostic ability of wide-field optical coherence tomography angiography (OCTA) density map for detection of glaucomatous damage in high myopic (HM) eyes and to further compare the diagnostic ability of OCTA with that of conventional imaging approaches including red-free photography and swept-source OCT (SS-OCT) wide-field maps. A total of 77 healthy HM eyes and 72 HM eyes with open angle glaucoma (OAG) participated in this retrospective observational study. Patients underwent a comprehensive ocular examination, including wide-field SS-OCT scan and peripapillary area and macular OCTA scans. An integrated OCTA density map thereafter was merged by vascular landmark-guided superimposition of peripapillary and macular superficial vascular density maps onto the red-free photography (resulting in the OCTA-PanoMap). Glaucoma specialists then determined the presence of glaucomatous damage in HM eyes by reading the OCTA-PanoMap and compared its sensitivity and specificity with those of conventional images. Sensitivity and specificity of OCTA-PanoMap for HM-OAG diagnosis was 94.4% and 96.1%, respectively. Compared with other imaging methods, the sensitivity of OCTA-PanoMap was significantly higher than that of red-free photography (P = 0.022) and comparable to that of wide-field SS-OCT maps. Specificity of OCTA-PanoMap was significantly higher than those of other conventional imaging methods (except for wide-field thickness map). The OCTA-PanoMap showed good diagnostic ability for discrimination of HM-OAG eyes from healthy HM eyes. As a complementary method of an alternative imaging modality, OCTA-PanoMap can be a useful tool for detection of HM-OAG.
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Location of Disc Hemorrhage and Direction of Progression in Glaucomatous Retinal Nerve Fiber Layer Defects. J Glaucoma 2019; 27:504-510. [PMID: 29557833 DOI: 10.1097/ijg.0000000000000945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between glaucomatous disc hemorrhage (DH) location with respect to the nasal or temporal margin of the retinal nerve fiber layer defect (RNFLD) and the direction of RNFLD widening. MATERIALS AND METHODS This is a retrospective, cross-sectional study. Patients with any documented episode of glaucomatous DH throughout the follow-up period, and definite RNFLD widening on retinal nerve fiber layer photographs were analyzed. The location of DH was recorded as either nasal or temporal, and the direction of RNFLD widening was investigated. The laterality of DH location on the RNFLD border and the direction of RNFLD widening were correlated with each other. We also compared clinical parameters between eyes with nasal versus temporal margin DHs. RESULTS We analyzed 123 eyes from 116 patients with definite widening of the RNFLD and glaucomatous DH at the border between the healthy and damaged retinal nerve fiber layer. The most common diagnosis was normal-tension glaucoma (109, 87.9%). The most frequent location of DH was the temporal margin of an inferotemporal RNFLD (75, 61.0%), and the most frequent pattern of change in RNFLD was temporal widening (89, 72.4%). The absolute congruency was 82.9% and the total congruency was 99.2%. No significant differences were identified between eyes with nasal versus temporal margin DHs. CONCLUSIONS The lateral location of DH on the RNFLD border was highly congruent with the direction of RNFLD widening. This correspondence of laterality between DH development and progression of RNFLD may suggest an intimate structural relationship during the pathogenesis of DH, at the enlarging RNFLD border.
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Comparison of glaucoma-diagnostic ability between wide-field swept-source OCT retinal nerve fiber layer maps and spectral-domain OCT. Eye (Lond) 2018; 32:1483-1492. [PMID: 29789659 DOI: 10.1038/s41433-018-0104-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 02/05/2018] [Accepted: 02/08/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To compare the diagnostic ability of wide-field swept-source optical coherence tomography (SS-OCT) retinal nerve fiber layer (RNFL) maps with spectral-domain OCT (SD-OCT) maps for detection of preperimetric (PPG) and early glaucoma (EG). PATIENTS AND METHODS One hundred and forty-six eyes, including 37 healthy eyes, 38 eyes with PPG, and 71 eyes with EG, were analyzed. The patients underwent both SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA, USA) and wide-field SS-OCT scanning (DRI-OCT-1 Atlantis; Topcon, Tokyo, Japan). By SD-OCT, circumpapillary RNFL and macular ganglion cell analyses were performed. SS-OCT provides a wide-field RNFL thickness map and a SuperPixel map, which are composed of an RNFL deviation map of the peripapillary area and a deviation map of the composition of the ganglion cell layer with the inner plexiform layer and RNFL [GC-IPL+RNFL] in the macular area. The ability to discriminate PPG and EG from healthy eyes was assessed according to sensitivity, specificity and area under the receiver operating characteristic curve for parameters and criteria provided by SD-OCT and wide-field SS-OCT scanning. RESULTS The wide-field RNFL thickness map obtained by SS-OCT showed the highest sensitivity to PPG and EG (92.1 and 97.2%, respectively) as compared with the other, SD-OCT criteria. The wide-field RNFL thickness map showed PPG-diagnostic performance comparable to the SD-OCT RNFL thickness and GC-IPL deviation maps (p = 0.453 and 0.180), and PPG-diagnostic performance superior to the SD-OCT RNFL deviation and GC-IPL thickness maps (p = 0.003 and 0.039). In EG, the wide-field RNFL thickness and SuperPixel maps showed diagnostic performance comparable to the SD-OCT thickness and deviation maps (p = 0.065 to 0.100), except for the GC-IPL thickness map (p = 0.004). CONCLUSIONS The wide-field SS-OCT RNFL thickness maps showed a diagnostic ability for distinguishing PPG and EG from healthy eyes that was similar to that of SD-OCT. In the clinical setting, these maps can be effective for detection of early-glaucomatous changes.
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Diagnostic Ability of Wide-field Retinal Nerve Fiber Layer Maps Using Swept-Source Optical Coherence Tomography for Detection of Preperimetric and Early Perimetric Glaucoma. J Glaucoma 2017; 26:577-585. [PMID: 28368998 DOI: 10.1097/ijg.0000000000000662] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the diagnostic ability of wide-field retinal nerve fiber layer (RNFL) maps with swept-source optical coherence tomography (SS-OCT) for detection of preperimetric (PPG) and early perimetric glaucoma (EG). METHODS One hundred eighty-four eyes, including 67 healthy eyes, 43 eyes with PPG, and 74 eyes with EG, were analyzed. Patients underwent a comprehensive ocular examination including red-free RNFL photography, visual field testing and wide-field SS-OCT scanning (DRI-OCT-1 Atlantis; Topcon, Tokyo, Japan). SS-OCT provides a wide-field RNFL thickness map and a SuperPixel map, which are composed of the RNFL deviation map of the peripapillary area and the deviation map of the composition of the ganglion cell layer with the inner plexiform layer and RNFL (GC-IPL+RNFL) in the macular area. The ability to discriminate PPG and EG from healthy eyes was assessed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for all parameters and criteria provided by the wide-field SS-OCT scan. RESULTS The wide-field RNFL thickness map using SS-OCT showed the highest sensitivity of PPG-diagnostic and EG-diagnostic performance compared with the other SS-OCT criteria based on the internal normative base (93.0 and 97.3%, respectively). Among the SS-OCT continuous parameters, the RFNL thickness of the 7 clock-hour, inferior and inferotemporal macular ganglion cell analyses showed the largest AUC of PPG-diagnostic and EG-diagnostic performance (AUC=0.809 to 0.865). CONCLUSIONS The wide-field RNFL thickness map using SS-OCT performed well in distinguishing eyes with PPG and EG from healthy eyes. In the clinical setting, wide-field RNFL maps of SS-OCT can be useful tools for detection of early-stage glaucoma.
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Patterns of Retinal Nerve Fiber Layer Loss in Different Subtypes of Open Angle Glaucoma Using Spectral Domain Optical Coherence Tomography. J Glaucoma 2017; 25:865-872. [PMID: 27599175 DOI: 10.1097/ijg.0000000000000534] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE STUDY The purpose of the study was to determine whether there are different patterns of retinal nerve fiber layer (RNFL) thinning as measured by spectral domain optical coherence tomography (SD-OCT) for 4 subtypes of open angle glaucoma (OAG): primary OAG (POAG), normal tension glaucoma (NTG), pseudoexfoliation glaucoma (PXG), and pigmentary glaucoma (PDG) and to compare them with normal controls. MATERIALS AND METHODS SD-OCT RNFL thickness values were measured for 4 quadrants and for 4 sectors (ie, superior-nasal, superior-temporal, inferior-nasal, and inferior-temporal). Differences in RNFL thickness values between groups were analyzed using analysis of variance. Paired t tests were used for quadrant comparisons. RESULTS Two hundred eighty-five participants (102 POAG patients, 33 with NTG, 48 with PXG, 13 with PDG, and 89 normal patients) were included in this study. All 4 subtypes of OAG showed significant RNFL thinning in the superior, inferior, and nasal quadrants as well as the superior-temporal and inferior-temporal sectors (all P-values <0.0001) compared with normals. POAG and NTG patients had greater RNFL thinning inferiorly and inferior-temporally than superiorly (P-values: 0.002 to 0.018 and 0.006, respectively) compared with PXG patients. In contrast, PDG patients had greater RNFL thinning superiorly and superior-nasally than inferiorly compared with other OAG subtypes (ie, POAG, NTG, PXG groups, with P-values: 0.009, 0.003, 0.009, respectively). Of the 4 OAG subtypes, PXG patients exhibited the greatest degree of inter-eye RNFL asymmetry. CONCLUSIONS This study suggests that SD-OCT may be able to detect significant differences in patterns of RNFL thinning for different subtypes of OAG.
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Joshi R, Pankova N, Wang H, Baek DSH, Zhao X, Reyad M, Boyd SR. Spontaneously occurring fundus findings observed using confocal scanning laser ophthalmoscopy in wild type Sprague Dawley rats. Regul Toxicol Pharmacol 2016; 77:160-6. [PMID: 26873774 DOI: 10.1016/j.yrtph.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Non-invasive in vivo imaging is an increasingly used component of pre-clinical research. However, to reliably interpret data, it may be necessary to identify and document pre-existent findings prior to initiating long-term or intensive protocols, particularly where toxicity or efficacy is under investigation. Here we report here spontaneously occurring findings from the Sprague Dawley (SD) rat eye using multi-modal confocal scanning laser ophthalmoscopy (cSLO). METHODS As part of ongoing studies, with the goal of excluding animals with abnormalities from further investigation, a total of 165 wild type SD rats (312 eyes) were assessed using cSLO imaging at baseline prior to initiating experiments to detect, describe, and determine the prevalence of spontaneous fundus findings. RESULTS Using fundus autofluorescence (FAF) as the primary screening modality, over 30% of analyzed eyes possessed some fundus finding that differed from the normal composite reference image. Unexpectedly, 100% of eyes demonstrated a diffuse hyperfluorescent region in the posterior pole that was ultimately considered normal, and formed part of the reference. Evaluated by three independent reviewers, five groups of FAF abnormalities were defined, based primarily on shape and size of the lesion. Of these, the most extensive lesions were further analyzed using infrared reflectance (IR) and red free (RF) imaging. White light and autofluorescent microscopy of excised tissue confirmed that the extensive lesions were derived from abnormalities in both the isolated retina and posterior eyecups. CONCLUSIONS Given the newly described hyperfluorescent glow that appears in all eyes, and the high basal rate of spontaneous lesions in the outbred SD rat, we suggest that investigators be aware of the variants of normal, and that baseline in vivo screening be considered prior to initiating intensive or expensive investigation.
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Affiliation(s)
- Rahul Joshi
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada, M5B 1W8
| | - Natalie Pankova
- University of Toronto, Department of Laboratory Medicine and Pathobiology, 1 King's College Circle, Toronto, ON, Canada, M5S 1A8; University of Toronto, Department of Ophthalmology and Vision Sciences, 340 College Street, Toronto, ON, Canada, M5T 3A9; Keenan Research Centre for Biomedical Science, St Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada, M5B 1W8
| | - Hai Wang
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada, M5B 1W8
| | - David Sung Hyeon Baek
- University of Toronto, Department of Laboratory Medicine and Pathobiology, 1 King's College Circle, Toronto, ON, Canada, M5S 1A8; Keenan Research Centre for Biomedical Science, St Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada, M5B 1W8
| | - Xu Zhao
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada, M5B 1W8
| | - Matthew Reyad
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada, M5B 1W8
| | - Shelley R Boyd
- University of Toronto, Department of Laboratory Medicine and Pathobiology, 1 King's College Circle, Toronto, ON, Canada, M5S 1A8; University of Toronto, Department of Ophthalmology and Vision Sciences, 340 College Street, Toronto, ON, Canada, M5T 3A9; Keenan Research Centre for Biomedical Science, St Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada, M5B 1W8; Department of Ophthalmology, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8; Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, Canada, L8S 4K1.
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