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Abu-Qamar O, Biery DW, Mendonça LSM, Barrett L, Martell L, Freire CVS, Brown JM, Divakaran S, Wilson E, Werner A, Huck D, Blankstein R, Duker JS, Deo R, Waheed NK, Di Carli M, Weber BN. Association between abnormal retinal perfusion indices by optical coherence tomography angiography and myocardial flow reserve by positron emission tomography/computed tomography. J Nucl Cardiol 2024:101852. [PMID: 38537731 DOI: 10.1016/j.nuclcard.2024.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Omar Abu-Qamar
- New England Eye Center, Tufts Medical Center, Boston MA, USA
| | - David W Biery
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA; Albert Einstein College of Medicine, Bronx NY, USA
| | - Luísa S M Mendonça
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Leanne Barrett
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Laurel Martell
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Camila Veronica S Freire
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA; Escola Bahiana de Medicina e Saúde Pública, Salvador BA, Brazil
| | - Jenifer M Brown
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Sanjay Divakaran
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Evan Wilson
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Astrid Werner
- New England Eye Center, Tufts Medical Center, Boston MA, USA
| | - Daniel Huck
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston MA, USA
| | - Rahul Deo
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston MA, USA
| | - Marcelo Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Brittany N Weber
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA.
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Abu-Qamar O, Lewis W, Mendonca LSM, De Sisternes L, Chin A, Alibhai AY, Gendelman I, Reichel E, Magazzeni S, Kubach S, Durbin M, Witkin AJ, Baumal CR, Duker JS, Waheed NK. Pseudoaveraging for denoising of OCT angiography: a deep learning approach for image quality enhancement in healthy and diabetic eyes. Int J Retina Vitreous 2023; 9:62. [PMID: 37822004 PMCID: PMC10568842 DOI: 10.1186/s40942-023-00486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/02/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND This study aimed to develop a deep learning (DL) algorithm that enhances the quality of a single-frame enface OCTA scan to make it comparable to 4-frame averaged scan without the need for the repeated acquisitions required for averaging. METHODS Each of the healthy eyes and eyes from diabetic subjects that were prospectively enrolled in this cross-sectional study underwent four repeated 6 × 6 mm macular scans (PLEX Elite 9000 SS-OCT), and the repeated scans of each eye were co-registered to produce 4-frame averages. This prospective dataset of original (single-frame) enface scans and their corresponding averaged scans was divided into a training dataset and a validation dataset. In the training dataset, a DL algorithm (named pseudoaveraging) was trained using original scans as input and 4-frame averages as target. In the validation dataset, the pseudoaveraging algorithm was applied to single-frame scans to produce pseudoaveraged scans, and the single-frame and its corresponding averaged and pseudoaveraged scans were all qualitatively compared. In a separate retrospectively collected dataset of single-frame scans from eyes of diabetic subjects, the DL algorithm was applied, and the produced pseudoaveraged scan was qualitatively compared against its corresponding original. RESULTS This study included 39 eyes that comprised the prospective dataset (split into 5 eyes for training and 34 eyes for validating the DL algorithm), and 105 eyes that comprised the retrospective test dataset. Of the total 144 study eyes, 58% had any level of diabetic retinopathy (with and without diabetic macular edema), and the rest were from healthy eyes or eyes of diabetic subjects but without diabetic retinopathy and without macular edema. Grading results in the validation dataset showed that the pseudoaveraged enface scan ranked best in overall scan quality, background noise reduction, and visibility of microaneurysms (p < 0.05). Averaged scan ranked best for motion artifact reduction (p < 0.05). Grading results in the test dataset showed that pseudoaveraging resulted in enhanced small vessels, reduction of background noise, and motion artifact in 100%, 82%, and 98% of scans, respectively. Rates of false-positive/-negative perfusion were zero. CONCLUSION Pseudoaveraging is a feasible DL approach to more efficiently improve enface OCTA scan quality without introducing notable image artifacts.
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Affiliation(s)
- Omar Abu-Qamar
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA
| | - Warren Lewis
- Research and Development, Carl Zeiss Meditec, Dublin, CA, 94568, USA
| | - Luisa S M Mendonca
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Luis De Sisternes
- Research and Development, Carl Zeiss Meditec, Dublin, CA, 94568, USA
| | - Adam Chin
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA
| | - A Yasin Alibhai
- Boston Image Reading Center, 55 Causeway street, Boston, MA, 02114, USA
| | - Isaac Gendelman
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA
| | - Elias Reichel
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA
| | | | - Sophie Kubach
- Research and Development, Carl Zeiss Meditec, Dublin, CA, 94568, USA
| | - Mary Durbin
- Research and Development, Carl Zeiss Meditec, Dublin, CA, 94568, USA
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, 800 Washington St., Box 450, Boston, MA, 02111, USA.
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Girgis JM, Liu Y, Liang MC, Baumal CR, Duker JS, Waheed NK. Retinal Pigment Epithelium Aperture Preceding Collapse of Vascular and Avascular Pigment Epithelial Detachments Secondary to AMD. Retin Cases Brief Rep 2023:01271216-990000000-00170. [PMID: 37104942 DOI: 10.1097/icb.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE To describe retinal pigment epithelium (RPE) aperture preceding the collapse of retinal pigment epithelium detachments (RPED) in eyes with neovascular and non-neovascular age-related macular degeneration (AMD). METHODS Medical records from five patients with RPE aperture associated with vascular and avascular RPED were reviewed between 2010 and 2021 at the New England Eye Center at Tufts Medical Center. Main outcome measures were analysis of RPE aperture characteristics and temporal course of RPED collapse. RESULTS RPE apertures were identified in six eyes from five women (mean age of 72.6 years). Two eyes had neovasacular AMD and four eyes had non-neovascular AMD. The RPE aperture initially appeared as a discontinuity at the apex of the RPED without rippling or retraction. Each aperture was associated with hypertransmission of OCT signal into the choroid as well as hyperreflective foci. The mean time between the appearance of the RPE aperture to near complete collapse of the RPED was 9 months. Following RPED collapse, one eye developed choroidal neovascularization, three eyes progressed to geographic atrophy, one eye had recurrence of the RPED, and one eye remained unchanged. CONCLUSION RPE aperture is a characteristic OCT finding that can be observed in avascular or vascularized RPED secondary to AMD. RPE apertures precede RPED collapse, which are most likely to occur within nine months of RPE aperture detection.
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Affiliation(s)
- Jessica M Girgis
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Yingna Liu
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Michelle C Liang
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA, USA
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Girgis JM, Saukkonen D, Hüther A, Alibhai AY, Moult EM, Abu-Qamar O, Fujimoto JG, Baumal CR, Witkin AJ, Duker JS, Waheed NK. Optical Coherence Tomography Angiography Analysis Toolbox: A Repeatable and Reproducible Software Tool for Quantitative Optical Coherence Tomography Angiography Analysis. Ophthalmic Surg Lasers Imaging Retina 2023; 54:114-122. [PMID: 36780632 DOI: 10.3928/23258160-20230206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this article is to demonstrate the optical coherence tomography angiography (OCTA) Analysis Toolkit (OAT), a custom-designed software package, as a repeatable and reproducible tool for computing OCTA metrics across different devices. MATERIALS AND METHODS Fourteen participants were imaged using three devices. Foveal avascular zone, vessel index, vessel length index, and vessel diameter index were calculated using the OAT. Repeatability and reproducibility were assessed using the coefficient of variation and interclass correlation coefficient (ICC). RESULTS Analysis of identical images demonstrated perfect levels of repeatability for all metrics (coefficient of variation 0%), which was a consequence of the software being deterministic (ie, producing the same outputs for the same inputs). Foveal avascular zone ICC values were in the excellent-to-good range (ICC > 0.6) for all devices. All values for vessel index (VI), vessel length index, and vessel diameter index fell in the good-to-fair (ICC > 0.4) or excellent-to-good range, except for vessel index analysis in the Cirrus device (ICC = 0.34). CONCLUSIONS The OAT appears to be a reliable tool that may enable comparison between OCTA data sets acquired on different imaging instruments, thereby facilitating a more consistent approach to OCTA analysis. [Ophthalmic Surg Lasers Imaging Retina 2023;54:114-122.].
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Rezende FA, Ferreira BG, Rampakakis E, Steel DH, Koss MJ, Nawrocka ZA, Bacherini D, Rodrigues EB, Meyer CH, Caporossi T, Mahmoud TH, Rizzo S, Johnson MW, Duker JS. Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group. Int J Retina Vitreous 2023; 9:4. [PMID: 36717928 PMCID: PMC9885593 DOI: 10.1186/s40942-022-00439-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The CLOSE study group proposes an updated surgical classification for large macular holes based on a systematic review of new treatments. Recently, many new techniques have been introduced to treat large full-thickness macular holes (FTMH); although the indications are not clear. An updated surgical classification is needed to help surgical decision-making. METHODS We gathered published series by the CLOSE Study Group members and from literature search until June 2021. Techniques included: internal limiting membrane peeling (ILM peeling), ILM flaps, macular hydrodissection (macular hydro), human amniotic membrane graft (hAM), and autologous retinal transplantation (ART). Within each technique, chi-square test assessed association between the minimal linear diameter (MLD) (in µm) and closure rate; the postoperative best-corrected visual acuity (BCVA) gains were compared among groups. RESULTS Data extraction included 31 published articles: total of 1135 eyes. Eyes were divided into the following groups: ILM peel (n: 683), ILM Flap (n: 233), macular hydrodissection (n: 64), hAM (n: 59), and ART (n: 96). The initial BCVA and size were heterogenous between the groups. ILM peel showed the best results in large FTMH ≤ 535 µm (closure rate 96.8%); adjusted mean BCVA: 0.49 (LogMAR) with a statistical difference among groups. Large FTMH between 535 and 799 µm: ILM flap technique showed better results (closure rate 99.0%); adjusted mean BCVA: 0.67(LogMAR); also with a statistical difference. For large FTMH ≥ 800 µm more invasive techniques are required. Use of hAM, macular hydrodissection and ART showed higher closure rates for this category (100%, 83.3% and 90.5% respectively), and adjusted mean BCVA varied from 0.76 to 0.89. Although there was no statistical difference between those techniques for this group due to the smaller number of cases. CONCLUSIONS The CLOSE study group demonstrated the potential usefulness of a new surgical classification for large FTMHs and propose OCT biomarkers for use in clinical practice and future research. This new classification demonstrated that Large (400-550 µm) and X-Large (550-800 µm) holes can be treated highly successfully with ILM peel and ILM flap techniques, respectively. Further studies are necessary for the larger FTMHs (XX-Large and Giant), using the CLOSE classification, in order to determine which technique is better suited for each hole size and characteristics.
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Affiliation(s)
- Flavio A. Rezende
- grid.14848.310000 0001 2292 3357Department of Ophthalmology, Maisonneuve-Rosemont Hospital, CIUSSS de l’est d’ile de Montréal, University of Montreal, 801 Rue de la Commune est, ap 501, Montreal, QC H2V0A3 Canada
| | - Bruna G. Ferreira
- grid.14848.310000 0001 2292 3357Department of Ophthalmology, Maisonneuve-Rosemont Hospital, CIUSSS de l’est d’ile de Montréal, University of Montreal, 801 Rue de la Commune est, ap 501, Montreal, QC H2V0A3 Canada
| | - Emmanouil Rampakakis
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - David H. Steel
- grid.1006.70000 0001 0462 7212Sunderland Eye Infirmary, Sunderland, and Newcastle University, Newcastle-Upon-Tyne, UK
| | - Michael J. Koss
- Augenzentrum Nymphenburger Höfe/Augenklinik Herzog Carl Theodor, Munich, Germany
| | | | - Daniela Bacherini
- grid.8404.80000 0004 1757 2304Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, Florence, Italy
| | - Eduardo B. Rodrigues
- grid.262962.b0000 0004 1936 9342Department of Ophthalmology, St. Louis University, St. Louis, MO USA
| | | | - Tomaso Caporossi
- grid.8142.f0000 0001 0941 3192Fondazione Policlínico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.418879.b0000 0004 1758 9800Instituto di Neuroscienze - CNR, Pisa, Italy
| | - Tamer H. Mahmoud
- grid.261277.70000 0001 2219 916XAssociated Retinal Consultants, Beaumont Neuroscience Center, Oakland University William Beaumont School of Medicine, Royal Oak, MI USA
| | - Stanislao Rizzo
- grid.8142.f0000 0001 0941 3192Fondazione Policlínico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.418879.b0000 0004 1758 9800Instituto di Neuroscienze - CNR, Pisa, Italy
| | - Mark W. Johnson
- grid.214458.e0000000086837370Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI USA
| | - Jay S. Duker
- grid.67033.310000 0000 8934 4045New England Eye Center, Tufts Medical Center, Boston, MA USA ,grid.67033.310000 0000 8934 4045Department of Ophthalmology, Tufts Medical Center, Boston, MA USA
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Sharma A, Mignano JE, Duker JS. Relationship between gene expression profile class and tumor thickness regression after plaque brachytherapy for choroidal melanoma. Int J Retina Vitreous 2022; 8:47. [PMID: 35842719 PMCID: PMC9288032 DOI: 10.1186/s40942-022-00397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To examine the relationship between gene expression profile class and tumor thickness reduction as measured by ultrasonography in response to plaque brachytherapy using a single-center, retrospective cohort study. METHODS A total of 15 patients with choroidal melanoma who underwent biopsy for gene expression profiling and were treated with plaque brachytherapy from a single institution from 12/8/14 through 12/19/19 were retrospectively reviewed for clinical characteristics and rate of tumor regression. Ultrasonographic B-scan tumor height was recorded just prior to plaque placement and following plaque removal in the patient's chart to assess percent reduction in tumor thickness from baseline. RESULTS A total of 15 patients met inclusion criteria and were analyzed in this study. Minimum follow-up was 6 months after plaque removal. The percent regression in tumor thickness from baseline as measured by ultrasonography was greater for class 2 tumors than for class 1 tumors at 12-month follow up after treatment, and this difference was statistically significant (P = 0.012). There was no statistical significance in reduction at 3 months (P = 0.46) and 9 months (P = 0.10) after plaque brachytherapy. Although not statistically significant, class 2 tumors appeared to regress more rapidly than class 1 tumors in response to radiation. CONCLUSIONS In this study, class 2 choroidal melanoma tumors show a more rapid anatomic response to treatment than class 1 tumors at 12 months post plaque brachytherapy.
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Affiliation(s)
- Arjun Sharma
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - John E Mignano
- Department of Radiation Oncology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Jay S Duker
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA. .,New England Eye Center, 800 Washington Street Box 450, 260 Tremont St Biewend Building, 9th-11th Floors, Boston, MA, 02116, USA.
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Levine ES, Moult EM, Greig EC, Zhao Y, Pramil V, Gendelman I, Alibhai AY, Baumal CR, Witkin AJ, Duker JS, Fujimoto JG, Waheed NK. MULTISCALE CORRELATION OF MICROVASCULAR CHANGES ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY WITH RETINAL SENSITIVITY IN DIABETIC RETINOPATHY. Retina 2022; 42:357-368. [PMID: 34510129 PMCID: PMC8892687 DOI: 10.1097/iae.0000000000003299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess global, zonal, and local correlations between vessel density changes measured by optical coherence tomography angiography and retinal sensitivity measured by microperimetry across diabetic retinopathy severity. METHODS Diabetic patients and nondiabetic controls underwent optical coherence tomography angiography imaging and microperimetry testing. Pearson's correlation was used to assess associations between average sensitivity and skeletonized vessel density (SVD) or foveal avascular zone area centrally. Linear mixed effects modeling was used to assess relationships between local SVD measurements and their spatially corresponding retinal sensitivity measurements. RESULTS Thirty-nine eyes from 39 participants were imaged. In all slabs, there was a statistically significant positive correlation between retinal sensitivities and SVDs on both global and zonal scales. No statistically significant correlation was found between central retinal sensitivities and the foveal avascular zone areas. Assessment of 1,136 spatially paired retinal sensitivity and SVD measurements revealed a statistically significant local relationship; this seemed to be driven by eyes with proliferative diabetic retinopathy that had reduced retinal sensitivities. CONCLUSION This study supports positive correlations between SVD and retinal sensitivity at global and zonal spatial scales in diabetic eyes. However, our analysis did not find evidence of statistically significant correlations between retinal sensitivity and SVD on a local scale until advanced diabetic retinopathy.
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Affiliation(s)
- Emily S. Levine
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Eric M. Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Eugenia Custo Greig
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Yi Zhao
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Varsha Pramil
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Isaac Gendelman
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - A. Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Caroline R. Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Andre J. Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
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Abstract
PURPOSE To describe the long-term visual, clinical, and optical coherence tomography (OCT) recovery after 4 years in a patient who incurred severe bilateral handheld laser pointer damage. METHODS The findings on clinical examination, color fundus photography, and spectral domain OCT at presentation followed by sequential time points over 4 years are presented. RESULTS A 9-year-old healthy boy presented with bilateral reduced vision to count fingers in each eye with yellow irregular lesions. After extensive evaluation, he admitted to multiple, prolonged episodes of staring at a handheld red laser pointer reflected in a mirror. Initial visual acuity was count fingers bilaterally. Clinical examination revealed bilateral yellow streaks radiating from the fovea without hemorrhages or fluid and retinal pigment epithelium pigmentary mottling. Spectral domain OCT showed disruption of the foveal outer retina extending from the outer plexiform layer to the retinal pigment epithelium spanning 896 μm in the right eye and 564 μm in the left eye. Six months after injury, vision had only minimally improved to 20/200 with resolution of outer plexiform layer and outer nuclear layer opacification on OCT. Over the ensuing 4 years, visual acuity slowly recovered to 20/30 in each eye and the regions of outer retinal disruption progressively reduced in size to 295 μm in the right eye and 115 μm in the left eye. CONCLUSION This case illustrates gradual vision and anatomical improvement over 4 years despite initial poor vision after severe laser pointer macular damage. Visual recovery may be related to patient and exposure factors as well as initial OCT features where an intact Bruch membrane can provide a scaffold for photoreceptors to recover, thereby reducing the outer retinal defect.
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Affiliation(s)
- Xuejing Chen
- Retina Department, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
- Retina Service, Ophthalmic Consultants of Boston, Boston, Massachusetts
| | - Omar A W Dajani
- Retina Department, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
| | - Agha Yasin Alibhai
- Retina Department, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
| | - Jay S Duker
- Retina Department, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
| | - Caroline R Baumal
- Retina Department, New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
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Sorour OA, Elsheikh M, Chen S, Elnahry AG, Baumal CR, Pramil V, Abdelhalim TI, Nassar E, Moult EM, Witkin AJ, Duker JS, Waheed NK. Mean macular intercapillary area in eyes with diabetic macular oedema after anti-vascular endothelial growth factor therapy and its association with treatment response. Clin Exp Ophthalmol 2021; 49:714-723. [PMID: 34189816 DOI: 10.1111/ceo.13966] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND To evaluate the changes in the mean macular intercapillary area (ICA) from sequential enface optical coherence tomography angiography (OCTA) images following intravitreal anti-vascular endothelial growth factor (VEGF) therapy in initially treatment-naïve eyes with diabetic macular oedema (DME). METHODS In this multicentre retrospective study, 6 × 6 and 3 × 3 mm customised, total retinal projection enface OCTA images were collected and processed for quantitative assessment of ICA by a customised MATLAB software. Measurements were done in concentric regions centred on the fovea-with the exclusion of foveal avascular zone (FAZ)-in 0.5 mm diameter increments as well as within the intervening rings. RESULTS In this study, 6 × 6 mm OCTA images from 46 eyes of 29 patients, and 3 × 3 mm OCTA images from 23 eyes of 15 patients were included. There was no significant change in mean ICA after treatment in either scan size or in any measurement regions (all p > 0.05). Multivariate analysis revealed that baseline BCVA was significantly correlated with the visual outcome (p = 0.039). Additionally, after correction for age, baseline central retinal thickness (CRT), baseline BCVA, and retinopathy severity, mean ICA in the 1.5 mm circle was found to be a significant predictor of post treatment CRT, (p = 0.006). CONCLUSIONS Absence of significant change in mean ICA after a minimum of three intravitreal anti-VEGF injections, may indicate that, in the short term, anti-VEGF injections neither impair nor improve macular perfusion in DME. Baseline BCVA was found to be a robust predictor of functional outcome, while inner mean ICA was a significant predictor for macular thickness outcomes.
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Affiliation(s)
- Osama A Sorour
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt.,New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Mohamed Elsheikh
- Department of Geomatics Engineering, University of Calgary, Calgary, Canada.,Department of Electronics and Electrical Communications Engineering, Tanta University, Tanta, Egypt
| | - Siyu Chen
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Varsha Pramil
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Tamer I Abdelhalim
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Elsayed Nassar
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, Massachusetts, USA
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Shields CL, Lally SE, Dalvin LA, Sagoo MS, Pellegrini M, Kaliki S, Gündüz AK, Furuta M, Mruthyunjaya P, Fung AT, Duker JS, Selig SM, Yaghy A, Ferenczy SR, Eydelman MB, Blumenkranz MS. White Paper on Ophthalmic Imaging for Choroidal Nevus Identification and Transformation into Melanoma. Transl Vis Sci Technol 2021; 10:24. [PMID: 34003909 PMCID: PMC7900849 DOI: 10.1167/tvst.10.2.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose To discuss the evolution of noninvasive diagnostic methods in the identification of choroidal nevus and determination of risk factors for malignant transformation as well as introduce the novel role that artificial intelligence (AI) can play in the diagnostic process. Methods White paper. Results Longstanding diagnostic methods to stratify benign choroidal nevus from choroidal melanoma and to further determine the risk for nevus transformation into melanoma have been dependent on recognition of key clinical features by ophthalmic examination. These risk factors have been derived from multiple large cohort research studies over the past several decades and have garnered widespread use throughout the world. More recent publications have applied ocular diagnostic testing (fundus photography, ultrasound examination, autofluorescence, and optical coherence tomography) to identify risk factors for the malignant transformation of choroidal nevus based on multimodal imaging features. The widespread usage of ophthalmic imaging systems to identify and follow choroidal nevus, in conjunction with the characterization of malignant transformation risk factors via diagnostic imaging, presents a novel path to apply AI. Conclusions AI applied to existing ophthalmic imaging systems could be used for both identification of choroidal nevus and as a tool to aid in earlier detection of transformation to malignant melanoma. Translational Relevance Advances in AI models applied to ophthalmic imaging systems have the potential to improve patient care, because earlier detection and treatment of melanoma has been proven to improve long-term clinical outcomes.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital and NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Minoru Furuta
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan and Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Prithvi Mruthyunjaya
- Ocular Oncology Service, Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Adrian T Fung
- Westmead and Central Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Australia and Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Sara M Selig
- Melanoma Research Foundation, Washington, DC, USA
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sandor R Ferenczy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Malvina B Eydelman
- Office of Ophthalmic, Anesthesia, Respiratory, Ear, Nose and Throat (ENT), and Dental Devices, Food & Drug Administration (FDA), Washington, DC
| | - Mark S Blumenkranz
- Department of Ophthalmology, Ophthalmology Innovation Program, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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11
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de Souza EC, de Campos VE, Duker JS. Atypical unilateral multifocal choroiditis in a COVID-19 positive patient. Am J Ophthalmol Case Rep 2021; 22:101034. [PMID: 33623832 PMCID: PMC7893242 DOI: 10.1016/j.ajoc.2021.101034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To present a case of an atypical unilateral multifocal choroiditis that occurred in temporal association to an acute covid-19 infection. METHOD A 23-year-old highly myopic man presented with reduced vision in the right eye while under medical quarantine due to direct exposure to COVID-19 infection. Five days after developing mild COVID symptoms (fever, cough and anosmia) he noticed acute painless loss of central vision in his right eye. Systemic evaluation at presentation was positive for SARS-CoV-2 detected via both a pharyngeal swab and serologic titers. Dilated fundus exam was performed, followed by color fundus pictures, optic coherence tomography (OCT), fundus autofluorescence (FAF) and fluorescein angiography (FA). RESULTS Fundoscopic examination of the right eye revealed the presence of multiple discrete, slightly elevated yellow-whitish placoid lesions at the posterior pole. The visual acuity was 20/800. The left eye was normal with 20/20 vision. The patient was placed on oral corticosteroids and the lesions rapidly improved. CONCLUSION The patient had an MFC chorioretinitis around the same time that he had a documented acute covid infection. Though the temporal relationship could be by chance alone, communicating this case to the ophthalmic community is warranted to see if other similar cases are noted.
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Affiliation(s)
| | | | - Jay S. Duker
- Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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12
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Greig EC, Laver NV, Mendonca LS, Levine ES, Baumal CR, Waheed NK, Duker JS. SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN SMALL CHOROIDAL MELANOMAS AND CHOROIDAL NEVI. Retina 2021; 41:1182-1192. [PMID: 33315830 PMCID: PMC8140669 DOI: 10.1097/iae.0000000000003053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the use of swept-source optical coherence tomography angiography to detect distinct vascular features in small choroidal melanomas and choroidal nevi. METHODS Patients with a choroidal nevus or a treatment-naïve choroidal melanoma were imaged with color fundus photography, ultrasound, and swept-source optical coherence tomography angiography (12 × 12 mm). High-risk features including overlying fluid, orange pigment, shaggy photoreceptors, acoustic hollowness, depth >2 mm, and basal diameter >5 mm were assessed. Optical coherence tomography angiography vascular markers included: choroidal vessel visualization, choroidal vessel depth, and choriocapillaris flow signal, assessed qualitatively by comparison with surrounding, unaffected choriocapillaris. RESULTS Twenty-nine lesions were included in this study, seven flat choroidal nevi, 17 elevated choroidal nevi, and 5 choroidal melanomas. Distinct vascular patterns were noted between flat nevi, elevated nevi, and small choroidal melanomas. Choroidal melanomas displayed two types of vasculature: "nevus-like" vasculature with straight parallel vessels and complex vasculature with vascular loops and crosslinking. Visualized choroidal vessels were significantly deeper in melanomas (110 µm) than elevated (84 µm) or flat nevi (70 µm). In a size-matched subanalysis of 5 elevated choroidal nevi and 5 choroidal melanomas, choroidal melanomas had increased mean choroidal vessel depth (P = 0.015), deepest choroidal vessel visualized (P = 0.034), and presence of a deep choroidal vessel >155 µm (P = 0.048). CONCLUSION Swept-source optical coherence tomography angiography may detect distinct vascular features in choroidal nevi and small choroidal melanomas.
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Affiliation(s)
- Eugenia Custo Greig
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Yale School of Medicine, New Haven, Connecticut; and
| | - Nora V. Laver
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Luisa S.M. Mendonca
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Emily S. Levine
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Caroline R. Baumal
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nadia K. Waheed
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Jay S. Duker
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, Massachusetts
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13
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Cohen MN, Jumper JM, Duker JS. Treatment and Excision of Retinal Capillary Hemangioblastoma. Ophthalmic Surg Lasers Imaging Retina 2021; 52:165-167. [PMID: 34038690 DOI: 10.3928/23258160-20210302-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This is a case report detailing a pars plana vitrectomy and resection of a retinal capillary hemangioblastoma in a 19-year-old female with a history of von Hippel-Lindau syndrome with secondary retinal detachment and sub-retinal exudates limiting her vision. Intraoperatively, long duration endolaser and generous endodiathermy applied to the feeder vessels are essential to minimize bleeding. Complete and careful resection of the lesion and installation of a silicone oil tamponade are recommended. This technique can allow for retinal reattachment and improvement in visual acuity in advanced cases of secondary retinal detachment.
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Konstantinou EK, Mendonça LSM, Braun P, Monahan KM, Mehta N, Gendelman I, Levine ES, Baumal CR, Witkin AJ, Duker JS, Waheed NK. Retinal Imaging Using a Confocal Scanning Laser Ophthalmoscope-Based High-Magnification Module. Ophthalmol Retina 2021; 5:438-449. [PMID: 32861857 DOI: 10.1016/j.oret.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To evaluate the usefulness of a high-magnification module (HMM) lens to visualize retinal photoreceptors, retinal nerve fiber layer (RNFL), and superficial retinal vasculature in physiologic and pathologic retinal conditions. DESIGN Observational descriptive study. PARTICIPANTS Thirty-two participants with normal and pathologic retina examination results. METHODS Normal and pathologic maculae were imaged in vivo using still and video HMM lens modes, with fixation and contrast adjustments to enhance visualization. The HMM images were classified qualitatively based on structures identified as either good (photoreceptors seen), average (photoreceptor mosaic cannot be visualized clearly, retinal vessels and other retinal changes can be seen), or poor (no identifiable structures). Selected eyes were imaged with fundus photography, OCT, OCT angiography, indocyanine green angiography, and fluorescein angiography for comparison with the pathologic maculae. MAIN OUTCOMES MEASURES Description of HMM module-obtained macula images. RESULTS From 32 eyes imaged (16 normal and 16 pathologic retinas), 12 of 16 normal and 11 of 16 pathologic retinas demonstrated at least average image quality, in which retinal vasculature and landmarks could be visualized. The mosaic pattern of hexagonal shapes representing photoreceptors could not be resolved in most pathologic retinas. For the retinas in which the photoreceptor mosaics were visualized (12 of 16 normal and 2 of 16 pathologic retinas), parafoveal mosaic patterns appeared denser with better image quality for all participants compared with foveal photoreceptors. Difficulty in resolving the photoreceptors in the umbo, fovea, and perifovea was encountered, similar to what has been reported with adaptive optics devices. The RNFL was seen as arcuate hyperreflective bundles. Flow was observed in the macular microvasculature. Poorly resolved photoreceptors and scattered hyperreflective foci were correlated with changes in the retinal pigment epithelium in eyes with age-related macular degeneration or central serous chorioretinopathy. Macular striae were seen in eyes with epiretinal membrane. CONCLUSIONS In most eyes, regardless of whether retinal pathologic features were present, it was challenging to obtain average quality (or better) images. In the few participants with good-quality imaging, the parafoveal photoreceptor mosaic, vascular flow, and various features of pathologic eyes could be visualized.
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Affiliation(s)
- Eleni K Konstantinou
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Luísa S M Mendonça
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Phillip Braun
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; Yale University School of Medicine, New Haven, Connecticut
| | - Kyle M Monahan
- Data Lab, Tufts Technology Services, Tufts University, Medford, Massachusetts
| | - Nihaal Mehta
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts; Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Isaac Gendelman
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Emily S Levine
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Caroline R Baumal
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Andre J Witkin
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Jay S Duker
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Nadia K Waheed
- New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.
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15
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Custo Greig EP, Duker JS. Retinal hemangioblastoma vascular detail elucidated on swept source optical coherence tomography angiography. Am J Ophthalmol Case Rep 2021; 21:101005. [PMID: 33385098 PMCID: PMC7771098 DOI: 10.1016/j.ajoc.2020.101005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/17/2020] [Accepted: 12/14/2020] [Indexed: 01/26/2023] Open
Abstract
Purpose To report the distinct vascular pattern of a treatment-naïve retinal hemangioblastoma imaged on swept source optical coherence tomography angiography (SS-OCTA). Observations A 33-year-old female with a history of Von Hippel-Lindau disease presented for follow-up of bilateral retinal hemangioblastomas. Ultra-widefield fundus photography of the left eye revealed a small, juxtapapillary lesion. SS-OCTA imaging centered at the lesion identified two distinct vascular foci. Centrally, the lesion was composed of a dense capillary meshwork. Peripherally, a pattern of branching vessels with terminal budding was identified. The patient was diagnosed with a new juxtapapillary retinal hemangioblastoma. Conclusions and Importance SS-OCTA can visualize the in-vivo vascular structure of retinal hemangioblastomas. Early lesion identification can help in prompt diagnosis and monitoring. Further investigation is needed to assert if the branching and budding pattern described in this case report is broadly characteristic of this tumor entity.
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Affiliation(s)
- Eugenia P. Custo Greig
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
- Corresponding author. Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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16
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Ploner SB, Kraus MF, Moult EM, Husvogt L, Schottenhamml J, Yasin Alibhai A, Waheed NK, Duker JS, Fujimoto JG, Maier AK. Efficient and high accuracy 3-D OCT angiography motion correction in pathology. Biomed Opt Express 2021; 12:125-146. [PMID: 33520381 PMCID: PMC7818965 DOI: 10.1364/boe.411117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 05/27/2023]
Abstract
We describe a novel method for non-rigid 3-D motion correction of orthogonally raster-scanned optical coherence tomography angiography volumes. This is the first approach that aligns predominantly axial structural features such as retinal layers as well as transverse angiographic vascular features in a joint optimization. Combined with orthogonal scanning and favorization of kinematically more plausible displacements, subpixel alignment and micrometer-scale distortion correction is achieved in all 3 dimensions. As no specific structures are segmented, the method is by design robust to pathologic changes. Furthermore, the method is designed for highly parallel implementation and short runtime, allowing its integration into clinical workflow even for high density or wide-field scans. We evaluated the algorithm with metrics related to clinically relevant features in an extensive quantitative evaluation based on 204 volumetric scans of 17 subjects, including patients with diverse pathologies and healthy controls. Using this method, we achieve state-of-the-art axial motion correction and show significant advances in both transverse co-alignment and distortion correction, especially in the subgroup with pathology.
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Affiliation(s)
- Stefan B. Ploner
- Pattern Recognition Lab,
Friedrich-Alexander-Universität Erlangen-Nürnberg,
Martensstr. 3, Erlangen, 91058, Germany
- Department of Electrical Engineering and
Computer Science and Research Laboratory of Electronics, Massachusetts
Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139,
USA
| | - Martin F. Kraus
- Pattern Recognition Lab,
Friedrich-Alexander-Universität Erlangen-Nürnberg,
Martensstr. 3, Erlangen, 91058, Germany
| | - Eric M. Moult
- Department of Electrical Engineering and
Computer Science and Research Laboratory of Electronics, Massachusetts
Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139,
USA
| | - Lennart Husvogt
- Pattern Recognition Lab,
Friedrich-Alexander-Universität Erlangen-Nürnberg,
Martensstr. 3, Erlangen, 91058, Germany
- Department of Electrical Engineering and
Computer Science and Research Laboratory of Electronics, Massachusetts
Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139,
USA
| | - Julia Schottenhamml
- Pattern Recognition Lab,
Friedrich-Alexander-Universität Erlangen-Nürnberg,
Martensstr. 3, Erlangen, 91058, Germany
| | - A. Yasin Alibhai
- New England Eye Center, Tufts Medical
Center, 800 Washington St. Box 450, Boston, MA 02111, USA
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical
Center, 800 Washington St. Box 450, Boston, MA 02111, USA
| | - Jay S. Duker
- New England Eye Center, Tufts Medical
Center, 800 Washington St. Box 450, Boston, MA 02111, USA
| | - James G. Fujimoto
- Department of Electrical Engineering and
Computer Science and Research Laboratory of Electronics, Massachusetts
Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139,
USA
| | - Andreas K. Maier
- Pattern Recognition Lab,
Friedrich-Alexander-Universität Erlangen-Nürnberg,
Martensstr. 3, Erlangen, 91058, Germany
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17
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Schottenhamml J, Moult EM, Ploner SB, Chen S, Novais E, Husvogt L, Duker JS, Waheed NK, Fujimoto JG, Maier AK. OCT-OCTA segmentation: combining structural and blood flow information to segment Bruch's membrane. Biomed Opt Express 2021; 12:84-99. [PMID: 33520378 PMCID: PMC7818963 DOI: 10.1364/boe.398222] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 05/13/2023]
Abstract
In this paper we present a fully automated graph-based segmentation algorithm that jointly uses optical coherence tomography (OCT) and OCT angiography (OCTA) data to segment Bruch's membrane (BM). This is especially valuable in cases where the spatial correlation between BM, which is usually not visible on OCT scans, and the retinal pigment epithelium (RPE), which is often used as a surrogate for segmenting BM, is distorted by pathology. We validated the performance of our proposed algorithm against manual segmentation in a total of 18 eyes from healthy controls and patients with diabetic retinopathy (DR), non-exudative age-related macular degeneration (AMD) (early/intermediate AMD, nascent geographic atrophy (nGA) and drusen-associated geographic atrophy (DAGA) and geographic atrophy (GA)), and choroidal neovascularization (CNV) with a mean absolute error of ∼0.91 pixel (∼4.1 μm). This paper suggests that OCT-OCTA segmentation may be a useful framework to complement the growing usage of OCTA in ophthalmic research and clinical communities.
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Affiliation(s)
- Julia Schottenhamml
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91058, Germany
| | - Eric M. Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Stefan B. Ploner
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91058, Germany
| | - Siyu Chen
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Eduardo Novais
- New England Eye Center, Tufts Medical Center, Boston, MA 02116, USA
- Federal University of São Paulo, School of Medicine, São Paulo - SP, 04021-001, Brazil
| | - Lennart Husvogt
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91058, Germany
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, MA 02116, USA
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA 02116, USA
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Andreas K. Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, 91058, Germany
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Greig EC, Duker JS, Waheed NK. A practical guide to optical coherence tomography angiography interpretation. Int J Retina Vitreous 2020; 6:55. [PMID: 33292740 PMCID: PMC7666474 DOI: 10.1186/s40942-020-00262-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022] Open
Abstract
Background Optical coherence tomography angiography (OCTA) can image the retinal vasculature in vivo, without the need for contrast dye. This technology has been commercially available since 2014, however, much of its use has been limited to the research setting. Over time, more clinical practices have adopted OCTA imaging. While countless publications detail OCTA’s use for the study of retinal microvasculature, few studies outline OCTA’s clinical utility. Body This review provides an overview of OCTA imaging and details tips for successful interpretation. The review begins with a summary of OCTA technology and artifacts that arise from image acquisition. New methods and best practices to prevent image artifacts are discussed. OCTA has the unique ability among retinovascular imaging modalities to individually visualize each retinal plexus. Slabs offered in standard OCTA devices are reviewed, and clinical uses for each slab are outlined. Lastly, the use of OCTA for the clinical interpretation of retinal pathology, such as diabetic retinopathy and age-related macular degeneration, is discussed. Conclusion OCTA is evolving from a scientific tool to a clinical imaging device. This review provides a toolkit for successful image interpretation in a clinical setting.
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Affiliation(s)
- Eugenia Custo Greig
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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Mendonça LS, Braun PX, Martin SM, Hüther A, Mehta N, Zhao Y, Abu-Qamar O, Konstantinou EK, Regatieri CV, Witkin AJ, Baumal CR, Duker JS, Waheed NK. Repeatability and Reproducibility of Photoreceptor Density Measurement in the Macula Using the Spectralis High Magnification Module. ACTA ACUST UNITED AC 2020; 4:1083-1092. [DOI: 10.1016/j.oret.2020.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 12/20/2022]
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20
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Mehta N, Lee CS, Mendonça LSM, Raza K, Braun PX, Duker JS, Waheed NK, Lee AY. Model-to-Data Approach for Deep Learning in Optical Coherence Tomography Intraretinal Fluid Segmentation. JAMA Ophthalmol 2020; 138:1017-1024. [PMID: 32761143 PMCID: PMC7411940 DOI: 10.1001/jamaophthalmol.2020.2769] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/06/2020] [Indexed: 12/27/2022]
Abstract
Importance Amid an explosion of interest in deep learning in medicine, including within ophthalmology, concerns regarding data privacy, security, and sharing are of increasing importance. A model-to-data approach, in which the model itself is transferred rather than data, can circumvent many of these challenges but has not been previously demonstrated in ophthalmology. Objective To determine whether a model-to-data deep learning approach (ie, validation of the algorithm without any data transfer) can be applied in ophthalmology. Design, Setting, and Participants This single-center cross-sectional study included patients with active exudative age-related macular degeneration undergoing optical coherence tomography (OCT) at the New England Eye Center from August 1, 2018, to February 28, 2019. Data were primarily analyzed from March 1 to June 20, 2019. Main Outcomes and Measures Training of the deep learning model, using a model-to-data approach, in recognizing intraretinal fluid (IRF) on OCT B-scans. Results The model was trained (learning curve Dice coefficient, >80%) using 400 OCT B-scans from 128 participants (69 female [54%] and 59 male [46%]; mean [SD] age, 77.5 [9.1] years). In comparing the model with manual human grading of IRF pockets, no statistically significant difference in Dice coefficients or intersection over union scores was found (P > .05). Conclusions and Relevance A model-to-data approach to deep learning applied in ophthalmology avoided many of the traditional hurdles in large-scale deep learning, including data sharing, security, and privacy concerns. Although the clinical relevance of these results is limited at this time, this proof-of-concept study suggests that such a paradigm should be further examined in larger-scale, multicenter deep learning studies.
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Affiliation(s)
- Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle
| | - Luísa S. M. Mendonça
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Khadija Raza
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Phillip X. Braun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
- Yale School of Medicine, New Haven, Connecticut
| | - Jay S. Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle
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Wang D, Au A, Duker JS, Sarraf D. PAMM and the ischemic cascade associated with radiation retinopathy. Am J Ophthalmol Case Rep 2020; 20:100918. [PMID: 32984654 PMCID: PMC7495006 DOI: 10.1016/j.ajoc.2020.100918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/28/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To report a case of paracentral acute middle maculopathy (PAMM) and evidence of the ischemic cascade documented with spectral domain optical coherence tomography (SD-OCT) following radiation treatment of a choroidal melanoma. Observations A healthy young patient was evaluated for an asymptomatic choroidal nevus in the left eye. Fundus examination was remarkable for a choroidal melanocytic lesion that measured 1.8 mm in thickness by initial B-scan ultrasound. Clinical examination 6 months later showed growth of the tumor at several margins with new subretinal fluid, and a B-scan measured thickness of 1.9 mm. The lesion was diagnosed as a small choroidal melanoma and treated with gamma knife radiation with a dose of 3000 cGy. Sixteen months later, examination showed signs of radiation retinopathy including cotton wool spots and PAMM via SD-OCT and OCT angiography and evidence of the ischemic cascade (i.e., alternating zones of middle and combined middle and inner retinal layer infarction). Conclusions Radiation retinopathy can include signs of microvascular damage and ischemia including lesions such as cotton wool spots and PAMM. A case is presented in this report of radiation retinopathy with OCT evidence of PAMM and the ischemic cascade.
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Affiliation(s)
- Derrick Wang
- Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles (UCLA), CA, USA
| | - Adrian Au
- Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles (UCLA), CA, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - David Sarraf
- Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles (UCLA), CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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22
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Chen VM, Mehta N, Robbins CC, Noh E, Pramil V, Duker JS, Waheed NK. Anterior-segment spectral domain optical coherence tomography in epidermolysis bullosa. Ocul Surf 2020; 18:912-919. [PMID: 32976999 DOI: 10.1016/j.jtos.2020.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Assess epidermolysis bullosa (EB)-related corneal pathology using anterior segment optical coherence tomography (AS-OCT) and correlate imaging with clinical metrics in EB patients versus age-matched controls. METHODS EB patients and controls were recruited during an EB conference (July 2018) and at Tufts Medical Center (June-August 2019). Subjects completed a questionnaire, had best corrected visual acuity (BCVA) tested, and underwent AS-OCT scanning. Stromal and epithelial thickness were measured. Depth, length, and type of the three largest lesions were assessed by a masked examiner using a novel pathology grading system. Multivariate analysis of AS-OCT findings and clinical metrics was performed. RESULTS 62 EB patients and 60 age-matched controls were enrolled. Mean BCVA was 1.8 lines worse in patients (p < 0.001). Vision loss was associated with increased stromal thickness. Discrete lesions were seen in 60.2% of patient eyes, averaging 1.71 ± 1.75 lesions in patients and 0.14 ± 0.42 in controls (p < 0.001). Mean primary lesion depth was 151.88 ± 97.49 μm in patients. Patients showed significant stromal thickening versus controls and lesions were most common in the periphery and inferiorly. Differences in frequency and duration of abrasions and severity of pain were all statistically and clinically significant in patients versus controls (p < 0.001). CONCLUSIONS AS-OCT can visualize and quantify differences in the corneas of EB patients compared with age-matched controls. Novel findings include quantification of average depth, length, and severity of discrete lesions, and sparing of the superior quadrant from stromal thickening in EB patients. These results support use of AS-OCT and a questionnaire in clinical trials for new EB therapies.
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Affiliation(s)
- Vicki M Chen
- New England Eye Center, Tufts Medical Center, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA.
| | - Nihaal Mehta
- Dpartment of Ophthalmology, University of Colorado, Denver, CO, USA
| | | | - Elizabeth Noh
- Tufts University School of Medicine, Boston, MA, USA
| | - Varsha Pramil
- New England Eye Center, Tufts Medical Center, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
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23
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Mehta N, Braun PX, Gendelman I, Alibhai AY, Arya M, Duker JS, Waheed NK. Repeatability of binarization thresholding methods for optical coherence tomography angiography image quantification. Sci Rep 2020; 10:15368. [PMID: 32958813 PMCID: PMC7505834 DOI: 10.1038/s41598-020-72358-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Binarization is a critical step in analysis of retinal optical coherence tomography angiography (OCTA) images, but the repeatability of metrics produced from various binarization methods has not been fully assessed. This study set out to examine the repeatability of OCTA quantification metrics produced using different binarization thresholding methods, all of which have been applied in previous studies, across multiple devices and plexuses. Successive 3 × 3 mm foveal OCTA images of 13 healthy eyes were obtained on three different devices. For each image, contrast adjustments, 3 image processing techniques (linear registration, histogram normalization, and contrast-limited adaptive histogram equalization), and 11 binarization thresholding methods were independently applied. Vessel area density (VAD) and vessel length were calculated for retinal vascular images. Choriocapillaris (CC) images were quantified for VAD and flow deficit metrics. Repeatability, measured using the intra-class correlation coefficient, was inconsistent and generally not high (ICC < 0.8) across binarization thresholds, devices, and plexuses. In retinal vascular images, local thresholds tended to incorrectly binarize the foveal avascular zone as white (i.e., wrongly indicating flow). No image processing technique analyzed consistently resulted in highly repeatable metrics. Across contrast changes, retinal vascular images showed the lowest repeatability and CC images showed the highest.
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Affiliation(s)
- Nihaal Mehta
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Department of Ophthalmology, University of Colorado, Denver, CO, USA
| | - Phillip X Braun
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Isaac Gendelman
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.,Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - A Yasin Alibhai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Malvika Arya
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Jay S Duker
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Nadia K Waheed
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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24
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Braun PX, Mehta N, Gendelman I, Alibhai AY, Baumal CR, Duker JS, Waheed NK. Using the Pathophysiology of Dry AMD to Guide Binarization of the Choriocapillaris on OCTA: A Model. Transl Vis Sci Technol 2020; 9:44. [PMID: 32855890 PMCID: PMC7422830 DOI: 10.1167/tvst.9.8.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
Especially since the incorporation of swept laser sources, optical coherence tomography angiography (OCTA) has enabled quantification of choriocapillaris perfusion. A critical step in this process is binarization, which makes angiographic images quantifiable in terms of perfusion metrics. It remains challenging to have confidence that choriocapillaris perfusion metrics reflect the reality of pathophysiologic flow, largely because choice of binarization method can result in significantly different perfusion metric outcomes. This commentary discusses a proof-of-concept case involving comparative assessment of binarization methods for a set of dry age-related macular degeneration OCTA data. One of these methods was deemed preferable based on superior agreement with suspected physiologic and pathophysiologic characteristics, thus demonstrating the principle that, in the absence of gold standards for measurement of choriocapillaris perfusion, the best available approximations of pathophysiology may be used to guide choice of binarization method.
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Affiliation(s)
- Phillip X Braun
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Nihaal Mehta
- Department of Ophthalmology, University of Colorado, Denver, CO, USA
| | - Isaac Gendelman
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
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25
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Levine ES, Custo Greig E, Mendonça LSM, Gulati S, Despotovic IN, Alibhai AY, Moult E, Muakkassa N, Quaranta-El Maftouhi M, El Maftouhi A, Chakravarthy U, Fujimoto JG, Baumal CR, Witkin AJ, Duker JS, Hartnett ME, Waheed NK. The long-term effects of anti-vascular endothelial growth factor therapy on the optical coherence tomography angiographic appearance of neovascularization in age-related macular degeneration. Int J Retina Vitreous 2020; 6:39. [PMID: 32844038 PMCID: PMC7441632 DOI: 10.1186/s40942-020-00242-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background The short-term effects of anti-vascular endothelial growth factor (anti-VEGF) treatment on macular neovascularization (MNV) morphology is well described, but long-term studies on morphologic changes and correlation of such changes to the type of MNV have not been conducted. This study aims to determine if different types of MNVs in neovascular AMD (nAMD) behave differently with anti-VEGF treatment as visualized on optical coherence tomography angiography (OCTA). Methods Treatment-naïve nAMD patients were retrospectively screened for baseline and follow-up OCTA imaging 10 or more months after initial treatment. Images were graded for MNV type, area, activity, mature versus immature vessels, vessel density, presence of atrophy, atrophy location and area. Growth rate was calculated as the percent change in lesion area from baseline over the years of follow-up. In addition, the occurrence of complete regression and the percent of lesions that grew, remained stable, and shrunk per type was also evaluated. Results Forty-three eyes from 43 patients with a mean follow-up of 2 years were evaluated. On structural OCT, 26 lesions were classified as pure type 1 MNVs, 12 MNVs had a type 2 component, and 5 MNVs had a type 3 component. Of these cases, 2 mixed-type MNVs were considered to have completely regressed. There was no significant differences in MNV area and growth rate between type 1 and type 2 lesions, but all cases of type 3 lesions shrunk in the follow-up period. There was no correlation between the number of injections per year and growth rate, endpoint MNV area or endpoint activity status for any MNV type. There was no significant association between the development of atrophy and the number of injections, baseline MNV area, baseline vessel density, or lesion growth rate. Conclusions In nAMD, complete regression of an MNV network exposed to anti-VEGF is rare. This work emphasizes the role of anti-VEGF as anti-leakage rather than vascular regression agents in nAMD.
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Affiliation(s)
- Emily S Levine
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,Tufts University School of Medicine, Boston, MA USA
| | - Eugenia Custo Greig
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,Yale School of Medicine, New Haven, CT USA
| | - Luísa S M Mendonça
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Shilpa Gulati
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | | | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Eric Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA USA
| | | | | | | | | | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA USA
| | | | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA USA
| | | | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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26
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Arya M, Filho MB, Rebhun CB, Moult EM, Lee B, Alibhai Y, Witkin AJ, Baumal CR, Duker JS, Fujimoto JG, Waheed NK. Analyzing Relative Flow Speeds in Diabetic Retinopathy Using Variable Interscan Time Analysis OCT Angiography. Ophthalmol Retina 2020; 5:49-59. [PMID: 32585373 DOI: 10.1016/j.oret.2020.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Further insight into the flow characteristics of the vascular features associated with diabetic retinopathy (DR) may improve assessment and treatment of disease progression. The variable interscan time analysis (VISTA) algorithm is an extension of OCT angiography (OCTA) that detects relative blood flow speeds, which then can be depicted on a color-coded map. This study used VISTA to analyze relative blood flow speeds in the microvascular changes associated with DR. DESIGN Cross-sectional study. PARTICIPANTS Thirteen patients with varying severities of DR treated at New England Eye Center, Boston, Massachusetts. METHODS OCT angiography images centered at the fovea were obtained on a prototype swept-source OCT device, and the VISTA algorithm was applied to visualize relative blood flow speeds. MAIN OUTCOME MEASURES Descriptive flow analysis of the retinal vascular features of DR was conducted on the VISTA-generated images. RESULTS Twenty-six eyes were included in this study. Of these, 3 eyes had mild nonproliferative DR (NPDR), 6 eyes had moderate NPDR, 4 eyes had severe NPDR, 9 eyes had proliferative DR, and 4 eyes were normal controls. Microaneurysms, intraretinal microvascular abnormalities (IRMAs), and neovascularization appeared to originate from areas of relatively slow blood flow speeds. Microaneurysms showed relatively slower flow, IRMAs showed turbulent, intermediate to slow flow, and venous beading and looping presented with relatively high flow speeds that tapered progressively. Neovascularization of venous origin demonstrated slower flow speeds, whereas that of arterial origin showed relatively high flow speeds. Additionally, increased disease severity was associated with globally slower flow speeds, with particularly slower flow around the foveal avascular zone. CONCLUSIONS The VISTA algorithm seems to be a useful extension of OCTA that overcomes some of the limitations of normal gray-scale OCTA. It seems to have some potential in providing relevant insight into the pathogenesis of the microvascular changes associated with DR. These findings may assist in improving our understanding of the pathogenic changes that take place in DR.
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Affiliation(s)
- Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Marco Bonini Filho
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts; Department of Ophthalmology, Sao Juliao Hospital, Campo Grande, MS, Brazil
| | - Carl B Rebhun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Byungkung Lee
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts.
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27
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Sorour OA, Liu K, Mehta N, Braun P, Gendelman I, Nassar E, Baumal CR, Witkin AJ, Duker JS, Waheed NK. Visual and anatomic outcomes of sustained single agent anti-VEGF treatment versus double anti-VEGF switching in the treatment of persistent diabetic macular edema. Int J Retina Vitreous 2020; 6:17. [PMID: 32523776 PMCID: PMC7278067 DOI: 10.1186/s40942-020-00220-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/25/2020] [Indexed: 01/01/2023] Open
Abstract
Background To compare the anatomical and visual outcomes in eyes with persistent diabetic macular edema (DME) after initial anti-VEGF therapy that were retreated continuously with the same anti-VEGF drug versus those that underwent two successive cycles of medication change in anti-VEGF drugs (double anti-VEGF switch). Methods Retrospective review of eyes with persistent DME after 3 initial consecutive monthly anti-VEGF injections. This cohort was divided into two groups: Group 1 continued to receive the same initial anti-VEGF drug for at least 18 months while group 2 eyes were switched to different anti-VEGF medications twice. Group 1 was further subdivided into: Group 1A composed of eyes with less than 20% reduction in central subfield thickness (CRT) at month 3; and group 1B eyes with greater than or equal to 20% reduction in CRT. The percentage of eyes that achieved greater than 10 letters visual acuity (VA) gain or loss was recorded as the primary end point (through month 18 in group 1 and month 6 after 2nd switch in group 2). Results Group 1A, 1B and group 2 were composed of 24, 18, and 14 eyes respectively. 34.7%, 56.2% and 36.3% of eyes achieved > 10 letters gain, while 4.3%, 6.2% and 27.2% of eyes lost > 10 letters in groups 1A, 1B, and 2, respectively. Analysis of the visual acuity (VA) letter change in this time interval revealed no significant difference between all groups (p = 0.11). Mean VA and CRT measurements at the primary endpoint in all groups were 0.5, 0.39, and 0.47 logMAR (p = 0.44), and 369.7, 279.9, 321 µm, (p = 0.01) respectively. Conclusions There was no difference in the visual outcomes between the two treatment strategies in eyes with persistent DME after 3 consecutive anti-VEGF injections. This may indicate that anti-VEGF switching—even if it is done twice—may have comparable clinical outcomes to sustained treatment with one agent.
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Affiliation(s)
- Osama A Sorour
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Keke Liu
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA.,University of Hawai'i John A. Burns School of Medicine, Honolulu, HI USA
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA.,The Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Phillip Braun
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA.,Yale School of Medicine, Yale University, New Haven, CT USA
| | - Isaac Gendelman
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA.,Tufts University School of Medicine, Tufts University, Boston, MA USA
| | - Elsayed Nassar
- Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Tufts University, Boston, MA USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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28
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Moult EM, Alibhai AY, Lee B, Yu Y, Ploner S, Chen S, Maier A, Duker JS, Waheed NK, Fujimoto JG. A Framework for Multiscale Quantitation of Relationships Between Choriocapillaris Flow Impairment and Geographic Atrophy Growth. Am J Ophthalmol 2020; 214:172-187. [PMID: 31843474 DOI: 10.1016/j.ajo.2019.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 12/06/2019] [Accepted: 12/09/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To develop a multiscale analysis framework for investigating the relationships between geographic atrophy (GA) growth rate and choriocapillaris (CC) blood flow impairment using optical coherence tomography (OCT) and OCT angiography (OCTA). DESIGN Retrospective case series. METHODS We developed an OCT/OCTA analysis framework that quantitatively measures GA growth rates at global and local scales and CC impairment at global, zonal, and local scales. A geometric GA growth model was used to measure local GA growth rates. The utility of the framework was demonstrated on 7 eyes with GA imaged at 2 time points using a prototype 400-kHz, 1050-nm swept-source OCTA system. RESULTS Qualitatively, there was a trend of increasing GA growth rate with increasing CC impairment. The local analysis model enabled growth rates to be estimated at each point on the GA boundary. However, there was no generally observed trend between local GA growth rates and local CC impairment. CONCLUSIONS The global, zonal, and local analysis framework may be useful for investigating relationships between GA growth and CC impairment at different spatial scales. The geometric GA growth model enables spatially resolved growth measurements that capture the anisotropy of GA growth and may improve the characterization of GA progression.
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Affiliation(s)
- Eric M Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - ByungKun Lee
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Yue Yu
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts; Department of Biomedical Engineering, Peking University, Beijing, China
| | - Stefan Ploner
- Department of Computer Science, Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Siyu Chen
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Andreas Maier
- Department of Computer Science, Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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29
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Sorour OA, Mehta N, Baumal CR, Ishibazawa A, Liu K, Konstantinou EK, Martin S, Braun P, Alibhai AY, Arya M, Witkin AJ, Duker JS, Waheed NK. Morphological changes in intraretinal microvascular abnormalities after anti-VEGF therapy visualized on optical coherence tomography angiography. Eye Vis (Lond) 2020; 7:29. [PMID: 32514410 PMCID: PMC7262762 DOI: 10.1186/s40662-020-00195-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/09/2020] [Indexed: 11/10/2022]
Abstract
Background To examine the baseline morphological characteristics and alterations in intraretinal microvascular abnormalities (IRMAs) in response to anti-vascular endothelial growth factor (anti-VEGF) treatment, documented by optical coherence tomography angiography (OCTA) in diabetic eyes. Methods In this retrospective study, IRMAs were evaluated with multimodal imaging (fundus photography, fluorescein angiography, OCTA) in treatment-naïve diabetic eyes before and after anti-VEGF treatment for diabetic macular edema (DME) and/or proliferative diabetic retinopathy (PDR) and compared to diabetic control eyes with similar diabetic retinopathy (DR) severity that did not receive anti-VEGF therapy. The morphological characteristics of IRMAs on enface OCTA imaging were graded by masked readers at baseline, then after anti-VEGF therapy in treated eyes or after observation in control eyes. Characterization of interval changes in an IRMA were based on the following parameters: branching, vessel caliber and area of adjacent capillary non-perfusion. Results The treated group included 45 IRMA foci from 15 eyes of 11 patients, while the control group included 27 IRMA foci from 15 eyes of 14 patients. Following anti-VEGF treatment, enface OCTA demonstrated that 14 foci of IRMA (31%) demonstrated regression with normalization of appearance of the capillary bed, 20 IRMAs (44%) remained unchanged, six IRMAs (13%) progressed with enlargement or development of new IRMAs and five IRMAs (11%) demonstrated complete obliteration defined as IRMA disappearance with advancing capillary drop-out. In the control group, 17 IRMA (63%) remained stable, 8 IRMAs (29.6%) progressed and 2 experienced total obliteration (7.4%). The difference in rank order between the two groups was statistically significant (p = 0.022). Conclusions In eyes with DR status post anti-VEGF therapy, foci of IRMAs have a variable course demonstrating one of four possible outcomes: regression, stability, progression or complete obliteration. In contrast, none of the untreated control diabetic eyes demonstrated regression of IRMAs, consistent with known progression of DR severity in high risk eyes. Morphologic evaluation of IRMAs with OCTA may help to monitor changes in retinal blood flow as well as the response to anti-VEGF treatment.
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Affiliation(s)
- Osama A Sorour
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Nihaal Mehta
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,The Warren Alpert Medical School of Brown University, Providence, Rhode Island USA
| | - Caroline R Baumal
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Akihiro Ishibazawa
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan
| | - Keke Liu
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,University of Hawai'i John A. Burns School of Medicine, Honolulu, HI USA
| | - Eleni K Konstantinou
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Sarah Martin
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Phillip Braun
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Yale School of Medicine, New Haven, Connecticut USA
| | - A Yasin Alibhai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Malvika Arya
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Andre J Witkin
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Jay S Duker
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Nadia K Waheed
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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Alibhai AY, Mehta N, Hickson-Curran S, Moreira-Neto C, Levine ES, Reichel E, Duker JS, Waheed NK. Test-retest variability of microperimetry in geographic atrophy. Int J Retina Vitreous 2020; 6:16. [PMID: 32377380 PMCID: PMC7193411 DOI: 10.1186/s40942-020-00217-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/11/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose Microperimetry (MP) allows for measurement of retinal sensitivity at precise locations and is now commonly employed as a clinical trial endpoint. Test-retest reliability is important when evaluating treatment effects in patients with geographic atrophy (GA). This study aimed to determine the test-retest variability of MP in patients with moderate to severe GA using the MAIA MP device. Methods In this prospective study, patients with a confirmed diagnosis of foveal-involving GA were enrolled. Participants performed three MP assessments of a selected eye over two visits with the Macular Integrity Assessment (MAIA) 2 instrument (Centervue, Padova, Italy) utilizing a wide 30° grid, consisting of 93 stimuli (Goldmann III) using a 4-2 representation strategy, encompassing the entire area of GA and beyond. Mean retinal sensitivity (MS) was expressed as an average threshold value (dB) for the entire field tested. Coefficients of Repeatability at a 95% level (CoR95) were calculated for Point Wise Sensitivity (PWS). Fixation stability (FS) was assessed by evaluating the area of an elliptical representation encompassing 95% of the cloud of fixation points (CFP) dataset generated by the MAIA MP, known as the bivariate contour ellipse area (BCEA). Results A total of 8 subjects were enrolled (21 tests), with six subjects completing 3 MP assessments. BCVA in these patients ranged from 20/100 to 20/800. The mean area of GA was 18.7 ± 12.3 mm2. The average time to complete one MP assessment was 13 min 9 s and mean BCEA@95% was 38.5 ± 19.3°2. The MS was 14.3 ± 4.5 dB. No significant increase in MS was noted between testing pairs 1&2 and 2&3. The preferred retinal locus was maintained in the same quadrant on successive tests. The mean CoR95 for PWS were similar for testing pairs 1&2 (± 3.50 dB) and 2&3 (± 3.40). Conclusion Microperimetry using a wide grid can be reliably performed in a reasonable amount of time in patients with moderate and severe vision loss secondary to GA. There was no learning effect seen between sequential assessments when analyzing MS or PWS. A change of approximately 4 dB in PWS provides a threshold for considering a true change in this patient cohort.
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Affiliation(s)
- A Yasin Alibhai
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Nihaal Mehta
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
| | | | | | - Emily S Levine
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Elias Reichel
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Jay S Duker
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Nadia K Waheed
- 3Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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Gendelman I, Alibhai AY, Moult EM, Levine ES, Braun PX, Mehta N, Zhao Y, Ishibazawa A, Sorour OA, Baumal CR, Witkin AJ, Reichel E, Fujimoto JG, Duker JS, Waheed NK. Topographic analysis of macular choriocapillaris flow deficits in diabetic retinopathy using swept-source optical coherence tomography angiography. Int J Retina Vitreous 2020; 6:6. [PMID: 32206342 PMCID: PMC7081691 DOI: 10.1186/s40942-020-00209-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background The purpose of this study was to investigate the association between diabetic retinopathy (DR) severity and macular choriocapillaris (CC) flow deficit percentage (FD %) in different macular regions using swept-source optical coherence tomography angiography (SS-OCTA). Methods Diabetic patients with SS-OCTA images were graded by severity and retrospectively assessed. CC FD % was calculated in four different regions of the OCTA image: inner, middle, outer, and full-field region. The generalized estimating equations (GEE) approach for clustered eye data was used to determine effect size and significance of age and disease severity on FD % for each region. Results 160 eyes from 90 total diabetic patients met inclusion criteria. Out of 90 patients, 33 had no DR, 17 had mild nonproliferative DR (NPDR), 8 had moderate NPDR, 10 had severe NPDR and 22 had proliferative DR. Age and DR severity had a significant positive association with FD % for each region studied with a greater effect in the two centermost regions. The increase in flow deficit percentage per year of age by region was: inner 0.12 (p < 0.001), middle 0.09 (p < 0.001), outer 0.05 (p < 0.001, full-field 0.06 (p < 0.001). The increase in flow deficit percentage per increase in diabetic retinopathy severity stage by region was: inner 0.65 (p < 0.0087), middle 0.56 (p < 0.0012), outer 0.33 (p < 0.045), full-field 0.36 (p < 0.018). Conclusions Topographic analysis of the CC FD % in diabetic eyes suggests that CC flow impairment corresponds to DR severity, with all studied regions of the CC significantly affected. There was greater regional impairment due to age and disease severity in the inner and middle regions.
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Affiliation(s)
- Isaac Gendelman
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,2Tufts University School of Medicine, Boston, MA USA
| | - A Yasin Alibhai
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - Eric M Moult
- 5Department Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Emily S Levine
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,2Tufts University School of Medicine, Boston, MA USA
| | - Phillip X Braun
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,3Yale University School of Medicine, New Haven, CT USA
| | - Nihaal Mehta
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,4Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Yi Zhao
- 6Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
| | - Akihiro Ishibazawa
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,7Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Osama A Sorour
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA.,8Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Caroline R Baumal
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - Andre J Witkin
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - Elias Reichel
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - James G Fujimoto
- 5Department Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Jay S Duker
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
| | - Nadia K Waheed
- 1New England Eye Center, Tufts Medical Center, 260 Tremont St, Boston, MA 02116 USA
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Mehta N, Cheng Y, Alibhai AY, Duker JS, Wang RK, Waheed NK. Optical coherence tomography angiography distortion correction in widefield montage images. Quant Imaging Med Surg 2020; 11:928-938. [PMID: 33654666 DOI: 10.21037/qims-20-791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Optical coherence tomography (OCT) imaging is inherently susceptible to distortion artifacts due to the natural curvature of the eye. This study proposes a novel model for widefield OCT angiography (OCTA) distortion correction and analyzes the effects of this correction on quantification metrics. Methods Widefield OCTA images were obtained on normal subjects at five fixation spatial positions. Radial and field distortion correction were applied and images stitched together to form a corrected widefield montage image. Vessel area density (VAD), vessel complexity index (VCI), and flow impairment area were quantified on the original and corrected montage images. Results This model allows for distortion correction and montaging of widefield images. There were either statistically insignificant or small magnitude changes in vessel density and vessel complexity between uncorrected and corrected widefield images. There was a significant and large difference in flow impairment area, both in the macular (+8.2%, P=0.049) and peripheral areas (+17.2%, P=0.011), following correction. The relationship between pre- and post-correction flow impairment area was non-linear. Conclusions Distortion correction of widefield OCTA images can result in clinically and statistically significant differences in important quantification metrics. This effect appears to be most pronounced in the periphery.
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Affiliation(s)
- Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, University of Colorado, Denver, CO, USA
| | - Yuxuan Cheng
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Ruikang K Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
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Braun PX, Mehta N, Gendelman I, Alibhai AY, Moult EM, Zhao Y, Ishibazawa A, Sorour O, Konstantinou EK, Baumal CR, Witkin AJ, Fujimoto JG, Duker JS, Waheed NK. Global Analysis of Macular Choriocapillaris Perfusion in Dry Age-Related Macular Degeneration using Swept-Source Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2020; 60:4985-4990. [PMID: 31791062 PMCID: PMC6890395 DOI: 10.1167/iovs.19-27861] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose Swept-source optical coherence tomography angiography (SS-OCTA) was used to investigate if the clinical stage of dry age-related macular degeneration (AMD) was correlated with global and regional macular choriocapillaris (CC) perfusion. Methods In this retrospective, cross-sectional study, 6 × 6-mm SS-OCTA images from eyes with early, intermediate, and advanced dry AMD (56 eyes, 41 patients) were analyzed using algorithms described in the literature to assess regional flow deficit percentage (FD%) and average flow deficit size. Regions were defined by concentric areas centered on the fovea: a 1-mm-diameter area, 3-mm-diameter ring, 5-mm-diameter area, 5-mm-diameter ring, and 6 × 6-mm whole image. Data were modeled using the generalized estimating equations approach. Results The relationship between age and CC FD% and average flow deficit size was statistically significant (P ≤ 0.05) in all regions of analysis by linear modeling. The relationship between dry AMD stage and FD% was statistically significant by linear modeling in the 5-mm ring, and between dry AMD stage and average flow deficit size in the 3-mm ring, 5-mm area, 5-mm ring, and 6 × 6-mm whole image. Conclusions Linear modeling suggests a statistically significant relationship between dry AMD stage and CC perfusion, most prominent in the more peripheral regions of the macula.
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Affiliation(s)
- Phillip X Braun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Isaac Gendelman
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Tufts University School of Medicine, Boston, Massachusetts, United States
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Yi Zhao
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States
| | - Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Eleni K Konstantinou
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
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Liu K, Mehta N, Alibhai AY, Arya M, Sorour O, Ishibazawa A, Byon I, Baumal CR, Witkin AJ, Duker JS, Sadda SR, Waheed NK. Effects of enhanced depth imaging and en face averaging on optical coherence tomography angiography image quantification. Graefes Arch Clin Exp Ophthalmol 2020; 258:979-986. [PMID: 32020294 DOI: 10.1007/s00417-020-04610-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/11/2020] [Accepted: 01/23/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To examine the effects of enhanced depth imaging (EDI) and en face averaging on global vascular measurements of optical coherence tomography angiography (OCTA) images. METHODS All eyes were imaged with 3 mm × 3 mm fields centered at the fovea using the Carl Zeiss Cirrus 5000 spectral-domain OCTA, with and without EDI, and the Zeiss PLEX Elite 9000 swept-source OCTA. Vessel area density (VAD), vessel length (VL), and vessel diameter index (VDI) were calculated for the superficial capillary plexus (SCP) en face angiograms. For the choriocapillaris (CC), VAD and the number, total area, and average size of flow voids were calculated. These metrics were compared between SD- and SS-OCTA images, with and without en face averaging and EDI. RESULTS Both averaging and EDI had a significant effect on quantitative metrics. EDI images trended toward a decrease in SCP VAD. In the CC, EDI decreased average flow void size. Averaging increased CC VAD while decreasing number of flow voids, total flow void area, and average flow void size. With both averaging and EDI, SD-OCTA was not able to visualize as many CC flow voids, particularly of a smaller size, compared with SS-OCTA. CONCLUSIONS Averaging and EDI affect quantitative metrics from SCP and CC OCTA images. EDI resulted in a trend toward decreased VAD in SCP images. Averaging had a major effect on CC imaging. Even with the combination of EDI and en face averaging, SD-OCTA images do not appear to approximate SS-OCTA images in terms of quantitative metrics. This has implications for clinical and research use of SD-OCTA for retinal imaging.
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Affiliation(s)
- Keke Liu
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Iksoo Byon
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA. .,Department of Ophthalmology, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA, 02111, USA.
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Rebhun CB, Moreira-Neto C, Gune S, Hill L, Duker JS, Waheed NK. MACULAR ATROPHY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Pilot Post Hoc Analysis of Patients With Pigment Epithelial Detachments. Retina 2020; 40:266-272. [PMID: 31972796 DOI: 10.1097/iae.0000000000002402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine optical coherence tomography signs associated with macular atrophy (MA) in eyes with neovascular age-related macular degeneration and pigment epithelial detachments treated with vascular endothelial growth factor inhibitors. METHODS Optical coherence tomography scans from a subgroup of the pigment epithelial detachment cohort of the HARBOR study were analyzed for MA. Two groups were formed based on MA presence/absence at Month 24. Then, optical coherence tomography scans from each baseline visit were graded with standard reading center grading parameters including ellipsoid zone disruption, intraretinal cysts, subretinal fluid, and MA or nascent MA in the study and fellow eyes. RESULTS Twenty-eight eyes from 28 patients were included in the analysis. Fourteen eyes had optical coherence tomography-based MA at Month 24 and 14 did not. Macular atrophy at Month 24 was significantly associated with 1) MA/nascent MA at baseline (P = 0.0136), 2) intraretinal cysts at baseline (P = 0.0048), and 3) collapse of pigment epithelial detachments in the study eye (P = 0.0025). Macular atrophy was not associated with ellipsoid zone disruption or subretinal fluid in the study eye at baseline. CONCLUSION This study suggests that some optical coherence tomography findings in eyes of patients with neovascular age-related macular degeneration were present before the start of anti-vascular endothelial growth factor therapy and may predict the development of MA.
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Affiliation(s)
- Carl B Rebhun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
| | | | - Shamika Gune
- Genentech, Inc., South San Francisco, California
| | - Lauren Hill
- Genentech, Inc., South San Francisco, California
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts; and
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Ishibazawa A, De Pretto LR, Alibhai AY, Moult EM, Arya M, Sorour O, Mehta N, Baumal CR, Witkin AJ, Yoshida A, Duker JS, Fujimoto JG, Waheed NK. Retinal Nonperfusion Relationship to Arteries or Veins Observed on Widefield Optical Coherence Tomography Angiography in Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2020; 60:4310-4318. [PMID: 31622467 PMCID: PMC6996665 DOI: 10.1167/iovs.19-26653] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose To evaluate whether retinal capillary nonperfusion is found predominantly adjacent to arteries or veins in eyes with diabetic retinopathy (DR). Methods Sixty-three eyes from 44 patients with proliferative DR (PDR) or non-PDR (NPDR) were included. Images (12 × 12-mm) foveal-centered optical coherence tomography (OCT) angiography (OCTA) images were taken using the Zeiss Plex Elite 9000. In 37 eyes, widefield montages with five fixation points were also obtained. A semiautomatic algorithm that detects nonperfusion in full-retina OCT slabs was developed, and the percentages of capillary nonperfusion within the total image area were calculated. Retinal arteries and veins were manually traced. Based on the shortest distance, nonperfusion pixels were labeled as either arterial-side or venous-side. Arterial-adjacent and venous-adjacent nonperfusion and the A/V ratio (arterial-adjacent nonperfusion divided by venous-adjacent nonperfusion) were quantified. Results Twenty-two eyes with moderate NPDR, 16 eyes with severe NPDR, and 25 eyes with PDR were scanned. Total nonperfusion area in PDR (median: 8.93%) was greater than in moderate NPDR (3.49%, P < 0.01). Arterial-adjacent nonperfusion was greater than venous-adjacent nonperfusion for all stages of DR (P < 0.001). The median A/V ratios were 1.93 in moderate NPDR, 1.84 in severe NPDR, and 1.78 in PDR. The A/V ratio was negatively correlated with the total nonperfusion area (r = −0.600, P < 0.0001). The results from the widefield montages showed similar patterns. Conclusions OCTA images with arteries and veins traced allowed us to estimate the nonperfusion distribution. In DR, smaller nonperfusion tends to be arterial-adjacent, while larger nonperfusion tends toward veins.
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Affiliation(s)
- Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Lucas R De Pretto
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States.,Nuclear and Energy Research Institute, Sao Paulo, Sao Paulo, Brazil
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
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Choudhry N, Duker JS, Freund KB, Kiss S, Querques G, Rosen R, Sarraf D, Souied EH, Stanga PE, Staurenghi G, Sadda SR. Classification and Guidelines for Widefield Imaging. ACTA ACUST UNITED AC 2019; 3:843-849. [DOI: 10.1016/j.oret.2019.05.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/21/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022]
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Moein HR, Bierman LW, Novais EA, Moreira-Neto C, Baumal CR, Rogers A, Duker JS, Witkin AJ. Short-term eplerenone for treatment of chronic central serous chorioretinopathy; a prospective study. Int J Retina Vitreous 2019; 5:39. [PMID: 31516734 PMCID: PMC6734298 DOI: 10.1186/s40942-019-0190-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background Increased mineralocorticoid activity is one of the plausible causes of chronic central serous chorioretinopathy (CSCR) and mineralocorticoid inhibitors such as eplerenone have been investigated as its potential therapy. This study investigates the short-term safety and efficacy of oral eplerenone in patients with chronic CSCR. Patients and methods Prospective study of 13 eyes of 13 patients with the diagnosis of chronic CSCR. All patients received eplerenone 50 mg/day for 4 weeks. Enhanced depth imaging optical coherence tomography (OCT) was obtained. Best corrected visual acuity (BCVA), and OCT parameters including sub retinal fluid (SRF), choroidal thickness (CT) and central macular thickness (CMT), were measured manually. Results The mean SRF height decreased slightly at 1-month follow-up as compared to baseline, but the change was not statistically significant (94.18 ± 17.53 vs. 113.15 ± 18.69; p = 0.08). Subfoveal CT and CMT was significantly reduced as compared to baseline (6.6% [p = 0.002] and 7.05% [p = 0.04], respectively). The BCVA did not change significantly (20/28 vs. 20/30 [p = 0.16]). Conclusion This study suggests that oral eplerenone may be used as a safe and potentially effective treatment in chronic CSCR, however there are minimal short-term effects on subretinal fluid or visual acuity therefore therapeutic trials longer than one month are necessary to test its benefits.Trial registration Clinicaltrials.gov identification number: NCT01822561. Registered 3/25/13, https://clinicaltrials.gov/ct2/show/study/NCT01822561.
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Affiliation(s)
- Hamid-Reza Moein
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Lauren W Bierman
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Eduardo A Novais
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,2School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos Moreira-Neto
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Hospital de Olhos do Parana, Curitiba, Brazil
| | - Caroline R Baumal
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Adam Rogers
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Jay S Duker
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - André J Witkin
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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Mehta N, Liu K, Alibhai AY, Gendelman I, Braun PX, Ishibazawa A, Sorour O, Duker JS, Waheed NK. Impact of Binarization Thresholding and Brightness/Contrast Adjustment Methodology on Optical Coherence Tomography Angiography Image Quantification. Am J Ophthalmol 2019; 205:54-65. [PMID: 30885708 DOI: 10.1016/j.ajo.2019.03.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Binarization is a critical technique in optical coherence tomography angiography (OCTA) image analysis, but there is no consistency in the method used in published OCTA studies. This study assessed whether differences in OCTA binarization and brightness and contrast adjustments affect quantification measurements. DESIGN Prospective cross-sectional validity study. METHODS This was a single-center study examining 21 eyes of 11 healthy individuals. All eyes were imaged using a swept-source OCTA (Zeiss), and quantitative measurements resulting from five binarization thresholding and five brightness/contrast adjustment methods were compared. All measurements were calculated for the superficial plexus and choriocapillaris (CC), as well as unaveraged and averaged en face OCTA images. RESULTS There were statistically significant differences between measurements from different binarization thresholding methods (P < 0.0001), as well as measurements from different histogram adjustments (P < 0.0001). The binarization thresholds yielded different measurements when combined with variable brightness/contrast adjustments. The method of analysis also affected the directionality of trends in imaging measurements between unaveraged and averaged CC images. CONCLUSIONS The method of OCTA image binarization thresholding and histogram adjustment significantly alters quantitative measurements and the directionality of trends. Results obtained from different OCTA binarization methods should be seen as valid only for that given method. This has significant consequences for clinical trials using OCTA measurements as outcome measurements. A consensus is needed across the research community for a consistent method for OCTA image quantification and greater attention paid to fully describing methods in published studies.
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Ishibazawa A, Mehta N, Sorour O, Braun P, Martin S, Alibhai AY, Saifuddin A, Arya M, Baumal CR, Duker JS, Waheed NK. Accuracy and Reliability in Differentiating Retinal Arteries and Veins Using Widefield En Face OCT Angiography. Transl Vis Sci Technol 2019; 8:60. [PMID: 31316862 PMCID: PMC6602142 DOI: 10.1167/tvst.8.3.60] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/07/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the accuracy and reliability in differentiating retinal arteries from veins using widefield optical coherence tomography angiography (OCTA). Methods Ten healthy eyes and 12 eyes from diabetic patients were included. Foveal-centered swept-source OCTA images (12 × 12 mm) were obtained using the PLEX Elite 9000. Vessels were graded as arteries or veins by two independent, masked readers. Arteriovenous crossings were also evaluated in healthy eyes. The vessel identification gold standard was defined using color fundus photographs (CFP) for normal eyes and both CFP and fluorescein angiography for diabetic eyes. Grading accuracy was compared to the gold standard and reliability between readers assessed. Results The study evaluated 538 vessels (119 first order, 110 second, 309 third) in healthy eyes and 645 vessels (184 first order, 159 second, 302 third). In healthy eyes, the average accuracies identifying all, first-, second-, and third-order vessels were 98.61%, 99.16%, 100%, and 98.06%, respectively. Cohen's κ between graders in all vessels was 0.948. In diabetic eyes, the average accuracies identifying vessels were 96.90%, 99.46%, 97.77%, and 94.85%, respectively. Cohen's κ between graders for all vessels was 0.888. For crossing identification, the average accuracy and Cohen's κ were low (60.71% and 0.659, respectively). Conclusions En face OCTA allows for accurate and reliable artery and vein identification; for small branches and crossings, identification by en face OCTA alone may be less accurate and reliable. Translational Relevance Arteries and veins can be differentiated on OCTA, assisting in clinically identifying pathology as arterial or venous side.
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Affiliation(s)
- Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Phillip Braun
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Sarah Martin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Adnan Saifuddin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
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De Pretto LR, Moult EM, Alibhai AY, Carrasco-Zevallos OM, Chen S, Lee B, Witkin AJ, Baumal CR, Reichel E, de Freitas AZ, Duker JS, Waheed NK, Fujimoto JG. Controlling for Artifacts in Widefield Optical Coherence Tomography Angiography Measurements of Non-Perfusion Area. Sci Rep 2019; 9:9096. [PMID: 31235795 PMCID: PMC6591294 DOI: 10.1038/s41598-019-43958-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/23/2019] [Indexed: 01/09/2023] Open
Abstract
The recent clinical adoption of optical coherence tomography (OCT) angiography (OCTA) has enabled non-invasive, volumetric visualization of ocular vasculature at micron-scale resolutions. Initially limited to 3 mm × 3 mm and 6 mm × 6 mm fields-of-view (FOV), commercial OCTA systems now offer 12 mm × 12 mm, or larger, imaging fields. While larger FOVs promise a more complete visualization of retinal disease, they also introduce new challenges to the accurate and reliable interpretation of OCTA data. In particular, because of vignetting, wide-field imaging increases occurrence of low-OCT-signal artifacts, which leads to thresholding and/or segmentation artifacts, complicating OCTA analysis. This study presents theoretical and case-based descriptions of the causes and effects of low-OCT-signal artifacts. Through these descriptions, we demonstrate that OCTA data interpretation can be ambiguous if performed without consulting corresponding OCT data. Furthermore, using wide-field non-perfusion analysis in diabetic retinopathy as a model widefield OCTA usage-case, we show how qualitative and quantitative analysis can be confounded by low-OCT-signal artifacts. Based on these results, we suggest methods and best-practices for preventing and managing low-OCT-signal artifacts, thereby reducing errors in OCTA quantitative analysis of non-perfusion and improving reproducibility. These methods promise to be especially important for longitudinal studies detecting progression and response to therapy.
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Affiliation(s)
- Lucas R De Pretto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Nuclear and Energy Research Institute IPEN-CNEN/SP, São Paulo, Brazil
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Oscar M Carrasco-Zevallos
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Siyu Chen
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - ByungKun Lee
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Elias Reichel
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
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Sorour OA, Sabrosa AS, Yasin Alibhai A, Arya M, Ishibazawa A, Witkin AJ, Baumal CR, Duker JS, Waheed NK. Optical coherence tomography angiography analysis of macular vessel density before and after anti-VEGF therapy in eyes with diabetic retinopathy. Int Ophthalmol 2019; 39:2361-2371. [PMID: 31119505 DOI: 10.1007/s10792-019-01076-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/14/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate changes in macular vessel density following intravitreal anti-VEGF injection in patients with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). METHODS In this retrospective case series, optical coherence tomography angiography (OCTA) images from 55 eyes of 35 patients with either DME (46 eyes) or PDR (9 eyes) were included. Macular capillary vessel density at the level of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DCP) and total retinal capillary plexus (TCP) before and after anti-VEGF treatment was calculated. Longitudinal changes in vessel density following serial anti-VEGF treatment were analyzed in a subset of eyes. RESULTS Vessel density in the SCP, DCP or TCP was not found to be significantly different after one, two or three intravitreal injections (p > 0.05 for all time points). Subgroup analysis revealed no significant change in the DME and PDR subgroups (all p > 0.05). Multivariate analysis revealed no effect of type of injected anti-VEGF agent or presence of previous treatment on VD measurements (all p > 0.05). There was no correlation between the anatomic response of DME to treatment and VD measurements. CONCLUSIONS In this study, macular vessel density remained statistically unchanged following up to three intravitreal injections of any anti-VEGF agent. This indicates that there may not be an early effect of anti-VEGF treatment on macular vessel density and its effect on macular perfusion may not be a direct change in microvascular flow.
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Affiliation(s)
- Osama A Sorour
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Ophthalmology Department, Tanta University, Tanta, Egypt
| | - Almyr S Sabrosa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Institute Ophthalmology Rio de Janeiro/Hospital da Gamboa, Rio de Janeiro, Brazil
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Malvika Arya
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.,Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | | | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, MA, USA.
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Arya M, Rebhun CB, Alibhai AY, Chen X, Moreira-Neto C, Baumal CR, Reichel E, Witkin AJ, Duker JS, Sadda SR, Waheed NK. Parafoveal Retinal Vessel Density Assessment by Optical Coherence Tomography Angiography in Healthy Eyes. Ophthalmic Surg Lasers Imaging Retina 2019; 49:S5-S17. [PMID: 30339262 DOI: 10.3928/23258160-20180814-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/01/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE To assess variability in vessel density (VD) measurements across three optical coherence tomography angiography (OCTA) devices to identify a methodology that offers the least amount of variation in VD, and to assess the effect of averaging of multiple scans on VD variability. PATIENTS AND METHODS Fifteen eyes of eight healthy individuals were imaged consecutively on three OCTA devices. Segmentations at the superficial, deep, and full retinal layers were generated. Repeat scans for each retinal layer were registered and averaged to generate one OCTA image. Two different automated thresholding techniques were used to calculate vessel area density (VAD) from binarized images and vessel skeleton density (VSD) from skeletonized images. Vessel length, a linear measure of the combined lengths of vessels, was calculated. Foveal avascular zone (FAZ) area was measured. RESULTS All three OCTA devices were significantly different (P < .0001). This finding remained after averaging images (P < .0001). VSD was more repeatable within a device but less reproducible across devices. Conversely, VAD demonstrated less repeatability but greater reproducibility. Differences in VSD between devices were systematic and attributable to differences in resolution. Vessel length, unaffected by resolution, demonstrated no significant differences between the devices (P > .107). There was no significant difference in FAZ area across devices (P = .51). After averaging images, VD was significantly different from the single images for each device and plexus (P < .05) but remained within 1% of the value of a single scan. CONCLUSIONS OCTA devices show variability in VD for healthy individuals. With greater repeatability, VSD appeared useful for following a patient on one device. VAD and vessel length seemed ideal for comparing vessel parameters between OCTA devices. After averaging multiple scans, VSD remained within 1% of a single scan, for which clinical significance remains to be determined. Caution is advised when comparing quantitative analyses across OCTA devices. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S5-S17.].
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Lu CD, Waheed NK, Witkin A, Baumal CR, Liu JJ, Potsaid B, Joseph A, Jayaraman V, Cable A, Chan K, Duker JS, Fujimoto JG. Microscope-Integrated Intraoperative Ultrahigh-Speed Swept-Source Optical Coherence Tomography for Widefield Retinal and Anterior Segment Imaging. Ophthalmic Surg Lasers Imaging Retina 2019; 49:94-102. [PMID: 29443358 DOI: 10.3928/23258160-20180129-03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/18/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To demonstrate the feasibility of retinal and anterior segment intraoperative widefield imaging using an ultrahigh-speed, swept-source optical coherence tomography (SS-OCT) surgical microscope attachment. PATIENTS AND METHODS A prototype post-objective SS-OCT using a 1,050-nm wavelength, 400 kHz A-scan rate, vertical cavity surface-emitting laser (VCSEL) light source was integrated to a commercial ophthalmic surgical microscope after the objective. Each widefield OCT data set was acquired in 3 seconds (1,000 × 1,000 A-scans, 12 × 12 mm2 for retina and 10 × 10 mm2 for anterior segment). RESULTS Intraoperative SS-OCT was performed in 20 eyes of 20 patients. In six of seven membrane peels and five of seven rhegmatogenous retinal detachment repair surgeries, widefield retinal imaging enabled evaluation pre- and postoperatively. In all seven cataract cases, anterior imaging evaluated the integrity of the posterior lens capsule. CONCLUSIONS Ultrahigh-speed SS-OCT enables widefield intraoperative viewing in the posterior and anterior eye. Widefield imaging visualizes ocular structures and pathology without requiring OCT realignment. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:94-102.].
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Garrity ST, Jung JY, Zambrowski O, Pichi F, Su D, Arya M, Waheed NK, Duker JS, Chetrit Y, Miserocchi E, Giuffrè C, Kaden TR, Querques G, Souied EH, Freund KB, Sarraf D. Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects. Br J Ophthalmol 2019; 103:1600-1604. [DOI: 10.1136/bjophthalmol-2018-313350] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 11/04/2022]
Abstract
Background/AimsHydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing.MethodsData from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal electroretinography and microperimetry was performed in these patients.ResultsSeventeen eyes from 10 patients illustrated abnormalities with OCT and normal HVF testing. These OCT alterations included (1) attenuation of the parafoveal ellipsoid zone and (2) loss of a clear continuous interdigitation zone. Several eyes progressed to advanced parafoveal outer retinal disruption and/or paracentral visual field defects.ConclusionPatients with high risk HCQ exposure and normal HVF testing may develop subtle but characteristic OCT abnormalities. This novel finding indicates that, in some cases of early HCQ toxicity, structural alterations may precede functional impairment. It is therefore important to employ a screening approach that includes OCT to assess for these early findings. Ancillary testing should be considered in cases with suspicious OCT changes and normal HVFs.
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Arya M, Duker JS. Vinorelbine-induced regression of a choroidal metastasis from primary breast carcinoma. Int J Retina Vitreous 2018; 4:17. [PMID: 29785284 PMCID: PMC5950186 DOI: 10.1186/s40942-018-0121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022] Open
Abstract
Background Various therapeutic options exist to treat choroidal metastatic lesions. However, they are all associated with potential long-term adverse effects. This case report discusses a case of choroidal metastasis from primary breast carcinoma that regressed after single-agent chemotherapy. Case presentation We report a case of choroidal metastasis from estrogen receptor (ER) positive breast carcinoma that became resistant to endocrine therapy. The primary malignancy was treated with surgical resection and adjuvant chemoradiation, followed by hormone therapy with various agents in combination with kinase inhibitors for ER resistance. The choroidal metastatic lesion regressed after the initiation of vinorelbine. Vinorelbine is a cytotoxic vinca alkaloid with tolerable systemic adverse effects. Conclusions This case report highlights the possible role of vinorelbine as a single chemotherapeutic agent for the conservative therapy of uveal metastasis from advanced breast carcinoma, irrespective of responsiveness to hormone therapy.
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Bakhoum MF, Freund KB, Dolz-Marco R, Leong BCS, Baumal CR, Duker JS, Sarraf D. Paracentral Acute Middle Maculopathy and the Ischemic Cascade Associated With Retinal Vascular Occlusion. Am J Ophthalmol 2018; 195:143-153. [PMID: 30081014 DOI: 10.1016/j.ajo.2018.07.031] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/14/2018] [Accepted: 07/25/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyze the spectrum of ischemia associated with paracentral acute middle maculopathy (PAMM) in eyes with acute retinal vascular occlusion and to describe an ischemic cascade. DESIGN A retrospective observational case series. METHODS Patients presenting with PAMM secondary to acute retinal vascular occlusion were identified. Analysis of multimodal imaging was performed at baseline and at follow-up visits to elucidate the patterns and progression of ischemia within the retinal layers. RESULTS Multimodal retinal imaging from 16 eyes of 16 patients with acute retinal vascular occlusion associated with PAMM was studied. Analysis of en face optical coherence tomography (OCT) segmentation of the inner nuclear layer (INL) identified distinct patterns of PAMM correlating with the severity of ischemia and not the type of occlusion. A perivenular fern-like PAMM pattern was associated with better visual outcomes (average final visual acuity was 20/25). This pattern was noted to sequentially progress in 2 cases to a diffuse globular PAMM pattern in the INL, or to a pattern of ischemia involving both the middle and inner retinal layers with commensurate vision loss. Globular patterns of PAMM or ischemia involving both the middle and inner retina correlated with poorer visual outcomes (average final visual acuity was counting fingers at 5.5 ft). These various patterns of ischemia developed in eyes with retinal vascular occlusions in which blood flow through the retinal capillary plexuses was present but was significantly reduced and delayed. CONCLUSIONS This study describes OCT findings suggestive of an ischemic cascade in eyes with retinal vascular occlusion. The middle retina at the level of the deep capillary plexus, especially at the venular pole, may be more vulnerable to ischemic injury.
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Affiliation(s)
- Mathieu F Bakhoum
- Department of Ophthalmology, Shiley Eye Institute and Jacobs Retina Center, University of California San Diego, La Jolla, California, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | | | - Belinda C S Leong
- Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Caroline R Baumal
- Department of Ophthalmology, New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jay S Duker
- Department of Ophthalmology, New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David Sarraf
- Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA; Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA.
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Arya M, Sabrosa AS, Duker JS, Waheed NK. Choriocapillaris changes in dry age-related macular degeneration and geographic atrophy: a review. Eye Vis (Lond) 2018; 5:22. [PMID: 30238015 PMCID: PMC6138930 DOI: 10.1186/s40662-018-0118-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/29/2018] [Indexed: 01/16/2023]
Abstract
Age-related macular degeneration (AMD) is a leading cause of central vision loss worldwide. The progression of dry AMD from early to intermediate stages is primarily characterized by increasing drusen formation and adverse impact on outer retinal cells. Late stage AMD consists of either geographic atrophy (GA), the non-exudative (dry) AMD subtype, or choroidal neovascularization, the exudative (wet) AMD subtype. GA is characterized by outer retinal and choroidal atrophy, specifically the photoreceptor layer, RPE, and choriocapillaris. Much remains to be discovered regarding the pathogenesis of AMD progression and subsequent development of GA. As the functionality of all three layers is closely linked, the temporal sequence of events that end up in atrophy is important in the understanding of the pathogenic pathway of the disease. The advent of OCTA, and particularly of swept-source technology, has allowed for depth-resolved imaging of retinal vasculature and the choriocapillaris. With the use of OCTA, recent studies demonstrate that choriocapillaris flow alterations are closely associated with the development and progression of AMD. Such changes may even possibly offer predictive value in determining progression of GA. This article reviews studies demonstrating choriocapillaris changes in dry AMD and summarizes the existing literature on the potential role of the choriocapillaris as a key factor in the pathogenesis of AMD.
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Affiliation(s)
- Malvika Arya
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA.,Institude of Ophthalmology, Rio de Janeiro, Brazil
| | - Almyr S Sabrosa
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA.,Institude of Ophthalmology, Rio de Janeiro, Brazil
| | - Jay S Duker
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
| | - Nadia K Waheed
- 1New England Eye Center, Tufts Medical Center, Boston, MA USA
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49
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Hussain RM, Garoon RB, Duker JS, Dubovy SR, Albini TA. Primary Vitreoretinal Lymphoma Presenting as a Posterior Capsule Plaque. Ophthalmic Surg Lasers Imaging Retina 2018; 49:732-734. [PMID: 30222812 DOI: 10.3928/23258160-20180831-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary vitreoretinal lymphoma (PVRL) can be a diagnostic challenge and commonly presents as a partially steroid-responsive vitritis or as subretinal cream-colored infiltrates. The authors present a patient with PVRL who initially presented with bilateral vitritis; however, after two non-diagnostic vitrectomy specimens and two unremarkable brain MRIs, she was lost to follow-up. She presented 2.5 years later with a white plaque on the posterior capsule of her left intraocular lens, though the vitreous cavity was free of infiltrate. Repeat biopsy revealed diffuse large B-cell lymphoma, and brain MRI demonstrated an enhancing lesion of the cerebellum, consistent with primary central nervous system lymphoma.
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50
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Affiliation(s)
- Lana M Rifkin
- New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Jay S Duker
- New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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