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Franco JJ, Liu KX, Ioakeim-Ioannidou M, Davila JR, Chen YL, Kim IK, Gragoudas ES, Mukai S, MacDonald SM. Low-dose proton radiotherapy for pediatric choroidal hemangioma: A case series. Pediatr Blood Cancer 2022; 69:e29925. [PMID: 35989464 DOI: 10.1002/pbc.29925] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
Management of pediatric choroidal hemangioma complicated by large exudative retinal detachment can be challenging, with few options available. Limited data have been published on outcomes following proton radiotherapy (PRT) for management of these patients. In this retrospective case series, nine patients were treated with a low-dose PRT regimen of 20 Gy(relative biological effectiveness [RBE]) in 10 fractions, and two were treated with 15 Gy(RBE) in four fractions. Visual acuity improved in seven patients (64%) and remained stable in the remaining four (36%). In patients with imaging follow-up (10 patients), subretinal fluid resolved in nine patients (90%) and tumor thickness decreased or remained stable in 10 (100%). Complications were observed in eight of 11 patients (73%). One patient developed grade 2 cataract; otherwise, no grade ≥2 complications were observed.
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Affiliation(s)
| | - Kevin X Liu
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jose R Davila
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Yen-Lin Chen
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ivana K Kim
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Evangelos S Gragoudas
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Shizuo Mukai
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Shannon M MacDonald
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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2
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Davila JR, Singh K, Hernandez-Boussard T, Wang S. Outcomes of Primary Trabeculectomy versus Combined Phacoemulsification-Trabeculectomy Using Automated Electronic Health Record Data Extraction. Curr Eye Res 2022; 47:923-929. [PMID: 35317681 PMCID: PMC10000312 DOI: 10.1080/02713683.2022.2045611] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Cataract is a known effect of trabeculectomy (TE), but some surgeons are hesitant to perform combined phacoemulsification-TE (PTE) due to a risk of increased TE failure. Herein, we compare intraocular pressure (IOP) lowering between trabeculectomy (TE) and phacoemulsification-TE (PTE) and investigate factors that impact patient outcomes. METHODS We performed a retrospective study of adults undergoing primary TE or PTE at our institution from 2010 to 2017. We used Kaplan-Meier survival analysis to investigate time to TE failure, and Cox proportional hazards modeling to investigate predictors of TE failure, defined as undergoing a second glaucoma surgery or using more IOP-lowering medications than pre-operatively. RESULTS 318 surgeries (218 TE; 100 PTE) from 268 patients were included. Median follow-up time was 753 days. Mean baseline IOP was 21.1 mmHg. There were no significant differences in IOP between TE and PTE groups beyond postoperative year 1, with 28.9-46.5% of TE and 35.5-44.4% of PTE groups achieving IOP ≤10. Final IOP was similar in both groups (p = 0.22): 12.41 (SD 4.18) mmHg in the TE group and 14.05 (SD 5.45) in the PTE group. 84 (26.4%) surgeries met failure criteria. After adjusting for surgery type, sex, age, race, surgeon, and glaucoma diagnosis there were no significant differences in TE failure. CONCLUSION This study suggests there is no significant difference in the risk of TE failure in patients receiving TE versus those receiving PTE.
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Affiliation(s)
- Jose R Davila
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Kuldev Singh
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Tina Hernandez-Boussard
- Stanford Center for Biomedical Informatics Research, Stanford University, Palo Alto, CA, USA
| | - Sophia Wang
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
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3
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Azad AD, Davila JR, Rayess N, Cao M, Mruthyunjaya P, Pan CK. The Effect of Obstructive Sleep Apnea Treatment and Severity on Choroidal Thickness in Patients With Central Serous Chorioretinopathy. Journal of VitreoRetinal Diseases 2022; 6:22-30. [PMID: 37007726 PMCID: PMC9976222 DOI: 10.1177/24741264211009677] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work aimed to analyze the association of obstructive sleep apnea (OSA) with choroidal thickness (CT) in patients with central serous chorioretinopathy (CSC). Methods: We identified patients in the Stanford Research Repository with a diagnosis of CSC and OSA. Age- and sex-matched controls with either CSC or OSA only were also identified. CT was measured at 5 points (subfoveal, and 1500 and 3000 µm nasal and temporal) by 2 graders. In addition to OSA treatment and severity, we also investigated the association of Oxygen Desaturation Index and nocturnal oxygen saturation nadir with subfoveal CT (SFCT). Results: A total of 57 patients and 72 eyes met the study inclusion criteria. The mean SFCT was significantly different across the 3 groups: OSA-only was the thinnest, followed by CSC with OSA, and CSC-only was the thickest (194.2 μm, 295.1 μm, and 357.8 μm, respectively, P < .001). SFCT was thicker in CSC with OSA compared with those with only OSA ( P < .05). OSA treatment status and OSA severity did not show a significant difference in SFCT in multivariable modeling. Nocturnal oxygen saturation nadir was positively associated with SFCT, but this did not reach significance.. Conclusions: SFCT is significantly different in patients with OSA alone, CSC with OSA, and CSC alone. While OSA treatment status did not demonstrate a significant difference in SFCT in this study, future studies should evaluate patients for OSA in patients known to have CSC and atypically thin CT to further investigate the novel metrics leveraged in this study.
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Affiliation(s)
- Amee D. Azad
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jose R. Davila
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nadim Rayess
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michelle Cao
- Stanford Sleep Medicine Clinic, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Carolyn K. Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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4
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Davila JR, Mishra K, Leung LS. Macular Edema and Serous Macular Detachment after a Standard Dose of Intracameral Cefuroxime. Ophthalmic Surg Lasers Imaging Retina 2021; 52:615-618. [PMID: 34766852 DOI: 10.3928/23258160-20211027-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Intracameral cefuroxime has been associated with postoperative macular edema and sub-retinal fluid. To date, nearly all published cases are attributed to errors in antibiotic dilution, leading to administration of supratherapeutic doses. We report three cases of postoperative macular edema and subretinal fluid following a standard dose of 1 mg/0.1 mL of cefuroxime at the end of cataract surgery. Distinguishing features of these cases were intraoperative zonular instability and history of vitrectomy. We hypothesize that certain factors may increase the risk of cefuroxime-associated retinal toxicity, including history of vitrectomy, zonular compromise, posterior capsular break, surgery for a secondary intraocular lens, and unicameral state. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:615-618.].
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5
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Garcia GA, Hines JA, Wang EW, Davila JR, Chiang B, Choi DY. Contamination of multiuse eyedrop bottles by exhaled air from patients wearing face masks during the COVID-19 pandemic: Schlieren imaging analysis. J Cataract Refract Surg 2021; 47:1167-1174. [PMID: 34468454 PMCID: PMC10954301 DOI: 10.1097/j.jcrs.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/15/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether mask-induced redirected exhaled air through the superior mask gap contacts multiuse eyedrop bottles during drop administration and the efficacy of interventions to reduce such exposure. SETTING Academic ophthalmology center. DESIGN Interventional analysis. METHODS Schlieren airflow imaging was taken of an examinee wearing frequently used face masks and enacting common clinical scenarios-with and without manual occlusion of the superior mask gap and/or neck extension-and maximum visible vertical breath plume height was quantified. Bottle height during eyedrop administration was measured for 4 ophthalmologists during instillation to 8 eyes of 4 subjects. RESULTS Breath plume height (mean ± SD 275.5 ± 16.3 mm) was significantly greater than mean bottle height (13.9 ± 4.7 mm; P < .01). Plume height was reduced with manual mask occlusion vs without (P < .01) and was also lower than mean bottle height with manual mask occlusion (P < .01) but not in the absence of occlusion (P < .01). Neck extension alone did not adequately redirect liberated breath to prevent contact with a bottle. CONCLUSIONS Exhaled air liberated from commonly worn patient face masks was able to contact multiuse eyedrop bottles during eyedrop administration. These findings have important patient safety implications during the coronavirus disease 2019 pandemic and with other respiratory pathogens because these multiuse bottles could potentially serve as vectors of disease. Occlusion of the superior mask gap significantly reduces breath contamination and should be strongly considered by eyecare providers during drop administration in eye clinics.
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Affiliation(s)
- Giancarlo A. Garcia
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Jacob A. Hines
- Department of Applied Physics, Stanford University, Stanford, CA, USA
| | - Evan W. Wang
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Jose R. Davila
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Bryce Chiang
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
| | - Daniel Y. Choi
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, CA, USA
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6
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Abstract
Innovations in ophthalmic imaging have made a profound impact on the diagnosis and treatment of ophthalmic disease. In ocular oncology, the development of optical coherence tomography with enhanced depth imaging and swept source technologies has made it possible to visualize the anatomical characteristics of retinoblastoma and uveal melanoma with a level of detail previously unobtainable on clinical exam alone. As a result, our understanding of the pathophysiology of vision loss in choroidal melanoma in particular has improved. These modalities have also helped identify fundoscopically “invisible” tumors and risk stratify pre-malignant choroidal lesions, making a strong case for their inclusion in all screening evaluations. Optical coherence tomography angiography, on the other hand, has allowed non-invasive imaging of the retinal and uveal vasculatures, providing insight into vascular changes associated with malignant transformation and vision loss following exposure to radiation. While the impact of new imaging technologies on clinical outcomes and overall survival in ocular oncology has yet to be determined, several reports cited herein offer promising results.
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Affiliation(s)
- Jose R Davila
- Ophthalmology, Stanford Byers Eye Institute, Palo Alto, CA, 94303, USA
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7
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Li P, Paulus YM, Davila JR, Gosbee J, Margolis T, Fletcher DA, Kim TN. Usability testing of a smartphone-based retinal camera among first-time users in the primary care setting. ACTA ACUST UNITED AC 2019; 5:120-126. [PMID: 32864157 DOI: 10.1136/bmjinnov-2018-000321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Smartphone-based retinal photography is a promising method for increasing accessibility of retinal screening in the primary care and community settings. Recent work has focused on validating its use in detection of diabetic retinopathy. However, retinal imaging can be technically challenging and additional work is needed to improve ease of retinal imaging in the primary care setting. We therefore performed usability testing of a smartphone-based retinal camera, RetinaScope, among medical assistants in primary care who had never performed retinal imaging. A total of 24 medical assistants performed first-time imaging in a total of five rounds of testing, and iterative improvements to the device were made between test rounds based on the results. The time to acquire a single ~50 degree image of the posterior pole of a model eye decreased from 283 ± 60 seconds to 34 ± 17 seconds (p < 0.01) for first-time users. The time to acquire 5 overlapping images of the retina decreased from 325 ± 60 seconds to 118 ± 26 seconds (p = 0.02) for first-time users. Testing in the human eye demonstrated that a single wide-view retinal image could be captured in 65 ± 7 seconds and 5 overlapping images in 229 ± 114 seconds. Users reported high Systems Usability Scores of 86 ± 13 throughout the rounds, reflecting a high level of comfort in first-time operation of the device. Our study demonstrates that smartphone-based retinal photography has the potential to be quickly adopted among medical assistants in the primary care setting.
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Affiliation(s)
- Patrick Li
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Yannis M Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jose R Davila
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John Gosbee
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Todd Margolis
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Daniel A Fletcher
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Tyson N Kim
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
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8
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Kim TN, Myers F, Reber C, Loury PJ, Loumou P, Webster D, Echanique C, Li P, Davila JR, Maamari RN, Switz NA, Keenan J, Woodward MA, Paulus YM, Margolis T, Fletcher DA. A Smartphone-Based Tool for Rapid, Portable, and Automated Wide-Field Retinal Imaging. Transl Vis Sci Technol 2018; 7:21. [PMID: 30280006 PMCID: PMC6166894 DOI: 10.1167/tvst.7.5.21] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [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: 03/13/2018] [Accepted: 08/05/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose High-quality, wide-field retinal imaging is a valuable method for screening preventable, vision-threatening diseases of the retina. Smartphone-based retinal cameras hold promise for increasing access to retinal imaging, but variable image quality and restricted field of view can limit their utility. We developed and clinically tested a smartphone-based system that addresses these challenges with automation-assisted imaging. Methods The system was designed to improve smartphone retinal imaging by combining automated fixation guidance, photomontage, and multicolored illumination with optimized optics, user-tested ergonomics, and touch-screen interface. System performance was evaluated from images of ophthalmic patients taken by nonophthalmic personnel. Two masked ophthalmologists evaluated images for abnormalities and disease severity. Results The system automatically generated 100° retinal photomontages from five overlapping images in under 1 minute at full resolution (52.3 pixels per retinal degree) fully on-phone, revealing numerous retinal abnormalities. Feasibility of the system for diabetic retinopathy (DR) screening using the retinal photomontages was performed in 71 diabetics by masked graders. DR grade matched perfectly with dilated clinical examination in 55.1% of eyes and within 1 severity level for 85.2% of eyes. For referral-warranted DR, average sensitivity was 93.3% and specificity 56.8%. Conclusions Automation-assisted imaging produced high-quality, wide-field retinal images that demonstrate the potential of smartphone-based retinal cameras to be used for retinal disease screening. Translational Relevance Enhancement of smartphone-based retinal imaging through automation and software intelligence holds great promise for increasing the accessibility of retinal screening.
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Affiliation(s)
- Tyson N Kim
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA.,Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Frank Myers
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Clay Reber
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - P J Loury
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Panagiota Loumou
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Doug Webster
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Chris Echanique
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA
| | - Patrick Li
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jose R Davila
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Robi N Maamari
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA.,Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Neil A Switz
- Department of Physics and Astronomy, San José State University, San Jose, CA, USA
| | - Jeremy Keenan
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Yannis M Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Todd Margolis
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Daniel A Fletcher
- Department of Bioengineering and Biophysics Program, University of California, Berkeley, Berkeley, CA, USA.,Chan-Zuckerberg Biohub, San Francisco, CA, USA
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9
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Joltikov KA, de Castro VM, Davila JR, Anand R, Khan SM, Farbman N, Jackson GR, Johnson CA, Gardner TW. Multidimensional Functional and Structural Evaluation Reveals Neuroretinal Impairment in Early Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2017; 58:BIO277-BIO290. [PMID: 28973314 PMCID: PMC5624741 DOI: 10.1167/iovs.17-21863] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 11/24/2022] Open
Abstract
Purpose To test whether quantitative functional tests and optical coherence tomography (OCT)-defined structure can serve as effective tools to diagnose and monitor early diabetic neuroretinal disease. Methods Fifty-seven subjects with diabetes (23 without diabetic retinopathy [no DR], 19 with mild nonproliferative diabetic retinopathy [mild NPDR], 15 with moderate to severe [moderate NPDR]), and 18 controls underwent full ophthalmic examination, fundus photography, spectral-domain optical coherence tomography (SD-OCT), e-ETDRS (Early Treatment Diabetic Retinopathy Study) acuity, and the quick contrast sensitivity function (qCSF) method. Perimetry testing included short-wavelength automated perimetry (SWAP), standard automated perimetry (SAP), frequency doubling perimetry (FDP), and rarebit perimetry (RBP). Results ETDRS acuity and RBP were not sensitive for functional differences among subjects with diabetes. AULCSF, a metric of qCSF, was reduced in diabetics with moderate compared to mild NPDR (P = 0.03), and in subjects with no DR compared to controls (P = 0.04). SWAP and SAP mean deviation (MD) and foveal threshold (FT) were reduced in moderate compared to mild NPDR (SWAP, MD P = 0.002, FT P = 0.0006; SAP, MD P = 0.02, FT P = 0.007). FDP 10-2 showed reduced MD in moderate compared to mild NPDR (P = 0.02), and FDP 24-2 revealed reduced pattern standard deviation (PSD) in mild NPDR compared to no DR (P = 0.02). Structural analysis revealed thinning of the ganglion cell layer and inner plexiform layer (GCL+IPL) of moderate NPDR subjects compared to controls. The thinner GCL+IPL correlated with impaired retinal function. Conclusions This multimodal testing analysis reveals insights into disruption of the neuroretina in diabetes and may accelerate the testing of novel therapies.
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Affiliation(s)
- Katherine A Joltikov
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Vinicius M de Castro
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Jose R Davila
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Rohit Anand
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Sami M Khan
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Neil Farbman
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
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10
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Davila JR, Sengupta SS, Niziol LM, Sindal MD, Besirli CG, Upadhyaya S, Woodward MA, Venkatesh R, Robin AL, Grubbs J, Newman-Casey PA. Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy. Ophthalmologica 2017; 238:89-99. [PMID: 28675903 DOI: 10.1159/000475773] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 11/21/2016] [Accepted: 04/10/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyze predictors of image quality for a handheld nonmydriatic fundus camera used for screening of vision-threatening diabetic retinopathy. METHODS An ophthalmic photographer at an Aravind Eye Hospital obtained nonmydriatic and mydriatic fundus images from 3 fields in 275 eyes of 155 participants over 13 months using a Smartscope camera (Optomed, Oulu, Finland) and a Topcon tabletop fundus camera (Topcon, Tokyo, Japan). Two fellowship-trained retina specialists graded the images. Repeated-measures logistic regression assessed predictors of the main outcome measure: gradability of the fundus images. RESULTS Of 2,475 images, 76.2% of the Smartscope nonmydriatic images, 90.1% of the Smartscope mydriatic images, and 92.0% of the Topcon mydriatic images were gradable. Eyes with vitreous hemorrhage (OR = 0.24, p < 0.0001) or advanced cataract (OR = 0.08, p < 0.0001) had decreased odds of image gradability. Excluding eyes with cataract or vitreous hemorrhage, nonmydriatic macular image gradability improved from 68.4% in the first set of 55 eyes to 94.6% in the final set of 55 eyes. CONCLUSION With sufficient training, paraprofessional health care staff can obtain high-quality images with a portable nonmydriatic fundus camera, particularly in patients with clear lenses and clear ocular media.
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Affiliation(s)
- Jose R Davila
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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11
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Gardner TW, Davila JR. The neurovascular unit and the pathophysiologic basis of diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2016; 255:1-6. [PMID: 27832340 DOI: 10.1007/s00417-016-3548-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To relate the concept of the retinal neurovascular unit and its alterations in diabetes to the pathophysiology of diabetic retinopathy. METHODS Case illustrations and conceptual frameworks are presented that illustrate adaptive and maladaptive "dis-integration" of the retinal neurovascular unit with the progression of diabetes. RESULTS Retinopathy treatment should address pathophysiologic processes rather than pathologic lesions as is current practice. CONCLUSIONS Future improvements in the treatment of diabetic retinopathy requires deeper understanding of the cellular and molecular changes induced by diabetes, coupled with the use of quantitative phenotyping methods that assess the pathophysiologic processes.
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Affiliation(s)
- Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI, 48105, USA.
| | - Jose R Davila
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI, 48105, USA
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