1
|
Rezapour J, Walker E, Belghith A, Bowd C, Fazio MA, Jiravarnsirikul A, Hyman L, Jonas JB, Weinreb RN, Zangwill LM. Diagnostic accuracy of optic nerve head and macula OCT parameters for detecting glaucoma in eyes with and without high axial myopia. Am J Ophthalmol 2024:S0002-9394(24)00165-X. [PMID: 38754801 DOI: 10.1016/j.ajo.2024.04.022] [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] [Received: 01/11/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To characterize structural differences and assess the diagnostic accuracy of optic nerve head (ONH) and macula optical coherence tomography (OCT) parameters to detect glaucoma in eyes with and without high axial myopia. DESIGN Cross-sectional study METHODS: 368 glaucoma and 411 healthy eyes with no axial myopia, 393 glaucoma and 271 healthy eyes with mild axial myopia and 124 glaucoma and 85 healthy eyes with high axial myopia were included. Global and sectoral peripapillary retinal nerve fiber layer thickness (pRNFLT), Bruch's membrane opening minimum rim width (BMO-MRW), ganglion cell inner plexiform layer thickness (GCIPLT), and macula RNFLT (mRNFLT) were compared and the diagnostic accuracy for glaucoma detection was evaluated using adjusted area under the receiver operating characteristic curve (AUC). RESULTS Diagnostic accuracy for ONH and macula parameters to detect glaucoma was generally high and differed by myopia group. For ONH parameters the diagnostic accuracy was highest for global (AUC=0.95) and inferotemporal (AUC=0.91) pRNFLT for high myopes and global BMO-MRW for non-myopes (AUC=1.0) and mild myopes (AUC=0.97). For macula parameters, the diagnostic accuracy was higher in high myopes with 6 of the 11 GCIPLT global/sectors having adjusted AUCs > 0.90 compared to non-high myopes with no AUCs > 0.90. In all myopia groups, mRNFLT had lower AUCs than GCIPLT. CONCLUSIONS The diagnostic accuracy for pRNFL and GCIPL was high for high axial myopic eyes and shows promise for glaucoma detection in high myopes. Further analysis is needed to determine whether the high diagnostic accuracy can be confirmed in other populations.
Collapse
Affiliation(s)
- Jasmin Rezapour
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Germany; Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, United States
| | - Evan Walker
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, United States
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, United States
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, United States
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Science, The Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States; Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anuwat Jiravarnsirikul
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, United States; Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leslie Hyman
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Switzerland
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, United States
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, United States.
| |
Collapse
|
2
|
Mahmoudinezhad G, Moghimi S, Nishida T, Walker E, Latif K, Liebmann JM, Fazio MA, Girkin CA, Zangwill L, Weinreb RN. Association of Long-Term Intraocular Pressure Variability and Rate of Ganglion Complex Thinning in Patients With Glaucoma. Am J Ophthalmol 2024; 264:104-119. [PMID: 38579920 DOI: 10.1016/j.ajo.2024.03.028] [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] [Received: 11/17/2023] [Revised: 03/20/2024] [Accepted: 03/31/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE To evaluate the association of mean intraocular pressure (IOP) and IOP variability (IOP fluctuation [SD of IOP] and the IOP range) with the rate of ganglion cell complex (GCC) layer thinning over time in patients with glaucoma. DESIGN Prospective cohort study. METHODS Participants with at least 4 visits and 2 years of follow-up of optical coherence tomography tests were included. A linear mixed-effect model was used to investigate the association of IOP parameters with the rates of GCC thinning. Subgroup analyses were conducted for eyes with early (MD ≥ -6 dB), and moderate to advanced stage (MD < -6 dB) at baseline. RESULTS The cohort consisted of 369 eyes of 249 glaucoma patients (282 early glaucoma and 87 moderate to advanced glaucoma) with mean (standard deviation [SD]) age of 68.2 (10.7) years over 5.1 years of follow-up. The mean rate of GCC change was -0.59 (95% confidence interval [CI], -0.67 to -0.52) µm per year. In multivariable models, faster annual rate of GCC thinning was associated with a higher IOP fluctuation (-0.17 [95% CI, -0.23 to -0.11] µm per 1-mmHg higher, P < .001) or higher IOP range (-0.07 [95% CI, -0.09 to -0.05] µm per 1-mmHg higher, P < .001) after adjustment for mean IOP and other confounding factors. Similar results were found for early and moderate to advanced stages of glaucoma. CONCLUSIONS IOP variability showed an independent association with macular change in patients with glaucoma regardless of severity at baseline, even after adjustment for mean IOP, supporting its potential value as a therapeutic target for clinical decision-making.
Collapse
Affiliation(s)
- Golnoush Mahmoudinezhad
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego (G.M., S.M., T.N., E.W., K.L., L.Z., R.N.W.), La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego (G.M., S.M., T.N., E.W., K.L., L.Z., R.N.W.), La Jolla, California, USA
| | - Takashi Nishida
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego (G.M., S.M., T.N., E.W., K.L., L.Z., R.N.W.), La Jolla, California, USA
| | - Evan Walker
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego (G.M., S.M., T.N., E.W., K.L., L.Z., R.N.W.), La Jolla, California, USA
| | - Kareem Latif
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego (G.M., S.M., T.N., E.W., K.L., L.Z., R.N.W.), La Jolla, California, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center (J.M.L.), New York City, New York, USA
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, Callahan Eye Hospital, Heersink School of Medicine, University of Alabama-Birmingham (M.A.F., C.A.G.), Birmingham, Alabama, USA; Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham (M.A.F.), Birmingham, Alabama, USA
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, Callahan Eye Hospital, Heersink School of Medicine, University of Alabama-Birmingham (M.A.F., C.A.G.), Birmingham, Alabama, USA
| | - Linda Zangwill
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego (G.M., S.M., T.N., E.W., K.L., L.Z., R.N.W.), La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego (G.M., S.M., T.N., E.W., K.L., L.Z., R.N.W.), La Jolla, California, USA.
| |
Collapse
|
3
|
KhalafAllah MT, Zangwill LM, Proudfoot J, Walker E, Girkin CA, Fazio MA, Weinreb RN, Bowd C, Moghimi S, De Moraes CG, Liebmann JM, Racette L. Racial Differences in Diagnostic Accuracy of Retinal Nerve Fiber Layer Thickness in Primary Open-Angle Glaucoma. Am J Ophthalmol 2024; 259:7-14. [PMID: 38708401 PMCID: PMC11068369 DOI: 10.1016/j.ajo.2023.10.012] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Purpose To evaluate the diagnostic accuracy of retinal nerve fiber layer thickness (RNFLT) by spectral-domain optical coherence tomography (OCT) in primary open-angle glaucoma (POAG) in eyes of African (AD) and European descent (ED). Design Comparative diagnostic accuracy analysis by race. Participants 379 healthy eyes (125 AD and 254 ED) and 442 glaucomatous eyes (226 AD and 216 ED) from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Methods Spectralis (Heidelberg Engineering GmbH) and Cirrus (Carl Zeiss Meditec) OCT scans were taken within one year from each other. Main Outcome Measures Diagnostic accuracy of RNFLT measurements. Results Diagnostic accuracy for Spectralis-RNFLT was significantly lower in eyes of AD compared to those of ED (area under the receiver operating curve [AUROC]: 0.85 and 0.91, respectively, P=0.04). Results for Cirrus-RNFLT were similar but did not reach statistical significance (AUROC: 0.86 and 0.90 in AD and ED, respectively, P =0.33). Adjustments for age, central corneal thickness, axial length, disc area, visual field mean deviation, and intraocular pressure yielded similar results. Conclusions OCT-RNFLT has lower diagnostic accuracy in eyes of AD compared to those of ED. This finding was generally robust across two OCT instruments and remained after adjustment for many potential confounders. Further studies are needed to explore the potential sources of this difference.
Collapse
Affiliation(s)
- Mahmoud T. KhalafAllah
- Vision Science Graduate Program, The University of Alabama at Birmingham, Birmingham, USA
- Department of Ophthalmology, Menoufia University, Shebin Elkom, Egypt
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - James Proudfoot
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - Evan Walker
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - Christopher A. Girkin
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, USA
| | - Massimo A. Fazio
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, USA
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - Christopher Bowd
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, USA
| | - C. Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, NY, USA
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, NY, USA
| | - Lyne Racette
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, USA
| |
Collapse
|
4
|
Micheletti E, El-Nimri N, Nishida T, Moghimi S, Rezapour J, Fazio MA, Suh MH, Bowd C, Belghith A, Christopher M, Jonas JB, Weinreb RN, Zangwill LM. Central visual field damage in glaucoma eyes with choroidal microvasculature dropout with and without high axial myopia. Br J Ophthalmol 2024; 108:372-379. [PMID: 36805846 DOI: 10.1136/bjo-2022-322234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 07/15/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE To characterise the relationship between a deep-layer microvasculature dropout (MvD) and central visual field (VF) damage in primary open-angle glaucoma (POAG) patients with and without high axial myopia. DESIGN Cross-sectional study. METHODS Seventy-one eyes (49 patients) with high axial myopia and POAG and 125 non-highly myopic POAG eyes (97 patients) were enrolled. Presence, area and angular circumference of juxtapapillary MvD were evaluated on optical coherence tomography angiography B-scans and en-face choroidal images. RESULTS Juxtapapillary MvD was detected more often in the highly myopic POAG eyes (43 eyes, 86%) than in the non-highly myopic eyes (73 eyes, 61.9%; p=0.002). In eyes with MvD, MvD area and angular circumference (95% CI) were significantly larger in the highly myopic eyes compared with the non-highly myopic eyes (area: (0.69 (0.40, 0.98) mm2 vs 0.31 (0.19, 0.42) mm2, p=0.011) and (angular circumference: 84.3 (62.9, 105.8) vs 74.5 (58.3, 90.9) degrees, p<0.001), respectively. 24-2 VF mean deviation (MD) was significantly worse in eyes with MvD compared with eyes without MvD in both groups (p<0.001). After adjusting for 24-2 MD VF, central VF defects were more frequently found in eyes with MvD compared with eyes without MvD (82.7% vs 60.9%, p<0.001). In multivariable analysis, higher intraocular pressure, worse 24-2 VF MD, longer axial length and greater MvD area and angular circumference were associated with worse 10-2 VF MD. CONCLUSIONS MvD was more prevalent and larger in POAG eyes with high myopia than in non-highly myopic POAG eyes. In both groups, eyes with MvD showed worse glaucoma severity and more central VF defects.
Collapse
Affiliation(s)
- Eleonora Micheletti
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Nevin El-Nimri
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Takashi Nishida
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Jasmin Rezapour
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Massimo A Fazio
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Min Hee Suh
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
- Department of Ophthalmology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Christopher Bowd
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Akram Belghith
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Mark Christopher
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Jost B Jonas
- Department of Ophthalmology, University of Heidelberg Faculty of Medicine Mannheim Institute of Public Health, Mannheim, Germany
| | - Robert N Weinreb
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| | - Linda M Zangwill
- Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
| |
Collapse
|
5
|
Christopher M, Gonzalez R, Huynh J, Walker E, Radha Saseendrakumar B, Bowd C, Belghith A, Goldbaum MH, Fazio MA, Girkin CA, De Moraes CG, Liebmann JM, Weinreb RN, Baxter SL, Zangwill LM. Proactive Decision Support for Glaucoma Treatment: Predicting Surgical Interventions with Clinically Available Data. Bioengineering (Basel) 2024; 11:140. [PMID: 38391627 PMCID: PMC10886033 DOI: 10.3390/bioengineering11020140] [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: 11/29/2023] [Revised: 01/06/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
A longitudinal ophthalmic dataset was used to investigate multi-modal machine learning (ML) models incorporating patient demographics and history, clinical measurements, optical coherence tomography (OCT), and visual field (VF) testing in predicting glaucoma surgical interventions. The cohort included 369 patients who underwent glaucoma surgery and 592 patients who did not undergo surgery. The data types used for prediction included patient demographics, history of systemic conditions, medication history, ophthalmic measurements, 24-2 VF results, and thickness measurements from OCT imaging. The ML models were trained to predict surgical interventions and evaluated on independent data collected at a separate study site. The models were evaluated based on their ability to predict surgeries at varying lengths of time prior to surgical intervention. The highest performing predictions achieved an AUC of 0.93, 0.92, and 0.93 in predicting surgical intervention at 1 year, 2 years, and 3 years, respectively. The models were also able to achieve high sensitivity (0.89, 0.77, 0.86 at 1, 2, and 3 years, respectively) and specificity (0.85, 0.90, and 0.91 at 1, 2, and 3 years, respectively) at an 0.80 level of precision. The multi-modal models trained on a combination of data types predicted surgical interventions with high accuracy up to three years prior to surgery and could provide an important tool to predict the need for glaucoma intervention.
Collapse
Affiliation(s)
- Mark Christopher
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Ruben Gonzalez
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Justin Huynh
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Evan Walker
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Bharanidharan Radha Saseendrakumar
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Christopher Bowd
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Akram Belghith
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Michael H Goldbaum
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Christopher A Girkin
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| |
Collapse
|
6
|
Chuter B, Huynh J, Bowd C, Walker E, Rezapour J, Brye N, Belghith A, Fazio MA, Girkin CA, De Moraes G, Liebmann JM, Weinreb RN, Zangwill LM, Christopher M. Deep Learning Identifies High-Quality Fundus Photographs and Increases Accuracy in Automated Primary Open Angle Glaucoma Detection. Transl Vis Sci Technol 2024; 13:23. [PMID: 38285462 PMCID: PMC10829806 DOI: 10.1167/tvst.13.1.23] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose To develop and evaluate a deep learning (DL) model to assess fundus photograph quality, and quantitatively measure its impact on automated POAG detection in independent study populations. Methods Image quality ground truth was determined by manual review of 2815 fundus photographs of healthy and POAG eyes from the Diagnostic Innovations in Glaucoma Study and African Descent and Glaucoma Evaluation Study (DIGS/ADAGES), as well as 11,350 from the Ocular Hypertension Treatment Study (OHTS). Human experts assessed a photograph as high quality if of sufficient quality to determine POAG status and poor quality if not. A DL quality model was trained on photographs from DIGS/ADAGES and tested on OHTS. The effect of DL quality assessment on DL POAG detection was measured using area under the receiver operating characteristic (AUROC). Results The DL quality model yielded an AUROC of 0.97 for differentiating between high- and low-quality photographs; qualitative human review affirmed high model performance. Diagnostic accuracy of the DL POAG model was significantly greater (P < 0.001) in good (AUROC, 0.87; 95% CI, 0.80-0.92) compared with poor quality photographs (AUROC, 0.77; 95% CI, 0.67-0.88). Conclusions The DL quality model was able to accurately assess fundus photograph quality. Using automated quality assessment to filter out low-quality photographs increased the accuracy of a DL POAG detection model. Translational Relevance Incorporating DL quality assessment into automated review of fundus photographs can help to decrease the burden of manual review and improve accuracy for automated DL POAG detection.
Collapse
Affiliation(s)
- Benton Chuter
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Justin Huynh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Evan Walker
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Jasmin Rezapour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
- Department of Ophthalmology, University Medical Center Mainz, Germany
| | - Nicole Brye
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Massimo A. Fazio
- School of Medicine, Callahan Eye Hospital, University of Alabama-Birmingham, Birmingham, Alabama, United States
| | - Christopher A. Girkin
- School of Medicine, Callahan Eye Hospital, University of Alabama-Birmingham, Birmingham, Alabama, United States
| | - Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| | - Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California, United States
| |
Collapse
|
7
|
Wu JH, Moghimi S, Walker E, Nishida T, Liebmann JM, Fazio MA, Girkin CA, Zangwill LM, Weinreb RN. Long-term variability of retinal nerve fibre layer thickness measurement in patients with glaucoma of African and European descents. Br J Ophthalmol 2023:bjo-2023-324404. [PMID: 38164556 DOI: 10.1136/bjo-2023-324404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/11/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND To examine long-term retinal nerve fibre layer thickness (RNFLT) variability and associated clinical factors in African (AD) and European descent (ED) individuals with glaucoma. METHODS This retrospective cohort study included glaucoma eyes of AD and ED from Diagnostic Innovations in Glaucoma Study/The African Descent and Glaucoma Evaluation Study with ≥4 visits/2 years of follow-up. We calculated optic nerve head RNFLT variability per-examination/visit as the absolute error of its residuals across follow-up. Full, baseline and parsimonious linear-mixed models were fit to evaluate the effects of clinical factors (demographics and ocular characteristics, prior/intervening glaucoma surgeries and cataract extraction (CE), RNFLT thinning rate, scan quality, visit/testing frequency, etc) on RNFLT variability in both races. RESULTS There were 376 and 625 eyes (226 and 349 participants) of AD and ED, and the mean (95% CI) RNFLT variability was 1.62 (1.52, 1.71) µm and 1.42 (1.34, 1.50) µm, respectively (p=0.002). AD and ED had some shared predictors of RNFLT variability, including intraocular pressure fluctuation and scan quality, although the effects varied (p<0.05). In both races, intervening CE was most strongly correlated with higher RNFLT variability (β: 0.24-0.92, p<0.05). After excluding eyes with intervening CE, RNFLT variability was reduced and the small racial difference was no longer significant (AD: 1.40 (1.31, 1.48) µm vs ED: 1.34 (1.27, 1.40) µm; p=0.280). CONCLUSIONS Although some predictors were identified, long-term RNFLT variability appeared small for both AD and ED eyes. Moreover, the racial difference did not remain once intervening CE, the strongest predictor of variability, was eliminated. Our findings inform on strategies to optimise structural assessment and suggest that, when accounting for relevant factors, RNFLT is reliable across races.
Collapse
Affiliation(s)
- Jo-Hsuan Wu
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Evan Walker
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Takashi Nishida
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University Medical Center, New York, New York, USA
| | - Massimo A Fazio
- Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher A Girkin
- Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
8
|
Girkin CA, Garner MA, Gardiner SK, Clark ME, Hubbard M, Karuppanan U, Bianco G, Bruno L, Fazio MA. Displacement of the Lamina Cribrosa With Acute Intraocular Pressure Increase in Brain-Dead Organ Donors. Invest Ophthalmol Vis Sci 2023; 64:19. [PMID: 38099735 PMCID: PMC10729839 DOI: 10.1167/iovs.64.15.19] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose To examine deformations of the optic nerve head (ONH) deep tissues in response to acute elevation of intraocular pressure (IOP). Methods Research-consented brain-dead organ donors underwent imaging by spectral domain optical coherence tomography (OCT). OCT imaging was repeated while the eye was sequentially maintained at manometric pressures of 10, 30, and 50 mm Hg. Radial scans of the ONH were automatically segmented by deep learning and quantified in three dimensions by a custom algorithm. Change in lamina cribrosa (LC) depth and choroidal thickness was correlated with IOP and age by linear mixed-effect models. LC depth was computed against commonly utilized reference planes. Results Twenty-six eyes from 20 brain-dead organ donors (age range, 22-62 years; median age, 43 years) were imaged and quantified. LC depth measured against a reference plane based on Bruch's membrane (BM), BM opening, and an anterior sclera canal opening plane showed both a reduction and an increase in LC depth with IOP elevation. LC depth universally increased in depth when measured against a sclera reference plane. Choroidal (-0.5222 µm/mm Hg, P < 0.001) and retinal nerve fiber layer thickness (-0.0717 µm/mm Hg, P < 0.001) significantly thinned with increasing IOP. The magnitude of LC depth change with IOP was significantly smaller with increasing age (P < 0.03 for all reference planes). Conclusions LC depth changes with IOP reduce with age and are significantly affected by the reference plane of choice, which highlights a need for standardizing LC metrics to properly follow progressive remodeling of the loadbearing tissues of the ONH by OCT imaging and for the definition of a reference database.
Collapse
Affiliation(s)
- Christopher A. Girkin
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| | - Mary A. Garner
- Department of Neuroscience, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | | | - Mark E. Clark
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| | | | - Udayakumar Karuppanan
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| | - Gianfranco Bianco
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| | - Luigi Bruno
- Department of Mechanical, Energy and Management Engineering, University of Calabria, Rende, Italy
| | - Massimo A. Fazio
- Department of Ophthalmology, University of Alabama at Birmingham/Callahan Eye Hospital, Birmingham, Alabama, United States
| |
Collapse
|
9
|
Nishida T, Mahmoudinezhad G, Weinreb RN, Baxter SL, Eslani M, Liebmann JM, Girkin CA, Fazio MA, M Zangwill L, Moghimi S. Smoking and progressive retinal nerve fibre layer thinning in glaucoma. Br J Ophthalmol 2023; 107:1658-1664. [PMID: 36100361 DOI: 10.1136/bjo-2022-321237] [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] [Received: 02/03/2022] [Accepted: 09/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To investigate the relationship between smoking and smoking intensity, and the rate of retinal nerve fibre layer (RNFL) thinning in patients with primary open angle glaucoma (POAG). METHODS In this longitudinal study, patients with POAG who had at least 3 years of follow-up with a minimum of 5 visits of optical coherence tomography (OCT) were enrolled. The smoking intensity was calculated as the pack-year at the baseline OCT. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on the rates of RNFL thinning over time. Non-linear least-squares estimation with piecewise regression model was used to investigate the cut-off point for the relationship between circumpapillary RNFL thinning and smoking intensity. RESULTS A total of 466 eyes of 314 patients were included over the mean (95% CI) follow-up of 6.6 (6.4 to 6.7) years. Of the 314 patients, 121 (39%) had reported any history of smoking. Greater smoking intensity was associated with faster RNFL thinning (-0.06 (95% CI -0.11 to 0.00) µm/year per 10 pack-year higher; p=0.031) after adjusted for confounding factors. RNFL thinning became significantly faster when smoking intensity was >8 pack-year. CONCLUSIONS Smoking intensity is associated with faster rates of RNFL thinning. Evaluation of smoking intensity might add information to the assessment of risk of glaucoma progression. Future studies are required to explore if withdrawing smoking as a modifiable risk factor can decrease progression in patients with glaucoma.
Collapse
Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
- Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Medi Eslani
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, USA
| | - Christopher A Girkin
- Bernard School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Massimo A Fazio
- Bernard School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
10
|
Bowd C, Belghith A, Rezapour J, Christopher M, Jonas JB, Hyman L, Fazio MA, Weinreb RN, Zangwill LM. Multimodal Deep Learning Classifier for Primary Open Angle Glaucoma Diagnosis Using Wide-Field Optic Nerve Head Cube Scans in Eyes With and Without High Myopia. J Glaucoma 2023; 32:841-847. [PMID: 37523623 DOI: 10.1097/ijg.0000000000002267] [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: 02/02/2023] [Accepted: 06/18/2023] [Indexed: 08/02/2023]
Abstract
PRCIS An optical coherence tomography (OCT)-based multimodal deep learning (DL) classification model, including texture information, is introduced that outperforms single-modal models and multimodal models without texture information for glaucoma diagnosis in eyes with and without high myopia. BACKGROUND/AIMS To evaluate the diagnostic accuracy of a multimodal DL classifier using wide OCT optic nerve head cube scans in eyes with and without axial high myopia. MATERIALS AND METHODS Three hundred seventy-one primary open angle glaucoma (POAG) eyes and 86 healthy eyes, all without axial high myopia [axial length (AL) ≤ 26 mm] and 92 POAG eyes and 44 healthy eyes, all with axial high myopia (AL > 26 mm) were included. The multimodal DL classifier combined features of 3 individual VGG-16 models: (1) texture-based en face image, (2) retinal nerve fiber layer (RNFL) thickness map image, and (3) confocal scanning laser ophthalmoscope (cSLO) image. Age, AL, and disc area adjusted area under the receiver operating curves were used to compare model accuracy. RESULTS Adjusted area under the receiver operating curve for the multimodal DL model was 0.91 (95% CI = 0.87, 0.95). This value was significantly higher than the values of individual models [0.83 (0.79, 0.86) for texture-based en face image; 0.84 (0.81, 0.87) for RNFL thickness map; and 0.68 (0.61, 0.74) for cSLO image; all P ≤ 0.05]. Using only highly myopic eyes, the multimodal DL model showed significantly higher diagnostic accuracy [0.89 (0.86, 0.92)] compared with texture en face image [0.83 (0.78, 0.85)], RNFL [0.85 (0.81, 0.86)] and cSLO image models [0.69 (0.63, 0.76)] (all P ≤ 0.05). CONCLUSIONS Combining OCT-based RNFL thickness maps with texture-based en face images showed a better ability to discriminate between healthy and POAG than thickness maps alone, particularly in high axial myopic eyes.
Collapse
Affiliation(s)
- Christopher Bowd
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, Hamilton Glaucoma Center
| | - Akram Belghith
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, Hamilton Glaucoma Center
| | - Jasmin Rezapour
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, Hamilton Glaucoma Center
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz
| | - Mark Christopher
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, Hamilton Glaucoma Center
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham, Birmingham, AL
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, Hamilton Glaucoma Center
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, Hamilton Glaucoma Center
| |
Collapse
|
11
|
Rezapour J, Bowd C, Dohleman J, Belghith A, Proudfoot JA, Christopher M, Hyman L, Jonas JB, Penteado RC, Moghimi S, Hou H, El-Nimri NW, Micheletti E, Fazio MA, Weinreb RN, Zangwill LM. Macula structural and vascular differences in glaucoma eyes with and without high axial myopia. Br J Ophthalmol 2023; 107:1286-1294. [PMID: 35725293 DOI: 10.1136/bjophthalmol-2021-320430] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/24/2022] [Indexed: 11/04/2022]
Abstract
AIMS To identify clinically relevant parameters for identifying glaucoma in highly myopic eyes, an investigation was conducted of the relationship between the thickness of various retinal layers and the superficial vessel density (sVD) of the macula with axial length (AL) and visual field mean deviation (VFMD). METHODS 270 glaucoma patients (438 eyes) participating in the Diagnostic Innovations in Glaucoma cross-sectional study representing three axial myopia groups (non-myopia: n=163 eyes; mild myopia: n=218 eyes; high myopia (AL>26 mm): n=57 eyes) who completed macular optical coherence tomography (OCT) and OCT-angiography imaging were included. Associations of AL and VFMD with the thickness of the ganglion cell inner plexiform layer (GCIPL), macular retinal nerve fibre layer (mRNFL), ganglion cell complex (GCC), macular choroidal thickness (mCT) and sVD were evaluated. RESULTS Thinner Global GCIPL and GCC were significantly associated with worse VFMD (R2=34.5% and R2=32.9%; respectively p<0.001), but not with AL (all p>0.1). Thicker mRNFL showed a weak association with increasing AL (R2=2.4%; p=0.005) and a positive association with VFMD (global R2=19.2%; p<0.001). Lower sVD was weakly associated with increasing AL (R2=1.8%; p=0.028) and more strongly associated with more severe glaucoma VFMD (R2=29.6%; p<0.001). Thinner mCT was associated with increasing AL (R2=15.5% p<0.001) and not associated with VFMD (p=0.194). mRNFL was thickest while mCT was thinnest in all sectors of high myopic eyes. CONCLUSIONS As thinner GCIPL and GCC were associated with increasing severity of glaucoma but were not significantly associated with AL, they may be useful for monitoring glaucoma in highly myopic eyes.
Collapse
Affiliation(s)
- Jasmin Rezapour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Jade Dohleman
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Leslie Hyman
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Rafaella C Penteado
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Huiyuan Hou
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Nevin W El-Nimri
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Massimo A Fazio
- Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
12
|
Jackson AB, Martin KR, Coote MA, Medeiros FA, Girkin CA, Fazio MA, Liebmann JM, De Moraes CG, Weinreb RN, Zangwill LM, Wu Z. Fast Progressors in Glaucoma: Prevalence Based on Global and Central Visual Field Loss. Ophthalmology 2023; 130:462-468. [PMID: 36693593 PMCID: PMC10121866 DOI: 10.1016/j.ophtha.2023.01.008] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/04/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To determine the prevalence of fast global and central visual field (VF) progression in individuals with glaucoma under routine care. DESIGN Observational study. PARTICIPANTS Six hundred ninety-three eyes of 461 individuals with glaucoma followed up over a median of 4.5 years. METHODS This study included (1) patients at a private ophthalmology clinic in Melbourne, Australia, and (2) individuals in 2 prospective longitudinal observational studies across 3 sites in the United States. All individuals had a diagnosis of glaucoma and were under routine care, and had performed 5 or more reliable 24-2 VF tests over a 1- to 5-year period. Ordinary least squares regression analyses were used to calculate the rate of global mean deviation (MD) change over time and the rate of the mean total deviation values of the 12 test locations within the central 10° region (MTD10) for each eye. MAIN OUTCOME MEASURES Prevalence of progression based on the rate of MD and the MTD10 change across various fixed cutoffs and cutoffs based on the estimated normal distribution (from the positive slopes). RESULTS Based on the MD and the MTD10, 12.5% and 11.7% of the eyes, respectively, exhibited a rate of change that was less than -1.0 dB/year (being a rate that typically is defined as "fast progression" for MD values), and 29.0% of the eyes showed a change of less than -0.5 dB/year on MTD10. Furthermore, 12.7% and 9.1% of the eyes exhibited a rate of change that exceeded the 1% cutoff of the estimated normal distribution MD and the MTD10 values, respectively. CONCLUSIONS This study found that approximately 1 in 8 eyes with glaucoma receiving routine care showed fast progression based on global MD values (< -1.0 dB/year) and that nearly 1 in 3 eyes showed a < -0.5 dB/year decline centrally. These findings highlight the clinical importance of assessing progressive central VF loss and reinforce the need for new therapies to prevent functional disability in a notable proportion of individuals who continue to exhibit fast progression. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Aidan B Jackson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Keith R Martin
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia; John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom
| | - Michael A Coote
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Felipe A Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
| |
Collapse
|
13
|
Nishida T, Moghimi S, Yamane MLM, Wu JH, Mohammadzadeh V, Kamalipour A, Mahmoudinezhad G, Liebmann JM, Fazio MA, Girkin CA, Zangwill LM, Weinreb RN. Vision-Related Quality of Life Among Healthy, Preperimetric Glaucoma, and Perimetric Glaucoma Patients. Am J Ophthalmol 2023; 248:127-136. [PMID: 36581193 PMCID: PMC10038908 DOI: 10.1016/j.ajo.2022.12.018] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the association of vision-related quality of life (VRQOL) with the central visual field and macular ganglion cell complex (GCC) thickness in healthy control participants, patients with preperimetric glaucoma, and patients with perimetric glaucoma. DESIGN Retrospective cross-sectional study. METHODS A total of 39 healthy, 34 preperimetric glaucoma, and 145 perimetric glaucoma patients completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ). A linear mixed-effect models was used to investigate the association between the glaucoma stage as measured by binocular 10-2 visual field mean sensitivity (VFMS) and GCC thickness with the Rasch-calibrated NEI-VFQ score. RESULTS A total of 436 eyes from 218 participants (mean age = 67.2 [95% CI = 65.1 to 69.2] years) were enrolled. VRQOL calculated by the NEI-VFQ Rasch-calibrated score was worst for patients with perimetric glaucoma (50.7 [95% CI = 47.2 to 54.2]), followed by patients with preperimetric glaucoma (41.2 [95% CI = 34.5 to 47.9]) and healthy controls (29.3 [95% CI = 24.0 to 34.7]. Worse VRQOL had a moderate association with a worse global binocular 10-2 VFMS (-3.4 [95% CI = -5.0 to -1.9] dB per 1 score; P < .001; adjusted R2 = 0.27), but not with a thinner global GCC in the better eye (-0.1 [95% CI = -0.2 to 0.1] µm per 1 score; P =.0485; adjusted R2 = 0.17). CONCLUSIONS These findings suggest that patients with perimetric and preperimetric glaucoma have worse VRQOL than patients with healthy eyes. As compared to macular thickness measurements, the central visual field is more strongly associated with VRQOL and may better help to identify patients in need of intervention.
Collapse
Affiliation(s)
- Takashi Nishida
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA
| | - Maya L M Yamane
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA
| | - Jo-Hsuan Wu
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA
| | - Vahid Mohammadzadeh
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA
| | - Alireza Kamalipour
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA
| | - Golnoush Mahmoudinezhad
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.), Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, USA
| | - Massimo A Fazio
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA; Heersink School of Medicine (M.A.F., C.A.G.), University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Christopher A Girkin
- Heersink School of Medicine (M.A.F., C.A.G.), University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (T.N., S.M., M.L.M.Y., J.-H.W., V.M., A.K., G.M., M.A.F., L.M.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California-San Diego, La Jolla, California, USA.
| |
Collapse
|
14
|
Girkin CA, Garner MA, Fazio MA, Clark ME, Karuppanan U, Hubbard MG, Bianco G, Hubbard ST, Fortune B, Gross AK. Retinal electrophysiologic response to IOP elevation in living human eyes. Exp Eye Res 2023; 229:109420. [PMID: 36806673 PMCID: PMC11048619 DOI: 10.1016/j.exer.2023.109420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/23/2022] [Revised: 01/26/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The relationships between intraocular pressure (IOP), ocular perfusion pressure (OPP), retinal perfusion, and retinal electrophysiologic responses have been explored experimentally across several animal models. These studies have demonstrated that elevated IOP reduces OPP, and when this reduction in OPP exceeds the autoregulatory capacity of the retina vasculature, retinal perfusion and electrophysiologic responses are reduced. This study aimed to evaluate these interactions for the first time in the living human eye. METHODS Five eyes from three research-consented brain-dead organ donors underwent optical coherence tomography with angiographic (OCT/A; Spectralis, Heidelberg Engineering) and electroretinographic (ERG, Diagnosys LLC) measurements while IOP was manometrically-elevated stepwise to pressures of 10, 30 and 50 mmHg. Systemic blood pressure (BP) was monitored continuously during testing. Correlation analysis was applied to assess association between ERG and OPP changes. In a single eye, prolonged IOP elevation was induced with viscoelastic injection and serial ERG measurements were obtained. RESULTS Reductions in inner retinal function defined by photopic ERG were observed with elevation in IOP and concomitant reduction in OPP. Reductions, especially in b-wave, and photopic negative response (PhNR) amplitudes and implicit times were significantly correlated with elevation in IOP and reduction in OPP. There were more appreciable changes in perfusion and functional responses in eyes tested while systemic blood pressure was lower. With prolonged IOP elevation, selective loss of the PhNR response was observed. CONCLUSIONS In the living human eye, retinal perfusion and inner retinal function are acutely impacted by elevation of IOP, and this impact is related to systemic BP and OPP. This novel approach provides a viable model to study the autoregulatory responses to IOP elevation in the living human eye.
Collapse
Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States.
| | - Mary Anne Garner
- Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States; Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States
| | - Mark E Clark
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Udayakumar Karuppanan
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Meredith G Hubbard
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States; Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Gianfranco Bianco
- Department of Ophthalmology and Visual Sciences, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Seth T Hubbard
- Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States; Science and Technology Honors Program, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Brad Fortune
- Devers Eye Institute, Legacy Health, Portland, OR, United States
| | - Alecia K Gross
- Department of Neurobiology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| |
Collapse
|
15
|
Christopher M, Hoseini P, Walker E, Proudfoot JA, Bowd C, Fazio MA, Girkin CA, De Moraes CG, Liebmann JM, Weinreb RN, Schwartzman A, Zangwill LM, Welsbie DS. A Deep Learning Approach to Improve Retinal Structural Predictions and Aid Glaucoma Neuroprotective Clinical Trial Design. Ophthalmol Glaucoma 2023; 6:147-159. [PMID: 36038107 DOI: 10.1016/j.ogla.2022.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/13/2022] [Revised: 08/02/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To investigate the efficacy of a deep learning regression method to predict macula ganglion cell-inner plexiform layer (GCIPL) and optic nerve head (ONH) retinal nerve fiber layer (RNFL) thickness for use in glaucoma neuroprotection clinical trials. DESIGN Cross-sectional study. PARTICIPANTS Glaucoma patients with good quality macula and ONH scans enrolled in 2 longitudinal studies, the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovations in Glaucoma Study. METHODS Spectralis macula posterior pole scans and ONH circle scans on 3327 pairs of GCIPL/RNFL scans from 1096 eyes (550 patients) were included. Participants were randomly distributed into a training and validation dataset (90%) and a test dataset (10%) by participant. Networks had access to GCIPL and RNFL data from one hemiretina of the probe eye and all data of the fellow eye. The models were then trained to predict the GCIPL or RNFL thickness of the remaining probe eye hemiretina. MAIN OUTCOME MEASURES Mean absolute error (MAE) and squared Pearson correlation coefficient (r2) were used to evaluate model performance. RESULTS The deep learning model was able to predict superior and inferior GCIPL thicknesses with a global r2 value of 0.90 and 0.86, r2 of mean of 0.90 and 0.86, and mean MAE of 3.72 μm and 4.2 μm, respectively. For superior and inferior RNFL thickness predictions, model performance was slightly lower, with a global r2 of 0.75 and 0.84, r2 of mean of 0.81 and 0.82, and MAE of 9.31 μm and 8.57 μm, respectively. There was only a modest decrease in model performance when predicting GCIPL and RNFL in more severe disease. Using individualized hemiretinal predictions to account for variability across patients, we estimate that a clinical trial can detect a difference equivalent to a 25% treatment effect over 24 months with an 11-fold reduction in the number of patients compared to a conventional trial. CONCLUSIONS Our deep learning models were able to accurately estimate both macula GCIPL and ONH RNFL hemiretinal thickness. Using an internal control based on these model predictions may help reduce clinical trial sample size requirements and facilitate investigation of new glaucoma neuroprotection therapies. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California
| | - Pourya Hoseini
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California
| | - Evan Walker
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California
| | - Massimo A Fazio
- Callahan Eye Hospital, Heersink School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama
| | - Christopher A Girkin
- Callahan Eye Hospital, Heersink School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California
| | - Armin Schwartzman
- Division of Biostatistics, Herbert Wertheim School of Public Health, University of California, San Diego, California; Halıcıoğlu Data Science Institute, University of California, San Diego, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California
| | - Derek S Welsbie
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California.
| |
Collapse
|
16
|
Kamalipour A, Moghimi S, Khosravi P, Jazayeri MS, Nishida T, Mahmoudinezhad G, Li EH, Christopher M, Liebmann JM, Fazio MA, Girkin CA, Zangwill L, Weinreb RN. Deep Learning Estimation of 10-2 Visual Field Map Based on Circumpapillary Retinal Nerve Fiber Layer Thickness Measurements. Am J Ophthalmol 2023; 246:163-173. [PMID: 36328198 DOI: 10.1016/j.ajo.2022.10.013] [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] [Received: 06/07/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To estimate central 10-degree visual field (VF) map from spectral-domain optical coherence tomography (SD-OCT) retinal nerve fiber layer thickness (RNFL) measurements in glaucoma with artificial intelligence. DESIGN Artificial intelligence (convolutional neural networks) study. METHODS This study included 5352 SD-OCT scans and 10-2 VF pairs from 1365 eyes of 724 healthy patients, patients with suspected glaucoma, and patients with glaucoma. Convolutional neural networks (CNNs) were developed to estimate the 68 individual sensitivity thresholds of 10-2 VF map using all-sectors (CNNA) and temporal-sectors (CNNT) RNFL thickness information of the SD-OCT circle scan (768 thickness points). 10-2 indices including pointwise total deviation (TD) values, mean deviation (MD), and pattern standard deviation (PSD) were generated using the CNN-estimated sensitivity thresholds at individual test locations. Linear regression (LR) models with the same input were used for comparison. RESULTS The CNNA model achieved an average pointwise mean absolute error of 4.04 dB (95% confidence interval [CI] 3.76-4.35) and correlation coefficient (r) of 0.59 (95% CI 0.52-0.64) over 10-2 map and the mean absolute error and r of 2.88 dB (95% CI 2.63-3.15) and 0.74 (95% CI 0.67-0.80) for MD, and 2.31 dB (95% CI 2.03-2.61) and 0.59 (95% CI 0.51-0.65) for PSD estimations, respectively, significantly outperforming the LRA model. CONCLUSIONS The proposed CNNA model improved the estimation of 10-2 VF map based on circumpapillary SD-OCT RNFL thickness measurements. These artificial intelligence methods using SD-OCT structural data show promise to individualize the frequency of central VF assessment in patients with glaucoma and would enable the reallocation of resources from patients at lowest risk to those at highest risk of central VF damage.
Collapse
Affiliation(s)
- Alireza Kamalipour
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pooya Khosravi
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mohammad Sadegh Jazayeri
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Takashi Nishida
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Golnoush Mahmoudinezhad
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth H Li
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark Christopher
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey M Liebmann
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Massimo A Fazio
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher A Girkin
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Linda Zangwill
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (A.K., S.M., T.N., G.M., E.H.L., M.C., M.A.F., L.Z., R.N.W.),; Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla; School of Medicine (P.K.),; University of California Irvine, Irvine; Department of Civil, Construction, and Environmental Engineering (M.S.J.),; San Diego State University, San Diego, California; Bernard and Shirlee Brown Glaucoma Research Laboratory (J.M.L.),; Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York; and the Department of Ophthalmology and Vision Sciences (M.A.F., C.A.G.),; Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA..
| |
Collapse
|
17
|
Mahmoudinezhad G, Moghimi S, Nishida T, Latif K, Yamane M, Micheletti E, Mohammadzadeh V, Wu JH, Kamalipour A, Li E, Liebmann JM, Girkin CA, Fazio MA, Zangwill LM, Weinreb RN. Association Between Rate of Ganglion Cell Complex Thinning and Rate of Central Visual Field Loss. JAMA Ophthalmol 2023; 141:33-39. [PMID: 36416837 PMCID: PMC9856692 DOI: 10.1001/jamaophthalmol.2022.4973] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/01/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022]
Abstract
Importance Whether rapid ganglion cell complex (GCC) thinning during an initial follow-up period is associated with rates of central visual field loss over time is unclear but important to understand because risk of glaucoma progression can help guide treatment intensity. Objective To investigate the association between the rate of GCC thinning during initial follow-up and the rate of central visual field loss. Design, Setting, and Participants This retrospective cohort study assessed patients older than 18 years with glaucoma at a tertiary glaucoma center who were followed up from June 18, 2014, to January 11, 2019. Data analysis for the current study was undertaken in March 2022. Main Outcomes and Measures Initial rates of GCC thinning were obtained from global GCC thickness values of the first 3 optical coherence tomography (OCT) scans. Rates of central visual field loss were assessed as the change in central (10-2) visual field mean deviation during the 4.7-year follow-up period by univariable and multivariable linear mixed-effects models. Eyes were categorized as slow (>-1 μm/y) or fast (≤-1 μm/y) progressors based on rates of GCC thinning. Results The cohort consisted of 202 eyes of 139 patients (mean [SD] age, 68.7 [10.0] years; 72 male [51.8%]); 44 African American patients (31.7%), 13 Asian patients (9.4%), 80 White patients (57.6%), and 2 patients who identified as other race and ethnicity (1.4%) were analyzed. The rate of GCC change was -0.56 μm/y (95% CI, -0.66 to -0.46 μm/y) during a mean initial follow-up of 1.8 years (95% CI, 1.7-2.0 years). A total of 163 eyes (80.7%) were slow OCT progressors, and 39 (19.3%) were fast OCT progressors, with rates of GCC thinning of -0.3 μm/y (95% CI, -0.4 to -0.2 μm/y) and -1.6 μm/y (-1.8 to -1.3 μm/y), respectively. The rates of 10-2 visual field mean deviation worsening among slow and fast OCT progressors were -0.10 dB/y (95% CI, -0.16 to 0.00 dB/y) and -0.34 dB/y (95% CI, -0.51 to -0.16 dB/y), respectively (difference, -0.26 dB/y; 95% CI, -0.45 to -0.07 dB/y; P = .008). Conclusions and Relevance In this cohort study, rapid GCC thinning during an initial follow-up period was associated with faster rates of central visual field decline. These findings support use of longitudinal macular OCT scans assisting clinical decision-making for glaucoma and also may guide possible intensification of therapy in high-risk patients.
Collapse
Affiliation(s)
- Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Kareem Latif
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Maya Yamane
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Vahid Mohammadzadeh
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Jo-Hsuan Wu
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Elizabeth Li
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Christopher A. Girkin
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, The University of Alabama at Birmingham
| | - Massimo A. Fazio
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, The University of Alabama at Birmingham
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| |
Collapse
|
18
|
Nishida T, Moghimi S, Chang AC, Walker E, Liebmann JM, Fazio MA, Girkin CA, Zangwill LM, Weinreb RN. Association of Intraocular Pressure With Retinal Nerve Fiber Layer Thinning in Patients With Glaucoma. JAMA Ophthalmol 2022; 140:1209-1216. [PMID: 36301523 PMCID: PMC9614677 DOI: 10.1001/jamaophthalmol.2022.4462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/24/2022] [Accepted: 09/03/2022] [Indexed: 01/12/2023]
Abstract
Importance Higher intraocular pressure variability may be associated with faster structural changes in patients with glaucoma. Objectives To investigate the association of mean intraocular pressure and intraocular pressure variability (defined as the SD of intraocular pressure and the intraocular pressure range) with the rate of retinal nerve fiber layer thinning over time in patients with glaucoma. Design, Setting, and Participants In this retrospective analysis of a longitudinal cohort, patients were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation study. A total of 815 eyes (564 with perimetric glaucoma and 251 with preperimetric glaucoma) from 508 patients with imaging follow-up for a mean of 6.3 years from December 2008 to October 2020 were studied. Data were analyzed from November 2021 to March 2022. Main Outcomes and Measures In this longitudinal study, eyes with at least 4 visits and 2 years of follow-up optical coherence tomography and intraocular pressure measurement were included. A linear mixed-effect model was used to investigate the association of intraocular pressure parameters with the rates of retinal nerve fiber layer thinning. Dominance analysis was performed to determine the relative importance of the intraocular pressure parameters. Results Of 508 included patients, 280 (55.1%) were female, 195 (38.4%) were African American, 24 (4.7%) were Asian, 281 (55.3%) were White, and 8 (1.6%) were another race or ethnicity; the mean (SD) age was 65.5 (11.0) years. The mean rate of retinal nerve fiber layer change was -0.67 (95% CI, -0.73 to -0.60) μm per year. In multivariable models adjusted for mean intraocular pressure and other confounding factors, faster annual rate of retinal nerve fiber layer thinning was associated with a higher SD of intraocular pressure (-0.20[ 95% CI, -0.26 to -0.15] μm per 1-mm Hg higher; P < .001) or higher intraocular pressure range (-0.05 [95% CI, -0.06 to -0.03] μm per 1-mm Hg higher; P < .001). Conclusions and Relevance In this study, intraocular pressure variability was independently associated with structural change in patients with glaucoma, even after adjustment for mean intraocular pressure, supporting its potential value in clinical management.
Collapse
Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Aimee C. Chang
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Evan Walker
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Massimo A. Fazio
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, The University of Alabama at Birmingham
| | - Christopher A. Girkin
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, The University of Alabama at Birmingham
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| |
Collapse
|
19
|
Mahmoudinezhad G, Nishida T, Weinreb RN, Baxter SL, Eslani M, Micheletti E, Liebmann JM, Fazio MA, Girkin CA, Zangwill LM, Moghimi S. Impact of Smoking on Visual Field Progression in a Long-term Clinical Follow-up. Ophthalmology 2022; 129:1235-1244. [PMID: 35752211 PMCID: PMC10002405 DOI: 10.1016/j.ophtha.2022.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/28/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To investigate the effect of smoking on rates of progressive visual field (VF) damage over time in glaucoma. DESIGN Retrospective cohort study. PARTICIPANTS Five hundred eleven eyes of 354 patients with glaucoma followed up from multicenter glaucoma registries. METHODS In this longitudinal study, 354 patients with primary open-angle glaucoma with a minimum of 3 years of follow-up and 5 VF tests were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Univariate and multivariate linear mixed models were used to investigate the effects of smoking on rates of 24-2 VF mean deviation loss. Visual field progression was defined using pointwise linear and significant negative VF mean deviation loss. Logistic regression was used to identify baseline factors and whether different levels of smoking intensity were associated with VF progression. Kaplan-Meier survival analysis and the log-rank test were used to compare the cumulative risk ratio of progression between smoker and never smoker groups. MAIN OUTCOME MEASURES Visual field progression. RESULTS Five hundred eleven eyes of 354 patients were included over the median follow-up of 12.5 years. Median baseline age was 64.8 years. Of the 354 patients, 124 (35%) were Black, and 149 (42.1%) and 168 (59.8%) had reported a history of smoking or alcohol consumption, respectively. In a multivariate model, higher smoking intensity was associated with faster VF loss (coefficient, -0.05 decibels (dB)/year per 10 pack-years; 95% confidence interval [CI], -0.08 to -0.01 dB/year per 10 pack-years; P = 0.010). Developing VF progression in eyes of heavy smokers (≥ 20 pack-years) was 2.2 times more than in eyes of patients without smoking history (odds ratio, 2.21; 95% CI, 1.02-4.76; P = 0.044). Statistically significant differences were found between heavy smokers (≥ 20 pack-years) and never smokers by Kaplan-Meier analysis (P = 0.011, log-rank test). CONCLUSIONS Heavy smokers are more likely to sustain VF loss in eyes with glaucoma. The prospective longitudinal design of this study supports the hypothesis that levels of smoking may be a significant predictor for glaucoma progression. Additionally, this information can be used for clinically relevant tobacco prevention and intervention messages.
Collapse
Affiliation(s)
- Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Sally L Baxter
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Biomedical Informatics, University of California, San Diego, La Jolla, California
| | - Medi Eslani
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Massimo A Fazio
- Bernard School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher A Girkin
- Bernard School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
| |
Collapse
|
20
|
Melchior B, De Moraes CG, Paula JS, Cioffi GA, Girkin CA, Fazio MA, Weinreb RN, Zangwill LM, Liebmann JM. Frequency of Optical Coherence Tomography Testing to Detect Progression in Glaucoma. J Glaucoma 2022; 31:854-859. [PMID: 35980865 PMCID: PMC9633358 DOI: 10.1097/ijg.0000000000002101] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
PRCIS With high specificity and less variability than perimetry, more frequent testing resulted in shorter time to detect progression, though a 6-month testing interval provides a reasonable trade-off for following glaucoma patients using optical coherence tomography (OCT). PURPOSE To investigate the time to detect progression in glaucomatous eyes using different OCT test intervals. MATERIALS AND METHODS Participants with manifest glaucoma from the African Descent and Glaucoma Evaluation Study (ADAGES), a multicenter, prospective, observational cohort study, were included. A total of 2699 OCT tests from 171 glaucomatous and 149 normal eyes of 182 participants, with at least 5 tests and 2 years of follow-up, were analyzed. Computer simulations (n=10,000 eyes) were performed to estimate time to detect progression of global circumpapillary retinal nerve fiber layer thickness (cpRNFL) measured with OCT tests. Simulations were based on different testing paradigms (every 4, 6, 12, and 24 mo) and different rates of change (µm/year). Time to detect significant progression ( P <0.05) at 80% and 90% power were calculated for each paradigm and rate of cpRNFL change. RESULTS As expected, more frequent testing resulted in shorter time to detect progression. Although there was clear disadvantage for testing at intervals of 24 versus 12 months (~22.4% time [25 mo] increase in time to progression detection) and when testing 12 versus 6 months (~22.1% time [20 mo] increase), the improved time to detect progression was less pronounced when comparing 6 versus 4 months (~11.5% time [10 mo] reduction). CONCLUSION With high specificity and less variability than perimetry, a 6-month testing interval provides a reasonable trade-off for following glaucoma patients using OCT.
Collapse
Affiliation(s)
- Bruna Melchior
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Carlos G De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Jayter S Paula
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | | | - Massimo A Fazio
- Department of Ophthalmology, University of Alabama-Birmingham, Birmingham, AL
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute University of California-San Diego, La Jolla, CA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute University of California-San Diego, La Jolla, CA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
21
|
El-Nimri NW, Moghimi S, Nishida T, Yarmohammadi A, Zangwill LM, Hou H, Proudfoot J, Walker E, Fazio MA, Girkin CA, Liebmann JM, Weinreb RN. Racial Differences in Detection of Glaucoma Using Retinal Nerve Fiber Layer Thickness and Bruch Membrane Opening Minimum Rim Width. Am J Ophthalmol 2022; 246:223-235. [PMID: 36662535 DOI: 10.1016/j.ajo.2022.10.010] [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] [Received: 07/20/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE To compare the sensitivities and specificities of the retinal nerve fiber layer thickness (RNFLT) and Bruch membrane opening minimum rim width (BMO-MRW) reference database-based criteria for detection of glaucoma in individuals of European descent (ED) and individuals of African descent (AD). DESIGN Comparative diagnostic analysis by race METHODS: 382 eyes of 255 glaucoma patients (ED = 170, AD = 85) and 94 eyes of 50 healthy individuals (ED = 30, AD = 20) with global and sectoral RNFLT and BMO-MRW measured with Spectralis optical coherence tomography (OCT) were included. Six diagnostic criteria were evaluated: global measurement below the 5th or 1st percentile, ≥1 of the 6 sector measurements below the 5th or 1st percentile, and superotemporal (ST) and/or inferotemporal (IT) measurement below the 5th or 1st percentile. The sensitivities and specificities of these measurements for detection of glaucoma were compared using bootstrapping methods. RESULTS ST and/or IT RNFLT below the 5th percentile has the best performance for detection of glaucoma among RNFLT classifications with a sensitivity (95% CI) of 89.5% (86.1, 92.5) and specificity of 87.2% (77.8, 95.1). In AD individuals, sensitivities of ST and IT RNFLT and BMO-MRW measurements below the 5th percentile criteria were lower than in ED individuals (RNFLT: 83.7% vs 92.5%, and BMO-MRW: 72.1% vs 88.5%, respectively), as well as specificities (AD RNFLT: 73.7% and BMO-MRW: 89.5% vs ED RNFLT: 96.4% and BMO-MRW: 98.2%, respectively). CONCLUSIONS RNFLT and BMO-MRW had consistently lower diagnostic performance in AD individuals compared with ED individuals. BMO-MRW criteria might fail to detect as many as one-third of eyes with glaucoma, specifically in AD individuals. With the current reference database, RNFLT, and especially BMO-MRW, criteria are not adequate for diagnosing glaucoma in AD individuals.
Collapse
Affiliation(s)
- Nevin W El-Nimri
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.).
| | - Takashi Nishida
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Adeleh Yarmohammadi
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Huiyuan Hou
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - James Proudfoot
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Evan Walker
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (M.A.F., C.A.G.) and
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (M.A.F., C.A.G.) and
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York (J.M.L.), USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center, Shiley Eye Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California (N.W.E.-N., S.M., T.N., A.Y., L.M.Z., H.H., J.P., E.W., R.N.W.)
| |
Collapse
|
22
|
Fan R, Alipour K, Bowd C, Christopher M, Brye N, Proudfoot JA, Goldbaum MH, Belghith A, Girkin CA, Fazio MA, Liebmann JM, Weinreb RN, Pazzani M, Kriegman D, Zangwill LM. Detecting Glaucoma from Fundus Photographs Using Deep Learning without Convolutions: Transformer for Improved Generalization. Ophthalmol Sci 2022; 3:100233. [PMID: 36545260 PMCID: PMC9762193 DOI: 10.1016/j.xops.2022.100233] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 06/17/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022]
Abstract
Purpose To compare the diagnostic accuracy and explainability of a Vision Transformer deep learning technique, Data-efficient image Transformer (DeiT), and ResNet-50, trained on fundus photographs from the Ocular Hypertension Treatment Study (OHTS) to detect primary open-angle glaucoma (POAG) and identify the salient areas of the photographs most important for each model's decision-making process. Design Evaluation of a diagnostic technology. Subjects Participants and Controls Overall 66 715 photographs from 1636 OHTS participants and an additional 5 external datasets of 16 137 photographs of healthy and glaucoma eyes. Methods Data-efficient image Transformer models were trained to detect 5 ground-truth OHTS POAG classifications: OHTS end point committee POAG determinations because of disc changes (model 1), visual field (VF) changes (model 2), or either disc or VF changes (model 3) and Reading Center determinations based on disc (model 4) and VFs (model 5). The best-performing DeiT models were compared with ResNet-50 models on OHTS and 5 external datasets. Main Outcome Measures Diagnostic performance was compared using areas under the receiver operating characteristic curve (AUROC) and sensitivities at fixed specificities. The explainability of the DeiT and ResNet-50 models was compared by evaluating the attention maps derived directly from DeiT to 3 gradient-weighted class activation map strategies. Results Compared with our best-performing ResNet-50 models, the DeiT models demonstrated similar performance on the OHTS test sets for all 5 ground-truth POAG labels; AUROC ranged from 0.82 (model 5) to 0.91 (model 1). Data-efficient image Transformer AUROC was consistently higher than ResNet-50 on the 5 external datasets. For example, AUROC for the main OHTS end point (model 3) was between 0.08 and 0.20 higher in the DeiT than ResNet-50 models. The saliency maps from the DeiT highlight localized areas of the neuroretinal rim, suggesting important rim features for classification. The same maps in the ResNet-50 models show a more diffuse, generalized distribution around the optic disc. Conclusions Vision Transformers have the potential to improve generalizability and explainability in deep learning models, detecting eye disease and possibly other medical conditions that rely on imaging for clinical diagnosis and management.
Collapse
Key Words
- AI, artificial intelligence
- AUROC, areas under the receiver operating characteristic curve
- CI, confidence interval
- CNN, convolutional neural network
- DL, deep learning
- Deep learning
- DeiT, Data-efficient image Transformer
- Fundus photographs
- Glaucoma detection
- LAG, Large-Scale Attention-Based Glaucoma
- OHTS, Ocular Hypertension Treatment Study
- POAG, primary open-angle glaucoma
- SoTA, state-of-the-art
- VF, visual field
- ViT, Vision Transformer
- Vision Transformers
Collapse
Affiliation(s)
- Rui Fan
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California,Department of Computer Science and Engineering, University of California San Diego, La Jolla, California,Department of Control Science and Engineering, Tongji University, Shanghai 201804, China
| | - Kamran Alipour
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California
| | - Christopher Bowd
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Mark Christopher
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Nicole Brye
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - James A. Proudfoot
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Michael H. Goldbaum
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Akram Belghith
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Christopher A. Girkin
- Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Massimo A. Fazio
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California,Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama,Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Michael Pazzani
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California
| | - David Kriegman
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, California
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California,Correspondence: Linda M. Zangwill, 9500 Gilman Dr., #0946, La Jolla, California 92093-0946.
| |
Collapse
|
23
|
Kamalipour A, Moghimi S, Eslani M, Nishida T, Mohammadzadeh V, Micheletti E, Girkin CA, Fazio MA, Liebmann JM, Zangwill LM, Weinreb RN. A Prospective Longitudinal Study to Investigate Corneal Hysteresis as a Risk Factor of Central Visual Field Progression in Glaucoma. Am J Ophthalmol 2022; 240:159-169. [PMID: 35278360 PMCID: PMC10249485 DOI: 10.1016/j.ajo.2022.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 10/29/2021] [Revised: 02/07/2022] [Accepted: 02/27/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the role of corneal hysteresis (CH) as a risk factor of central visual field (VF) progression in a cohort of glaucoma suspect and glaucoma patients. DESIGN Prospective cohort study. METHODS Two hundred forty-eight eyes of 143 subjects who were followed for an average of 4.8 years with a minimum of 5 visits with 10-2 and 24-2 VF tests were included. Univariable and multivariable linear mixed-effects models were used to identify characteristics associated with the rate of change over time in 10-2 and 24-2 mean deviation (MD). Mixed-effects logistic regression was used to evaluate characteristics associated with an increased likelihood of event-based 10-2 VF progression based on the clustered pointwise linear regression criterion. RESULTS CH was significantly associated with 10-2 and 24-2 VF progression in the univariable trend-based analysis. In multivariable trend-based analyses, lower CH was associated with a faster rate of decline in 10-2 MD (0.07 dB/y per 1 mm Hg, P < .001) but not with 24-2 MD (P = .490). In multivariable event-based analysis, lower CH was associated with an increased likelihood of 10-2 VF progression (odds ratio = 1.35 per 1 mm Hg lower, P = .025). Similar results were found in eyes with early glaucomatous damage at the baseline (baseline: 24-2 MD ≥ -6 dB). CONCLUSIONS Lower CH was associated with a statistically significant, but relatively small, increased risk of central VF progression on the 10-2 test grid. Given the substantial influence of central VF impairment on the quality of life, clinicians should consider using CH to assess the risk of progression in patients with primary open-angle glaucoma including those with early disease.
Collapse
Affiliation(s)
- Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Medi Eslani
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Vahid Mohammadzadeh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | | | - Massimo A Fazio
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology and Visual Sciences, Heersink School of Medicine; Department of Biomedical Engineering, School of Engineering
| | - Jeffrey M Liebmann
- University of Alabama at Birmingham, Alabama, and Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California.
| |
Collapse
|
24
|
Melchior B, Valenzuela IA, De Moraes CG, Paula JS, Fazio MA, Girkin CA, Proudfoot J, Cioffi GA, Weinreb RN, Zangwill LM, Liebmann JM. Glaucomatous Visual Field Progression in the African Descent and Glaucoma Evaluation Study (ADAGES): Eleven Years of Follow-up. Am J Ophthalmol 2022; 239:122-129. [PMID: 35172170 DOI: 10.1016/j.ajo.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare the rates of visual field (VF) progression between individuals of Black and White race and to investigate whether treatment effects may help explain differences previously reported between racial groups. DESIGN Multicenter prospective observational cohort study. METHODS Participants were patients in referral tertiary care glaucoma clinics with open angle glaucoma. Eyes were excluded who had <5 VF tests and <2 years of follow-up or any disease that could affect the optic nerve or the VF. The VF mean deviation (MD) slopes over time (dB/y) were calculated with linear regression models. Socioeconomic variables, rates of glaucoma surgery, medications, treated intraocular pressure (IOP), and central corneal thickness (CCT) were investigated. RESULTS A total of 516 eyes were included with a mean (95% CI) follow-up time of 11.0 (range, 10.5-11.5) years and 15.0 (range, 14.1-15.8) visits. Participants of Black race were significantly younger (59.7 vs 66.9 years, P < .01) than those of White race. The mean CCT and socioeconomic variables were similar between Black and White groups (P = 0.20 and P = .56, respectively), as were treatment with topical medications (P = .90) and the rate of VF MD change (-0.24 [-0.31 to -0.17] dB/year vs -0.32 [-0.36 to -0.27], P = .11), despite higher treated mean IOP (14.9 [14.5 to 15.4] vs 14.0 [13.6 to 14.4] mm Hg, P = .03) and fewer trabeculectomies (29.5% vs 50.0%, P < .01) in the Black race group. CONCLUSIONS Rates of VF progression were similar despite higher treated IOP in the Black race group. Mitigation of health access disparities in this study may have equalized previously reported different rates of VF progression between racial groups.
Collapse
|
25
|
Nishida T, Moghimi S, Mohammadzadeh V, Wu JH, Yamane MLM, Kamalipour A, Mahmoudinezhad G, Micheletti E, Liebmann JM, Fazio MA, Girkin CA, Zangwill LM, Weinreb RN. Association Between Ganglion Cell Complex Thinning and Vision-Related Quality of Life in Glaucoma. JAMA Ophthalmol 2022; 140:800-806. [PMID: 35771529 DOI: 10.1001/jamaophthalmol.2022.2140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Faster structural changes may be associated with worse vision-related quality of life in patients with glaucoma. Objectives To evaluate the association between the rate of ganglion cell complex thinning and the Vision Function Questionnaire in glaucoma. Design, Setting, and Participants This retrospective analysis of a longitudinal cohort was designed in October 2021. Patients were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Two hundred thirty-six eyes of 118 patients with diagnosed or suspected glaucoma were followed up with imaging for a mean of 4.1 years from September 2014 to March 2020. Main Outcomes and Measures The Vision Function Questionnaire was evaluated using the 25-item National Eye Institute Visual Function at the last follow-up visit. Ganglion cell complex thickness was derived from macular optical coherence tomography scans and averaged within 3 circular areas (3.4°, 5.6°, and 6.8° from the fovea) and superior and inferior hemiregions. Linear mixed-effects models were used to investigate the association between the rate of ganglion cell complex thinning and Rasch-calibrated Vision Function Questionnaire score. Results The mean (SD) age was 73.2 (8.7) years, 65 participants (55.1%) were female, and 53 participants (44.9%) were African American. Race was self-reported by the participants. Mean composite Rasch-calibrated National Eye Institute Visual Function Questionnaire score was 50.3 (95% CI, 45.9-54.6). A faster annual rate of global ganglion cell complex thinning in the better eye was associated with a higher disability reflected by the composite National Eye Institute Visual Function Questionnaire score (-15.0 [95% CI, -28.4 to -1.7] per 1 μm faster; P = .03). When stratified by degrees from the fovea, the 5.6° and 6.8° areas were associated with the composite National Eye Institute Visual Function Questionnaire Rasch-calibrated score (-14.5 [95% CI, -27.0 to -2.0] per 1 μm faster; R2 = 0.201; P = .03; and -23.7 [95% CI, -45.5 to -1.9] per 1 μm faster; R2 = 0.196; P = .02, respectively), and -8.0 (95% CI, -16.8 to 0.8) per 1 μm faster for the 3.4° area (R2 = 0.184; P = .07) after adjusting for confounding factors. Conclusions and Relevance These findings suggest that faster and sectoral central location of ganglion cell complex thinning provides useful information in determining the risk of vision-related quality of life in glaucoma. Monitoring macular structure may be useful for determining the risk of functional impairment in glaucoma.
Collapse
Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Vahid Mohammadzadeh
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Jo-Hsuan Wu
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Maya L M Yamane
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Eleonora Micheletti
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Massimo A Fazio
- Bernard School of Medicine, University of Alabama-Birmingham, Birmingham
| | | | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| |
Collapse
|
26
|
Rezapour J, Tran AQ, Bowd C, El-Nimri NW, Belghith A, Christopher M, Brye N, Proudfoot JA, Dohleman J, Fazio MA, Jonas JB, Weinreb RN, Zangwill LM. Comparison of Optic Disc Ovality Index and Rotation Angle Measurements in Myopic Eyes Using Photography and OCT Based Techniques. Front Med (Lausanne) 2022; 9:872658. [PMID: 35814778 PMCID: PMC9263212 DOI: 10.3389/fmed.2022.872658] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 02/09/2022] [Accepted: 05/24/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To compare optic nerve head (ONH) ovality index and rotation angle measurements based on semi-automated delineation of the clinical ONH margin derived from photographs and automated BMO configuration derived from optical coherence tomography (OCT) images in healthy and glaucomatous eyes with high-, mild- and no axial myopia. Methods One hundred seventy-five healthy and glaucomatous eyes of 146 study participants enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) with optic disc photographs and Spectralis OCT ONH scans acquired on the same day were stratified by level of axial myopia (non-myopic [n = 56, axial length (AL) <24 mm], mild-myopic [n = 58, AL 24–26 mm] and high-myopic [n = 32, AL >26 mm]. The clinical disc margin of each photograph was manually annotated, and semi-automated measurements were recorded of the ovality index and rotation angle based on a best-fit ellipse generated using ImageJ software. These semi-automated photograph-based measurements were compared to ovality index and rotation angle generated from custom automated BMO-based analysis using segmented OCT ONH volumes. R2 values from linear mixed effects models were used to describe the associations between semi-automated, photograph-based and automated OCT-based measurements. Results Average (95% CI) axial length was 23.3 (23.0, 23.3) mm, 24.8 (24.7, 25.0) mm and 26.8 (26.6, 27.0) mm in non-myopic, mild-myopic and high-myopic eyes, respectively (ANOVA, p ≤ 0.001 for all). The R2 association (95% CI) between semi-automated photograph-based and automated OCT-based assessment of ONH OI for all eyes was [0.26 (0.16, 0.36); p < 0.001]. This association was weakest in non-myopic eyes [0.09 (0.01, 0.26); p = 0.02], followed by mild-myopic eyes [0.13 (0.02, 0.29); p = 0.004] and strongest in high-myopic eyes [0.40 (0.19, 0.60); p < 0.001]. No significant associations were found between photography- and OCT-based assessment of rotation angle with R2 values ranging from 0.00 (0.00, 0.08) in non-myopic eyes to 0.03 (0.00, 0.21) in high-myopic eyes (all associations p ≥ 0.33). Conclusions Agreement between photograph-based and automated OCT-based ONH morphology measurements is limited, suggesting that these methods cannot be used interchangeably for characterizing myopic changes in the ONH.
Collapse
Affiliation(s)
- Jasmin Rezapour
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andrew Q. Tran
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - Christopher Bowd
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - Nevin W. El-Nimri
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - Akram Belghith
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - Mark Christopher
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - Nicole Brye
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - James A. Proudfoot
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - Jade Dohleman
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - Massimo A. Fazio
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
- Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Robert N. Weinreb
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
| | - Linda M. Zangwill
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, San Diego, CA, United States
- *Correspondence: Linda M. Zangwill
| |
Collapse
|
27
|
Rezapour J, Proudfoot JA, Bowd C, Dohleman J, Christopher M, Belghith A, Vega SM, Dirkes K, Suh MH, Jonas JB, Hyman L, Fazio MA, Sella R, Afshari NA, Weinreb RN, Zangwill LM. Bruch Membrane Opening Detection Accuracy in Healthy Eyes and Eyes With Glaucoma With and Without Axial High Myopia in an American and Korean Cohort. Am J Ophthalmol 2022; 237:221-234. [PMID: 34902327 DOI: 10.1016/j.ajo.2021.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/21/2021] [Revised: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the predictors of Bruch membrane opening (BMO) location accuracy and the visibility of the BMO location in glaucoma and healthy individuals with and without axial high myopia. DESIGN Cross-sectional study. METHODS Healthy eyes and eyes with glaucoma from an American study and a Korean clinic population were classified into 2 groups: those with no axial high myopia (axial length [AL] <26 mm) and those with axial high myopia (AL ≥26 mm). The accuracy of the automated BMO location on optic nerve head Spectralis optical coherence tomography radial scans was assessed by expert reviewers. RESULTS Four hundred thirty-eight non-highly myopic eyes (263 subjects) and 113 highly myopic eyes (81 subjects) were included. In healthy eyes with and without axial high myopia, 9.1% and 1.7% had indiscernible BMOs while 54.5% and 87.6% were accurately segmented, respectively. More than a third (36.4%) and 10.7% of eyes with indiscernible BMOs were manually correctable (respectively, P = .017). In eyes with glaucoma with and without high myopia, 15.0% and 3.2% had indiscernible BMOs, 55.0% and 38.2% were manually corrected, and 30.0% and 58.7% were accurately segmented without the need for manual correction (respectively, P = .005). Having axial high myopia, a larger AL, a larger BMO tilt angle, a lower BMO ovality index (more oval), and a glaucoma diagnosis were significant predictors of BMO location inaccuracy in multivariable logistic regression analysis. CONCLUSIONS As BMO location inaccuracy was 2.4 times more likely in eyes with high axial myopia regardless of diagnosis, optical coherence tomography images of high myopes should be reviewed carefully, and when possible, BMO location should be corrected before using optic nerve head scan results for the clinical management of glaucoma.
Collapse
Affiliation(s)
- Jasmin Rezapour
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA; Department of Ophthalmology (J.R.), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - James A Proudfoot
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Christopher Bowd
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jade Dohleman
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Mark Christopher
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Akram Belghith
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Suzanne M Vega
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Keri Dirkes
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Min Hee Suh
- Department of Ophthalmology (M.H.S.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jost B Jonas
- Department of Ophthalmology (J.B.J.), Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Institute of Molecular and Clinical Ophthalmology Basel (J.B.J.), Basel, Switzerland; Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda (J.B.J.), Heidelberg, Germany
| | - Leslie Hyman
- Wills Eye Hospital (L.H.), Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Science (M.A.F.), School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Biomedical Engineering (M.A.F.), School of Engineering, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ruti Sella
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA; Department of Ophthalmology (R.S.), Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine (R.S.), Tel Aviv University, Tel Aviv, Israel
| | - Natalie A Afshari
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Linda M Zangwill
- From the Hamilton Glaucoma Center (J.R., J.A.P., C.B., J.D., M.C., A.B., S.M.V., K.D., R.S., N.A.A., R.N.W., L.M.Z.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA.
| |
Collapse
|
28
|
Fan R, Bowd C, Christopher M, Brye N, Proudfoot JA, Rezapour J, Belghith A, Goldbaum MH, Chuter B, Girkin CA, Fazio MA, Liebmann JM, Weinreb RN, Gordon MO, Kass MA, Kriegman D, Zangwill LM. Detecting Glaucoma in the Ocular Hypertension Study Using Deep Learning. JAMA Ophthalmol 2022; 140:383-391. [PMID: 35297959 PMCID: PMC8931672 DOI: 10.1001/jamaophthalmol.2022.0244] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Automated deep learning (DL) analyses of fundus photographs potentially can reduce the cost and improve the efficiency of reading center assessment of end points in clinical trials. OBJECTIVE To investigate the diagnostic accuracy of DL algorithms trained on fundus photographs from the Ocular Hypertension Treatment Study (OHTS) to detect primary open-angle glaucoma (POAG). DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, 1636 OHTS participants from 22 sites with a mean (range) follow-up of 10.7 (0-14.3) years. A total of 66 715 photographs from 3272 eyes were used to train and test a ResNet-50 model to detect the OHTS Endpoint Committee POAG determination based on optic disc (287 eyes, 3502 photographs) and/or visual field (198 eyes, 2300 visual fields) changes. Three independent test sets were used to evaluate the generalizability of the model. MAIN OUTCOMES AND MEASURES Areas under the receiver operating characteristic curve (AUROC) and sensitivities at fixed specificities were calculated to compare model performance. Evaluation of false-positive rates was used to determine whether the DL model detected POAG before the OHTS Endpoint Committee POAG determination. RESULTS A total of 1147 participants were included in the training set (661 [57.6%] female; mean age, 57.2 years; 95% CI, 56.6-57.8), 167 in the validation set (97 [58.1%] female; mean age, 57.1 years; 95% CI, 55.6-58.7), and 322 in the test set (173 [53.7%] female; mean age, 57.2 years; 95% CI, 56.1-58.2). The DL model achieved an AUROC of 0.88 (95% CI, 0.82-0.92) for the OHTS Endpoint Committee determination of optic disc or VF changes. For the OHTS end points based on optic disc changes or visual field changes, AUROCs were 0.91 (95% CI, 0.88-0.94) and 0.86 (95% CI, 0.76-0.93), respectively. False-positive rates (at 90% specificity) were higher in photographs of eyes that later developed POAG by disc or visual field (27.5% [56 of 204]) compared with eyes that did not develop POAG (11.4% [50 of 440]) during follow-up. The diagnostic accuracy of the DL model developed on the optic disc end point applied to 3 independent data sets was lower, with AUROCs ranging from 0.74 (95% CI, 0.70-0.77) to 0.79 (95% CI, 0.78-0.81). CONCLUSIONS AND RELEVANCE The model's high diagnostic accuracy using OHTS photographs suggests that DL has the potential to standardize and automate POAG determination for clinical trials and management. In addition, the higher false-positive rate in early photographs of eyes that later developed POAG suggests that DL models detected POAG in some eyes earlier than the OHTS Endpoint Committee, reflecting the OHTS design that emphasized a high specificity for POAG determination by requiring a clinically significant change from baseline.
Collapse
Affiliation(s)
- Rui Fan
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla
- Department of Control Science and Engineering, College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Christopher Bowd
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Mark Christopher
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Nicole Brye
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - James A. Proudfoot
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Jasmin Rezapour
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
- Department of Ophthalmology, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Rheinland-Pfalz, Germany
| | - Akram Belghith
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Michael H. Goldbaum
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Benton Chuter
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Christopher A. Girkin
- Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham
| | - Massimo A. Fazio
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
- Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham
- Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| | - Mae O. Gordon
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Michael A. Kass
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - David Kriegman
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla
| |
Collapse
|
29
|
Zhalechian M, Van Oyen MP, Lavieri MS, De Moraes CG, Girkin CA, Fazio MA, Weinreb RN, Bowd C, Liebmann JM, Zangwill LM, Andrews CA, Stein JD. Augmenting Kalman Filter Machine Learning Models with Data from OCT to Predict Future Visual Field Loss: An Analysis Using Data from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovation in Glaucoma Study. Ophthalmol Sci 2022; 2:100097. [PMID: 36246178 PMCID: PMC9560647 DOI: 10.1016/j.xops.2021.100097] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
Purpose To assess whether the predictive accuracy of machine learning algorithms using Kalman filtering for forecasting future values of global indices on perimetry can be enhanced by adding global retinal nerve fiber layer (RNFL) data and whether model performance is influenced by the racial composition of the training and testing sets. Design Retrospective, longitudinal cohort study. Participants Patients with open-angle glaucoma (OAG) or glaucoma suspects enrolled in the African Descent and Glaucoma Evaluation Study or Diagnostic Innovation in Glaucoma Study. Methods We developed a Kalman filter (KF) with tonometry and perimetry data (KF-TP) and another KF with tonometry, perimetry, and global RNFL data (KF-TPO), comparing these models with one another and with 2 linear regression (LR) models for predicting mean deviation (MD) and pattern standard deviation values 36 months into the future for patients with OAG and glaucoma suspects. We also compared KF model performance when trained on individuals of European and African descent and tested on patients of the same versus the other race. Main Outcome Measures Predictive accuracy (percentage of MD values forecasted within the 95% repeatability interval) differences among the models. Results Among 362 eligible patients, the mean ± standard deviation age at baseline was 71.3 ± 10.4 years; 196 patients (54.1%) were women; 202 patients (55.8%) were of European descent, and 139 (38.4%) were of African descent. Among patients with OAG (n = 296), the predictive accuracy for 36 months in the future was higher for the KF models (73.5% for KF-TP, 71.2% for KF-TPO) than for the LR models (57.5%, 58.0%). Predictive accuracy did not differ significantly between KF-TP and KF-TPO (P = 0.20). If the races of the training and testing set patients were aligned (versus nonaligned), the mean absolute prediction error of future MD improved 0.39 dB for KF-TP and 0.48 dB for KF-TPO. Conclusions Adding global RNFL data to existing KFs minimally improved their predictive accuracy. Although KFs attained better predictive accuracy when the races of the training and testing sets were aligned, these improvements were modest. These findings will help to guide implementation of KFs in clinical practice.
Collapse
Key Words
- AD, African descent
- ADAGES, African Descent and Glaucoma Evaluation Study
- Algorithm bias
- CI, confidence interval
- D, diopter
- DIGS, Diagnostic Innovation in Glaucoma Study
- ED, European descent
- Glaucoma
- IOP, intraocular pressure
- KF, Kalman filter
- KF-TP, Kalman filter with tonometry and perimetry data
- KF-TPO, Kalman filter with tonometry, perimetry, and global retinal nerve fiber layer data
- Kalman filter
- LR1, linear regression model 1
- LR2, linear regression model 2
- MAE, mean absolute error
- MD, mean deviation
- Machine learning
- OAG, open-angle glaucoma
- OCT
- PSD, pattern standard deviation
- RMSE, root mean square error
- RNFL, retinal nerve fiber layer
- SD, standard deviation
- VF, visual field
Collapse
Affiliation(s)
- Mohammad Zhalechian
- Department of Industrial and Operations Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan
| | - Mark P. Van Oyen
- Department of Industrial and Operations Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan
| | - Mariel S. Lavieri
- Department of Industrial and Operations Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Christopher A. Girkin
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Massimo A. Fazio
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla, California
| | - Christopher Bowd
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla, California
| | - Jeffrey M. Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, La Jolla, California
| | - Christopher A. Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Joshua D. Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan
| |
Collapse
|
30
|
Grytz R, El Hamdaoui M, Fuchs PA, Fazio MA, McNabb RP, Kuo AN, Girkin CA, Samuels BC. Nonlinear distortion correction for posterior eye segment optical coherence tomography with application to tree shrews. Biomed Opt Express 2022; 13:1070-1086. [PMID: 35284162 PMCID: PMC8884212 DOI: 10.1364/boe.447595] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
We propose an empirical distortion correction approach for optical coherence tomography (OCT) devices that use a fan-scanning pattern to image the posterior eye segment. Two types of reference markers were used to empirically estimate the distortion correction approach in tree shrew eyes: retinal curvature from MRI images and implanted glass beads of known diameter. Performance was tested by correcting distorted images of the optic nerve head. In small animal eyes, our purposed method effectively reduced nonlinear distortions compared to a linear scaling method. No commercial posterior segment OCT provides anatomically correct images, which may bias the 3D interpretation of these scans. Our method can effectively reduce such bias.
Collapse
Affiliation(s)
- Rafael Grytz
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, AL, USA
| | - Mustapha El Hamdaoui
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, AL, USA
| | - Preston A. Fuchs
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, AL, USA
| | - Massimo A. Fazio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, AL, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, AL, USA
- Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | - Ryan P. McNabb
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Anthony N. Kuo
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Christopher A. Girkin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, AL, USA
| | - Brian C. Samuels
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, AL, USA
| |
Collapse
|
31
|
Melchior B, De Moraes CG, Paula JS, A Cioffi G, Girkin CA, Fazio MA, N Weinreb R, M Zangwill L, M Liebmann J. Relationship between mean follow-up intraocular pressure, rates of visual field progression and current target intraocular pressure guidelines. Br J Ophthalmol 2022; 106:229-233. [PMID: 33130556 DOI: 10.1136/bjophthalmol-2020-317406] [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] [Received: 07/02/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 01/22/2023]
Abstract
AIMS To investigate if eyes presenting intraocular pressure (IOP) within the limits of current guideline-driven target IOP indeed experience slow rates of glaucomatous visual field (VF) progression. METHODS A total of 8598 24-2 VF tests from 603 eyes from the African Descent and Glaucoma Evaluation Study with manifest glaucoma were included. The sample was split into three groups based on baseline VF mean deviation (MD): G1 (better than -5.0 dB), G2 (-5.0 to -10 dB) and G3 (worse than -10 dB). We investigated the relationship between existing target IOP guidelines and rates of MD progression in these groups. RESULTS For stable eyes, the medians and IQR of the mean follow-up IOP were G1=15.0 mmHg (IQR: 13.1 to 17.7), G2=13.2 mmHg (IQR: 11.6 to 14.3) and G3=11.9 mmHg (IQR: 10.1 to 13.8) (p<0.01). When considering the mean follow-up IOP within the limits proposed by current guidelines, the median MD slopes were: -0.20 dB/y (IQR: -0.43 to -0.02) for G1<21 mmHg, -0.19 dB/y (IQR: -0.51 to -0.01) for G2<18 mmHg and -0.15 dB/y (IQR: -0.47 to 0.05) for G3<15 mmHg (p=0.63). There were no significant differences between racial groups. CONCLUSION In a sample of patients with manifest glaucoma, despite substantial variability between eyes, adherence to treatment guidelines helped slow the rates of global VF progression at various stages of disease. TRIAL REGISTRATION NUMBER clinicaltrials.gov Identifier: NCT00221923.
Collapse
Affiliation(s)
- Bruna Melchior
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jayter S Paula
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - George A Cioffi
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher A Girkin
- Department of Ophthalmology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Massimo A Fazio
- Department of Ophthalmology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California San-Diego, La Jolla, California, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Department of Ophthalmology, University of California San-Diego, La Jolla, California, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
32
|
Christopher M, Bowd C, Proudfoot JA, Belghith A, Goldbaum MH, Rezapour J, Fazio MA, Girkin CA, De Moraes G, Liebmann JM, Weinreb RN, Zangwill LM. Deep Learning Estimation of 10-2 and 24-2 Visual Field Metrics Based on Thickness Maps from Macula OCT. Ophthalmology 2021; 128:1534-1548. [PMID: 33901527 DOI: 10.1016/j.ophtha.2021.04.022] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To develop deep learning (DL) systems estimating visual function from macula-centered spectral-domain (SD) OCT images. DESIGN Evaluation of a diagnostic technology. PARTICIPANTS A total of 2408 10-2 visual field (VF) SD OCT pairs and 2999 24-2 VF SD OCT pairs collected from 645 healthy and glaucoma subjects (1222 eyes). METHODS Deep learning models were trained on thickness maps from Spectralis macula SD OCT to estimate 10-2 and 24-2 VF mean deviation (MD) and pattern standard deviation (PSD). Individual and combined DL models were trained using thickness data from 6 layers (retinal nerve fiber layer [RNFL], ganglion cell layer [GCL], inner plexiform layer [IPL], ganglion cell-IPL [GCIPL], ganglion cell complex [GCC] and retina). Linear regression of mean layer thicknesses were used for comparison. MAIN OUTCOME MEASURES Deep learning models were evaluated using R2 and mean absolute error (MAE) compared with 10-2 and 24-2 VF measurements. RESULTS Combined DL models estimating 10-2 achieved R2 of 0.82 (95% confidence interval [CI], 0.68-0.89) for MD and 0.69 (95% CI, 0.55-0.81) for PSD and MAEs of 1.9 dB (95% CI, 1.6-2.4 dB) for MD and 1.5 dB (95% CI, 1.2-1.9 dB) for PSD. This was significantly better than mean thickness estimates for 10-2 MD (0.61 [95% CI, 0.47-0.71] and 3.0 dB [95% CI, 2.5-3.5 dB]) and 10-2 PSD (0.46 [95% CI, 0.31-0.60] and 2.3 dB [95% CI, 1.8-2.7 dB]). Combined DL models estimating 24-2 achieved R2 of 0.79 (95% CI, 0.72-0.84) for MD and 0.68 (95% CI, 0.53-0.79) for PSD and MAEs of 2.1 dB (95% CI, 1.8-2.5 dB) for MD and 1.5 dB (95% CI, 1.3-1.9 dB) for PSD. This was significantly better than mean thickness estimates for 24-2 MD (0.41 [95% CI, 0.26-0.57] and 3.4 dB [95% CI, 2.7-4.5 dB]) and 24-2 PSD (0.38 [95% CI, 0.20-0.57] and 2.4 dB [95% CI, 2.0-2.8 dB]). The GCIPL (R2 = 0.79) and GCC (R2 = 0.75) had the highest performance estimating 10-2 and 24-2 MD, respectively. CONCLUSIONS Deep learning models improved estimates of functional loss from SD OCT imaging. Accurate estimates can help clinicians to individualize VF testing to patients.
Collapse
Affiliation(s)
- Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Michael H Goldbaum
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Jasmin Rezapour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Massimo A Fazio
- School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama
| | | | - Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California.
| |
Collapse
|
33
|
Kim J, Gardiner SK, Ramazzotti A, Karuppanan U, Bruno L, Girkin CA, Downs JC, Fazio MA. Strain by virtual extensometers and video-imaging optical coherence tomography as a repeatable metric for IOP-Induced optic nerve head deformations. Exp Eye Res 2021; 211:108724. [PMID: 34375590 PMCID: PMC8511063 DOI: 10.1016/j.exer.2021.108724] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine if in vivo strain response of the Optic Nerve Head (ONH) to IOP elevation visualized using Optical Coherence Tomography (OCT) video imaging and quantified using novel virtual extensometers was able to be provided repeatable measurements of tissue specific deformations. METHODS The ONHs of 5 eyes from 5 non-human primates (NHPs) were imaged by Spectralis OCT. A vertical and a horizontal B-scan of the ONH were continuously recorded for 60 s at 6 Hz (video imaging mode) during IOP elevation from 10 to 30 mmHg. Imaging was repeated over three imaging sessions. The 2D normal strain was computed by template-matching digital image correlation using virtual extensometers. ANOVA F-test (F) was used to compare inter-eye, inter-session, and inter-tissue variability for the prelaminar, Bruch's membrane opening (BMO), lamina cribrosa (LC) and choroidal regions (against variance the error term). F-test of the ratio between inter-eye to inter-session variability was used to test for strain repeatability across imaging sessions (FIS). RESULTS Variability of strain across imaging session (F = 0.7263, p = 0.4855) and scan orientation was not significant (F = 1.053, p = 0.3066). Inter session variability of strain was significantly lower than inter-eye variability (FIS = 22.63, p = 0.0428) and inter-tissue variability (FIS = 99.33 p = 0.00998). After IOP elevation, strain was highest in the choroid (-18.11%, p < 0.001), followed by prelaminar tissue (-11.0%, p < 0.001), LC (-3.79%, p < 0.001), and relative change in BMO diameter (-0.57%, p = 0.704). CONCLUSIONS Virtual extensometers applied to video-OCT were sensitive to the eye-specific and tissue-specific mechanical response of the ONH to IOP and were repeatable across imaging sessions.
Collapse
Affiliation(s)
- Jihee Kim
- Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Andrea Ramazzotti
- Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Udayakumar Karuppanan
- Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Luigi Bruno
- Department of Mechanical, Energy and Management Engineering, University of Calabria, Rende, CS, Italy
| | - Christopher A Girkin
- Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Crawford Downs
- Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Massimo A Fazio
- Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL, USA; Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, USA; The Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA.
| |
Collapse
|
34
|
Orbach A, Ang GS, Camp AS, Welsbie DS, Medeiros FA, Girkin CA, Fazio MA, Oh WH, Weinreb RN, Zangwill LM, Wu Z. Qualitative Evaluation of the 10-2 and 24-2 Visual Field Tests for Detecting Central Visual Field Abnormalities in Glaucoma. Am J Ophthalmol 2021; 229:26-33. [PMID: 33626360 DOI: 10.1016/j.ajo.2021.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine whether glaucomatous central visual field abnormalities can be more effectively detected using a qualitative, expert evaluation of the 10-2 test compared with the topographically corresponding central 12 locations of the 24-2 test (C24-2). DESIGN Cross-sectional study. METHODS Eyes with a glaucomatous optic nerve appearance or ocular hypertension (n = 523) and healthy eyes (n = 107) were included as cases and control subjects, respectively. The 10-2 and C24-2 visual field results of all eyes were graded by 4 glaucoma specialists for the probability that central visual field abnormalities were present. RESULTS The sensitivity of the 10-2 and C24-2 tests for detecting the cases at 95% specificity were not significantly different (e.g., 32.2% and 31.4%, respectively, for grader 1, P = .87; all graders P ≥ .25). At 95% specificity, the pattern standard deviation values from these tests had a similar sensitivity to the qualitative evaluation for the C24-2 test for all graders (P ≥ .083), but it had a significantly higher sensitivity than the qualitative evaluation for the 10-2 test for 3 graders (P ≤ .016). CONCLUSIONS The similarity in performance of the 10-2 and C24-2 test suggests that the increased sampling density of the former does not significantly improve the detection of central visual field abnormalities, even when based on expert assessment. These findings should not be taken to mean that the 10-2 test is not useful, but it underscores the need for its utility to be clearly established before incorporating it as routine glaucoma standard of care.
Collapse
|
35
|
Bowd C, Belghith A, Christopher M, Goldbaum MH, Fazio MA, Girkin CA, Liebmann JM, de Moraes CG, Weinreb RN, Zangwill LM. Individualized Glaucoma Change Detection Using Deep Learning Auto Encoder-Based Regions of Interest. Transl Vis Sci Technol 2021; 10:19. [PMID: 34293095 PMCID: PMC8300051 DOI: 10.1167/tvst.10.8.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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 compare change over time in eye-specific optical coherence tomography (OCT) retinal nerve fiber layer (RNFL)-based region-of-interest (ROI) maps developed using unsupervised deep-learning auto-encoders (DL-AE) to circumpapillary RNFL (cpRNFL) thickness for the detection of glaucomatous progression. Methods Forty-four progressing glaucoma eyes (by stereophotograph assessment), 189 nonprogressing glaucoma eyes (by stereophotograph assessment), and 109 healthy eyes were followed for ≥3 years with ≥4 visits using OCT. The San Diego Automated Layer Segmentation Algorithm was used to automatically segment the RNFL layer from raw three-dimensional OCT images. For each longitudinal series, DL-AEs were used to generate individualized eye-based ROI maps by identifying RNFL regions of likely progression and no change. Sensitivities and specificities for detecting change over time and rates of change over time were compared for the DL-AE ROI and global cpRNFL thickness measurements derived from a 2.22-mm to 3.45-mm annulus centered on the optic disc. Results The sensitivity for detecting change in progressing eyes was greater for DL-AE ROIs than for global cpRNFL annulus thicknesses (0.90 and 0.63, respectively). The specificity for detecting not likely progression in nonprogressing eyes was similar (0.92 and 0.93, respectively). The mean rates of change in DL-AE ROI were significantly faster than for cpRNFL annulus thickness in progressing eyes (-1.28 µm/y vs. -0.83 µm/y) and nonprogressing eyes (-1.03 µm/y vs. -0.78 µm/y). Conclusions Eye-specific ROIs identified using DL-AE analysis of OCT images show promise for improving assessment of glaucomatous progression. Translational Relevance The detection and monitoring of structural glaucomatous progression can be improved by considering eye-specific regions of likely progression identified using deep learning.
Collapse
Affiliation(s)
- Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | - Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | - Michael H Goldbaum
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | - Massimo A Fazio
- School of Medicine, University of Alabama-Birmingham, Birmingham, AL, USA
| | | | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Carlos Gustavo de Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, CA, USA
| |
Collapse
|
36
|
Bianco G, Levy AM, Grytz R, Fazio MA. Effect of different preconditioning protocols on the viscoelastic inflation response of the posterior sclera. Acta Biomater 2021; 128:332-345. [PMID: 33932581 DOI: 10.1016/j.actbio.2021.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/11/2022]
Abstract
Preconditioning by repeated cyclic loads is routinely used in ex vivo mechanical testing of soft biological tissues. The goal of preconditioning is to achieve a steady and repeatable mechanical response and to measure material properties that are representative of the in vivo condition. Preconditioning protocols vary across studies, and their effect on the viscoelastic response of tested soft tissue is typically not reported or analyzed. We propose a methodology to systematically analyze the preconditioning process with application to inflation testing. We investigated the effect of preconditioning on the viscoelastic inflation response of tree shrew posterior sclera using two preconditioning protocols: (i) continuous cyclic loading-unloading without rest and (ii) cyclic loading-unloading with 15-min rest between cycles. Posterior scleral surface strain was measured using three-dimensional Digital Image Correlation (3D-DIC). We used five variables of characterizing features of the stress-strain loop curve to compare the two preconditioning protocols. Our results showed protocol-dependent differences in the tissue response during preconditioning and at the preconditioned state. Incorporating a resting time between preconditioning cycles significantly decreased the number of cycles (10.5 ± 2.9 cycles vs. 3.1 ± 0.5 cycles, p < 0.001) but increased the total time (15.8 ± 4.4 min vs. 51.2 ± 8.3 min, p < 0.001) needed to reach preconditioned state. At the preconditioned state, 2 of 5 characteristic variables differed significantly between protocols: hysteresis loop area (difference=0.023 kJ/m3, p = 0.0020) and elastic modulus at high IOPs (difference=24.0 MPa, p = 0.0238). Our results suggest that the analysis of the preconditioning process is an essential part of inflation experiments and a prerequisite to properly characterize the tissue viscoelastic response. Furthermore, material properties obtained at the preconditioned state can be impacted by the resting time used during preconditioning and may not be directly compared across studies if the resting time varies by 15 min between studies. STATEMENT OF SIGNIFICANCE: Although applying a preconditioning protocol by repeated cyclic loads is common practice in ex vivo mechanical characterization of soft tissues, the tissue response is typically not reported or analyzed, and the protocol's potential effect on the response remains unclear. This is partially caused by lack of a standardized methodology to precondition soft tissues. We present the first systematic analysis of two representative preconditioning protocols used during inflation testing in ocular biomechanics. Our results show protocol-dependent differences in the viscoelastic response during the preconditioning process and at the preconditioned state. Consequently, the analysis of the preconditioning response represents an essential part of mechanical testing and a prerequisite to properly characterize the tissue viscoelastic response. The effect of preconditioning on the preconditioned state response must be considered when comparing results across studies with different preconditioning protocols.
Collapse
|
37
|
Rezapour J, Bowd C, Dohleman J, Belghith A, Proudfoot JA, Christopher M, Hyman L, Jonas JB, Fazio MA, Weinreb RN, Zangwill LM. The influence of axial myopia on optic disc characteristics of glaucoma eyes. Sci Rep 2021; 11:8854. [PMID: 33893383 PMCID: PMC8065167 DOI: 10.1038/s41598-021-88406-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/05/2021] [Indexed: 12/21/2022] Open
Abstract
This study characterizes differences in glaucomatous eyes with and without high axial myopia using custom automated analysis of OCT images. 452 eyes of 277 glaucoma patients were stratified into non (n = 145 eyes), mild (n = 214 eyes), and high axial myopia (axial length (AL) > 26 mm, n = 93 eyes). Optic disc ovality index, tilt and rotation angle of Bruch´s membrane opening (BMO) and peripapillary choroidal thickness (PCT) were calculated using automated and deep learning strategies. High myopic optic discs were more oval and had larger BMO tilt than mild and non-myopic discs (both p < 0.001). Mean PCT was thinnest in high myopic eyes followed by mild and non-myopic eyes (p < 0.001). BMO rotation angle, global retinal nerve fiber layer (RNFL) thickness and BMO-minimum rim width (MRW) were similar among groups. Temporal RNFL was thicker and supranasal BMO-MRW was thinner in high myopic eyes. BMO tilt and PCT showed moderate and temporal RNFL and nasal BMO-MRW showed weak but significant associations with AL in multivariable analyses (all p < 0.05). Large BMO tilt angle and thin PCT are characteristics of highly myopic discs and were not associated with severity of glaucoma. Caution should be exercised when using sectoral BMO-MRW and RNFL thickness for glaucoma management decisions in myopic eyes.
Collapse
Affiliation(s)
- Jasmin Rezapour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Jade Dohleman
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Leslie Hyman
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Science, School of Medicine, The University of Alabama At Birmingham, Birmingham, AL, USA
- Department of Biomedical Engineering, School of Engineering, The University of Alabama At Birmingham, Birmingham, AL, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0946, USA.
| |
Collapse
|
38
|
Fazio MA, Gardiner SK, Bruno L, Hubbard M, Bianco G, Karuppanan U, Kim J, El Hamdaoui M, Grytz R, Downs JC, Girkin CA. Histologic validation of optical coherence tomography-based three-dimensional morphometric measurements of the human optic nerve head: Methodology and preliminary results. Exp Eye Res 2021; 205:108475. [PMID: 33516762 PMCID: PMC8044038 DOI: 10.1016/j.exer.2021.108475] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the three-dimensional (3D) morphology of the deep load-bearing structures of the human optic nerve head (ONH) as revealed in vivo by spectral domain optical coherence tomography (SDOCT) with ex vivo quantitative 3D histology. METHODS SDOCT imaging of the ONH was performed in six eyes from three brain-dead organ donors on life-support equipment awaiting organ procurement (in vivo conditions). Following organ procurement (ex vivo conditions), the eyes were enucleated and underwent a pars plana vitrectomy followed by pressurization to physiologic IOP and immersion fixation. Ex vivo ONH morphology was obtained from high-fidelity episcopic fluorescent 3D reconstruction. Morphologic parameters of the observed ONH canal geometry and peripapillary choroid, as well as the shape, visibility and depth of the lamina cribrosa were compared between ex vivo and in vivo measurements using custom software to align, scale, and manually delineate the different regions of the ONH. RESULTS There was significant correspondence between in vivo and ex vivo measurements of the depth and shape of the lamina cribrosa, along with the size and shape of Bruch's membrane opening (BMO) and anterior scleral canal opening (ASCO). Weaker correspondence was observed for choroidal thickness; as expected, a thinner choroid was seen ex vivo due to loss of blood volume upon enucleation (-79.9%, p < 0.001). In addition, the lamina was shallower (-32.3%, p = 0.0019) and BMO was smaller ex vivo (-3.38%, p = 0.026), suggesting post mortem shrinkage of the fixed tissue. On average, while highly variable, only 31% of the anterior laminar surface was visible in vivo with SDOCT (p < 0.001). CONCLUSIONS Morphologic parameters by SDOCT imaging of the deep ONH showed promising correspondence to histology metrics. Small but significant shrinkage artifact, along with large effects of exsanguination of the choroid, was seen in the ex vivo reconstructions of fixed tissues that may impact the quantification of ex vivo histoarchitecture, and this should be considered when developing models and biomarkers based on ex vivo imaging of fixed tissue. Lack of visibly of most of the lamina surface in SDOCT images is an important limitation to metrics and biomarkers based on in vivo images of the ONH deep tissues.
Collapse
Affiliation(s)
- Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States; Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL, United States; The Viterbi Family Department of Ophthalmology, University of California, San Diego, San Diego, CA, United States.
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight, Legacy Health, Portland, OR, United States
| | - Luigi Bruno
- Department of Mechanical, Energy and Management Engineering, University of Calabria, Rende, CS, Italy
| | - Meredith Hubbard
- Department of Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gianfranco Bianco
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Udayakumar Karuppanan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jihee Kim
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mustapha El Hamdaoui
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rafael Grytz
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - J Crawford Downs
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
39
|
Girkin CA, Belghith A, Bowd C, Medeiros FA, Weinreb RN, Liebmann JM, Proudfoot JA, Zangwill LM, Fazio MA. Racial Differences in the Rate of Change in Anterior Lamina Cribrosa Surface Depth in the African Descent and Glaucoma Evaluation Study. Invest Ophthalmol Vis Sci 2021; 62:12. [PMID: 33844828 PMCID: PMC8039570 DOI: 10.1167/iovs.62.4.12] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to determine if the rate of change in the depth of the surface of the lamina cribrosa due to glaucomatous remodeling differs between glaucoma patients of African descent (AD) and European descent (ED). Methods There were 1122 images taken longitudinally over an average of 3 years (range = 0.9-4.1 years) from 122 patients with glaucoma followed in the African Descent and Glaucoma Evaluation Study (ADAGES) and Diagnostic Intervention and Glaucoma Study (DIGS) were automatically segmented to compute anterior lamina cribrosa surface depth (ALCSD). The rate of ALCSD change was compared across racial groups after adjusting for baseline characteristics known to be associated with ALCSD or disease progression (visual field, ALCSD, corneal thickness, optic disk size, and age). Results After adjusting for all other covariates, the ED group had significantly greater ALCSD posterior migration (deepening) than the AD group (difference = 2.57 µm/year, P = 0.035). There was a wider range of ALCSD change in the ED compared with the AD group, and more individuals had greater magnitude of both deepening and shallowing. No other covariates measured at baseline had independent effects on the longitudinal changes in ALCSD (baseline visual field severity, baseline ALCSD, corneal thickness, Bruch's membrane opening [BMO] area, or age). Conclusions Glaucomatous remodeling of the lamina cribrosa differs between AD and ED patients with glaucoma. Unlike the cross-sectional associations seen with aging, in which a deeper ALCSD was seen with age in the ED group, glaucomatous remodeling in this longitudinal study resulted in more posterior migration of ALCSD in ED compared to AD patients.
Collapse
Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology and Visual Science, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Felipe A Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Science, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States.,Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States.,Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| |
Collapse
|
40
|
Jasien JV, Fazio MA, Samuels BC, Johnston JM, Downs JC. Quantification of Translaminar Pressure Gradient (TLPG) With Continuous Wireless Telemetry in Nonhuman Primates (NHPs). Transl Vis Sci Technol 2020; 9:18. [PMID: 33240571 PMCID: PMC7671865 DOI: 10.1167/tvst.9.12.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/27/2020] [Accepted: 10/10/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Recent retrospective clinical and animal studies suggest that cerebrospinal fluid pressure (CSFP) is important in glaucoma pathogenesis. Intraocular pressure (IOP) and CSFP are the driving components of translaminar pressure (TLP = IOP - CSFP), which acts across the lamina cribrosa (LC) thickness to create the translaminar pressure gradient (TLPG = TLP/LC thickness). Methods We developed an implantable wireless telemetry system based on a small piezoelectric sensor with low temporal drift. IOP, measured in the anterior chamber, and intracranial pressure (ICP), measured in the brain parenchyma (as a surrogate for CSFP) were measured at 200 Hz in three male rhesus macaques (nonhuman primates, NHPs) on a 10% duty cycle (15 seconds of every 150-second period). Three-dimensional LC thickness was autosegmented as the mean thickness of the visible hyperreflective band in 48 radial spectral-domain optical coherence tomography b-scans centered on the optic nerve head. Results Results indicated the rank order of IOP, ICP, TLP, and TLPG for waking, sleeping, and 24-hour periods averaged across all days. NHP 150110 had the highest IOP and ICP in all periods; however, it had the lowest TLPG in all periods due to its relatively thick LC. The other two NHPs showed similar shifts in the rank order of possible glaucoma risk factors. Conclusions IOP is the only modifiable and readily measurable pressure-based risk factor for glaucoma. However, other potential risk factors such as ICP, TLP, and TLPG, as well as their rank-order patterns, differed compared to IOP across subjects, demonstrating that a comprehensive view of relevant risk factors is warranted. Translational Relevance Future studies should consider including CSFP, TLP, and TLPG in addition to IOP as potential risk factors when assessing eye-specific glaucoma susceptibility.
Collapse
Affiliation(s)
- Jessica V Jasien
- Vision Science Graduate Program, School of Optometry, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian C Samuels
- Department of Ophthalmology and Visual Sciences, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Johnston
- Department of Neurosurgery, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Crawford Downs
- Department of Ophthalmology and Visual Sciences, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
41
|
Christopher M, Nakahara K, Bowd C, Proudfoot JA, Belghith A, Goldbaum MH, Rezapour J, Weinreb RN, Fazio MA, Girkin CA, Liebmann JM, De Moraes G, Murata H, Tokumo K, Shibata N, Fujino Y, Matsuura M, Kiuchi Y, Tanito M, Asaoka R, Zangwill LM. Effects of Study Population, Labeling and Training on Glaucoma Detection Using Deep Learning Algorithms. Transl Vis Sci Technol 2020; 9:27. [PMID: 32818088 PMCID: PMC7396194 DOI: 10.1167/tvst.9.2.27] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 09/30/2019] [Accepted: 03/04/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To compare performance of independently developed deep learning algorithms for detecting glaucoma from fundus photographs and to evaluate strategies for incorporating new data into models. Methods Two fundus photograph datasets from the Diagnostic Innovations in Glaucoma Study/African Descent and Glaucoma Evaluation Study and Matsue Red Cross Hospital were used to independently develop deep learning algorithms for detection of glaucoma at the University of California, San Diego, and the University of Tokyo. We compared three versions of the University of California, San Diego, and University of Tokyo models: original (no retraining), sequential (retraining only on new data), and combined (training on combined data). Independent datasets were used to test the algorithms. Results The original University of California, San Diego and University of Tokyo models performed similarly (area under the receiver operating characteristic curve = 0.96 and 0.97, respectively) for detection of glaucoma in the Matsue Red Cross Hospital dataset, but not the Diagnostic Innovations in Glaucoma Study/African Descent and Glaucoma Evaluation Study data (0.79 and 0.92; P < .001), respectively. Model performance was higher when classifying moderate-to-severe compared with mild disease (area under the receiver operating characteristic curve = 0.98 and 0.91; P < .001), respectively. Models trained with the combined strategy generally had better performance across all datasets than the original strategy. Conclusions Deep learning glaucoma detection can achieve high accuracy across diverse datasets with appropriate training strategies. Because model performance was influenced by the severity of disease, labeling, training strategies, and population characteristics, reporting accuracy stratified by relevant covariates is important for cross study comparisons. Translational Relevance High sensitivity and specificity of deep learning algorithms for moderate-to-severe glaucoma across diverse populations suggest a role for artificial intelligence in the detection of glaucoma in primary care.
Collapse
Affiliation(s)
- Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | | | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Michael H Goldbaum
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Jasmin Rezapour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA.,Department of Ophthalmology, University Medical Center Mainz, Germany
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Massimo A Fazio
- School of Medicine, University of Alabama-Birmingham, Birmingham, AL, USA
| | | | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Kana Tokumo
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | | | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, Graduate School of Medical Science, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan.,Seirei Hamamatsu General Hospital, Seirei Christopher University, Hamamatsu, Japan
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
42
|
Wong BJ, Moghimi S, Zangwill LM, Christopher M, Belghith A, Ekici E, Bowd C, Fazio MA, Girkin CA, Weinreb RN. Relationship of Corneal Hysteresis and Anterior Lamina Cribrosa Displacement in Glaucoma. Am J Ophthalmol 2020; 212:134-143. [PMID: 31770514 DOI: 10.1016/j.ajo.2019.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the relationship between corneal hysteresis (CH) and anterior lamina cribrosa surface (ALCS) displacement over time in a cohort of patients with glaucoma. DESIGN Prospective observational case series. METHODS In this study, 147 eyes from 96 glaucoma or glaucoma suspect patients were followed for a mean of 3.5 years and 7.9 visits. Baseline CH measurements were obtained using the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments Inc, Depew, New York, USA). The mean anterior lamina cribrosa surface depth (ALCSD) and choroidal thickness were by automated segmentation of spectral-domain optical coherence tomography (SD-OCT) scans. The rate of change of ALCSD was calculated using linear mixed effects models. Relationship between baseline CH and follow-up ALCSD rate of change was adjusted for confounding factors, including age, intraocular pressure (IOP), and choroidal thickness. RESULTS The mean baseline CH was 9.4 mm Hg (95% confidence interval [CI] 9.1-9.7). Overall, the ALCS was displaced posteriorly at a rate of 0.78 μm/y (95% CI -1.82, 0.26). Seventeen eyes (11.5%) showed a significant posterior displacement of ALCS, whereas 22 eyes (15.0%) showed a significant anterior displacement of ALCS. The choroidal thickness thinned at a rate of -1.09 μm/y during the follow-up (P = .001). Multivariable mixed modeling showed that choroidal thinning, lower IOP change, and lower corneal hysteresis were significantly associated with posterior ALCS displacement over time (P = .034, P = .037, and P = .048). Each 1 mm lower CH was associated with 0.66 μm/y posterior displacement of the ALCS. CONCLUSIONS Lower corneal hysteresis was significantly associated with posterior displacement of the anterior lamina cribrosa over time. These data provide additional support for lower corneal hysteresis being a risk factor for glaucoma progression.
Collapse
|
43
|
Girkin CA, Fazio MA, Bowd C, Medeiros FA, Weinreb RN, Liebmann JM, Proudfoot J, Zangwill LM, Belghith A. Racial Differences in the Association of Anterior Lamina Cribrosa Surface Depth and Glaucoma Severity in the African Descent and Glaucoma Evaluation Study (ADAGES). Invest Ophthalmol Vis Sci 2020; 60:4496-4502. [PMID: 31661550 PMCID: PMC6819052 DOI: 10.1167/iovs.19-26645] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose To determine if variation in anterior lamina cribrosa surface depth (ALCSD) differs between glaucoma patients of African (AD) and European descent (ED). Methods A total of 178 eyes from 123 glaucoma patients in the African Descent and Glaucoma Evaluation Study (ADAGES) and Diagnostic Innovations in Glaucoma Study (DIGS) were included. ALCSD and choroidal thickness were measured using the San Diego Automated Layer Segmentation Algorithm (SALSA). ALCSD was defined by both Bruch's membrane opening (BMO)-based (ALCSD-BMO) and scleral-based (ALCSD-Scl) reference planes. Racial differences in ALCSD were evaluated using cross-sectional univariate and multivariable models. Results A deeper ALCSD-Scl was found in males (52.4 μm, P = 0.0401), AD individuals (78.6 μm, P = 0.0004), younger individuals (−3.1 μm/year, P < 0.0213), and eyes with larger discs (81.0 μm/mm2, P = 0.024), increased visual field loss (mean defect, MD: −6.4 μm/dB [decibel], P = 0.0106), and higher intraocular pressure (IOP: 14.1 μm/mm Hg, P = 0.0256). Significant deepening of ALSCD was observed with increasing IOP and visual field severity only in the AD group. Race modified the relationship between ALCSD-Scl and age (P = 0.0145) with ALCSD-Scl in AD individuals becoming more shallow with increasing age (−3.1 μm/year, P = 0.0213), while there was no significant association in the ED group (2.1 μm/mm Hg, P < 0.2026). Conclusions This study demonstrates that a deeper ALCSD, regardless of the ALCSD reference plane used, is associated with more severe glaucoma and higher IOP in the ADAGES cohort, particularly in individuals of AD. These results suggest that characterizing ALCSD morphology and its relationships to IOP, aging, and glaucoma progression may help explain racial differences in disease susceptibility.
Collapse
Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Massimo A Fazio
- Department of Ophthalmology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States.,Department of Biomedical Engineering, School of Engineering, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Felipe A Medeiros
- Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
| | - James Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| |
Collapse
|
44
|
Bianco G, Bruno L, Girkin CA, Fazio MA. Full-field displacement measurement of corneoscleral shells by combining multi-camera speckle interferometry with 3D shape reconstruction. J Mech Behav Biomed Mater 2019; 103:103560. [PMID: 32090952 DOI: 10.1016/j.jmbbm.2019.103560] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022]
Abstract
Changes in the biomechanical properties of the connective tissue of the eye occur with age and underlie the development of several ocular diseases, such as glaucoma, myopia, and keratoconus. The biomechanical dynamics of ocular connective tissue are measured by ex vivo inflation testing, in which intraocular pressure (IOP) is varied and optical methods are used to produce maps of corneal and scleral displacement. Current optical methods are limited by acquisition rate, occlusions, poor spatial resolution, and insufficient 3D mapping. We developed an interferometric optical method integrates four-camera electronic speckle pattern interferometry (ESPI) and a novel three-dimensional (3D) shape reconstruction process to measure shape and full-field mechanical deformations of corneal and scleral shells during ex vivo inflation testing. Each camera provides accurate measurements of the laser beam phase related to deformations of the specimen surface; a multi-view stereovision method generates the shape of the specimen and a functional form that links every pixel of a given camera to 3D points on the specimen's visible surface. In this way, dynamic deformations of the specimen are localized, with quantification of the time-dependent 3D displacements of the specimen at nanometric accuracy. The ESPI-3D system is suitable for analyzing scleral deformation and morphological changes caused by time-varying IOP.
Collapse
Affiliation(s)
- Gianfranco Bianco
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, 1670, University Blvd - 35294, Birmingham, AL, USA.
| | - Luigi Bruno
- Department of Biomedical Engineering, University of Alabama at Birmingham, 1670, University Blvd - 35294, Birmingham, AL, USA; Department of Mechanical, Energy and Management Engineering, University of Calabria, Via Bucci 44C, 87036, Arcavacata di Rende, CS, Italy.
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, 1670, University Blvd - 35294, Birmingham, AL, USA.
| | - Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, 1670, University Blvd - 35294, Birmingham, AL, USA; Department of Biomedical Engineering, University of Alabama at Birmingham, 1670, University Blvd - 35294, Birmingham, AL, USA.
| |
Collapse
|
45
|
Fazio MA, Girard MJA, Lee W, Morris JS, Burgoyne CF, Downs JC. The Relationship Between Scleral Strain Change and Differential Cumulative Intraocular Pressure Exposure in the Nonhuman Primate Chronic Ocular Hypertension Model. Invest Ophthalmol Vis Sci 2019; 60:4141-4150. [PMID: 31598625 PMCID: PMC6785842 DOI: 10.1167/iovs.19-27060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/17/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose To determine the relationship between peripapillary scleral strain change and cumulative differential IOP exposure in nonhuman primates (NHPs) with unilateral chronic ocular hypertension. Methods Posterior scleral shells from 6 bilaterally normal and 10 unilateral chronic ocular hypertension NHPs were pressurized from 5 to 45 mm Hg, and the resulting full-field, three-dimensional, scleral surface deformations were acquired using laser speckle interferometry. Scleral tensile strain (local tissue deformation) was calculated by analytical differentiation of the displacement field; zero strain was assumed at 5 mm Hg. Maximum principal strain was used to represent the scleral strain, and strains were averaged over a 15°-wide (∼3.6-mm) circumpapillary region adjacent to the ONH. The relative difference in mean strain was calculated between fellow eyes and compared with the differential cumulative IOP exposure within NHPs during the study period. The relationship between the relative difference in scleral strain and the differential cumulative IOP exposure in fellow eyes was assessed using an F test and quadratic regression model. Results Relative differential scleral tensile strain was significantly associated with differential cumulative IOP exposure in contralateral eyes in the chronic ocular hypertension NHPs, with the bilaterally normal NHPs showing no significant strain difference between fellow eyes. The sclera in the chronic ocular hypertension eyes was more compliant than in their fellow eyes at low levels of differential cumulative IOP exposure, but stiffer at larger differential IOPs (P < 0.0001). Conclusions These cross-sectional findings suggest that longitudinal IOP-induced changes in scleral mechanical behavior are dependent on the magnitude of differential cumulative IOP exposure.
Collapse
Affiliation(s)
- Massimo A. Fazio
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Michael J. A. Girard
- In Vivo Biomechanics Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Wonyul Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Jeffrey S. Morris
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Claude F. Burgoyne
- Optic Nerve Head Biomechanics Laboratory, Devers Eye Institute, Portland, Oregon, United States
| | - J. Crawford Downs
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| |
Collapse
|
46
|
Christopher M, Bowd C, Belghith A, Goldbaum MH, Weinreb RN, Fazio MA, Girkin CA, Liebmann JM, Zangwill LM. Deep Learning Approaches Predict Glaucomatous Visual Field Damage from OCT Optic Nerve Head En Face Images and Retinal Nerve Fiber Layer Thickness Maps. Ophthalmology 2019; 127:346-356. [PMID: 31718841 DOI: 10.1016/j.ophtha.2019.09.036] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/05/2019] [Accepted: 09/23/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To develop and evaluate a deep learning system for differentiating between eyes with and without glaucomatous visual field damage (GVFD) and predicting the severity of GFVD from spectral domain OCT (SD OCT) optic nerve head images. DESIGN Evaluation of a diagnostic technology. PARTICIPANTS A total of 9765 visual field (VF) SD OCT pairs collected from 1194 participants with and without GVFD (1909 eyes). METHODS Deep learning models were trained to use SD OCT retinal nerve fiber layer (RNFL) thickness maps, RNFL en face images, and confocal scanning laser ophthalmoscopy (CSLO) images to identify eyes with GVFD and predict quantitative VF mean deviation (MD), pattern standard deviation (PSD), and mean VF sectoral pattern deviation (PD) from SD OCT data. MAIN OUTCOME MEASURES Deep learning models were compared with mean RNFL thickness for identifying GVFD using area under the curve (AUC), sensitivity, and specificity. For predicting MD, PSD, and mean sectoral PD, models were evaluated using R2 and mean absolute error (MAE). RESULTS In the independent test dataset, the deep learning models based on RNFL en face images achieved an AUC of 0.88 for identifying eyes with GVFD and 0.82 for detecting mild GVFD significantly (P < 0.001) better than using mean RNFL thickness measurements (AUC = 0.82 and 0.73, respectively). Deep learning models outperformed standard RNFL thickness measurements in predicting all quantitative VF metrics. In predicting MD, deep learning models based on RNFL en face images achieved an R2 of 0.70 and MAE of 2.5 decibels (dB) compared with 0.45 and 3.7 dB for RNFL thickness measurements. In predicting mean VF sectoral PD, deep learning models achieved high accuracy in the inferior nasal (R2 = 0.60) and superior nasal (R2 = 0.67) sectors, moderate accuracy in inferior (R2 = 0.26) and superior (R2 = 0.35) sectors, and lower accuracy in the central (R2 = 0.15) and temporal (R2 = 0.12) sectors. CONCLUSIONS Deep learning models had high accuracy in identifying eyes with GFVD and predicting the severity of functional loss from SD OCT images. Accurately predicting the severity of GFVD from SD OCT imaging can help clinicians more effectively individualize the frequency of VF testing to the individual patient.
Collapse
Affiliation(s)
- Mark Christopher
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Christopher Bowd
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Akram Belghith
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Michael H Goldbaum
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Massimo A Fazio
- School of Medicine, University of Alabama-Birmingham, Birmingham, Alabama
| | | | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California.
| |
Collapse
|
47
|
Levy AM, Fazio MA, Grytz R. Experimental myopia increases and scleral crosslinking using genipin inhibits cyclic softening in the tree shrew sclera. Ophthalmic Physiol Opt 2019; 38:246-256. [PMID: 29691925 DOI: 10.1111/opo.12454] [Citation(s) in RCA: 20] [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: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Myopia progression is thought to involve biomechanical weakening of the sclera, which leads to irreversible deformations and axial elongation of the eye. Scleral crosslinking has been proposed as a potential treatment option for myopia control by strengthening the mechanically weakened sclera. The biomechanical mechanism by which the sclera weakens during myopia and strengthens after crosslinking is not fully understood. Here, we assess the effect of lens-induced myopia and exogenous crosslinking using genipin on the inelastic mechanical properties of the tree shrew sclera measured by cyclic tensile tests. METHODS Cyclic tensile tests were performed on 2-mm wide scleral strips at physiological loading conditions (50 cycles, 0-3.3 g, 30 s cycle-1 ). Two scleral strips were obtained from each eye of juvenile tree shrews exposed to two different visual conditions: normal and 4 days of monocular -5 D lens wear to accelerate scleral remodelling and induce myopia. Scleral strips were mechanically tested at three alternative conditions: immediately after enucleation; after incubation in phosphate buffered saline (PBS) for 24 h at 37°C; and after incubation for 24 h in PBS supplemented with genipin at a low cytotoxicity concentration (0.25 mm). Cyclic softening was defined as the incremental strain increase from one cycle to the next. RESULTS -5D lens treatment significantly increased the cyclic softening response of the sclera when compared to contralateral control eyes (0.10% ± 0.029%, mean ± standard error, P = 0.037). Exogenous crosslinking of the lens treated sclera significantly decreased the cyclic softening response (-0.12% ± 0.014%, P = 2.2 × 10-5 ). Contrary to all other groups, the genipin-cross-linked tissue did not exhibit cyclic softening significantly different from zero within the 50-cycle test. CONCLUSIONS Results indicated that cyclic tensile loading leads to an inelastic, cyclic softening of the juvenile tree shrew sclera. The softening rate increased during lens-induced myopia and was diminished after genipin crosslinking. This finding suggests that axial elongation in myopia may involve a biomechanical weakening mechanism that increased the cyclic softening response of the sclera, which was inhibited by scleral crosslinking using genipin.
Collapse
Affiliation(s)
- Alexander M Levy
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, USA
| | - Massimo A Fazio
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, USA.,Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, USA
| | - Rafael Grytz
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, USA
| |
Collapse
|
48
|
Bowd C, Zangwill LM, Weinreb RN, Girkin CA, Fazio MA, Liebmann JM, Belghith A. Racial Differences in Rate of Change of Spectral-Domain Optical Coherence Tomography-Measured Minimum Rim Width and Retinal Nerve Fiber Layer Thickness. Am J Ophthalmol 2018; 196:154-164. [PMID: 30195890 DOI: 10.1016/j.ajo.2018.08.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare race-related differences in estimated rate of change of Bruch's membrane opening-minimum rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer thickness (RNFLT) in healthy, glaucoma suspect, and glaucoma eyes of individuals of European (ED) and African descent (AD). DESIGN Prospective cohort study. METHODS This study investigated rate of change of BMO-MRW and RNFLT in 124 healthy, 227 glaucoma suspect, and 177 glaucoma eyes followed for approximately 3 years and tested with optical coherence tomography every 6 months. Suspect eyes had a history of untreated intraocular pressure (IOP) ≥ 22 mm Hg or suspicion of glaucoma by optic disc photograph assessment without repeatable abnormal standard automated perimetry (SAP) results. Glaucoma eyes had repeatable abnormal SAP results (GHT ONL or PSD ≤ 5%). Mixed-effects models were used to estimate the rate of change after controlling for age, mean follow-up IOP, central corneal thickness, axial length, and BMO area. RESULTS A race-related difference in rate of change of global BMO-MRW but not average RNFLT in suspect eyes was observed. Rate of change of BMO-MRW was -1.82 μm/year and -2.20 μm/year in ED and AD suspect eyes, respectively (P = .03). Rate of change of RNFLT was -0.64 μm/year and -0.75 μm/year in ED and AD suspect eyes, respectively (P = .75). No race-related differences in change rate were found in healthy or glaucoma eyes. CONCLUSION Race is an important consideration when assessing structural change, particularly minimum rim width, in glaucoma suspect eyes. Differences in rate of structural change may help explain racial disparities in glaucoma susceptibility.
Collapse
|
49
|
Girkin CA, Fazio MA, Yang H, Reynaud J, Burgoyne CF, Smith B, Wang L, Downs JC. Variation in the Three-Dimensional Histomorphometry of the Normal Human Optic Nerve Head With Age and Race: Lamina Cribrosa and Peripapillary Scleral Thickness and Position. Invest Ophthalmol Vis Sci 2017; 58:3759-3769. [PMID: 28738420 PMCID: PMC5525554 DOI: 10.1167/iovs.17-21842] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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: 01/24/2023] Open
Abstract
Purpose This study quantified the thickness and depth of the lamina cribrosa (LC) and peripapillary scleral thickness in high-resolution three-dimensional (3D) fluorescent reconstructions of the optic nerve head (ONH) in eyes from donors of African (AD) and European descent (ED). Methods A total of 64 eyes (45 ED, 19 AD) from 51 normal donors were obtained within 6 hours of death and fixed at 10 mm Hg of pressure. The optic nerve head was trephined from the globe and digitally reconstructed at 1.5 × 1.5 × 1.5 μm voxel resolution with an automated episcopic fluorescence technique. The load-bearing ONH connective tissue surfaces were manually delineated in 3D using custom software. Results The lamina cribrosa and peripapillary sclera were significantly thinner in AD eyes adjusting for age and sex (LC was 24 ± 11 μm thinner; P = 0.0350; scleral was 56 ± 22 μm thinner; P = 0.0097). The lamina cribrosa was significantly thinner in females (23 ± 11 μm thinner; P = 0.0425). Age was not significantly associated with any morphologic parameter in the ED group. However, increasing age was associated with an increase in scleral thickness (1.3 μm/year, P = 0.0499) and an increase in LC depth (2.3 μm/year, P = 0.0035) in the AD group. The sclera was thickest in the superior and temporal regions while the LC was thinnest superiorly. Conclusions Substantial sectorial and racial differences in LC and scleral morphology were observed, as well as increasing LC depth and scleral thickness with age in the AD group. Results suggest greater age-related remodeling of the load-bearing ONH connective tissues in eyes from AD individuals that could explain, in part, the greater predilection to glaucomatous injury seen in aged AD populations.
Collapse
Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Massimo A Fazio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States 2Department of Biomedical Engineering, School of Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Hongli Yang
- Devers Eye Institute, Legacy Health System, Portland, Oregon, United States
| | - Juan Reynaud
- Devers Eye Institute, Legacy Health System, Portland, Oregon, United States
| | - Claude F Burgoyne
- Devers Eye Institute, Legacy Health System, Portland, Oregon, United States
| | - Brandon Smith
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Lan Wang
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - J Crawford Downs
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| |
Collapse
|
50
|
Fazio MA, Johnstone JK, Smith B, Wang L, Girkin CA. Displacement of the Lamina Cribrosa in Response to Acute Intraocular Pressure Elevation in Normal Individuals of African and European Descent. Invest Ophthalmol Vis Sci 2017; 57:3331-9. [PMID: 27367500 PMCID: PMC4961061 DOI: 10.1167/iovs.15-17940] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 12/13/2022] Open
Abstract
Purpose To assess if the in vivo mechanical displacement of the anterior laminar cribrosa surface (ALCS) as a response of an acute elevation in intraocular pressure (IOP) differs in individuals of European (ED) and African descent (AD). Methods Spectral-domain optical coherence tomography (SDOCT) scans were obtained from 24 eyes of 12 individuals of AD and 18 eyes of 9 individuals of ED at their normal baseline IOP and after 60 seconds IOP elevation using ophthalmodynamometry. Change in depth (displacement) of the LC and to the prelaminar tissue (PLT) were computed in association with the change (delta) in IOP (Δ IOP), race, age, corneal thickness, corneal rigidity (ocular response analyzer [ORA]), and axial. Results In the ED group for small IOP elevations (Δ IOP < 12 mm Hg), the ALCS initially displaced posteriorly but for larger increase of IOP an anterior displacement of the lamina followed. Inversely, in the AD group the ALCS did not show a significant posterior displacement for small Δ IOP, while for larger IOP increases the ALCS significantly displaced posteriorly. Posterior displacement of the lamina cribrosa (LC) was also significantly correlated with longer axial length, higher corneal thickness, and ORA parameters. Prelaminar tissue posteriorly displaced for any magnitude of Δ IOP, in both groups. Conclusions The African descent group demonstrated a greater acute posterior bowing of the LC after adjustment for age, axial length, Bruch's membrane opening (BMO) area, and ORA parameters. Greater PLT posterior displacement was also seen in the AD group with increasing IOP, which was tightly correlated with the displacement of the LC.
Collapse
Affiliation(s)
- Massimo A Fazio
- Department of Ophthalmology University of Alabama at Birmingham, Birmingham, Alabama, United States 2Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - John K Johnstone
- Department of Computer and Information Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Brandon Smith
- Department of Ophthalmology University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Lan Wang
- Department of Ophthalmology University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christopher A Girkin
- Department of Ophthalmology University of Alabama at Birmingham, Birmingham, Alabama, United States
| |
Collapse
|