1
|
van der Zee C, Muijzer MB, van den Biggelaar FJHM, Nuijts RMMA, Delbeke H, Dickman MM, Imhof SM, Wisse RPL. Cost-effectiveness of the ADVISE trial: An intraoperative OCT protocol in DMEK surgery. Acta Ophthalmol 2024; 102:254-262. [PMID: 37340731 DOI: 10.1111/aos.15729] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023]
Abstract
The intraoperative optical coherence tomography (iOCT) is recently introduced in Descemet membrane endothelial keratoplasty (DMEK) surgery, which aims to increase clinical performance and surgery safety. However, the acquisition of this modality is a substantial investment. The objective of this paper is to report on the cost-effectiveness of an iOCT-protocol in DMEK surgery with the Advanced Visualization in Corneal Surgery Evaluation (ADVISE) trial. This cost-effectiveness analysis uses data 6 months postoperatively from the multicentre prospective randomized clinical ADVISE trial. Sixty-five patients were randomized to usual care (n = 33) or the iOCT-protocol (n = 32). Quality-Adjusted Life Years (EQ-5D-5L), Vision-related Quality of Life (NEI-VFQ-25) and self-administered resources questionnaires were administered. Main outcome is the incremental cost-effectiveness ratio (ICER) and sensitivity analyses. The iOCT protocol reports no statistical difference in ICER. For the usual care group compared with the iOCT protocol, respectively, the mean societal costs are €5027 compared with €4920 (Δ€107). The sensitivity analyses report the highest variability on time variables. This economic evaluation learned that there is no added value in quality of life or cost-effectiveness in using the iOCT protocol in DMEK surgery. The variability of cost variables depends on the characteristics of an eye clinic. The added value of iOCT could gain incrementally by increasing surgical efficiency, and aiding in surgical decision-making.
Collapse
Affiliation(s)
- Casper van der Zee
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc B Muijzer
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Rudy M M A Nuijts
- University Eye Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Heleen Delbeke
- Ophthalmology Department, University Hospital Leuven, Leuven, Belgium
- KU Leuven, Biomedical Sciences Group, Department of Neurosciences, Research Group Ophthalmology, Leuven, Belgium
| | - Mor M Dickman
- University Eye Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Saskia M Imhof
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert P L Wisse
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
2
|
Nuijts MA, Stegeman I, Porro GL, Bennebroek CAM, van Seeters T, Proudlock FA, Schouten-van Meeteren AYN, Imhof SM. Diagnostic accuracy of retinal optical coherence tomography in children with a newly diagnosed brain tumour. Acta Ophthalmol 2023; 101:658-669. [PMID: 36924320 DOI: 10.1111/aos.15650] [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: 10/04/2022] [Revised: 01/15/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To estimate the diagnostic accuracy of circumpapillary retinal nerve fibre layer (RNFL) thickness and macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness measurements to discriminate an abnormal visual function (i.e. abnormal age-based visual acuity and/or visual field defect) in children with a newly diagnosed brain tumour. METHODS This cross-sectional analysis of a prospective longitudinal nationwide cohort study was conducted at four hospitals in the Netherlands, including the national referral centre for paediatric oncology. Patients aged 0-18 years with a newly diagnosed brain tumour and reliable visual acuity and/or visual field examination and optical coherence tomography were included. Diagnostic accuracy was evaluated with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS Of 115 patients included in the study (67 [58.3%] male; median age 10.6 years [range, 0.2-17.8 years]), reliable RNFL thickness and GCL-IPL thickness measurements were available in 92 patients (80.0%) and 84 patients (73.0%), respectively. The sensitivity for detecting an abnormal visual function was 74.5% for average RNFL thickness and 41.7% for average GCL-IPL thickness at a specificity of 44.5% and 82.9%, respectively. The PPV and NPV were 33.0% and 82.6% for the average RNFL thickness and 57.1% and 82.2% for the average GCL-IPL thickness. CONCLUSION An abnormal visual function was discriminated correctly by using the average RNFL thickness in seven out of ten patients and by using the average GCL-IPL thickness in four out of ten patients. The relatively high NPVs signified that patients with normal average RNFL thickness and average GCL-IPL thickness measurements had a relative high certainty of a normal visual function.
Collapse
Affiliation(s)
- Myrthe A Nuijts
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology and Head & Neck Surgery University, University Medical Centre Utrecht, Utrecht, The Netherlands
- Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Giorgio L Porro
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Carlien A M Bennebroek
- Department of Ophthalmology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van Seeters
- Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | | | - Saskia M Imhof
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
3
|
Muijzer MB, Delbeke H, Dickman MM, Nuijts RMMA, Jimale H, van Luijk CM, Imhof SM, Wisse RPL. Video Grading of Descemet Membrane Endothelial Keratoplasty Surgery to Identify Surgeon Risk Factors for Graft Detachment and Rebubbling: A Post Hoc Observational Analysis of the Advanced Visualization In Corneal Surgery Evaluation Trial. Cornea 2023; 42:1074-1082. [PMID: 36730371 PMCID: PMC10392889 DOI: 10.1097/ico.0000000000003181] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/28/2022] [Accepted: 09/10/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to explore video-graded intraoperative risk factors for graft detachment (GD) and rebubbling in Descemet membrane endothelial keratoplasty surgery. METHODS A post hoc analysis of 65 eyes of 65 pseudophakic subjects with Fuchs endothelial dystrophy that underwent Descemet membrane endothelial keratoplasty surgery as part of the Advanced Visualization In Corneal Surgery Evaluation trial. All surgical recordings were assessed by 2 graders using a structured assessment form. A multinominal regression was performed to estimate the independent effect of video-graded intraoperative factors on the incidence of GD and rebubbling. Secondary outcomes are corrected distance visual acuity and endothelial cell density. RESULTS In total, 33 GDs were recorded, of which 17 required rebubbling. No significant predictors for GD or rebubbling were identified. However, the results revealed 2 clinically relevant patterns. An unfavorable graft configuration (ie, wrinkled, tight scroll, or taco-shaped) and a gas-bubble size smaller than the graft diameter were associated with an increased risk of GD [odds ratio (OR) 2.5 and OR 2.26, respectively] and rebubbling (OR 2.0 and OR 2.60, respectively). Inversely, a larger gas-bubble size was associated with a reduced risk of GD (OR 0.37) and rebubbling (OR 0.36). At 3 and 6 months postoperatively, corrected distance visual acuity was poorer in subjects requiring a rebubbling and endothelial cell density loss was higher in subjects with a partial GD. CONCLUSIONS Our analysis revealed that the gas-bubble size and graft shape/geometry seem to be relevant clinical factors for GD and rebubbling, whereas descemetorhexis difficulty, degree of graft manipulation, graft overlap, and surgical iridectomy were not associated with an increased risk.
Collapse
Affiliation(s)
- Marc B. Muijzer
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Heleen Delbeke
- Ophthalmology Department, University Hospital Leuven, Leuven, Belgium
- KU Leuven, Biomedical Sciences Group, Department of Neurosciences, Research group Ophthalmology; Leuven, Belgium; and
| | - Mor M. Dickman
- University Eye Clinic, Department of Ophthalmology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rudy M. M. A. Nuijts
- University Eye Clinic, Department of Ophthalmology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Hanad Jimale
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Chantal M. van Luijk
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia M. Imhof
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert P. L. Wisse
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
4
|
Portengen BL, Porro GL, Bergsma D, Veldman EJ, Imhof SM, Naber M. Effects of Stimulus Luminance, Stimulus Color and Intra-Stimulus Color Contrast on Visual Field Mapping in Neurologically Impaired Adults Using Flicker Pupil Perimetry. Eye Brain 2023; 15:77-89. [PMID: 37287993 PMCID: PMC10243349 DOI: 10.2147/eb.s409905] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023] Open
Abstract
Purpose We improve pupillary responses and diagnostic performance of flicker pupil perimetry through alterations in global and local color contrast and luminance contrast in adult patients suffering from visual field defects due to cerebral visual impairment (CVI). Methods Two experiments were conducted on patients with CVI (Experiment 1: 19 subjects, age M and SD 57.9 ± 14.0; Experiment 2: 16 subjects, age M and SD 57.3 ± 14.7) suffering from absolute homonymous visual field (VF) defects. We altered global color contrast (stimuli consisted of white, yellow, cyan and yellow-equiluminant-to-cyan colored wedges) in Experiment 1, and we manipulated luminance and local color contrast with bright and dark yellow and multicolor wedges in a 2-by-2 design in Experiment 2. Stimuli consecutively flickered across 44 stimulus locations within the inner 60 degrees of the VF and were offset to a contrasting (opponency colored) dark background. Pupil perimetry results were compared to standard automated perimetry (SAP) to assess diagnostic accuracy. Results A bright stimulus with global color contrast using yellow (p= 0.009) or white (p= 0.006) evoked strongest pupillary responses as opposed to stimuli containing local color contrast and lower brightness. Diagnostic accuracy, however, was similar across global color contrast conditions in Experiment 1 (p= 0.27) and decreased when local color contrast and less luminance contrast was introduced in Experiment 2 (p= 0.02). The bright yellow condition resulted in highest performance (AUC M = 0.85 ± 0.10, Mdn = 0.85). Conclusion Pupillary responses and pupil perimetry's diagnostic accuracy both benefit from high luminance contrast and global but not local color contrast.
Collapse
Affiliation(s)
- Brendan L Portengen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Giorgio L Porro
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marnix Naber
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
5
|
Muijzer MB, Noordmans HJ, Delbeke H, Dickman MM, Nuijts RMMA, Dunker S, Imhof SM, Wisse RPL. Establishing a Biomarker for the Prediction of Short-Term Graft Detachment After Descemet Membrane Endothelial Keratoplasty. Cornea 2023; 42:204-210. [PMID: 35184123 DOI: 10.1097/ico.0000000000003006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/03/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to investigate the predictive value of pachymetry mapping 1 day after Descemet membrane endothelial keratoplasty (DMEK) as a biomarker for early graft detachment. METHODS This was a post hoc analysis of 65 pseudophakic subjects with Fuchs endothelial dystrophy who underwent DMEK surgery between December 2018 and April 2021 as part of the Advanced Visualization In Corneal Surgery Evaluation international multicenter randomized controlled trial. One eye per patient was included. Preoperatively and 1 day postoperatively, patients underwent anterior segment optical coherence tomography imaging. Using a grid consisting of 25 zones (ie, pachymetry map), corneal thickness and presence of a graft detachment were mapped for each patient. Detachments of any size were considered, regardless of subsequent clinical interventions. Missing data were imputed and subsequently divided into a training and test set. Two prediction methods were evaluated: one model based on absolute corneal thickness and a regression model. RESULTS A total of 65 eyes were included for analysis of which 33 developed any form of graft detachment. Preoperatively, no significant differences were observed between the groups ( P = 0.221). Corneal thickness in the corneal zones with a detached graft was significantly increased compared with corneal zones with an attached graft ( P < 0.001). The regression prediction model had an area under the curve of 0.87 (sensitivity: 0.79 and specificity: 0.75), whereas the absolute thickness cutoff model only reached 0.65. CONCLUSIONS Pachymetry mapping 1 day after DMEK was predictive for early graft detachment, and the prediction model had a good to excellent performance. This aids in identifying patients at risk for graft detachment and subsequent tailored postoperative care.
Collapse
Affiliation(s)
- Marc B Muijzer
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Herke-Jan Noordmans
- Medical Technical and Clinical Physics Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Heleen Delbeke
- Ophthalmology Department, University Hospital Leuven, Leuven, Belgium; and
| | - Mor M Dickman
- University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Suryan Dunker
- University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Saskia M Imhof
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert P L Wisse
- Utrecht Cornea Research Group, Ophthalmology Department, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
6
|
Claessens JLJ, Wanten JC, Bauer NJC, Nuijts RMMA, Findl O, Huemer J, Imhof SM, Wisse RPL. Remote follow-up after cataract surgery (CORE-RCT): study protocol of a randomized controlled trial. BMC Ophthalmol 2023; 23:41. [PMID: 36717799 PMCID: PMC9885558 DOI: 10.1186/s12886-023-02779-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Cataract surgery has become one of the most performed surgical procedures worldwide. Postoperative management consists of routine clinical examinations to assess post-operative visual function and detect possible adverse events. Due to the low incidence of complications, the majority of clinic visits after cataract surgery are uneventful. Nonetheless, valuable time and hospital resources are consumed. We hypothesize that remote post-operative follow-up involving teleconsultations and self-assessments of visual function and health status, could be a valid alternative to face-to-face clinical examinations in selected patient groups. The practice of remote follow-up after cataract surgery has not yet been evaluated. The aim of this study is to investigate the validity, safety and cost-effectiveness of remote cataract surgery follow-up, and to report on the patients' experiences with remotely self-assessing visual function. METHODS This study is a multicenter, open-label, randomized controlled trial. Patients planned for cataract surgery on both eyes, without ocular comorbidities, are eligible for participation. Participants will be allocated (1:1) into one of the two study groups: 'telemonitoring' or 'usual care'. Participants in the 'telemonitoring' group will perform in-home assessments after cataract surgery (remote web-based eye exams and digital questionnaires on their own devices). Participants in the 'usual care' group will have regular post-operative consultations, according to the study site's regular practice. Outcome measures include accuracy of the web-based eye exam for assessing visual acuity and refraction, patient-reported outcome measures (visual function and quality of life), adverse events, and cost aspects. DISCUSSION Investigating remote follow-up after cataract surgery fits the current trends of digitization of health care. We believe that remote self-care can be a promising avenue to comply with the increasing demands of cataract care. This randomized controlled trial provides scientific evidence on this unmet need and delivers the desired insights on (cost)effectiveness of remote follow-up after cataract surgery. TRIAL REGISTRATION ClinicalTrials.gov: NCT04809402. Date of registration: March 22, 2021.
Collapse
Affiliation(s)
- Janneau L. J. Claessens
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Postbus 85500, Huispostnummer E03.136, Utrecht, 3508 GA the Netherlands
| | - Joukje C. Wanten
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Noël J. C. Bauer
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Rudy M. M. A. Nuijts
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Oliver Findl
- grid.413662.40000 0000 8987 0344Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Josef Huemer
- grid.413662.40000 0000 8987 0344Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria ,grid.436474.60000 0000 9168 0080Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Saskia M. Imhof
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Postbus 85500, Huispostnummer E03.136, Utrecht, 3508 GA the Netherlands
| | - Robert P. L. Wisse
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Postbus 85500, Huispostnummer E03.136, Utrecht, 3508 GA the Netherlands
| |
Collapse
|
7
|
Abstract
Purpose A scene consisting of a white stimulus on a black background incorporates strong luminance contrast. When both stimulus and background receive different colors, luminance contrast decreases but color contrast increases. Here, we sought to characterize the pattern of stimulus salience across varying trade-offs of color and luminance contrasts by using the pupil light response. Methods Three experiments were conducted with 17, 16, and 17 healthy adults. For all experiments, a flickering stimulus (2 Hz; alternating color to black) was presented superimposed on a background with a complementary color to the stimulus (i.e., opponency colors in human color perception: blue and yellow for Experiment 1, red and green for Experiment 2, and equiluminant red and green for Experiment 3). Background luminance varied between 0% and 45% to trade off luminance and color contrast with the stimulus. By comparing the locus of the optimal trade-off between color and luminance across different color axes, we explored the generality of the trade-off. Results The strongest pupil responses were found when a substantial amount of color contrast was present (at the expense of luminance contrast). Pupil response amplitudes increased by 15% to 30% after the addition of color contrast. An optimal pupillary responsiveness was reached at a background luminance setting of 20% to 35% color contrast across several color axes. Conclusions These findings suggest that a substantial component of pupil light responses incorporates color processing. More sensitive pupil responses and more salient stimulus designs can be achieved by adding subtle levels of color contrast between stimulus and background. Translational Relevance More robust pupil responses will enhance tests of the visual field with pupil perimetry.
Collapse
Affiliation(s)
- Brendan L. Portengen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marnix Naber
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
8
|
Pameijer EM, Heus P, Damen JAA, Spijker R, Hooft L, Ringens PJ, Imhof SM, van Leeuwen R. What did we learn in 35 years of research on nutrition and supplements for age-related macular degeneration: a systematic review. Acta Ophthalmol 2022; 100:e1541-e1552. [PMID: 35695158 PMCID: PMC9796889 DOI: 10.1111/aos.15191] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/14/2022] [Indexed: 01/07/2023]
Abstract
The aim of this paper is to summarize all available evidence from systematic reviews, randomized controlled trials (RCTs) and comparative nonrandomized studies (NRS) on the association between nutrition and antioxidant, vitamin, and mineral supplements and the development or progression of age-related macular degeneration (AMD). The Cochrane Database of Systematic Reviews, Cochrane register CENTRAL, MEDLINE and Embase were searched and studies published between January 2015 and May 2021 were included. The certainty of evidence was assessed according to the GRADE methodology. The main outcome measures were development of AMD, progression of AMD, and side effects. We included 7 systematic reviews, 7 RCTs, and 13 NRS. A high consumption of specific nutrients, i.e. β-carotene, lutein and zeaxanthin, copper, folate, magnesium, vitamin A, niacin, vitamin B6, vitamin C, docosahexaenoic acid, and eicosapentaenoic acid, was associated with a lower risk of progression of early to late AMD (high certainty of evidence). Use of antioxidant supplements and adherence to a Mediterranean diet, characterized by a high consumption of vegetables, whole grains, and nuts and a low consumption of red meat, were associated with a decreased risk of progression of early to late AMD (moderate certainty of evidence). A high consumption of alcohol was associated with a higher risk of developing AMD (moderate certainty of evidence). Supplementary vitamin C, vitamin E, or β-carotene were not associated with the development of AMD, and supplementary omega-3 fatty acids were not associated with progression to late AMD (high certainty of evidence). Research in the last 35 years included in our overview supports that a high intake of specific nutrients, the use of antioxidant supplements and adherence to a Mediterranean diet decrease the risk of progression of early to late AMD.
Collapse
Affiliation(s)
| | - Pauline Heus
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, UMC UtrechtUtrecht UniversityThe Netherlands
| | - Johanna A. A. Damen
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, UMC UtrechtUtrecht UniversityThe Netherlands
| | - René Spijker
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, UMC UtrechtUtrecht UniversityThe Netherlands
| | - Lotty Hooft
- Cochrane Netherlands and Julius Center for Health Sciences and Primary Care, UMC UtrechtUtrecht UniversityThe Netherlands
| | - Peter J. Ringens
- Department of OphthalmologyMaastricht University Medical CenterMaastrichtThe Netherlands
| | | | | |
Collapse
|
9
|
Veldhuis N, Nuijts MA, Isphording L, Lee-Kong FVYL, Imhof SM, Stegeman I. Linguistic spin in randomized controlled trials about age-related macular degeneration. Front Epidemiol 2022; 2:961996. [PMID: 38455287 PMCID: PMC10910936 DOI: 10.3389/fepid.2022.961996] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/13/2022] [Indexed: 03/09/2024]
Abstract
Objective To evaluate the prevalence, type and extent of linguistic spin in randomized controlled trials (RCTs) exploring interventions in patients with age-related macular degeneration (AMD), as well as to investigate whether study variables were correlated with linguistic spin. Study design and setting PubMed was searched from 2011 to 2020 to identify RCTs including patients with AMD. Two authors independently assessed a total of 96 RCTs. Linear regression analyses were performed to investigate whether linguistic spin was correlated with predefined study variables. Results Linguistic spin was found in 61 of 96 abstracts (63.5%) and in 90 of 96 main texts (93.8%). Use of words pointing out the beneficial effect of a treatment and the use of '(statistically) significant/significance' without reporting a P-value or a 95% confidence interval (CI) were the most frequently identified categories of linguistic spin. Sample size was significantly correlated with the total linguistic spin score (95% CI 0.38-5.23, P = 0.02). Conclusion A high prevalence and extent of linguistic spin in RCTs about AMD was found. We highlighted the importance of objective reporting and awareness of linguistic spin among ophthalmologists and other readers.
Collapse
Affiliation(s)
- Nienke Veldhuis
- Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Myrthe A. Nuijts
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Luka Isphording
- Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge Stegeman
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
10
|
Nuijts MA, Stegeman I, van Seeters T, Borst MD, Bennebroek CAM, Buis DR, Naus NC, Porro GL, van Egmond-Ebbeling MB, Voskuil-Kerkhof ESM, Pott JR, Franke NE, de Vos-Kerkhof E, Hoving EW, Schouten-van Meeteren AYN, Imhof SM. Ophthalmological Findings in Youths With a Newly Diagnosed Brain Tumor. JAMA Ophthalmol 2022; 140:982-993. [PMID: 36107418 PMCID: PMC9478881 DOI: 10.1001/jamaophthalmol.2022.3628] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/26/2022] [Indexed: 08/15/2023]
Abstract
Importance Visual impairment is an irreversible adverse effect in individuals who experienced a childhood brain tumor. Ophthalmological evaluation at diagnosis enables early detection of vision loss, decision-making about treatment, and when applicable, the timely use of visual interventions. However, awareness of visual impairment in clinical practice is suboptimal, and adherence to ophthalmological evaluation needs to be improved. Objective To assess the prevalence and types of abnormal ophthalmological findings in youths with a newly diagnosed brain tumor. Design, Setting, and Participants In this nationwide, prospective cohort study, youths aged 0 to 18 years with a newly diagnosed brain tumor between May 15, 2019, and August 11, 2021, were consecutively enrolled in 4 hospitals in the Netherlands, including the dedicated tertiary referral center for pediatric oncology care. Exposures A standardized and comprehensive ophthalmological examination, including orthoptic evaluation, visual acuity testing, visual field examination, and ophthalmoscopy, was performed within 4 weeks from brain tumor diagnosis. Main Outcomes and Measures The main outcomes were prevalence and types of visual symptoms and abnormal ophthalmological findings at brain tumor diagnosis. Results Of 170 youths included in the study (96 [56.5%] male; median age, 8.3 years [range, 0.2-17.8 years]), 82 (48.2%) had infratentorial tumors; 53 (31.2%), supratentorial midline tumors; and 35 (20.6%), cerebral hemisphere tumors. A total of 161 patients (94.7%) underwent orthoptic evaluation (67 [41.6%] preoperatively; 94 [58.4%] postoperatively); 152 (89.4%), visual acuity testing (63 [41.4%] preoperatively; 89 [58.6%] postoperatively); 121 (71.2%), visual field examination (49 [40.4%] preoperatively; 72 [59.6%] postoperatively); and 164 (96.5%), ophthalmoscopy (82 [50.0%] preoperatively; 82 [50.0%] postoperatively). Overall, 101 youths (59.4%) presented with visual symptoms at diagnosis. Abnormal findings were found in 134 patients (78.8%) during ophthalmological examination. The most common abnormal findings were papilledema in 86 of 164 patients (52.4%) who underwent ophthalmoscopy, gaze deficits in 54 of 161 (33.5%) who underwent orthoptic evaluation, visual field defects in 32 of 114 (28.1%) with reliable visual field examination, nystagmus in 40 (24.8%) and strabismus in 32 (19.9%) of 161 who underwent orthoptic evaluation, and decreased visual acuity in 13 of 152 (8.6%) with reliable visual acuity testing. Forty-five of 69 youths (65.2%) without visual symptoms at diagnosis had ophthalmological abnormalities on examination. Conclusions and Relevance The results of this study suggest that there is a high prevalence of abnormal ophthalmological findings in youths at brain tumor diagnosis regardless of the presence of visual symptoms. These findings support the need of standardized ophthalmological examination and the awareness of ophthalmologists and referring oncologists, neurologists, and neurosurgeons for ophthalmological abnormalities in this patient group.
Collapse
Affiliation(s)
- Myrthe A. Nuijts
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Inge Stegeman
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Otorhinolaryngology and Head & Neck Surgery University, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tom van Seeters
- Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Marloes D. Borst
- Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Carlien A. M. Bennebroek
- Department of Ophthalmology, location AMC of Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Dennis R. Buis
- Department of Pediatric Neurosurgery, location AMC of Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nicole C. Naus
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - JanWillem R. Pott
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Niels E. Franke
- Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Evelien de Vos-Kerkhof
- Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Eelco W. Hoving
- Department of Neuro-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
11
|
Portengen BL, Naber M, Jansen D, van den Boomen C, Imhof SM, Porro GL. Maintaining fixation by children in a virtual reality version of pupil perimetry. J Eye Mov Res 2022; 15. [PMID: 37091859 PMCID: PMC10115433 DOI: 10.16910/jemr.15.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The assessment of visual field sensitivities in young children continues to be a challenge. Children often do not sit still, fail to fixate stimuli for longer durations, and have limited verbal capacity to report visibility. We investigated the use of a head-mounted VR display, gaze-contingent flicker pupil perimetry (gcFPP), and three fixation stimulus conditions to determine best practices for optimal fixation and pupil response quality. A total of twenty children (3-11y) passively fixated a dot, counted the repeated appearance of an animated character, and watched an animated movie in separate trials of 80s each. We presented large flickering patches at different eccentricities and angles in the periphery to evoke pupillary oscillations (20 locations, 4s per location). The results showed that gaze precision and accuracy did not differ significantly across the fixation conditions but pupil amplitudes were strongest for the dot and count task. We recommend the use of the fixation counting task for pupil perimetry because children enjoyed it the most and it achieved strongest pupil responses. The VR set-up appears to be an ideal apparatus for children to allow free range of movement, an engaging visual task, and reliable eye measurements.
Collapse
Affiliation(s)
- Brendan L Portengen
- Department of Ophthalmology, University Medical Center Utrecht, The Netherlands
- Experimental Psychology, Utrecht University, The Netherlands
| | - Marnix Naber
- Experimental Psychology, Utrecht University, The Netherlands
| | - Demi Jansen
- Experimental Psychology, Utrecht University, The Netherlands
| | | | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, The Netherlands
| | - Giorgio L Porro
- Department of Ophthalmology, University Medical Center Utrecht, The Netherlands
| |
Collapse
|
12
|
Portengen BL, Porro GL, Imhof SM, Naber M. Comparison of unifocal, flicker, and multifocal pupil perimetry methods in healthy adults. J Vis 2022; 22:7. [PMID: 35998063 PMCID: PMC9424968 DOI: 10.1167/jov.22.9.7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
To this day, the most popular method of choice for testing visual field defects (VFDs) is subjective standard automated perimetry. However, a need has arisen for an objective, and less time-consuming method. Pupil perimetry (PP), which uses pupil responses to onsets of bright stimuli as indications of visual sensitivity, fulfills these requirements. It is currently unclear which PP method most accurately detects VFDs. Hence, the purpose of this study is to compare three PP methods for measuring pupil responsiveness. Unifocal (UPP), flicker (FPP), and multifocal PP (MPP) were compared by monocularly testing the inner 60 degrees of vision at 44 wedge-shaped locations. The visual field (VF) sensitivity of 18 healthy adult participants (mean age and SD 23.7 ± 3.0 years) was assessed, each under three different artificially simulated scotomas for approximately 4.5 minutes each (i.e. stimulus was not or only partially present) conditions: quadrantanopia, a 20-, and 10-degree diameter scotoma. Stimuli that were fully present on the screen evoked strongest, partially present stimuli evoked weaker, and absent stimuli evoked the weakest pupil responses in all methods. However, the pupil responses in FPP showed stronger discriminative power for present versus absent trials (median d-prime = 6.26 ± 2.49, area under the curve [AUC] = 1.0 ± 0) and MPP performed better for fully present versus partially present trials (median d-prime = 1.19 ± 0.62, AUC = 0.80 ± 0.11). We conducted the first in-depth comparison of three PP methods. Gaze-contingent FPP had best discriminative power for large (absolute) scotomas, whereas MPP performed slightly better with small (relative) scotomas.
Collapse
Affiliation(s)
- Brendan L Portengen
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands.,Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands.,
| | - Giorgio L Porro
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands.,
| | - Saskia M Imhof
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands.,
| | - Marnix Naber
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands.,
| |
Collapse
|
13
|
Nuijts MA, Stegeman I, Porro GL, Duvekot JC, van Egmond-Ebbeling MB, van der Linden DCP, Hoving EW, Schouten-van Meeteren AYN, Imhof SM. Ophthalmological Evaluation in Children Presenting With a Primary Brain Tumor. J Neuroophthalmol 2022; 42:e99-e108. [PMID: 34812765 PMCID: PMC8834141 DOI: 10.1097/wno.0000000000001421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children with a brain tumor are prone to develop visual impairment, which to date is often underestimated and unrecognized. Our aim was to assess the prevalence of ophthalmological evaluation and abnormal ophthalmological findings, and investigate whether demographic and tumor-related characteristics are associated with abnormal ophthalmological findings in children presenting with a primary brain tumor. METHODS Medical records of all 90 children diagnosed with a primary brain tumor between June 2018 and May 2019 and treated at the Princess Máxima Center for Pediatric Oncology, a tertiary referral center in the Netherlands, were retrospectively reviewed. Univariate regression analysis was used to investigate associations between demographic, tumor-related and clinical characteristics, and abnormal ophthalmological findings. RESULTS Sixty children (34 male [56.7%]; median [range] age, 9.3 [0-16.9] years) underwent ophthalmological evaluation within 6 weeks before or after diagnosis, 11 children (5 male [45.5%]; median [range] age, 5.7 [0.1-17.2] years) were seen more than 6 weeks before or after diagnosis, and 19 children (7 male [36.8%]; median [range] age, 7.2 [1.9-16.6] years) did not receive ophthalmological evaluation within at least 6 months from diagnosis. A total of 19 children (21.1%) presented with visual symptoms as first sign leading to the diagnosis of a brain tumor. Children who presented with visual symptoms (odds ratio [OR], 22.52; 95% confidence interval [CI], 4.90-103.60) and/or hydrocephalus (OR, 3.60; 95% CI, 1.38-9.36) at diagnosis were more often seen for ophthalmological evaluation. The most common abnormal ophthalmological findings were eye movement disorders (66.0%), papilledema (44.1%), and visual field defects (58.1%). Eye movement disorders occurred more frequently in patients with an infratentorial tumor (OR, 4.71; 95% CI, 1.03-21.65). The risk of papilledema was associated with older age (OR, 1.19; 95% CI, 1.05-1.34), hydrocephalus (OR, 9.63; 95% CI, 2.68-34.61), and infratentorial (OR, 9.11; 95% CI, 1.77-46.78) and supratentorial (OR, 13.13; 95% CI, 1.92-89.52) tumors. CONCLUSIONS In this study, most children with a primary brain tumor underwent ophthalmological evaluation around diagnosis, 21% of the children were not evaluated. The high prevalence of abnormal ophthalmological findings stresses the importance of early standardized ophthalmological evaluation to detect visual impairment and provide timely treatment to potentially prevent permanent visual loss.
Collapse
|
14
|
Muijzer MB, Schellekens PA, Beckers HJM, de Boer JH, Imhof SM, Wisse RPL. Clinical applications for intraoperative optical coherence tomography: a systematic review. Eye (Lond) 2022; 36:379-391. [PMID: 34272509 PMCID: PMC8807841 DOI: 10.1038/s41433-021-01686-9] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
In this systematic review, we provide an overview of the current state of intraoperative optical coherence tomography (iOCT). As iOCT technology is increasingly utilized, its current clinical applications and potential uses warrant attention. Here, we categorize the findings of various studies by their respective fields, including the use of iOCT in vitreoretinal surgery, corneal surgery, glaucoma surgery, cataract surgery, and pediatric ophthalmology. The trend observed in recent decades towards performing minimally invasive ophthalmic surgery has caused practitioners to recognize the limitations of using a conventional surgical microscope for intraoperative visualization. Thus, the superior visualization provided by iOCT can improve the safety of these surgical techniques and promote the development of new minimally invasive ophthalmic surgeries. Landmark prospective studies found that iOCT can significantly affect surgical decision making and can cause a subsequent change in surgical strategy, and the use of iOCT has potential to improve surgical outcome. Despite these advantages, however, iOCT is still a relatively new technique, and beginning users of iOCT can encounter limitations that can preclude their reaching the full potential of iOCT and in this respect several improvements are needed.
Collapse
Affiliation(s)
- Marc B. Muijzer
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter A.W.J. Schellekens
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henny J. M. Beckers
- grid.412966.e0000 0004 0480 1382University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joke H. de Boer
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia M. Imhof
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert P. L. Wisse
- grid.7692.a0000000090126352Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
15
|
Nuijts MA, Imhof SM, Veldhuis N, Dekkers CC, Schouten – van Meeteren AYN, Stegeman I. The diagnostic accuracy and prognostic value of OCT for the evaluation of the visual function in children with a brain tumour: A systematic review. PLoS One 2021; 16:e0261631. [PMID: 34941930 PMCID: PMC8699950 DOI: 10.1371/journal.pone.0261631] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose To systematically review the evidence on the diagnostic accuracy and prognostic value of retinal optical coherence tomography (OCT) to detect visual acuity (VA) or visual field (VF) loss in children with a brain tumour. Methods PubMed, Embase and Cochrane Library databases were searched from inception to February 2021. We included studies evaluating retinal OCT and standard visual function parameters (VA and or VF) in children with a brain tumour. Two authors independently extracted data from each included study. They also assessed the methodological quality of the studies using the QUADAS-2 or QUIPS tool. The diagnostic accuracy of OCT was evaluated with receiver operating characteristic analysis, sensitivity, specificity, positive predictive value and negative predictive value. The prognostic value of OCT was evaluated with predictive measures (odds ratio). Results We included five diagnostic studies, with a total of 186 patients, all diagnosed with optic pathway glioma. No prognostic studies were eligible for inclusion. Included studies evaluated either retinal nerve fiber layer (RNFL) thickness or ganglion cell layer—inner plexiform layer (GCL-IPL) thickness. There was considerable heterogeneity between OCT devices, OCT protocols, visual function parameters and threshold values. Sensitivity and specificity for RNFL thickness measurement ranged from 60.0% to 100.0% and 76.6% to 100%, respectively. For GCL-IPL thickness measurement, area under the curve ranged from 0.91 to 0.98 for different diameters. Conclusion The literature regarding the diagnostic accuracy and prognostic value of OCT parameters in children with a brain tumour is scarce. Due to heterogeneity and a considerable risk of bias of included studies, we cannot draw solid conclusions regarding the accuracy of retinal OCT. Future research should investigate the potential of OCT as diagnostic and prognostic tool for the evaluation of the visual function and detection of visual impairment in children with any type of brain tumour.
Collapse
Affiliation(s)
- Myrthe A. Nuijts
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nienke Veldhuis
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Coco C. Dekkers
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | | | - Inge Stegeman
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology and Head & Neck Surgery University, University Medical Centre Utrecht, Utrecht, The Netherlands
- Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Claessens JLJ, Geuvers JR, Imhof SM, Wisse RPL. Digital Tools for the Self-Assessment of Visual Acuity: A Systematic Review. Ophthalmol Ther 2021; 10:715-730. [PMID: 34169468 PMCID: PMC8225487 DOI: 10.1007/s40123-021-00360-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Numerous digital tools to self-assess visual acuity have been introduced. The recent COVID-19 pandemic underlined the need for high-quality remote care. This review gives a current overview of digital tools for remotely assessing visual function and reports on their accuracy. Methods We searched the databases of Embase and Pubmed, and systematically reviewed the literature, conforming to PRISMA guidelines. Two preliminary papers were added from medRxiv.org. The main outcome was the agreement of the digital tools with conventional clinical charts, as expressed by mean differences and 95% limits of agreement (95% LoA). Results Seventeen publications included studies reported on 13 different digital tools. Most of the tools focus on distance visual acuity. The mean differences of the digital tools ranged from − 0.08 to 0.10 logMAR, when compared to traditional clinical assessments. The 95% LoA differed considerably between studies: from ± 0.08 logMAR to ± 0.47 logMAR, though the variability was less pronounced for higher visual acuities. Conclusion The low mean differences between digital visual acuity assessments and reference charts suggest clinical equivalence, though the wide 95% LoA identify a lower precision of digital self-assessments. This effect diminishes in individuals with better visual acuities, which is a common feature of visual acuity assessments. There is great potential for the digital tools to increase access to eye care and we expect the accuracy of the current tools to improve with every iteration in technology development. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00360-3.
Collapse
Affiliation(s)
- Janneau L J Claessens
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GX, Utrecht, The Netherlands.
| | - Judith R Geuvers
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GX, Utrecht, The Netherlands
| | - Robert P L Wisse
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GX, Utrecht, The Netherlands
| |
Collapse
|
17
|
Risseeuw S, van Leeuwen R, Imhof SM, Spiering W, Norel JOV. The Natural History of Bruch’s Membrane Calcification in Pseudoxanthoma Elasticum. Ophthalmology Science 2021. [PMID: 37487136 PMCID: PMC9560584 DOI: 10.1016/j.xops.2020.100001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose To describe the natural history of Bruch’s membrane (BM) calcification in patients with pseudoxanthoma elasticum (PXE). Design Retrospective cohort study. Participants Both eyes of 120 PXE patients younger than 50 years, 78 of whom had follow-up imaging after more than 1 year. Methods All patients underwent multimodal imaging, including color fundus photography, near-infrared reflectance (NIR) imaging, and late phase indocyanine green angiography (ICGA). We determined the distance from the optic disc to the central and temporal border of peau d’orange on NIR, expressed in horizontal optic disc diameter (ODD). The length of the longest angioid streak was classified into 5 zones. Main Outcome Measures Age-specific changes of peau d’orange, angioid streaks, and ICGA hypofluorescence as surrogate markers for the extent of BM calcification. Results In cross-sectional analysis, longer angioid streaks were associated with increasing age (P < 0.001 for trend). The temporal border of peau d’orange showed a weak association with increasing age (β = 0.02; 95% confidence interval [CI], 0.00–0.04), whereas the central border showed a strong association (β = 0.12; 95% CI, 0.09–0.15). Longitudinal analysis revealed a median shift of the central border to the periphery of 0.08 ODD per year (interquartile range [IQR], 0.00–0.17; P < 0.001). This shift was more pronounced in patients younger than 20 years (0.12 ODD per year [IQR, 0.08–0.28]) than in patients older than 40 years (0.07 ODD per year [IQR, –0.05 to 0.15]). The temporal border did not shift during follow-up (P = 0.69). New or growing angioid streaks were detected in 39 of 156 eyes (25%). The hypofluorescent area on ICGA was visible only in the fourth or fifth decade and correlated with longer angioid streaks. Conclusions In PXE patients, the speckled BM calcification slowly confluences during life. The location of the temporal border of peau d’orange remains rather constant, whereas the central border shifts to the periphery. This suggests the presence of a predetermined area for BM calcification. A larger ICGA hypofluorescent area correlates with older age and longer angioid streaks, which implies that it depends on the degree of BM calcification.
Collapse
|
18
|
Risseeuw S, Ossewaarde-van Norel J, van Buchem C, Spiering W, Imhof SM, van Leeuwen R. The Extent of Angioid Streaks Correlates With Macular Degeneration in Pseudoxanthoma Elasticum. Am J Ophthalmol 2020; 220:82-90. [PMID: 32702361 DOI: 10.1016/j.ajo.2020.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate whether the extent of Bruch's membrane calcification is associated with choroidal neovascularization (CNV) and macular atrophy in patients with pseudoxanthoma elasticum (PXE) by using the extent of angioid streaks as a surrogate marker for the degree of Bruch's membrane calcification. DESIGN Retrospective cross-sectional study. METHODS We investigated 301 patients with PXE (median age, 52 years; range, 9-79 years) in a tertiary referral center. For both eyes, we graded the extent of angioid streaks, that is, their distance from the optic disc, into 5 groups. Imaging was systematically assessed for signs of CNV and macular atrophy. Associations between the extent of angioid streaks and CNV or macular atrophy were investigated using regression analysis. RESULTS CNV was present in 148 patients (49%) and retinal atrophy in 71 patients (24%). The extent of angioid streaks was associated with older age (P for trend = 1.92 × 10-15) and a higher prevalence of CNV and/or macular atrophy (P for trend = 4.22 × 10-10 and P for trend = 5.17 × 10-6, respectively). In addition, the extent of angioid streaks was associated with the presence of CNV when adjusted for age and sex (odds ratio, 1.9; 95% confidence interval, 1.3-2.9) and with more severe macular atrophy (proportional odds ratio, 2.3; 95% confidence interval, 1.5-3.6). CONCLUSIONS In patients with PXE, longer angioid streaks are associated with an increased risk of CNV and macular atrophy, even after adjustment for age. These findings are relevant when counseling PXE patients on their visual prognosis.
Collapse
|
19
|
Portengen BL, Roelofzen C, Porro GL, Imhof SM, Fracasso A, Naber M. Blind spot and visual field anisotropy detection with flicker pupil perimetry across brightness and task variations. Vision Res 2020; 178:79-85. [PMID: 33161146 DOI: 10.1016/j.visres.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
The pupil can be used as an objective measure for testing sensitivities across the visual field (pupil perimetry; PP). The recently developed gaze-contingent flicker PP (gcFPP) is a promising novel form of PP, with improved sensitivity due to retinotopically stable and repeated flickering stimulations, in a short time span. As a diagnostic tool gcFPP has not yet been benchmarked in healthy individuals. The main aims of the current study were to investigate whether gcFPP has the sensitivity to detect the blind spot, and upper versus lower visual field differences that were found before in previous studies. An additional aim was to test for the effects of attentional requirements and background luminance. A total of thirty individuals were tested with gcFPP across two separate experiments. The results showed that pupil oscillation amplitudes were smaller for stimuli presented inside as compared to outside the blind spot. Amplitudes also decreased as a function of eccentricity (i.e., distance to fixation) and were larger for upper as compared to lower visual fields. We measured the strongest and most sensitive pupil responses to stimuli presented on dark- and mid-gray backgrounds, and when observers covertly focused their attention to the flickering stimulus. GcFPP thus evokes pupil responses that are sensitive enough to detect local, and global differences in pupil sensitivity. The findings further encourage (1) the use of a gray background to prevent straylight without affecting gcFPPs sensitivity and (2) the use of an attention task to enhance pupil sensitivity.
Collapse
Affiliation(s)
- Brendan L Portengen
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands.
| | - Carlien Roelofzen
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands; Experimental and Applied Psychology, VU University Amsterdam, The Netherlands; Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands
| | - Giorgio L Porro
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands
| | - Saskia M Imhof
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands
| | - Alessio Fracasso
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands; Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands; Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Marnix Naber
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands
| |
Collapse
|
20
|
Risseeuw S, van Leeuwen R, Imhof SM, de Jong PA, Mali WPTM, Spiering W, Ossewaarde–van Norel J. The effect of etidronate on choroidal neovascular activity in patients with pseudoxanthoma elasticum. PLoS One 2020; 15:e0240970. [PMID: 33079965 PMCID: PMC7575070 DOI: 10.1371/journal.pone.0240970] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/05/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To assess the effect of the bisphosphonate etidronate on choroidal neovascular (CNV) activity in patients with pseudoxanthoma elasticum (PXE). Methods This is an ancillary study in a single center, randomized, double-blind placebo-controlled trial (RCT) in which 74 patients with PXE were assigned to either one-year etidronate or placebo treatment. Spectral domain optical coherence tomography (SD-OCT) imaging and color fundus photography were performed every three months for one year and were systematically assessed on signs of CNV activity. Results In the etidronate group, 11 (30%) of the patients had CNV activity at baseline, compared to 25 (67%) of the patients in the placebo group (P = 0.005). The proportion of eyes with CNV activity during the study ranged from 18–33% in the etidronate group and 42–56% in the placebo group and no significant difference in improvement or worsening of CNV activity was found (P = 0.168). Using a generalized mixed model for repeated measures, there was a protective effect of etidronate in crude analysis (RR 0.86, 95% CI 0.75–0.98) that disappeared when adjusting for baseline CNV activity (RR 0.97, 95% CI 0.84–1.13). Conclusion In this post-hoc RCT analysis we did not observe a protecting or deteriorating effect of etidronate on CNV activity in patients with PXE after adjustment for baseline CNV.
Collapse
Affiliation(s)
- Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Willem P. Th. M. Mali
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | |
Collapse
|
21
|
Nuijts MA, Veldhuis N, Stegeman I, van Santen HM, Porro GL, Imhof SM, Schouten–van Meeteren AYN. Visual functions in children with craniopharyngioma at diagnosis: A systematic review. PLoS One 2020; 15:e0240016. [PMID: 33002047 PMCID: PMC7529266 DOI: 10.1371/journal.pone.0240016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Childhood craniopharyngioma is a rare and slow growing brain tumour, often located in the sellar and suprasellar region. It commonly manifests with visual impairment, increased intracranial pressure and hypothalamic and/or pituitary deficiencies. Visual impairment in childhood adversely affects a child’s daily functioning and quality of life. We systematically reviewed the literature to provide an extensive overview of the visual function in children with craniopharyngioma at diagnosis in order to estimate the diversity, magnitude and relevance of the problem of visual impairment. Of the 543 potentially relevant articles, 84 studies met our inclusion criteria. Visual impairment at diagnosis was reported in 1041 of 2071 children (50.3%), decreased visual acuity was reported in 546 of 1321 children (41.3%) and visual field defects were reported in 426 of 1111 children (38.3%). Other ophthalmological findings described were fundoscopic (32.5%) and orthoptic abnormalities (12.5%). Variations in ophthalmological testing methods and ophthalmological definitions precluded a meta-analysis. The results of this review confirm the importance of ophthalmological examination in children with craniopharyngioma at diagnosis in order to detect visual impairment and provide adequate support. Future studies should focus on long-term visual follow-up of childhood craniopharyngioma in response to different treatment strategies to provide insight in risks and ways to prevent further loss of vision.
Collapse
Affiliation(s)
- Myrthe A. Nuijts
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- * E-mail:
| | - Nienke Veldhuis
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hanneke M. van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | |
Collapse
|
22
|
Risseeuw S, Bartstra J, Ossewaarde-van Norel J, Geurts LJ, Li CHZ, Imhof SM, Spiering W, de Jong PA, van Leeuwen R. Is arterial stiffness in the carotid artery associated with choroidal thinning in patients with pseudoxanthoma elasticum or controls? Acta Ophthalmol 2020; 98:492-499. [PMID: 31943777 DOI: 10.1111/aos.14346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/20/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Patients with pseudoxanthoma elasticum (PXE) develop calcification of Bruch's membrane (BM) and choroidal thinning, as well as calcification of intracranial arteries, leading to arterial stiffness. We investigated whether arterial stiffness is associated with choroidal thinning in PXE patients, besides the presumed effect of BM calcification. METHODS Cross-sectional study with 75 PXE patients and 40 controls. Macular choroidal thickness was measured using optical coherence tomography scans. Functional magnetic resonance imaging was used to calculate the pulsatility index (PI) of the carotid siphon as a measure of arterial stiffness. Associations between PI and choroidal thickness were investigated using linear mixed effects models adjusted for age and ocular axial length. Furthermore, we investigated choroidal thickness in relation to the presence of retinal pigment epithelium (RPE) atrophy, its topographical distribution and age. RESULTS Median age was 58 years (IQR 53-66) in PXE patients and 62 years (IQR 56-67) in controls (p = 0.08). Pseudoxanthoma elasticum (PXE) patients had a thinner choroid than controls (138 μm versus 248 μm, p < 0.01). No association was observed between PI and choroidal thickness in PXE patients (β = -1.6, 95% CI -59.4 to 54.5) nor in controls (β =-47.6, 95% CI -129.7 to 31.9). In PXE patients, RPE atrophy was associated with a thinner choroid (p < 0.01). Also, the nasal choroid was thinner than the temporal choroid, and choroidal thickness already decreased with age in PXE eyes without RPE atrophy. CONCLUSION There was no independent association between measures of arterial stiffness and choroidal thinning in PXE patients and controls. Probably, changes in BM lead to choroidal thinning in PXE.
Collapse
Affiliation(s)
- Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jonas Bartstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Lennart J Geurts
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Catherina H Z Li
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
23
|
Risseeuw S, Bennink E, Poirot MG, de Jong PA, Spiering W, Imhof SM, van Leeuwen R, Ossewaarde-van Norel J. A Reflectivity Measure to Quantify Bruch's Membrane Calcification in Patients with Pseudoxanthoma Elasticum Using Optical Coherence Tomography. Transl Vis Sci Technol 2020; 9:34. [PMID: 32855880 PMCID: PMC7422762 DOI: 10.1167/tvst.9.8.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Progressive calcification of Bruch's membrane (BM) causes considerable visual morbidity in patients with pseudoxanthoma elasticum (PXE). Since calcification is hyperreflective on optical coherence tomography (OCT), our aim was to measure BM calcification with OCT imaging. Methods Case-control study with 45 patients with PXE under 40 years (range, 11-39) and 25 controls (range, 14-39). Spectralis HRA-OCT imaging consisted of seven macular B-scans with 250-µm spacing. Retinal segmentation was performed with the IOWA Reference Algorithms. MATLAB was used to extract and average z-axis reflectivity profiles. Layer reflectivities were normalized to the ganglion cell and inner plexiform layers. Both median and peak layer reflectivities were compared between patients with PXE and controls. The discriminative value of the retinal pigment epithelium (RPE)-BM peak reflectivity was analyzed using receiver operating characteristic analysis. Results The reflectivity profile of patients with PXE differed from controls in the outer retinal layers. The normalized median RPE-BM reflectivity was 41.1 (interquartile range [IQR], 26.3-51.9) in patients with PXE, compared with 22.5 (IQR, 19.3-29.5) in controls (P = 2.09 × 10-3). The normalized RPE-BM peak reflectivity was higher in patients with PXE (67.5; IQR, 42.1-84.2) than in controls (32.7; IQR, 25.7-38.9; P = 2.43 × 10-5) and had a high discriminative value with an area under the curve of 0.85 (95% confidence interval, 0.76-0.95). In patients with PXE under 40 years, increasing age did not have a statistically significant effect on the RPE-BM peak reflectivity (patients under 20 years: 44.2 [IQR, 40.5-74.6]; 20-30 years: 66.0 [IQR, 45.1-83.8]; 30-40 years: 70.8 [IQR, 49.0-88.0], P = 0.47). Conclusions BM calcification can be measured as increased RPE-BM reflectivity in young patients with PXE and has a high discriminative value. Translational Relevance In patients with PXE, the OCT reflectivity of Bruch's membrane may be the first biomarker for Bruch's membrane calcification and a valuable ophthalmologic endpoint in clinical trials.
Collapse
Affiliation(s)
- Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Edwin Bennink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten G Poirot
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | |
Collapse
|
24
|
Portengen BL, Koenraads Y, Imhof SM, Porro GL. Lessons Learned from 23 Years of Experience in Testing Visual Fields of Neurologically Impaired Children. Neuroophthalmology 2020; 44:361-370. [PMID: 33335343 PMCID: PMC7722704 DOI: 10.1080/01658107.2020.1762097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/07/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 11/21/2022] Open
Abstract
We sought to investigate the reliability of standard conventional perimetry (SCP) in neurologically impaired (NI) children using the examiner-based assessment of reliability scoring system and to determine the difference in time to diagnosis of a visual field defect between SCP and a behavioural visual field (BVF) test. Patient records of 115 NI children were retrospectively analysed. The full field peritest (FFP) had best reliability with 44% 'good' scores versus 22% for Goldmann perimetry (p < .001). The mean age of NI children able to perform SCP was 8.3 years versus 4.6 years for the BVF test (p < .001). Use of the BVF test may significantly reduce time to diagnosis.
Collapse
Affiliation(s)
- Brendan L. Portengen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne Koenraads
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
25
|
Nuijts MA, Degeling MH, Stegeman I, Schouten-van Meeteren AYN, Imhof SM. Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study). BMC Ophthalmol 2019; 19:220. [PMID: 31706271 PMCID: PMC6842490 DOI: 10.1186/s12886-019-1225-8] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/23/2019] [Indexed: 01/11/2023] Open
Abstract
Background Children with a brain tumor have a high risk of impaired vision. Up to now, visual acuity measurement, visual field testing and orthoptic testing are the most informative diagnostic investigations for the assessment of visual function. Evaluating vision in children can be challenging given the challenges in cooperation, concentration and age-dependent shifts in visual tests. Since visual loss due to a brain tumor can be progressive and irreversible, we must aim to detect visual impairment as early as possible. Several studies have shown that optical coherence tomography facilitates discovery of nerve fiber damage caused by optic nerve glioma. Consequently, early detection of potential ocular damage will effect treatment decisions and will provide timely referral to visual rehabilitation centers. Methods/design The CCISS study is a prospective, observational, multicenter cohort study in The Netherlands. Patients aged 0–18 years with a newly diagnosed brain tumor are invited for inclusion in this study. Follow-up visits are planned at 6, 12, 18 and 24 months. Primary endpoints are visual acuity, visual field and optical coherence tomography parameters (retinal nerve fiber layer thickness and ganglion cell layer – inner plexiform layer thickness). Secondary endpoints include the course of visual function (measured by visual acuity, visual field and optical coherence tomography at different follow-up visits), course of the disease and types of treatment. Discussion The CCISS study will heighten the awareness of visual impairment in different types of brain tumors in children. This study will show whether optical coherence tomography leads to earlier detection of visual impairment compared to standard ophthalmological testing (i.e. visual acuity, visual field testing) in children with a brain tumor. Furthermore, the systematic approach of ophthalmological follow-up in this study will give us insight in the longitudinal relation between the course of visual function, course of the disease and types of treatment in children with a brain tumor. Trial registration The CCISS study is prospectively registered in the Netherlands Trial Register (NTR) since April 2019. Identifier: NL7697.
Collapse
Affiliation(s)
- M A Nuijts
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Room E 03.136, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - M H Degeling
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Stegeman
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - S M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
26
|
Kranenburg G, de Jong PA, Bartstra JW, Lagerweij SJ, Lam MG, Ossewaarde-van Norel J, Risseeuw S, van Leeuwen R, Imhof SM, Verhaar HJ, de Vries JJ, Slart RHJA, Luurtsema G, den Harder AM, Visseren FLJ, Mali WP, Spiering W. Etidronate for Prevention of Ectopic Mineralization in Patients With Pseudoxanthoma Elasticum. J Am Coll Cardiol 2019. [PMID: 29519353 DOI: 10.1016/j.jacc.2017.12.062] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In pseudoxanthoma elasticum (PXE), low pyrophosphate levels may cause ectopic mineralization, leading to skin changes, visual impairment, and peripheral arterial disease. OBJECTIVES The authors hypothesized that etidronate, a pyrophosphate analog, might reduce ectopic mineralization in PXE. METHODS In the Treatment of Ectopic Mineralization in Pseudoxanthoma Elasticum trial, adults with PXE and leg arterial calcifications (n = 74) were randomly assigned to etidronate or placebo (cyclical 20 mg/kg for 2 weeks every 12 weeks). The primary outcome was ectopic mineralization, quantified with 18fluoride positron emission tomography scans as femoral arterial wall target-to-background ratios (TBRfemoral). Secondary outcomes were computed tomography arterial calcification and ophthalmological changes. Safety outcomes were bone density, serum calcium, and phosphate. RESULTS During 12 months of follow-up, the TBRfemoral increased 6% (interquartile range [IQR]: -12% to 25%) in the etidronate group and 7% (IQR: -9% to 32%) in the placebo group (p = 0.465). Arterial calcification decreased 4% (IQR: -11% to 7%) in the etidronate group and increased 8% (IQR: -1% to 20%) in the placebo group (p = 0.001). Etidronate treatment was associated with significantly fewer subretinal neovascularization events (1 vs. 9, p = 0.007). Bone density decreased 4% ± 12% in the etidronate group and 6% ± 9% in the placebo group (p = 0.374). Hypocalcemia (<2.20 mmol/l) occurred in 3 versus 1 patient (8.1% vs. 2.7%, p = 0.304). Eighteen patients (48.6%) treated with etidronate, compared with 0 patients treated with placebo (p < 0.001), experienced hyperphosphatemia (>1.5 mmol/l) and recovered spontaneously. CONCLUSIONS In patients with PXE, etidronate reduced arterial calcification and subretinal neovascularization events but did not lower femoral 18fluoride sodium positron emission tomography activity compared with placebo, without important safety issues. (Treatment of Ectopic Mineralization in Pseudoxanthoma elasticum; NTR5180).
Collapse
Affiliation(s)
- Guido Kranenburg
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jonas W Bartstra
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Suzanne J Lagerweij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marnix G Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Harald J Verhaar
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Job J de Vries
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gert Luurtsema
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Annemarie M den Harder
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Willem P Mali
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| |
Collapse
|
27
|
Verhagen FH, Stigter ECA, Pras-Raves ML, Burgering BMT, Imhof SM, Radstake TRDJ, de Boer JH, Kuiper JJW. Aqueous Humor Analysis Identifies Higher Branched Chain Amino Acid Metabolism as a Marker for Human Leukocyte Antigen-B27 Acute Anterior Uveitis and Disease Activity. Am J Ophthalmol 2019; 198:97-110. [PMID: 30312576 DOI: 10.1016/j.ajo.2018.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Human leukocyte antigen-B27 (HLA-B27)-positive acute anterior uveitis (AAU) has a higher recurrence rate and shows more anterior chamber cell infiltration compared with HLA-B27-negative patients, suggesting distinct etiologies of these clinically overlapping conditions. To advance our understanding of the biology of AAU, we characterized the metabolic profile of aqueous humor (AqH) of patients with HLA-B27-associated AAU (B27-AAU) and noninfectious idiopathic AAU (idiopathic AAU). DESIGN Experimental laboratory study. METHODS AqH samples from 2 independent cohorts totaling 30 patients with B27-AAU, 16 patients with idiopathic AAU, and 20 patients with cataracts underwent 2 individual rounds of direct infusion mass spectrometry. Features predicted by direct infusion mass spectrometry that facilitated maximum separation between the disease groups in regression models were validated by liquid chromatography/tandem mass spectrometry-based quantification with appropriate standards. RESULTS Partial least square-discriminant analysis revealed metabolite profiles that were able to separate patients with B27-AAU from those with iodiopathic AAU. Pathway enrichment analysis, based on metabolites on which separation of the groups in the partial least square-discriminant analysis model was based, demonstrated the involvement of branched-chain amino acid biosynthesis, ascorbate and aldarate metabolism, the tricarboxylic acid cycle, and glycolysis-diverting pathways (eg, serine biosynthesis) across all investigated cohorts. Notably, the metabolite ketoleucine was elevated in B27-AAU across all 3 runs and moderately-but robustly-correlated with anterior chamber cell count (correlation coefficient range 0.41-0.81). CONCLUSIONS These results illustrate metabolic heterogeneity between HLA-B27-positive and HLA-B27-negative AAU, including an increase of branched-chain amino acid biosynthesis, that reflects disease activity in AAU.
Collapse
Affiliation(s)
- Fleurieke H Verhagen
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Edwin C A Stigter
- Department Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mia L Pras-Raves
- Department Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Boudewijn M T Burgering
- Department Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Timothy R D J Radstake
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht, the Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands; Department Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands; Section of Metabolic Diseases, and the Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joke H de Boer
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands; Department Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jonas J W Kuiper
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
28
|
Verhagen FH, Hiddingh S, Rijken R, Pandit A, Leijten E, Olde Nordkamp M, Ten Dam-van Loon NH, Nierkens S, Imhof SM, de Boer JH, Radstake TRDJ, Kuiper JJW. High-Dimensional Profiling Reveals Heterogeneity of the Th17 Subset and Its Association With Systemic Immunomodulatory Treatment in Non-infectious Uveitis. Front Immunol 2018; 9:2519. [PMID: 30429855 PMCID: PMC6220365 DOI: 10.3389/fimmu.2018.02519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/12/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Non-infectious uveitis (NIU) is a severe intra ocular inflammation, which frequently requires prompt systemic immunosuppressive therapy (IMT) to halt the development of vision-threatening complications. IMT is considered when NIU cannot be treated with corticosteroids alone, which is unpredictable in advance. Previous studies have linked blood cell subsets to glucocorticoid sensitivity, which suggests that the composition of blood leukocytes may early identify patients that will require IMT. Objective: To map the blood leukocyte composition of NIU and identify cell subsets that stratify patients that required IMT during follow-up. Methods: We performed controlled flow cytometry experiments measuring a total of 37 protein markers in the blood of 30 IMT free patients with active non-infectious anterior, intermediate, and posterior uveitis, and compared these to 15 age and sex matched healthy controls. Results from manual gating were validated by automatic unsupervised gating using FlowSOM. Results: Patients with uveitis displayed lower relative frequencies of Natural Killer cells and higher relative frequencies of memory T cells, in particular the CCR6+ lineages. These results were confirmed by automatic gating by unsupervised clustering using FlowSOM. We observed considerable heterogeneity in memory T cell subsets and abundance of CXCR3-CCR6+ (Th17) cells between the uveitis subtypes. Importantly, regardless of the uveitis subtype, patients that eventually required IMT in the course of the study follow-up exhibited increased CCR6+ T cell abundance before commencing therapy. Conclusion: High-dimensional immunoprofiling in NIU patients shows that clinically distinct forms of human NIU exhibit shared as well as unique immune cell perturbations in the peripheral blood and link CCR6+ T cell abundance to systemic immunomodulatory treatment.
Collapse
Affiliation(s)
- Fleurieke H Verhagen
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sanne Hiddingh
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rianne Rijken
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Aridaman Pandit
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Emmerik Leijten
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Michel Olde Nordkamp
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ninette H Ten Dam-van Loon
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Stefan Nierkens
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joke H de Boer
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Timothy R D J Radstake
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jonas J W Kuiper
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
29
|
Wisse RPL, Gadiot S, Soeters N, Godefrooij DA, Imhof SM, van der Lelij A. Higher-order aberrations 1 year after corneal collagen crosslinking for keratoconus and their independent effect on visual acuity. J Cataract Refract Surg 2018; 42:1046-52. [PMID: 27492104 DOI: 10.1016/j.jcrs.2016.04.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of corneal collagen crosslinking (CXL) in progressive keratoconus patients on higher-order aberrations (HOAs) and the effect of change in HOAs on visual acuity between baseline and 1 year after CXL. SETTING Tertiary academic referral center, Utrecht, the Netherlands. DESIGN Prospective cohort study. METHODS This study included consecutive keratoconus patients who were treated with epithelium-off CXL and followed for a minimum of 1 year. The following corneal HOAs were measured with Scheimpflug tomography (Pentacam HR type 70900): coma, trefoil, spherical aberration, and total corneal HOAs. A 2-tailed paired-samples t test was used to compare baseline and postoperative aberrations. Multivariable linear regression was applied to assess the independent effects of HOA subtypes on changes in uncorrected (UDVA) and corrected (CDVA) distance visual acuity. RESULTS Overall, the degree of corneal HOAs in the patient cohort (N = 187) was relatively unchanged after CXL, with a mean change of -1.34% (P = .272). Horizontal coma contributed most to the total amount of HOAs but was virtually unchanged on average. The HOA subtype of spherical aberrations decreased significantly (-15.68%) (P < .001). There was no effect of the change in HOAs on the change in CDVA; however, there was a significant effect of the change in horizontal coma on the change in UDVA (P = .003; B -0.475). CONCLUSIONS Corneal HOAs in general were relatively unchanged from baseline to 1 year after CXL in eyes with progressive keratoconus. A change in horizontal coma had a strong and independent effect on UDVA. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Robert P L Wisse
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Stijn Gadiot
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nienke Soeters
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel A Godefrooij
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia M Imhof
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Allegonda van der Lelij
- From the Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
30
|
Verhagen FH, Bekker CPJ, Rossato M, Hiddingh S, de Vries L, Devaprasad A, Pandit A, Ossewaarde-van Norel J, Ten Dam N, Moret-Pot MCA, Imhof SM, de Boer JH, Radstake TRDJ, Kuiper JJW. A Disease-Associated MicroRNA Cluster Links Inflammatory Pathways and an Altered Composition of Leukocyte Subsets to Noninfectious Uveitis. Invest Ophthalmol Vis Sci 2018; 59:878-888. [PMID: 29435587 DOI: 10.1167/iovs.17-23643] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The cause of noninfectious uveitis (NIU) is poorly understood but is considered to be mediated by a complex interplay between genetic, environmental, and-relatively unexplored-epigenetic factors. MicroRNAs (miRNAs) are noncoding small RNAs that are important epigenetic regulators implicated in pathologic signaling. Therefore, we mapped the circulating miRNA-ome of NIU patients and studied miRNA perturbations within the broader context of the immune system. Methods We designed a strategy to robustly identify changes in the miRNA profiles of two independent cohorts totaling 54 untreated patients with active and eye-restricted disease and 26 age-matched controls. High-resolution miRNA-ome data were obtained by TaqMan OpenArray technology and subsequent RT-qPCR. Flow cytometry data, and proteomic data spanning the cellular immune system, were used to map the uveitis-miRNA signature to changes in the composition of specific leukocyte subsets in blood. Results Using stringent selection criteria, we identified and independently validated an miRNA cluster that is associated with NIU. Pathway enrichment analysis for genes targeted by this cluster revealed significant enrichment for the PI3K/Akt, MAPK, FOXO, and VEGF signaling pathways, and photoreceptor development. In addition, unsupervised multidomain analyses linked the presence of the uveitis-associated miRNA cluster to a different composition of leukocyte subsets, more specifically, CD16+CD11c+HLA-DR- cells. Conclusions Together, this study identified a unique miRNA cluster associated with NIU that was related to changes in leukocyte subsets demonstrating systemic changes in epigenetic regulation underlying NIU.
Collapse
Affiliation(s)
- Fleurieke H Verhagen
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis P J Bekker
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marzia Rossato
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sanne Hiddingh
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lieuwe de Vries
- Department of Ophthalmology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Abhinandan Devaprasad
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aridaman Pandit
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Ninette Ten Dam
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maartje C A Moret-Pot
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joke H de Boer
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Timothy R D J Radstake
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jonas J W Kuiper
- Ophthalmo-Immunology Unit, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
31
|
Abstract
Postgraduate medical training in the Netherlands has become increasingly individualized. In this article, the authors describe current practices for three residency programs at the University Medical Center Utrecht: anesthesiology, pediatrics, and ophthalmology. These programs are diverse yet share characteristics allowing for individualized residency training. New residents enter each program throughout the year, avoiding a large simultaneous influx of inexperienced doctors. The usual duration of each is five years. However, the actual duration of rotations or of the program as a whole can be reduced because of residents' previous medical experience or demonstration of early mastery of relevant competencies. If necessary, the duration of training can also increase.Although working hours are already restricted by the European Working Time Directive, most residents choose to train on a part-time basis. The length of their program then is extended proportionally. The extension period added for those residents training part-time can be used to develop specific competencies, complete an elective rotation or research, or explore a focus area. If the resident meets all training objectives before the extension period is completed, the program director can choose to shorten the program length. Recently, entrustable professional activities have been introduced to strengthen workplace-based assessment. The effects on program duration have yet to be demonstrated.Flexible postgraduate training is feasible. Although improving work-life balance for residents is a necessity, attention must be paid to ensuring that they gain the necessary experience and competencies and maintain continuity of care to ensure that high-quality patient care is provided.
Collapse
Affiliation(s)
- Reinier G Hoff
- R.G. Hoff is professor of education and training in perioperative, intensive, and emergency care and program director, Anesthesiology Residency, Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands. J. Frenkel is professor of patient- and family-centered education and program director, Pediatrics Residency, Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands. S.M. Imhof is professor of ophthalmology and program director, Ophthalmology Residency, Department of Ophthalmology, and chair, Central Residency Committee, University Medical Center Utrecht, Utrecht, The Netherlands. O. ten Cate is professor of medical education, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | |
Collapse
|
32
|
Verhagen FH, Wijnhoven R, Ossewaarde-van Norel J, Ten Dam-van Loon NH, Kuiper JJW, Imhof SM, de Boer JH. Prevalence and characteristics of ocular pain in non-infectious uveitis: a quality of life study. Br J Ophthalmol 2018. [PMID: 29378727 DOI: 10.1136/bjophthalmol–2017–311575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM To survey the frequency, character, severity and impact of ocular pain on quality of life in adult patients with non-infectious uveitis (NIU). METHODS This patient-requested cross-sectional survey study describes the results of three self-administered questionnaires (the National Eye Institute Visual Function Questionnaire, the 36-Item Short Form Health Survey (SF-36) and the McGill Pain Questionnaire Dutch Language Version) from 147 patients with NIUs from a university-based tertiary referral centre in Utrecht. RESULTS The mean Visual Function Questionnaire (VFQ) Ocular Pain Score of all patients with NIU was 72 (±24), which is significantly lower than an ocular disease-free reference group (90±15, P<0.0001), indicating more ocular pain. This was true for all types of NIU, regardless of the localisation: although Ocular Pain Scores were lower in patients with anterior uveitis (AU) compared with patients with non-AU (mean 62 (±24) vs 74 (±24), P=0.04), patients with non-AU still scored substantially lower than the reference group that had no ocular history (P<0.0001). Patients with NIU also scored significantly lower on all other VFQ subscales as well as on the SF-36 subscales 'Role Limitations due to physical problems', 'Vitality', 'General health' and 'Bodily Pain' compared with controls. The VFQ Ocular Pain subscale correlated with other quality of life subscales (both VFQ-25 and SF-36), indicating a relationship between pain and quality of life. CONCLUSION This study shows that ocular pain is highly prevalent in patients with NIU, regardless of the localisation. Furthermore, ocular pain has an impact on quality of life.
Collapse
Affiliation(s)
- Fleurieke H Verhagen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ralph Wijnhoven
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Ninette H Ten Dam-van Loon
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jonas J W Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
33
|
Verhagen FH, Wijnhoven R, Ossewaarde-van Norel J, Ten Dam-van Loon NH, Kuiper JJW, Imhof SM, de Boer JH. Prevalence and characteristics of ocular pain in non-infectious uveitis: a quality of life study. Br J Ophthalmol 2018; 102:1160-1166. [PMID: 29378727 DOI: 10.1136/bjophthalmol-2017-311575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/19/2017] [Accepted: 01/13/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM To survey the frequency, character, severity and impact of ocular pain on quality of life in adult patients with non-infectious uveitis (NIU). METHODS This patient-requested cross-sectional survey study describes the results of three self-administered questionnaires (the National Eye Institute Visual Function Questionnaire, the 36-Item Short Form Health Survey (SF-36) and the McGill Pain Questionnaire Dutch Language Version) from 147 patients with NIUs from a university-based tertiary referral centre in Utrecht. RESULTS The mean Visual Function Questionnaire (VFQ) Ocular Pain Score of all patients with NIU was 72 (±24), which is significantly lower than an ocular disease-free reference group (90±15, P<0.0001), indicating more ocular pain. This was true for all types of NIU, regardless of the localisation: although Ocular Pain Scores were lower in patients with anterior uveitis (AU) compared with patients with non-AU (mean 62 (±24) vs 74 (±24), P=0.04), patients with non-AU still scored substantially lower than the reference group that had no ocular history (P<0.0001). Patients with NIU also scored significantly lower on all other VFQ subscales as well as on the SF-36 subscales 'Role Limitations due to physical problems', 'Vitality', 'General health' and 'Bodily Pain' compared with controls. The VFQ Ocular Pain subscale correlated with other quality of life subscales (both VFQ-25 and SF-36), indicating a relationship between pain and quality of life. CONCLUSION This study shows that ocular pain is highly prevalent in patients with NIU, regardless of the localisation. Furthermore, ocular pain has an impact on quality of life.
Collapse
Affiliation(s)
- Fleurieke H Verhagen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ralph Wijnhoven
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Ninette H Ten Dam-van Loon
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jonas J W Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
34
|
Godefrooij DA, Mangen MJJ, Chan E, O'Brart DPS, Imhof SM, de Wit GA, Wisse RPL. Cost-Effectiveness Analysis of Corneal Collagen Crosslinking for Progressive Keratoconus. Ophthalmology 2017; 124:1485-1495. [PMID: 28532974 DOI: 10.1016/j.ophtha.2017.04.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the cost effectiveness of corneal collagen crosslinking (CXL) for progressive keratoconus from the healthcare payer's perspective. DESIGN A probabilistic Markov-type model using data from published clinical trials and cohort studies. PARTICIPANTS Two identical cohorts, each comprising 1000 virtual patients with progressive bilateral keratoconus, were modeled; one cohort underwent CXL and the other cohort received no intervention. METHODS Both cohorts were modeled and evaluated annually over a lifetime. Quality-adjusted life years (QALYs), total cost, disease progression, and the probability of corneal transplantation, graft failure, or both were calculated based on data from published trials and cohort studies. These outcomes were compared between the 2 cohorts. In our base scenario, the stabilizing effect of CXL was assumed to be 10 years; however, longer durations also were analyzed. One-way sensitivity analyses were performed to test the robustness of the outcomes. MAIN OUTCOME MEASURE Incremental cost-effectiveness ratio (ICER), defined as euros per QALY. RESULTS Assuming a 10-year effect of CXL, the ICER was €54 384/QALY ($59 822/QALY). When we adjusted the effect of CXL to a lifelong stabilizing effect, the ICER decreased to €10 149/QALY ($11 163/QALY). Other sensitivity and scenario analyses that had a relevant impact on ICER included the discount rate, visual acuity before CXL, and healthcare costs. CONCLUSIONS Corneal collagen crosslinking for progressive keratoconus is cost effective at a willingness-to-pay threshold of 3 times the current gross domestic product (GDP) per capita. Moreover, a longer stabilizing effect of CXL increases cost effectiveness. If CXL had a stabilizing effect on keratoconus of 15 years or longer, then the ICER would be less than the 1 × GDP per capita threshold and thus very cost effective.
Collapse
Affiliation(s)
- Daniel A Godefrooij
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Marie-Josee J Mangen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Elsie Chan
- Royal Victorian Eye and Ear Hospital, Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - David P S O'Brart
- King's College, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Saskia M Imhof
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Robert P L Wisse
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
35
|
Godefrooij DA, Gans R, Imhof SM, Wisse RPL. Nationwide reduction in the number of corneal transplantations for keratoconus following the implementation of cross-linking. Acta Ophthalmol 2016; 94:675-678. [PMID: 27213687 DOI: 10.1111/aos.13095] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [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: 09/25/2015] [Accepted: 03/17/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Keratoconus is characterized by corneal ectasia and irregular astigmatism, which can lead to diminished vision and corneal scarring. Approximately 10-20% of patients with keratoconus eventually require a corneal transplant. Corneal cross-linking (CXL) is a relatively new treatment that may help prevent the need for corneal transplantation. Here, we investigated whether the introduction of CXL has reduced the number of corneal transplants performed annually. METHODS Data regarding the transplantation procedures performed in patients under the age of 50 years were extracted from the Dutch National Organ Transplant Registry. The number of corneal transplants performed prior to (i.e. in 2005 through 2007) and following the introduction of CXL (i.e. in 2012 through 2014) were compared. Furthermore, a trend analysis on annual keratoplasties over time was performed. RESULTS Approximately 25% fewer corneal transplants were performed in the 3-year period following the introduction of CXL compared to the 3-year period prior to the introduction of CXL (201 versus 269 transplants, respectively; p = 0.005). Age, gender and visual acuity were similar between the patient groups in the two time periods. Trend analysis also demonstrated a significant decrease in the amount of corneal transplants (p = 0.001). CONCLUSION Significantly fewer corneal transplants were performed for treating keratoconus following the nationwide introduction of CXL. This reduction suggests that corneal cross-linking can significantly reduce the need for corneal transplantation.
Collapse
Affiliation(s)
- Daniel A. Godefrooij
- Department of Ophthalmology; Utrecht Cornea Research Group; University Medical Center Utrecht; Utrecht The Netherlands
| | - Renze Gans
- Department of Ophthalmology; Utrecht Cornea Research Group; University Medical Center Utrecht; Utrecht The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology; Utrecht Cornea Research Group; University Medical Center Utrecht; Utrecht The Netherlands
| | - Robert P. L. Wisse
- Department of Ophthalmology; Utrecht Cornea Research Group; University Medical Center Utrecht; Utrecht The Netherlands
| |
Collapse
|
36
|
Koenraads Y, van Egmond-Ebbeling MB, de Boer JH, Imhof SM, Braun KPJ, Porro GL. Visual outcome in Sturge-Weber syndrome: a systematic review and Dutch multicentre cohort. Acta Ophthalmol 2016; 94:638-645. [PMID: 27238857 DOI: 10.1111/aos.13074] [Citation(s) in RCA: 11] [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: 01/20/2016] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Abstract
Visual functions in Sturge-Weber syndrome (SWS) may be impaired by glaucoma, diffuse choroidal haemangioma (DCH) or leptomeningeal angioma. The aim of this study was to gain better insight in the visual deficits of SWS patients. A systematic literature search using PubMed and Embase medical databases was performed to identify articles describing visual acuity (VA) and/or visual field (VF) findings in SWS patients. In addition, a Dutch multicentre cohort with 33 SWS patients was collected and the combined results of VA and VF findings are presented. Visual acuity results of 25 studies and VF results of 12 studies were suitable for data extraction. Description of the combination of both VA and VF findings was scarce. Homonymous hemianopia (HH) was present in 42% of SWS patients. Seventy per cent of eyes had a (near) normal vision, while VA of eyes with glaucoma or DCH was severely impaired in 28% and 67%, respectively. In the Dutch cohort, only 18% (6/33) of patients had (near) normal findings of both visual parameters. In addition, half of the patients with glaucoma suffered from a combination of a HH and VA impairment. In conclusion, although SWS patients are exposed to severe functional visual impairment due to the possible cumulative consequences of glaucoma, DCH and cerebral injury, description of the combination of both VA and VF results is scarce in the literature. Particularly, the combination of visual impairment due to glaucoma or DCH, and HH might be invalidating.
Collapse
Affiliation(s)
- Yvonne Koenraads
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Joke H. de Boer
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht the Netherlands
| | - Kees P. J. Braun
- Department of Paediatric Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht the Netherlands
| | | |
Collapse
|
37
|
Verhagen F, Kuiper J, Nierkens S, Imhof SM, Radstake T, de Boer J. Systemic inflammatory immune signatures in a patient with CRB1 linked retinal dystrophy. Expert Rev Clin Immunol 2016; 12:1359-1362. [DOI: 10.1080/1744666x.2016.1241709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
38
|
Godefrooij DA, Gans R, Imhof SM, Wisse RP. Trends in penetrating and anterior lamellar corneal grafting techniques for keratoconus: a national registry study. Acta Ophthalmol 2016; 94:489-93. [PMID: 27061780 DOI: 10.1111/aos.13041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/04/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Keratoconus is a progressive disorder and one of the primary indications for corneal transplantation. Anterior lamellar keratoplasty offers several advantages over other techniques, including endothelial preservation and longer graft survival. In this study, we examined the recent trend of using lamellar techniques for keratoconus at a national level. METHODS Data were obtained from the Dutch national organ transplant database regarding corneal transplants for keratoconus performed in 2005 through 2014. Baseline characteristics for patients undergoing various techniques were obtained, and temporal trends were analysed. RESULTS A total of 1041 operations were performed, including 736 penetrating keratoplasties (PKPs) and 297 anterior lamellar keratoplasties (ALKs). The mean age of the total surgical group was 37.4 ± 13.4 years, and 68% of patients were male (p = 0.0001). Preoperative patient characteristics were reported in all 1041 cases. The relative proportion of ALKs increased from 2005 (19% of cases) to 2010 (39% of cases) and remained approximately 30-40% thereafter. Descemet baring or deep anterior lamellar keratoplasty (DALK) was increasingly applied and was the predominant anterior lamellar technique performed from 2009 onwards. CONCLUSIONS The number of corneal transplantations performed annually for keratoconus decreased during the past 10 years. Lamellar techniques were increasingly performed, accounting for approximately 35% of keratoplasties in 2010 and thereafter. Among ALK techniques, maximal depth DALK is the most prevalent keratoplasty performed for keratoconus in most recent years. Penetrating keratoplasty (PKP) is still common, with a stable frequency from 2010 onwards.
Collapse
Affiliation(s)
- Daniel A. Godefrooij
- Utrecht Cornea Research Group; Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Renze Gans
- Utrecht Cornea Research Group; Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Saskia M. Imhof
- Utrecht Cornea Research Group; Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Robert P.L. Wisse
- Utrecht Cornea Research Group; Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| |
Collapse
|
39
|
Haasnoot AMJW, Kuiper JJW, Hiddingh S, Schellekens PAWJF, de Jager W, Imhof SM, Radstake TRDJ, de Boer JH. Ocular Fluid Analysis in Children Reveals Interleukin-29/Interferon-λ1 as a Biomarker for Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Rheumatol 2016; 68:1769-79. [PMID: 26866822 DOI: 10.1002/art.39621] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Childhood uveitis is a vision-threatening inflammatory eye disease commonly attributed to juvenile idiopathic arthritis (JIA). The pathogenesis is poorly understood, which makes clinical management challenging. We analyzed soluble mediators in ocular fluid (aqueous humor [AqH]) and serum from children with JIA-associated uveitis and common childhood uveitis to identify potential biomarkers and investigate the ocular microenvironment of this sight-threatening eye disease. METHODS AqH (n = 73) and paired serum (n = 66) samples were analyzed for 51 soluble mediators of inflammation by multiplex immunoassay. Twenty-one children with JIA-associated uveitis were compared to 15 children with chronic anterior uveitis without arthritis, 29 children with noninfectious idiopathic uveitis, and 8 children with noninflammatory conditions (controls). For visualization of the joint effect of multiple mediators, we used the radial coordinate visualization (Radviz) method. Optimal biomarker level cutoffs were also determined. RESULTS The levels of interleukin-29 (IL-29)/interferon-λ1 (IFNλ1) were decreased (P < 0.001) and the levels of latency-associated peptide and osteoprotegerin were increased (P = 0.002 and P = 0.001, respectively) in samples of AqH, but not serum, from patients with JIA-associated uveitis. Multivariate analysis correcting for disease activity and treatment revealed that intraocular levels of IL-29/IFNλ1 were specifically decreased in patients with JIA-associated uveitis as compared to those with idiopathic uveitis. Indeed, JIA-associated uveitis patients and idiopathic uveitis patients showed distinct profiles of intraocular soluble mediators. IL-29/IFNλ1 showed a high area under the curve value (0.954), with 23.5 pg/ml as the optimal cutoff value. CONCLUSION We identified IL-29/IFNλ1 as an intraocular biomarker for JIA-associated uveitis, which suggests that aberrant IFNλ signaling might be important in JIA-associated uveitis and distinct from other forms of childhood uveitis.
Collapse
Affiliation(s)
| | | | - Sanne Hiddingh
- Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Wilco de Jager
- Utrecht University Medical Center and Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Saskia M Imhof
- Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Joke H de Boer
- Utrecht University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
40
|
van Diemen FR, Kruse EM, Hooykaas MJG, Bruggeling CE, Schürch AC, van Ham PM, Imhof SM, Nijhuis M, Wiertz EJHJ, Lebbink RJ. CRISPR/Cas9-Mediated Genome Editing of Herpesviruses Limits Productive and Latent Infections. PLoS Pathog 2016; 12:e1005701. [PMID: 27362483 PMCID: PMC4928872 DOI: 10.1371/journal.ppat.1005701] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/23/2016] [Indexed: 12/15/2022] Open
Abstract
Herpesviruses infect the majority of the human population and can cause significant morbidity and mortality. Herpes simplex virus (HSV) type 1 causes cold sores and herpes simplex keratitis, whereas HSV-2 is responsible for genital herpes. Human cytomegalovirus (HCMV) is the most common viral cause of congenital defects and is responsible for serious disease in immuno-compromised individuals. Epstein-Barr virus (EBV) is associated with infectious mononucleosis and a broad range of malignancies, including Burkitt’s lymphoma, nasopharyngeal carcinoma, Hodgkin’s disease, and post-transplant lymphomas. Herpesviruses persist in their host for life by establishing a latent infection that is interrupted by periodic reactivation events during which replication occurs. Current antiviral drug treatments target the clinical manifestations of this productive stage, but they are ineffective at eliminating these viruses from the infected host. Here, we set out to combat both productive and latent herpesvirus infections by exploiting the CRISPR/Cas9 system to target viral genetic elements important for virus fitness. We show effective abrogation of HCMV and HSV-1 replication by targeting gRNAs to essential viral genes. Simultaneous targeting of HSV-1 with multiple gRNAs completely abolished the production of infectious particles from human cells. Using the same approach, EBV can be almost completely cleared from latently infected EBV-transformed human tumor cells. Our studies indicate that the CRISPR/Cas9 system can be effectively targeted to herpesvirus genomes as a potent prophylactic and therapeutic anti-viral strategy that may be used to impair viral replication and clear latent virus infection. Herpesviruses are large DNA viruses that are carried by almost 100% of the adult human population. Herpesviruses include several important human pathogens, such as herpes simplex viruses (HSV) type 1 and 2 (causing cold sores and genital herpes, respectively), human cytomegalovirus (HCMV; the most common viral cause of congenital defects, and responsible for serious disease in immuno-compromised individuals), and Epstein-Barr virus (EBV; associated with infectious mononucleosis and a wide range of malignancies). Current antiviral drug treatments are not effective in clearing herpesviruses from infected individuals. Therefore, there is a need for alternative strategies to combat these pathogenic viruses and prevent or cure herpesvirus-associated diseases. Here, we have assessed whether a direct attack of herpesvirus genomes within virus-infected cells can inactivate these viruses. For this, we have made use of the recently developed CRISPR/Cas9 genome-engineering system to target and alter specific regions within the genome of these viruses. By targeting sites in the genomes of three different herpesviruses (HSV-1, HCMV, and EBV), we show complete inhibition of viral replication and in some cases even eradication of the viral genomes from infected cells. The findings presented in this study open new avenues for the development of therapeutic strategies to combat pathogenic human herpesviruses using novel genome-engineering technologies.
Collapse
Affiliation(s)
- Ferdy R. van Diemen
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth M. Kruse
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Anita C. Schürch
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra M. van Ham
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique Nijhuis
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robert Jan Lebbink
- Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| |
Collapse
|
41
|
Wisse RP, Peeters N, Imhof SM, van der Lelij A. Comparison of Diaton transpalpebral tonometer with applanation tonometry in keratoconus. Int J Ophthalmol 2016; 9:395-8. [PMID: 27158609 DOI: 10.18240/ijo.2016.03.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/23/2015] [Accepted: 06/10/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the added value of using a Diaton transpalpebral tonometer (DT) to measure IOP in keratoconus. Most type of tonometers use corneal applanation or biomechanical resistance to measure intraocular pressure (IOP); however, these factors can be altered by keratoconus. Specifically, we examined whether DT can detect false-negative low Goldmann applanation tonometry (AT) measurements. METHODS Patients with keratoconus were recruited from our tertiary academic treatment center. Measurements included AT and DT (in random order) and Scheimpflug imaging. An age- and gender-matched group of control subjects with no history of corneal disease or glaucoma was also recruited. RESULTS In total, 130 eyes from 66 participants were assessed. In the keratoconus group, mean AT was 11.0 ± 2.6, mean DT 11.2±5.5 (P=0.729), and the two measures were correlated significantly (P=0.006, R=0.323). However, a Bland-Altman plot revealed a wide distribution and poor agreement between both measurements. Previous corneal crosslinking, corneal pachymetry, and Krumeich classification had no effect on measured IOP. CONCLUSION Measurements obtained using a Diaton tonometer are not affected by corneal biomechanics; however, its poor agreement with Goldmann AT values calls into question the added value of using a Diaton tonometer to measure IOP in keratoconus.
Collapse
Affiliation(s)
- Robert Pl Wisse
- Utrecht Corneal Research Group Department of Ophthalmology, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Natalie Peeters
- Utrecht Corneal Research Group Department of Ophthalmology, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Saskia M Imhof
- Utrecht Corneal Research Group Department of Ophthalmology, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| | - Allegonda van der Lelij
- Utrecht Corneal Research Group Department of Ophthalmology, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands
| |
Collapse
|
42
|
Visser ES, Wisse RPL, Soeters N, Imhof SM, Van der Lelij A. Objective and subjective evaluation of the performance of medical contact lenses fitted using a contact lens selection algorithm. Cont Lens Anterior Eye 2016; 39:298-306. [PMID: 26917334 DOI: 10.1016/j.clae.2016.02.006] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/17/2015] [Accepted: 02/04/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the performance of medical contact lenses (CLs) for a wide range of clinical indications. DESIGN Prospective cross-sectional study. METHODS A total of 281 eyes were evaluated in 281 consecutive patients (≥18 years of age; CL use ≥3 months) who visited the contact lens service in a tertiary academic clinic for a scheduled follow-up visit. The main outcome measured were clinical indications for CL wear; CL type; change in corrected distance visual acuity (CDVA) with CL use; CL wearing duration; CL wearing time; subjective performance measured using a visual analog scale (VAS) questionnaire (score range: 0-100); and effectiveness of the lens-selection algorithm. RESULTS Wearing CLs significantly improved CDVA compared to wearing spectacles (median change: -0.15 logMAR, range: 1.00 to -2.10; P<.001). Daily-wear CLs were worn by 77% of patients for a median of 15h/day (range: 5-18h/day), median 7 days/week (range: 1-7 days/week). High subjective scores were measured, with similar results obtained between the scleral lens and soft lens groups. The medical CL fitting was found to be generally effective (the overall satisfaction rating was ≥70 for 81% of patients). CONCLUSIONS Fitting CLs based on the lens-selection algorithm yielded positive clinical results, including improved visual acuity, satisfactory wearing time, and high overall subjective performance. Moreover, subjective performance was similar between users of scleral lenses and users of soft lenses. These results underscore the importance of prescribing scleral lenses and the need for tertiary eye clinics to offer patients a variety of CL types.
Collapse
Affiliation(s)
- Esther-Simone Visser
- Visser Contact Lens Practice, Department of Ophthalmology, University Medical Center Utrecht, Room L.02.628, Postbus 85500, 3508 GA Utrecht, The Netherlands.
| | - Robert P L Wisse
- Department of Ophthalmology, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Nienke Soeters
- Department of Ophthalmology, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands
| | - Allegonda Van der Lelij
- Department of Ophthalmology, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, The Netherlands; Department of Ophthalmology, Central Military Hospital Utrecht, Postbus 90000, 3509 AA Utrecht, The Netherlands
| |
Collapse
|
43
|
Soeters N, Visser ES, Imhof SM, Tahzib NG. Scleral lens influence on corneal curvature and pachymetry in keratoconus patients. Cont Lens Anterior Eye 2015; 38:294-7. [DOI: 10.1016/j.clae.2015.03.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/12/2015] [Accepted: 03/06/2015] [Indexed: 11/29/2022]
|
44
|
Koenraads Y, Braun KPJ, van der Linden DCP, Imhof SM, Porro GL. Perimetry in young and neurologically impaired children: the Behavioral Visual Field (BEFIE) Screening Test revisited. JAMA Ophthalmol 2015; 133:319-25. [PMID: 25541916 DOI: 10.1001/jamaophthalmol.2014.5257] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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 Visual field examination in young or neurologically impaired children is a challenge. As a result, the Behavioral Visual Field (BEFIE) Screening Test was developed in 1995. OBJECTIVES To evaluate the applicability of the BEFIE test in a large population of young or neurologically impaired children, its reliability and consistency of findings across time, and its potential diagnostic value compared with standard conventional perimetry. DESIGN, SETTING, AND PARTICIPANTS The BEFIE tests were performed at an academic tertiary center and measured the peripheral visual field extension in degrees by observing an individual's response to a stimulus on a graded arc that moved from the periphery to the center of the visual field along different meridians. Patient files from all children who underwent this test were retrospectively analyzed. In total, 1788 BEFIE tests were performed in 835 children (median age, 3.4 years). MAIN OUTCOMES AND MEASURES Reliability and results of all tests were longitudinally evaluated. The diagnostic value of the BEFIE test was assessed by comparing monocular BEFIE test results with those of standard conventional perimetry in children who underwent both. RESULTS Of 1788 tests, 74% (95% CI, 72%-76%) were considered reliable from the age of 4 months and older, with increasing success with higher ages; 56% reliable in children younger than 1 year; 71% reliable in children between 1 and 2 years; and more than 75% reliable in children 2 years and older (Spearman r = 0.506; P = .11). Peripheral visual field defects were found in 28% (95% CI, 25%-31%) of all first reliable tests. In 75% of children who underwent serial testing, results were consistent and there were good explanations in the case of discrepancies. Comparison of monocular BEFIE tests with standard conventional perimetry results in 147 eyes yielded a positive predictive value of 98% (95% CI, 94%-100%), negative predictive value of 66% (95% CI, 56%-75%), specificity of 98% (95% CI, 95%-100%), sensitivity of 60% (95% CI, 50%-71%), and superior sensitivity of 80% (95% CI, 70%-91%) when only absolute peripheral visual field defects at standard conventional perimetry were accounted for. CONCLUSIONS AND RELEVANCE These data suggest that the BEFIE test is a valuable tool to detect peripheral visual field defects when standard conventional perimetry cannot be performed in young or neurologically impaired children.
Collapse
Affiliation(s)
- Yvonne Koenraads
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kees P J Braun
- Brain Center Rudolf Magnus, Department of Pediatric Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giorgio L Porro
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
45
|
Koenraads Y, van der Linden DCP, van Schooneveld MMJ, Imhof SM, Gosselaar PH, Porro GL, Braun KPJ. Visual function and compensatory mechanisms for hemianopia after hemispherectomy in children. Epilepsia 2014; 55:909-17. [PMID: 24754334 DOI: 10.1111/epi.12615] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Yvonne Koenraads
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Monique M. J. van Schooneveld
- Department of Pediatric Psychology; Sector Neuropsychology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - P. H. Gosselaar
- Department of Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Kees P. J. Braun
- Department of Pediatric Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| |
Collapse
|
46
|
Wisse RPL, Godefrooij DA, Soeters N, Imhof SM, Van der Lelij A. A multivariate analysis and statistical model for predicting visual acuity and keratometry one year after cross-linking for keratoconus. Am J Ophthalmol 2014; 157:519-25.e1-2. [PMID: 24211861 DOI: 10.1016/j.ajo.2013.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate putative prognostic factors for predicting visual acuity and keratometry 1 year following corneal cross-linking (CXL) for treating keratoconus. DESIGN Prospective cohort study. METHODS This study included all consecutively treated keratoconus patients (102 eyes) in 1 academic treatment center, with minimal 1-year follow-up following CXL. Primary treatment outcomes were corrected distance visual acuity (logMAR CDVA) and maximum keratometry (K(max)). Univariable analyses were performed to determine correlations between baseline parameters and follow-up measurements. Correlating factors (P ≤ .20) were then entered into a multivariable linear regression analysis, and a model for predicting CDVA and K(max) was created. RESULTS Atopic constitution, positive family history, and smoking were not independent factors affecting CXL outcomes. Multivariable analysis identified cone eccentricity as a major factor for predicting K(max) outcome (ß coefficient = 0.709, P = .02), whereas age, sex, and baseline keratometry were not independent contributors. Posttreatment visual acuity could be predicted based on pretreatment visual acuity (ß coefficient = -0.621, P < .01, R(2) = 0.45). Specifically, a low visual acuity predicts visual improvement. A prediction model for K(max) did not accurately estimate treatment outcomes (R(2) = 0.15). CONCLUSIONS Our results confirm the role of cone eccentricity with respect to the improvement of corneal curvature following CXL. Visual acuity outcome can be predicted accurately based on pretreatment visual acuity. Age, sex, and K(max) are debated as independent factors for predicting the outcome of treating keratoconus with CXL.
Collapse
Affiliation(s)
- Robert P L Wisse
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Daniël A Godefrooij
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nienke Soeters
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Saskia M Imhof
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Allegonda Van der Lelij
- Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
47
|
Riemens A, Te Boome LCJ, Kalinina Ayuso V, Kuiper JJW, Imhof SM, Lokhorst HM, Aniki R. Impact of ocular graft-versus-host disease on visual quality of life in patients after allogeneic stem cell transplantation: questionnaire study. Acta Ophthalmol 2014; 92:82-7. [PMID: 23601505 DOI: 10.1111/aos.12047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the influence of ocular complications on quality of life (QoL) 3 years after allogeneic stem cell transplantation (allo-SCT). METHODS All 54 adult patients that underwent and survived allo-SCT in 2006/2007 in our centre received two questionnaires (VFQ-25: visual function questionnaire-25 and OSDI: ocular surface disease index). In addition, the following data were included: gender, age, underlying disease, presence of chronic and/or ocular graft-versus-host disease (GVHD), number of visits to an ophthalmologist, manifestations of dry eye disease, the duration of follow-up and treatment for ocular GVHD. RESULTS Ocular GVHD developed in 26% (14 of 54) of patients and 71% (10 of 14) received treatment for ocular GVHD. The presence of ocular GVHD correlated with the severity of systemic GVHD (correlation coefficient: 0.52, p = 0.00). The Karnofsky scores were significantly lower in the patients with ocular GVHD compared to the patients with no ocular GVHD (p = 0.001). Karnofsky scores were weakly correlated with the severity of systemic GVHD (correlation coefficient: 0.25, p = 0.03. Three years after the all-SCT, OSDI and VFQ-25 scores were significantly impaired in patients with ocular GVHD [mean: 76.5; range (46.1-100) and mean: 31.1; range (0-72.9)] compared to patients with no ocular GVHD [mean: 89.4; range (45.2-100) and mean: 12.9; range (0-58.3); p = 0.02]. The scores of the VFQ-25 were significantly lower in the domains of general health, ocular pain, social functioning and role difficulties. CONCLUSION The long-term vision-related QoL measured by the OSDI and VFQ-25 was impaired in patients with ocular GVHD.
Collapse
Affiliation(s)
- Anjo Riemens
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The NetherlandsDepartment of Hematology, University Medical Center Utrecht, Utrecht, The NetherlandsDepartment of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
48
|
Dommering CJ, Marees T, van der Hout AH, Imhof SM, Meijers-Heijboer H, Ringens PJ, van Leeuwen FE, Moll AC. RB1 mutations and second primary malignancies after hereditary retinoblastoma. Fam Cancer 2012; 11:225-33. [PMID: 22205104 PMCID: PMC3365233 DOI: 10.1007/s10689-011-9505-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Survivors of hereditary retinoblastoma have a high risk of second primary malignancies, but it has not been investigated whether specific RB1 germline mutations are associated with greater risk of second primary malignancies in a large cohort. We conducted a retrospective cohort study of 199 survivors of hereditary retinoblastoma with a documented RB1 germline mutation diagnosed between 1905 and 2005. In total, 44 hereditary retinoblastoma survivors developed a second primary malignancy after a median follow-up of 30.2 years (range 1.33-76.0). A significantly increased risk of second primary malignancy was observed among carriers of one of the 11 recurrent CGA>TGA nonsense RB1 mutations (hazard ratio (HR) = 3.53; [95% confidence interval (CI) = 1.82-6.84]; P = .000), and there was a significantly lower risk for subjects with a low penetrance mutation (HR = .19; [95% CI = .05-.81]; P = .025). Our findings suggest a genotype-phenotype correlation for second primary cancers of retinoblastoma survivors and may impact on long-term surveillance protocols of patients with hereditary retinoblastoma, if confirmed by future studies.
Collapse
Affiliation(s)
- Charlotte J Dommering
- Department of Clinical Genetics, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
de Graaf P, Pouwels PJW, Rodjan F, Moll AC, Imhof SM, Knol DL, Sanchez E, van der Valk P, Castelijns JA. Single-shot turbo spin-echo diffusion-weighted imaging for retinoblastoma: initial experience. AJNR Am J Neuroradiol 2012; 33:110-8. [PMID: 22033715 DOI: 10.3174/ajnr.a2729] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Retinoblastoma may exhibit variable hyperintensities on DWI, resulting in different values in the ADC maps, depending on their histology and cellularity. However, EP-based DWI has susceptibility artifacts and image distortions, which make DWI of the orbit a challenging technique. The aim of this study was to investigate the feasibility of single-shot turbo spin-echo (HASTE) DWI in the evaluation of children with retinoblastoma and to assess the value of ADC maps in differentiating viable and necrotic tumor tissue. MATERIALS AND METHODS Two radiologists assessed conventional MR images, DWI, and ADC maps of 17 patients with retinoblastoma (n = 17 eyes). Non-EP DWI was performed by using a HASTE sequence with b-values of 0 and 1000 s/mm(2). ADC values were measured for enhancing and nonenhancing tumor tissue. ADC maps were compared with histopathologic findings regarding tumor differentiation and viability. RESULTS On DWI, vital tumor tissue showed hyperintensity with negligible intensity of surrounding vitreous. The difference in mean (range) ADC values between enhancing (1.03 [0.72-1.22] × 10(-3) mm(2) s(-1)) and nonenhancing (1.47 [0.99-1.80] × 10(-3) mm(2) s(-1)) parts of retinoblastoma was statistically significant (P < .0005). Nonenhancing tumor parts showed a significantly lower ADC compared with vitreous (2.67 [2.24-3.20]×10(-3) mm(2) s(-1)) (P < .0005) and subretinal fluid (2.20 [1.76-2.96] × 10(-3) mm(2) s(-1)) (P < .0005). Histopathologically, low ADC values (enhancing tumor part) correlated to viable tumor tissue, whereas intermediate ADC values (nonenhancing tumor parts) correlated to necrotic tumor tissue. CONCLUSIONS HASTE DWI allowed adequate characterization of retinoblastoma, and ADC is a helpful tool to differentiate viable and necrotic tumor tissue and might be valuable in monitoring the response to eye-preserving therapies.
Collapse
Affiliation(s)
- P de Graaf
- Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Dommering CJ, Garvelink MM, Moll AC, van Dijk J, Imhof SM, Meijers-Heijboer H, Henneman L. Reproductive behavior of individuals with increased risk of having a child with retinoblastoma. Clin Genet 2011; 81:216-23. [PMID: 21954974 DOI: 10.1111/j.1399-0004.2011.01791.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To investigate reproductive behavior of individuals at increased risk of having a child with retinoblastoma (Rb), we conducted a cross-sectional questionnaire survey among 118 counselees visiting the Clinical Genetics Department of the National Rb Center in the Netherlands. The recurrence risk for counselees ranged from <1% to 50%. The response rate was 69%. Of 43 respondents considering having children after becoming aware of their increased risk, Rb influenced reproductive behavior for 25 (58%), of whom 14 had a recurrence risk <3%. Twenty of these 25 decided against having more children and 5 used prenatal diagnosis. Eighteen of the 43 respondents did not use any of the alternative reproductive options and had children (or more children), although half indicated having had doubts about their decisions. Multiple logistic regression showed that only perceived risk (p = 0.003) was significantly associated with Rb influencing reproductive behavior. Of 17 respondents planning children (or more children), 11 (65%) considered using one of the alternative reproductive options. We conclude that reproductive behavior is greatly influenced by Rb and that perceived risk, not objective risk, is the most important factor of influence. It is important to offer individuals at increased risk continued access to genetic counseling, even when this risk is small.
Collapse
Affiliation(s)
- C J Dommering
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|