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Guymer R, Bailey C, Chaikitmongkol V, Chakravarthy U, Chaudhary V, Finger RP, Gallego-Pinazo R, Chuan AKH, Ishida S, Lövestam-Adrian M, Parravano M, Luna Pinto JD, Schmitz-Valckenberg S, Sheth V, Souied EH, Chi GC, Gilberg F, Glittenberg C, Scheidl S, Bengus M. Rationale and Design of VOYAGER: Long-term Outcomes of Faricimab and Port Delivery System with Ranibizumab for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in Clinical Practice. Ophthalmol Sci 2024; 4:100442. [PMID: 38304609 PMCID: PMC10831184 DOI: 10.1016/j.xops.2023.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Purpose To describe the rationale and design of the VOYAGER (NCT05476926) study, which aims to investigate the safety and effectiveness of faricimab and the Port Delivery System with ranibizumab (PDS) for neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) in clinical practice. VOYAGER also aims to understand drivers of clinical practice treatment outcomes by gaining novel insight into the intersection of treatment regimens, decisions, anatomic outcomes, and vision. Design Primary data collection, noninterventional, prospective, multinational, multicenter clinical practice study. Participants At least 5000 patients initiating/continuing faricimab or PDS for nAMD/DME (500 sites, 31 countries). Methods Management will be per usual care, with no mandated scheduled visits/imaging protocol requirements. Using robust methodologies, relevant clinical and ophthalmic data, including visual acuity (VA), and data on treatment clinical setting/regimens/philosophies, presence of anatomic features, and safety events will be collected. Routinely collected fundus images will be uploaded to the proprietary Imaging Platform for analysis. An innovative investigator interface will graphically display the patient treatment journey with the aim of optimizing treatment decisions. Main Outcome Measures Primary end point: VA change from baseline at 12 months per study cohort (faricimab in nAMD and in DME, PDS in nAMD). Secondary end points: VA change over time and per treatment regimens (fixed, treat-and-extend, pro re nata, and other) and number. Exploratory end points: VA change in relation to presence/location of anatomic features that impact vision (fluid, central subfield thickness, fibrosis, atrophy, subretinal hyperreflective material, diabetic retinopathy severity, and disorganization of retinal inner layers) and per treatment regimen/philosophies. The impact of regional and practice differences on outcomes will be assessed as will safety. Results Recruitment commenced in November 2022 and will continue until late 2027, allowing for up to 5 years follow-up. Exploratory interim analyses are planned annually. Conclusions VOYAGER is an innovative study of retinal diseases that will assess the effectiveness and safety of faricimab and PDS in nAMD and DME and identify clinician- and disease-related factors driving treatment outcomes in clinical practices globally to help optimize vision outcomes. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Clare Bailey
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Voraporn Chaikitmongkol
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Usha Chakravarthy
- Queen’s University of Belfast, Royal Victoria Hospital, Belfast, United Kingdom
| | - Varun Chaudhary
- Department of Surgery, Hamilton Regional Eye Institute, McMaster University, Hamilton, Ontario, Canada
| | - Robert P. Finger
- Department of Ophthalmology, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | | | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Monica Lövestam-Adrian
- Department of Ophthalmology, Department of Clinical Sciences, Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | | | - Steffen Schmitz-Valckenberg
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus, Bonn, Germany
| | | | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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Künzel SH, Broadbent E, Möller PT, Lindner M, Goerdt L, Czauderna J, Schmitz-Valckenberg S, Holz FG, Pfau M, Fleckenstein M. Association of lesion location and functional parameters on vision-related quality of life in geographic atrophy secondary to AMD. Ophthalmol Retina 2024:S2468-6530(24)00057-5. [PMID: 38311207 DOI: 10.1016/j.oret.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The primary goal of this study was to determine how structural and functional parameters influence the vision-related quality of life (VRQoL) in patients suffering from geographic atrophy (GA) secondary to age-related macular degeneration. DESIGN This study was designed as a prospective, non-interventional, natural-history study (Directional Spread in Geographic-Atrophy study, NCT02051998). SUBJECTS The research involved 82 patients with bilateral GA. METHODS The study examined parameters including GA location as assessed by the Early Treatment Diabetic Retinopathy Study grid, best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), reading acuity, and speed. These parameters were then correlated with VRQoL, which was gauged using the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25). The analysis method employed was the least absolute shrinkage and selection operator with linear mixed-effects models. MAIN OUTCOME MEASURES The central parameters measured in this study encompassed GA area, VRQoL scores associated with different GA subfields, and the significance of LLVA for foveal-sparing patients. RESULTS On average, patients showed a total GA area of 2.9 ± 1.2 mm2 in the better eye and 3.1 ± 1.3 mm2 in the worse eye. The most significant associations with VRQoL scores for distance and near activities were observed in the inner lower and inner left subfields of the better eye, respectively. For patients with foveal-sparing GA, the LLVA of the better eye stood out as the most influential variable across all VRQoL scales. CONCLUSIONS The study's findings point towards the pivotal role of GA location, especially the inner lower and inner left subfields of the better eye, in relation to VRQoL in GA patients. The LLVA's importance becomes even more pronounced for foveal-sparing patients. These observations highlight the need for healthcare professionals to better understand the association between lesion location and patient-reported outcomes. This is critical for informing treatment decisions and refining the planning of interventional trials.
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Affiliation(s)
| | - Eliza Broadbent
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
| | | | - Moritz Lindner
- Institute of Physiology and Pathophysiology, Department of Neurophysiology, Philipps University, Deutschhausstr. 1-2, Marburg 35037, Germany; Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
| | - Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Monika Fleckenstein
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
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3
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Zouache MA, Richards BT, Pappas CM, Anstadt RA, Liu J, Corsetti T, Matthews S, Seager NA, Schmitz-Valckenberg S, Fleckenstein M, Hubbard WC, Thomas J, Hageman JL, Williams BL, Hageman GS. Levels of complement factor H-related 4 protein do not influence susceptibility to age-related macular degeneration or its course of progression. Nat Commun 2024; 15:443. [PMID: 38200010 PMCID: PMC10781981 DOI: 10.1038/s41467-023-44605-0] [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: 02/02/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Dysregulation of the alternative pathway (AP) of the complement system is a significant contributor to age-related macular degeneration (AMD), a primary cause of irreversible vision loss worldwide. Here, we assess the contribution of the liver-produced complement factor H-related 4 protein (FHR-4) to AMD initiation and course of progression. We show that FHR-4 variation in plasma and at the primary location of AMD-associated pathology, the retinal pigment epithelium/Bruch's membrane/choroid interface, is entirely explained by three independent quantitative trait loci (QTL). Using two distinct cohorts composed of a combined 14,965 controls and 20,741 cases, we ascertain that independent QTLs for FHR-4 are distinct from variants causally associated with AMD, and that FHR-4 variation is not independently associated with disease. Additionally, FHR-4 does not appear to influence AMD progression course among patients with disease driven predominantly by AP dysregulation. Modulation of FHR-4 is therefore unlikely to be an effective therapeutic strategy for AMD.
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Affiliation(s)
- M A Zouache
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA.
| | - B T Richards
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - C M Pappas
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - R A Anstadt
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - J Liu
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - T Corsetti
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - S Matthews
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - N A Seager
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - S Schmitz-Valckenberg
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - M Fleckenstein
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - W C Hubbard
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - J Thomas
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - J L Hageman
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - B L Williams
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - G S Hageman
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA.
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Fleckenstein M, Schmitz-Valckenberg S, Chakravarthy U. Age-Related Macular Degeneration: A Review. JAMA 2024; 331:147-157. [PMID: 38193957 DOI: 10.1001/jama.2023.26074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Importance Age-related macular degeneration (AMD) affects approximately 20 million people in the US and 196 million people worldwide. AMD is a leading cause of severe vision impairment in older people and is expected to affect approximately 288 million people worldwide by 2040. Observations Older age, genetic factors, and environmental factors, such as cigarette smoking, are associated with development of AMD. AMD occurs when extracellular deposits accumulate in the outer retina, ultimately leading to photoreceptor degeneration and loss of central vision. The late stages of AMD are characterized by outer retinal atrophy, termed geographic atrophy, or neovascularization associated with subretinal and/or intraretinal exudation, termed exudative neovascular AMD. The annual incidence of AMD ranges from 0.3 per 1000 in people who are aged 55 to 59 years to 36.7 per 1000 in people aged 90 years or older. The estimated heritability of late-stage AMD is approximately 71% (95% CI, 18%-88%). Long-term prospective cohort studies show a significantly higher AMD incidence in people who smoke more than 20 cigarettes per day compared with people who never smoked. AMD is diagnosed primarily with clinical examination that includes a special lens that focuses light of the slit lamp through the pupil. Exudative neovascular AMD is best identified using angiography and by optical coherence tomography. Individuals with AMD who take nutritional supplements consisting of high-dose vitamin C, vitamin E, carotenoids, and zinc have a 20% probability to progress to late-stage AMD at 5 years vs a 28% probability for those taking a placebo. In exudative neovascular AMD, 94.6% of patients receiving monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections experience less than a 15-letter visual acuity loss after 12 months compared with 62.2% receiving sham treatment. Conclusions and Relevance The prevalence of AMD is anticipated to increase worldwide to 288 million individuals by 2040. Intravitreally administered anti-VEGF treatment is first-line therapy for exudative neovascular AMD.
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Affiliation(s)
| | - Steffen Schmitz-Valckenberg
- John A. Moran Eye Center, University of Utah Health, Salt Lake City
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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Pfau M, Künzel SH, Pfau K, Schmitz-Valckenberg S, Fleckenstein M, Holz FG. Multimodal imaging and deep learning in geographic atrophy secondary to age-related macular degeneration. Acta Ophthalmol 2023; 101:881-890. [PMID: 37933610 PMCID: PMC11044135 DOI: 10.1111/aos.15796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023]
Abstract
Geographic atrophy (GA) secondary to age-related macular degeneration is among the most common causes of irreversible vision loss in industrialized countries. Recently, two therapies have been approved by the US FDA. However, given the nature of their treatment effect, which primarily involves a relative decrease in disease progression, discerning the individual treatment response at the individual level may not be readily apparent. Thus, clinical decision-making may have to rely on the quantification of the slope of GA progression before and during treatment. A panel of imaging modalities and artificial intelligence (AI)-based algorithms are available for such quantifications. This article aims to provide a comprehensive overview of the fundamentals of GA imaging, the procedures for diagnosis and classification using these images, and the cutting-edge role of AI algorithms in automatically deriving diagnostic and prognostic insights from imaging data.
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Affiliation(s)
- Maximilian Pfau
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | | | - Kristina Pfau
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Monika Fleckenstein
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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Wu Z, Schmitz-Valckenberg S, Blodi BA, Holz FG, Jaffe GJ, Liakopoulos S, Sadda SR, Bonse M, Brown T, Choong J, Clifton B, Corradetti G, Corvi F, Dieu AC, Dooling V, Pak JW, Saßmannshausen M, Skalak C, Thiele S, Guymer RH. Reticular Pseudodrusen: Interreader Agreement of Evaluation on OCT Imaging in Age-Related Macular Degeneration. Ophthalmol Sci 2023; 3:100325. [PMID: 37292179 PMCID: PMC10244688 DOI: 10.1016/j.xops.2023.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 06/10/2023]
Abstract
Purpose To determine the interreader agreement for reticular pseudodrusen (RPD) assessment on combined infrared reflectance (IR) and OCT imaging in the early stages of age-related macular degeneration across a range of different criteria to define their presence. Design Interreader agreement study. Participants Twelve readers from 6 reading centers. Methods All readers evaluated 100 eyes from individuals with bilateral large drusen for the following: (1) the presence of RPD across a range of different criteria and (2) the number of Stage 2 or 3 RPD lesions (from 0 to ≥ 5 lesions) on an entire OCT volume scan and on a selected OCT B-scan. Supportive information was available from the corresponding IR image. Main Outcome Measures Interreader agreement, as assessed by Gwet's first-order agreement coefficient (AC1). Results When evaluating an entire OCT volume scan, there was substantial interreader agreement for the presence of any RPD, any or ≥ 5 Stage 2 or 3 lesions, and ≥ 5 definite lesions on en face IR images corresponding to Stage 2 or 3 lesions (AC1 = 0.60-0.72). On selected OCT B-scans, there was also moderate-to-substantial agreement for the presence of any RPD, any or ≥ 5 Stage 2 or 3 lesions (AC1 = 0.58-0.65) and increasing levels of agreement with increasing RPD stage (AC1 = 0.08, 0.56, 0.78, and 0.99 for the presence of any Stage 1, 2, 3, and 4 lesions, respectively). There was substantial agreement regarding the number of Stage 2 or 3 lesions on an entire OCT volume scan (AC1 = 0.68), but only fair agreement for this evaluation on selected B-scans (AC1 = 0.30). Conclusions There was generally substantial or near-substantial-but not near-perfect-agreement for assessing the presence of RPD on entire OCT volume scans or selected B-scans across a range of differing RPD criteria. These findings underscore how interreader variability would likely contribute to the variability of findings related to the clinical associations of RPD. The low levels of agreement for assessing RPD number on OCT B-scans underscore the likely challenges of quantifying RPD extent with manual grading. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
- Utah Retinal Reading Center (UREAD) John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Barbara A. Blodi
- Department of Ophthalmology and Visual Sciences, Wisconsin Reading Center (WRC), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Frank G. Holz
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Glenn J. Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Sandra Liakopoulos
- Cologne Image Reading Center and Laboratory (CIRCL) and Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department of Ophthalmology, Goethe-University Frankfurt, Germany
| | - Srinivas R. Sadda
- Doheny Imaging Reading Center (DIRC) and Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Mari Bonse
- Cologne Image Reading Center and Laboratory (CIRCL) and Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Tyler Brown
- Utah Retinal Reading Center (UREAD) John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - John Choong
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Bailey Clifton
- Utah Retinal Reading Center (UREAD) John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Giulia Corradetti
- Doheny Imaging Reading Center (DIRC) and Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Federico Corvi
- Doheny Imaging Reading Center (DIRC) and Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Andrew C. Dieu
- Department of Ophthalmology and Visual Sciences, Wisconsin Reading Center (WRC), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Vivienne Dooling
- Cologne Image Reading Center and Laboratory (CIRCL) and Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jeong W. Pak
- Department of Ophthalmology and Visual Sciences, Wisconsin Reading Center (WRC), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Cindy Skalak
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Sarah Thiele
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Robyn H. Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
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Schmitz-Valckenberg S, Saßmannshausen M, Braun M, Steffen V, Gao SS, Honigberg L, Ferrara D, Pfau M, Holz FG. Interreader Agreement and Longitudinal Progression of Incomplete/Complete Retinal Pigment Epithelium and Outer Retinal Atrophy in Age-Related Macular Degeneration. Ophthalmol Retina 2023; 7:1059-1068. [PMID: 37517799 DOI: 10.1016/j.oret.2023.07.021] [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: 03/21/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To analyze the ability to evaluate changes over time of individual lesions of incomplete or complete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA and cRORA, respectively) in patients with intermediate age-related macular degeneration (iAMD). DESIGN OCT images from patients enrolled in Proxima B clinical trial (NCT02399072) were utilized. PARTICIPANTS Patients enrolled in the Proxima B clinical trial, from the cohort with geographic atrophy (GA) in 1 eye and iAMD in the other eye at baseline, were included. METHODS Junior and senior readers analyzed OCT images for the qualitative presence of 9 distinct early atrophic features (presence of zone of choroidal hypertransmission, attenuation and/or disruption of RPE, disruption of ellipsoid zone [EZ] and external limiting membrane [ELM], outer nuclear layer [ONL] thinning, outer plexiform layer [OPL]/inner nuclear layer [INL] subsidence, and hyporeflective wedge-shaped band). If deemed "present," 7 features were quantified with a predefined tolerance level of 50 μm (diameter for the zone of choroidal hypertransmission, zone of attenuation and/or disruption of the RPE, outer retinal thickness left/right vertical diameter, outer retinal thickness thinnest vertical diameter, annotation of EZ, and ELM disruption). MAIN OUTCOME MEASURES Interreader agreements for qualitative assessments (κ-type statistics) and quantitative measurements (Bland-Altman statistics) were assessed. Progression of the lesion features over time was described. RESULTS Moderate agreement was found for presence of choroidal hypertransmission (κ = 0.54), followed by ELM disruption (κ = 0.58), OPL/INL subsidence (κ = 0.46), and a hyporeflective wedge-shaped band (κ = 0.47). Quantification measurements showed that choroidal hypertransmission had the highest agreement, whereas RPE attenuation/disruption had the lowest agreement. Longitudinal adjudicated changes for quantitative measurements of lesion progression showed that choroidal hypertransmission and ELM disruption showed significant progression, whereas EZ disruption and RPE attenuation/disruption did not. CONCLUSIONS The ability to evaluate changes over time for specific features of iRORA and cRORA was explored. The most robust biomarker was found to be choroidal hypertransmission, followed by ELM disruption and the qualitative markers of OPL/INL subsidence, as well as a wedge-shaped band. Disease progression over time could be assessed by some, but not all, spectral-domain OCT features that were explored. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Steffen Schmitz-Valckenberg
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah; GRADE Reading Center and Department of Ophthalmology, University of Bonn, Germany.
| | | | - Martina Braun
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Germany
| | | | - Simon S Gao
- Genentech, Inc., South San Francisco, California
| | | | | | - Maximilian Pfau
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Germany; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Frank G Holz
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Germany
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von der Emde L, Mallwitz M, Vaisband M, Hasenauer J, Saßmannshausen M, Terheyden JH, Sloan KR, Schmitz-Valckenberg S, Finger RP, Holz FG, Ach T. Retest variability and patient reliability indices of quantitative fundus autofluorescence in age-related macular degeneration: a MACUSTAR study report. Sci Rep 2023; 13:17417. [PMID: 37833348 PMCID: PMC10576044 DOI: 10.1038/s41598-023-43417-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to determine the retest variability of quantitative fundus autofluorescence (QAF) in patients with and without age-related macular degeneration (AMD) and evaluate the predictive value of patient reliability indices on retest reliability. A total of 132 eyes from 68 patients were examined, including healthy individuals and those with various stages of AMD. Duplicate QAF imaging was conducted at baseline and 2 weeks later across six study sites. Intraclass correlation (ICC) analysis was used to evaluate the consistency of imaging, and mean opinion scores (MOS) of image quality were generated by two researchers. The contribution of MOS and other factors to retest variation was assessed using mixed-effect linear models. Additionally, a Random Forest Regressor was trained to evaluate the extent to which manual image grading of image quality could be replaced by automated assessment (inferred MOS). The results showed that ICC values were high for all QAF images, with slightly lower values in AMD-affected eyes. The average inter-day ICC was found to be 0.77 for QAF segments within the QAF8 ring and 0.74 for peripheral segments. Image quality was predicted with a mean absolute error of 0.27 on a 5-point scale, and of all evaluated reliability indices, MOS/inferred MOS proved most important. The findings suggest that QAF allows for reliable testing of autofluorescence levels at the posterior pole in patients with AMD in a multicenter, multioperator setting. Patient reliability indices could serve as eligibility criteria for clinical trials, helping identify patients with adequate retest reliability.
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Affiliation(s)
- Leon von der Emde
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Merten Mallwitz
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Marc Vaisband
- Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Jan Hasenauer
- Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
- Helmholtz Center Munich-German Research Center for Environmental Health, Institute of Computational Biology, Neuherberg, Germany
| | - Marlene Saßmannshausen
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Jan Henrik Terheyden
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Kenneth R Sloan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Alabama, AL, USA
| | | | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany
| | - Thomas Ach
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, Ernst-Abbe-Straße 2, 53127, Bonn, Germany.
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9
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Künzel SH, Broadbent E, Möller PT, Lindner M, Goerdt L, Czauderna J, Schmitz-Valckenberg S, Holz FG, Pfau M, Fleckenstein M. Impact of lesion location and functional parameters on vision-related quality of life in geographic atrophy secondary to AMD. medRxiv 2023:2023.09.22.23295946. [PMID: 37790350 PMCID: PMC10543058 DOI: 10.1101/2023.09.22.23295946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background/Aims The primary objective was to determine how structural and functional parameters influence the vision-related quality of life (VRQoL) in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Methods This prospective, non-interventional, natural-history 'Directional Spread in Geographic-Atrophy' study was conducted at the University Eye Hospital in Bonn, enrolling 82 patients with bilateral GA. Parameters such as GA location (assessed by the Early Treatment Diabetic Retinopathy Study grid), best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), reading acuity, and speed were examined. The association between these parameters and VRQoL, as gauged using the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25), was analyzed through least absolute shrinkage and selection operator with linear mixed-effects models. Results The average total GA area observed was 2.9 ± 1.2 mm2 (better eye) and 3.1 ± 1.3 mm2 (worse eye). The VRQoL scores for distance and near activities were most associated with the inner lower and inner left subfields of the better eye. For foveal-sparing patients, the LLVA of the better eye was the predominant determinate impacting all VRQoL scales. Conclusion GA location, specifically the inner lower and inner left subfields of the better eye, has a notable effect on VRQoL in GA patients. LLVA stands out as especially vital in foveal-sparing patients, underscoring the importance for clinicians to incorporate considerations of GA location and functional parameters into their risk-benefit assessments for emerging treatments.
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Affiliation(s)
| | - Eliza Broadbent
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
| | | | - Moritz Lindner
- Institute of Physiology and Pathophysiology, Department of Neurophysiology, Philipps University, Deutschhausstr. 1-2, Marburg 35037, Germany
- Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, South Parks Road, Oxford OX1 3QU, UK
| | - Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Monika Fleckenstein
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, 84312, UT, United States
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10
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Weber C, Stasik I, Herrmann P, Schmitz-Valckenberg S, Holz FG, Liegl R. Early Vitrectomy with Silicone Oil Tamponade in the Management of Postoperative Endophthalmitis. J Clin Med 2023; 12:5097. [PMID: 37568501 PMCID: PMC10419538 DOI: 10.3390/jcm12155097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Background: Early vitrectomy for postsurgical endophthalmitis may improve visual acuity outcomes. Silicone oil as a tamponade has some potential benefits in the management of endophthalmitis. This study aims to evaluate the use of a silicone oil tamponade in the surgical management of endophthalmitis. Material and Methods: All patients with a pars plana vitrectomy with silicone oil tamponade for postsurgical endophthalmitis at the Department of Ophthalmology, University of Bonn, Germany, between 2017 and 2021 were retrospectively reviewed. We included all preoperative data, including BCVA at diagnosis, clinical findings, and symptoms. For every follow-up visit, we looked at BCVA and complications. Results: In total, 82 patients were included in this study. The mean follow-up was 13.1 months (range 1-58 months). An intravitreal injection was the cause in 42 patients (51.2%) and cataract surgery in 29 patients (35.4%). The mean interval between the causing event and the date of onset was 8.8 days (range, 1-59 days). The most prevalent pathogen was Staphylococcus epidermidis in 16 patients (19.5%). In 47 patients (57.3%), no pathogen was found. The initial best-corrected visual acuity was 2.1 logMAR and improved significantly to 1.0 logMAR after six months (p < 0.001) and 1.1 logMAR after 1 year (p < 0.001). In a multivariate analysis, a low BCVA at diagnosis (p = 0.041) was a significant predictor for poor visual acuity outcomes. A total of 17 patients (20.1%) developed postoperative complications. Five patients (6.1%) needed an anterior chamber washout with repeated injections of antibiotics. Two patients (2.4%) had persistent fibrin and were treated with YAG-laser treatment. Three patients (6.7%) developed a retinal detachment. Two patients (2.4%) had persistent corneal decompensation with endothelial cell loss and received perforating keratoplasty. We performed a matched-pair analysis (n = 30, each group n = 15) to compare a silicone oil tamponade with BSS at the end of surgery. The visual acuity outcome showed no significant differences (BCVA after one year: 1.17 logMAR in eyes with silicone oil and 0.90 logMAR in eyes with BSS; p = 0.684). Conclusions: In our study, a vitrectomy with silicone oil tamponade in the surgical management of postoperative endophthalmitis led to a significant improvement in visual acuity and had a low complication rate. Low BCVA at diagnosis was significantly associated with poor visual acuity outcomes. A comparison of silicone oil and BSS at the end of surgery showed similar results.
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Affiliation(s)
- Constance Weber
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
| | - Isabel Stasik
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
| | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT 84132, USA
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
| | - Raffael Liegl
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (C.W.); (I.S.); (P.H.); (S.S.-V.); (F.G.H.)
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11
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Spaide T, Jiang J, Patil J, Anegondi N, Steffen V, Kawczynski MG, Newton EM, Rabe C, Gao SS, Lee AY, Holz FG, Sadda S, Schmitz-Valckenberg S, Ferrara D. Geographic Atrophy Segmentation Using Multimodal Deep Learning. Transl Vis Sci Technol 2023; 12:10. [PMID: 37428131 DOI: 10.1167/tvst.12.7.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Purpose To examine deep learning (DL)-based methods for accurate segmentation of geographic atrophy (GA) lesions using fundus autofluorescence (FAF) and near-infrared (NIR) images. Methods This retrospective analysis utilized imaging data from study eyes of patients enrolled in Proxima A and B (NCT02479386; NCT02399072) natural history studies of GA. Two multimodal DL networks (UNet and YNet) were used to automatically segment GA lesions on FAF; segmentation accuracy was compared with annotations by experienced graders. The training data set comprised 940 image pairs (FAF and NIR) from 183 patients in Proxima B; the test data set comprised 497 image pairs from 154 patients in Proxima A. Dice coefficient scores, Bland-Altman plots, and Pearson correlation coefficient (r) were used to assess performance. Results On the test set, Dice scores for the DL network to grader comparison ranged from 0.89 to 0.92 for screening visit; Dice score between graders was 0.94. GA lesion area correlations (r) for YNet versus grader, UNet versus grader, and between graders were 0.981, 0.959, and 0.995, respectively. Longitudinal GA lesion area enlargement correlations (r) for screening to 12 months (n = 53) were lower (0.741, 0.622, and 0.890, respectively) compared with the cross-sectional results at screening. Longitudinal correlations (r) from screening to 6 months (n = 77) were even lower (0.294, 0.248, and 0.686, respectively). Conclusions Multimodal DL networks to segment GA lesions can produce accurate results comparable with expert graders. Translational Relevance DL-based tools may support efficient and individualized assessment of patients with GA in clinical research and practice.
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Affiliation(s)
- Theodore Spaide
- Roche Personalized Healthcare, Genentech, Inc., South San Francisco, CA, USA
| | - Jiaxiang Jiang
- Clinical Imaging Group, Genentech, Inc., South San Francisco, CA, USA
- Department of Electrical and Computer Engineering, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Jasmine Patil
- Clinical Imaging Group, Genentech, Inc., South San Francisco, CA, USA
| | - Neha Anegondi
- Roche Personalized Healthcare, Genentech, Inc., South San Francisco, CA, USA
- Clinical Imaging Group, Genentech, Inc., South San Francisco, CA, USA
| | - Verena Steffen
- Roche Personalized Healthcare, Genentech, Inc., South San Francisco, CA, USA
- Biostatistics, Genentech, Inc., South San Francisco, CA, USA
| | | | - Elizabeth M Newton
- Roche Personalized Healthcare, Genentech, Inc., South San Francisco, CA, USA
| | - Christina Rabe
- Roche Personalized Healthcare, Genentech, Inc., South San Francisco, CA, USA
- Biostatistics, Genentech, Inc., South San Francisco, CA, USA
| | - Simon S Gao
- Roche Personalized Healthcare, Genentech, Inc., South San Francisco, CA, USA
- Clinical Imaging Group, Genentech, Inc., South San Francisco, CA, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, School of Medicine, Seattle, WA, USA
| | - Frank G Holz
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
| | - SriniVas Sadda
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Daniela Ferrara
- Roche Personalized Healthcare, Genentech, Inc., South San Francisco, CA, USA
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12
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Dhooge PPA, Möller PT, Meland N, Stingl K, Boon CJF, Lotery AJ, Parodi MB, Herrmann P, Klein W, Fsadni MG, Wheeler-Schilling TH, Holz FG, Hoyng CB, Schmitz-Valckenberg S. Repeatability of Quantitative Autofluorescence Imaging in a Multicenter Study Involving Patients With Recessive Stargardt Disease 1. Transl Vis Sci Technol 2023; 12:1. [PMID: 36723966 PMCID: PMC9904328 DOI: 10.1167/tvst.12.2.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Indexed: 02/02/2023] Open
Abstract
Purpose This study assesses the repeatability of quantitative autofluorescence (qAF) in a multicenter setting and evaluates qAF as the end point for clinical trials in recessive Stargardt disease 1 (STGD1). Methods A total of 102 patients with STGD1 underwent qAF imaging as part of the Stargardt Remofuscin Treatment Trial (STARTT; EudraCT No. 2018-001496-20). For 166 eyes, we obtained qAF imaging at 2 visits, with 2 recordings per visit. The qAF8 values were independently determined by the study site and a central reading center. Intra- and inter-visit reproducibility, as well as interobserver (study site versus reading center) reproducibility were obtained using intraclass correlation (ICC), one-sample t-test, and Bland-Altman coefficient of repeatability. Results The qAF repeatability was ± 26.1% for intra-visit, ± 40.5% for inter-visit, and ± 20.2% for the interobserver reproducibility measures. Intra-visit repeatability was good to excellent for all sites (ICC of 0.88-0.96). Variability between visits was higher with an overall ICC of 0.76 (0.69-0.81). We observed no significant difference in qAF values across sites between visits (7.06 ± 93.33, P = 0.238). Conclusions Real-life test-retest variability of qAF is higher in this set of data than previously reported in single center settings. With improved operator training and by selecting the better of two recordings for evaluation, qAF serves as a useful method for assessing changes in autofluorescence signal. Translational Relevance The qAF can be adopted as a clinical trial end point, but steps to counterbalance variability should be considered.
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Affiliation(s)
- Patty P. A. Dhooge
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands,Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Philipp T. Möller
- Department of Ophthalmology, University of Bonn, Bonn, Germany,GRADE Reading Center, Bonn, Germany
| | - Nils Meland
- SMERUD Medical Research International AS, Thunes vei 2, Oslo, Norway
| | - Katarina Stingl
- Univeristy Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Camiel J. F. Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands,Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany,Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | | | - Mario G. Fsadni
- Katairo GmbH, Kusterdingen, Germany,International Pharm-Med Ltd., Bramhall, UK
| | | | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany,GRADE Reading Center, Bonn, Germany
| | - Carel B. Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands,Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany,GRADE Reading Center, Bonn, Germany,John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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13
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Saßmannshausen M, Behning C, Weinz J, Goerdt L, Terheyden JH, Chang P, Schmid M, Poor SH, Zakaria N, Finger RP, Holz FG, Pfau M, Schmitz-Valckenberg S, Thiele S. Characteristics and Spatial Distribution of Structural Features in Age-Related Macular Degeneration: A MACUSTAR Study Report. Ophthalmol Retina 2022; 7:420-430. [PMID: 36563964 DOI: 10.1016/j.oret.2022.12.007] [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: 08/12/2022] [Revised: 11/13/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To report the prevalence and topographic distribution of structural characteristics in study participants with age-related macular degeneration (AMD) and controls in the cross-sectional study part of the MACUSTAR study (ClinicalTrials.gov Identifier: NCT03349801). DESIGN European, multicenter cohort study. SUBJECTS Overall, 301 eyes of 301 subjects with early (n = 34), intermediate (n = 168), and late AMD (n = 43), as well as eyes without any AMD features (n = 56). METHODS In study eyes with intermediate AMD (iAMD), the presence of structural AMD biomarkers, including pigmentary abnormalities (PAs), pigment epithelium detachment (PED), refractile deposits, reticular pseudodrusen (RPD), hyperreflective foci (HRF), incomplete/complete retinal pigment epithelium (RPE), and outer retinal atrophy (i/cRORA), and quiescent choroidal neovascularization (qCNV) was systematically determined in the prospectively acquired multimodal retinal imaging cross-sectional data set of MACUSTAR. Retinal layer thicknesses and the RPE drusen complex (RPEDC) volume were determined for the total study cohort in spectral-domain (SD) OCT imaging using a deep-learning-based algorithm. MAIN OUTCOME MEASURES Prevalence and topographic distribution of structural iAMD features. RESULTS A total of 301 study eyes of 301 subjects with a mean (± standard deviation) age of 71.2 ± 7.20 years (63.1% women) were included. Besides large drusen, the most prevalent structural feature in iAMD study eyes were PA (57.1%), followed by HRF (51.8%) and RPD (22.0%). Pigment epithelium detachment lesions were observed in 4.8%, vitelliform lesions in 4.2%, refractile deposits in 3.0%, and qCNV in 2.4%. Direct precursor lesions for manifest retinal atrophy were detected in 10.7% (iRORA) and 4.2% (cRORA) in iAMD eyes. Overall, the highest RPEDC volume with a median of 98.92 × 10-4 mm³ was found in iAMD study eyes. Spatial analysis demonstrated a predominant distribution of RPD in the superior and temporal subfields at a foveal eccentricity of 1.5 to 2 mm, whereas HRF and large drusen had a distinct topographic distribution involving the foveal center. CONCLUSIONS Detailed knowledge of the prevalence and distribution of structural iAMD biomarkers is vital to identify reliable outcome measure for disease progression. Longitudinal analyses are needed to evaluate their prognostic value for conversion to advanced disease stages. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Marlene Saßmannshausen
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Jonas Weinz
- GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Lukas Goerdt
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Petrus Chang
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Stephen H Poor
- Ophthalmology Research, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Nadia Zakaria
- Ophthalmology Translational Medicine, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany; John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah
| | - Sarah Thiele
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany.
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14
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Pfau M, Schmitz-Valckenberg S, Ribeiro R, Safaei R, McKeown A, Fleckenstein M, Holz FG. Association of complement C3 inhibitor pegcetacoplan with reduced photoreceptor degeneration beyond areas of geographic atrophy. Sci Rep 2022; 12:17870. [PMID: 36284220 PMCID: PMC9596427 DOI: 10.1038/s41598-022-22404-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/14/2022] [Indexed: 01/20/2023] Open
Abstract
Preservation of photoreceptors beyond areas of retinal pigment epithelium atrophy is a critical treatment goal in eyes with geographic atrophy (GA) to prevent vision loss. Thus, we assessed the association of treatment with the complement C3 inhibitor pegcetacoplan with optical coherence tomography (OCT)-based photoreceptor laminae thicknesses in this post hoc analysis of the FILLY trial (NCT02503332). Retinal layers in OCT were segmented using a deep-learning-based pipeline and extracted along evenly spaced contour-lines surrounding areas of GA. The primary outcome measure was change from baseline in (standardized) outer nuclear layer (ONL) thickness at the 5.16°-contour-line at month 12. Participants treated with pegcetacoplan monthly had a thicker ONL along the 5.16° contour-line compared to the pooled sham arm (mean difference [95% CI] + 0.29 z-score units [0.16, 0.42], P < 0.001). The same was evident for eyes treated with pegcetacoplan every other month (+ 0.26 z-score units [0.13, 0.4], P < 0.001). Additionally, eyes treated with pegcetacoplan exhibited a thicker photoreceptor inner segment layer along the 5.16°-contour-line at month 12. These findings suggest that pegcetacoplan could slow GA progression and lead to reduced thinning of photoreceptor layers beyond the GA boundary. Future trials in earlier disease stages, i.e., intermediate AMD, aiming to slow photoreceptor degeneration warrant consideration.
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Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
- GRADE Reading Center, Bonn, Germany.
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, UT, 84312, USA.
| | | | | | | | - Monika Fleckenstein
- GRADE Reading Center, Bonn, Germany
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, UT, 84312, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
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15
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Dhooge PP, Möller PT, Boon CJ, Lotery AJ, Herrmann P, Battaglia Parodi M, Klein W, Fsadni MG, Wheeler-Schilling TH, Jungmann O, Müller H, Holz FG, Schmitz-Valckenberg S, Peters TM, Stingl K, Hoyng CB. The STArgardt Remofuscin Treatment Trial (STARTT): design and baseline characteristics of enrolled Stargardt patients. Open Res Eur 2022; 1:96. [PMID: 37645124 PMCID: PMC10445898 DOI: 10.12688/openreseurope.13872.3] [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] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 08/31/2023]
Abstract
Background: This report describes the study design and baseline characteristics of patients with Stargardt disease (STGD1) enrolled in the STArgardt Remofuscin Treatment Trial (STARTT). Methods: In total, 87 patients with genetically confirmed STGD1 were randomized in a double-masked, placebo-controlled proof of concept trial to evaluate the safety and efficacy of 20 milligram oral remofuscin for 24 months. The primary outcome measure is change in mean quantitative autofluorescence value of an 8-segment ring centred on the fovea (qAF 8). Secondary efficacy variables are best corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), mesopic microperimetry (mMP), spectral domain optical coherence tomography (SD-OCT), reading speed on Radner reading charts, and patient-reported visual function as assessed by the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) and Functional Reading Independence (FRI) Index. Results: Mean age of participants was 35±11 years with 49 (56%) female. Median qAF 8 value was 438 Units (range 210-729). Median BCVA and LLVA in decimal units were 0.50 (range 0.13-0.80) and 0.20 (range 0.06-0.63), respectively. The median of the mean retinal sensitivity with mMP was 20.4 dB (range 0.0-28.8). SD-OCT showed median central subfield retinal thickness of 142 µm (range 72-265) and median macular volume of 1.65 mm 3 (range 1.13-2.19). Compared to persons without vision impairment, both reading performance and patient-reported visual function were significantly lower (p<0.001, one sample t-test). Mean reading speed was 108±39 words/minute with logRAD-score of 0.45±0.28. Mean VFQ-25 composite score was 72±13. Mean FRI Index score 2.8±0.6. Conclusions: This trial design may serve as reference for future clinical trials as it explores the utility of qAF 8 as primary outcome measure. The baseline data represent the largest, multi-national, STGD1 cohort to date that underwent standardized qAF imaging, reading speed assessment and vision-related quality of life measures which all contribute to the characterization of STGD1. EudraCT registration: 2018-001496-20 (09/05/2019).
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Affiliation(s)
- Patty P.A. Dhooge
- Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, 6500HB, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6525EN, The Netherlands
| | - Philipp T. Möller
- GRADE reading center, Bonn, 53127, Germany
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
| | - Camiel J.F. Boon
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, 1081HV, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, 2333ZA, The Netherlands
| | - Andrew J. Lotery
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
- Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, 53113, Germany
| | | | | | - Mario G. Fsadni
- Katairo GmbH, Kusterdingen, 72127, Germany
- International Pharm-Med Ltd, Hemel Hempstead, HP1 1LD, UK
| | - Thomas H. Wheeler-Schilling
- University Eye Hospital, Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, 72076, Germany
| | - Oliver Jungmann
- Smerud Medical Research Germany GmbH, Mannheim, D-68161, Germany
| | - Hans Müller
- Smerud Medical Research Germany GmbH, Mannheim, D-68161, Germany
| | - Frank G. Holz
- GRADE reading center, Bonn, 53127, Germany
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
| | - Steffen Schmitz-Valckenberg
- GRADE reading center, Bonn, 53127, Germany
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, 84132, USA
| | - Tobias M. Peters
- University Eye Hospital, Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, 72076, Germany
| | - Katarina Stingl
- University Eye Hospital, Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, 72076, Germany
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, 72076, Germany
| | - Carel B. Hoyng
- Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, 6500HB, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6525EN, The Netherlands
| | - Soraprazan Consortium
- Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Nijmegen, 6500HB, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, 6525EN, The Netherlands
- GRADE reading center, Bonn, 53127, Germany
- Department of Ophthalmology, University of Bonn, Bonn, 53127, Germany
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, 1081HV, The Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, 2333ZA, The Netherlands
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
- Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, 53113, Germany
- Department of Ophthalmology, Ospedale San Raffaele, Milan, 20132, Italy
- Katairo GmbH, Kusterdingen, 72127, Germany
- International Pharm-Med Ltd, Hemel Hempstead, HP1 1LD, UK
- University Eye Hospital, Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, 72076, Germany
- Smerud Medical Research Germany GmbH, Mannheim, D-68161, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, 84132, USA
- Center for Rare Eye Diseases, University of Tübingen, Tübingen, 72076, Germany
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16
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Saßmannshausen M, Behning C, Isselmann B, Schmid M, Finger RP, Holz FG, Schmitz-Valckenberg S, Pfau M, Thiele S. Relative ellipsoid zone reflectivity and its association with disease severity in age-related macular degeneration: a MACUSTAR study report. Sci Rep 2022; 12:14933. [PMID: 36056113 PMCID: PMC9440143 DOI: 10.1038/s41598-022-18875-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
Quantification of the relative ellipsoid zone reflectivity (rEZR) might be a structural surrogate parameter for an early disease progression in the context of age-related macular degeneration (AMD). Within the European multicenter, cross-sectional MACUSTAR study, we have devised an automatic approach to determine the mean rEZR [arbitrary units, AU] at two independent visits in SD-OCT volume scans in study participants. Linear mixed-effects models were applied to analyze the association of AMD stage and AMD associated high-risk features including presence of pigmentary abnormalities, reticular pseudodrusen (RPD), volume of the retinal-pigment-epithelial-drusenoid-complex (RPEDC) with the rEZR. Intra-class correlation coefficients (ICC) were determined for rEZR reliability analysis. Within the overall study cohort (301 participants), we could observe decreased rEZR values (coefficient estimate ± standard error) of - 8.05 ± 2.44 AU (p = 0.0011) in the intermediate and of - 22.35 ± 3.28 AU (p < 0.0001) in the late AMD group. RPD presence was significantly associated with the rEZR in iAMD eyes (- 6.49 ± 3.14 AU; p = 0.0403), while there was a good ICC of 0.846 (95% confidence interval: 0.809; 0.876) in the overall study cohort. This study showed an association of rEZR with increasing disease severity and the presence of iAMD high-risk features. Further studies are necessary to evaluate the rEZR's value as a novel biomarker for AMD and disease progression.
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Affiliation(s)
- Marlene Saßmannshausen
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Ben Isselmann
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- GRADE Reading Center, University of Bonn, Bonn, Germany
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- GRADE Reading Center, University of Bonn, Bonn, Germany
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Bethesda, MD, USA
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- GRADE Reading Center, University of Bonn, Bonn, Germany.
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17
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Uhrmann MF, Peto T, Bullmann T, Andrassi-Darida M, Schumann M, Schmitz-Valckenberg S, Holz FG, Lorenz B. The feasibility of using ultra-widefield retinal imaging to identify ocular pathologies amongst those with systemic medical disease attending tertiary healthcare facility at a university hospital. Ophthalmologica 2022; 245:455-463. [PMID: 35977524 DOI: 10.1159/000526573] [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: 08/23/2021] [Accepted: 07/25/2022] [Indexed: 11/19/2022]
Abstract
Aims To evaluate the feasibility of ultra-widefield (UWF) imaging to identify ocular pathologies amongst in- and out-patients in a tertiary university hospital. Methods Prospective double-blinded multicenter clinical study. In total, 634 patients from a University Hospital with pulmonary, cardiovascular and endocrine diseases were examined by two teams by conventional slit-lamp biomicroscopy (CBM). UWF images with Optos Tx200 were recorded and graded independently by two retina specialists, and graders from two Reading Centers for presence of pre-defined pathologies. Interrater reliability was calculated using Fleiss statistical software. BL classified all UWF images with retinal hemorrhages by severity and interrater agreement. Results Complete data were available for 502 patients. Reading Center Moorfields Eye Hospital, London, UK (RM) reported the highest number of cases with retinal pathologies (378), Reading Center GRADE Bonn, Germany (RB) did so for cases with optic disc cupping (466), R1 with optic disc pallor (151) while R2 reported the lowest number optic disc pathologies (39). Interrater reliability was highest for retinal hemorrhages (0.59). To understand low interrater reliability, sub-analysis of retinal hemorrhages indicated high interrater agreement for obvious pathologies. Conclusions UWF imaging is convenient and effective to identify retinal pathologies in patients attending hospital clinics for a range of systemic diseases. Imaging the eye allows for remote assessment and reassessment of the retinal diseases, however the time taken to train graders and for image analysis and reporting should not be underestimated.
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Affiliation(s)
- Matthias Fritz Uhrmann
- The Giessen Optos Study Group, Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Giessen, Germany,
- Department of Health Economics, Justus-Liebig-University Giessen, Giessen, Germany,
| | - Tunde Peto
- Center for Public Health, Queen's University Belfast, Belfast, UK
| | - Timo Bullmann
- The Giessen Optos Study Group, Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Monika Andrassi-Darida
- The Giessen Optos Study Group, Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | - Mathis Schumann
- The Giessen Optos Study Group, Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Giessen, Germany
| | | | - Frank G Holz
- GRADE Reading Center, University Eye Hospital, Bonn, Germany
- University Eye Hospital, Bonn, Germany
| | - Birgit Lorenz
- The Giessen Optos Study Group, Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Giessen, Germany
- University Eye Hospital, Bonn, Germany
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18
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Schaub F, Schiller P, Hoerster R, Kraus D, Holz FG, Guthoff R, Agostini H, Spitzer MS, Wiedemann P, Lommatzsch A, Boden KT, Dimopoulos S, Bemme S, Tamm S, Maier M, Roider J, Enders P, Altay L, Fauser S, Kirchhof B, Agostini H, Bartz-Schmidt KU, Bemme S, Boden K, Callizo J, Dahlke C, Eberwein P, Ehlken C, Feltgen N, Gamulescu A, Gelisken F, Gutfleisch M, Guthoff R, Haus A, Helbig H, Hermann M, Holz FG, Januschowski K, Jochmann C, Kirchhof B, Krohne T, Lagrèze W, Lange C, Lohmann C, Lommatzsch A, Macek MA, Maier M, Märker D, Mayer C, Meier P, Müther P, Prahs P, Purtskhvanidze K, Rehak M, Schaub F, Schick T, Schmitz-Valckenberg S, Schultheiß M, Skevas C, Spitzer MS, Stahl A, Szurman P, Unterlauft JD. Intravitreal 5-Fluorouracil and Heparin to Prevent Proliferative Vitreoretinopathy: results from a randomized clinical trial. Ophthalmology 2022; 129:1129-1141. [DOI: 10.1016/j.ophtha.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022] Open
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19
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Schmitz-Valckenberg S, Zouache MA, Hageman GS, Fleckenstein M. From Genes, Proteins, and Clinical Manifestation: Why Do We Need to Better Understand Age-Related Macular Degeneration? Ophthalmology Science 2022; 2:100174. [PMID: 36249706 PMCID: PMC9560631 DOI: 10.1016/j.xops.2022.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Pfau M, Schmitz-Valckenberg S, Holz FG, Fleckenstein M. Re: Trivizki et al. Local Geographic Atrophy Growth Rates Not Influenced by Close Proximity to Non-Exudative Type 1 Macular Neovascularization. Invest Ophthalmol Vis Sci 2022; 63:10. [PMID: 35536717 PMCID: PMC9106973 DOI: 10.1167/iovs.63.5.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, United States. E-mail:
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | - Monika Fleckenstein
- GRADE Reading Center, Bonn, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, United States. E-mail:
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21
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Saßmannshausen M, Thiele S, Behning C, Pfau M, Schmid M, Leal S, Luhmann UFO, Finger RP, Holz FG, Schmitz-Valckenberg S. Intersession Repeatability of Structural Biomarkers in Early and Intermediate Age-Related Macular Degeneration: A MACUSTAR Study Report. Transl Vis Sci Technol 2022; 11:27. [PMID: 35333287 PMCID: PMC8963672 DOI: 10.1167/tvst.11.3.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To analyze the intersession repeatability of structural biomarkers in eyes with early and intermediate age-related macular degeneration (iAMD) within the cross-sectional part of the observational multicenter MACUSTAR study. Methods Certified site personnel obtained multimodal imaging data at two visits (38 ± 20 [mean ± standard deviation] days apart), including spectral-domain optical coherence tomography (SD-OCT). One junior reader performed systematic and blinded grading at the central reading center, followed by senior reader review. Structural biomarkers included maximum drusen size classification (>63 to ≤125 µm vs. >125 µm), presence of large pigment epithelium detachments (PEDs), reticular pseudodrusen (RPD), vitelliform lesions, and refractile deposits. Intrasession variability was assessed using Cohen's κ statistics. Results At the first visit, 202 study eyes of 202 participants were graded as manifesting with either early (n = 34) or intermediate (n = 168) AMD. Grading of imaging data between visits revealed perfect agreement for the maximum drusen size classification (κ = 0.817; 95% confidence interval, 0.70–0.94). In iAMD eyes, perfect to substantial agreement was determined for the presence of large PEDs (0.87; 0.69–1.00) and RPD (0.752; 0.63–0.87), while intersession agreement was lower for the presence of vitelliform lesions (0.649; 0.39–0.65) and refractile deposits (0.342; −0.029–0.713), respectively. Conclusions Multimodal retinal imaging analysis between sessions showed a higher repeatability for structural biomarkers with predefined cutoff values than purely qualitative defined parameters. Translational Relevance A high repeatability of retinal imaging biomarkers will be important to implement automatic grading approaches and to establish robust and meaningful structural clinical endpoints for future interventional clinical trials in patients with iAMD.
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Affiliation(s)
- Marlene Saßmannshausen
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany.,Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Bethesda, MD, USA
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | | | - Ulrich F O Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center Basel, Basel, Switzerland
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
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22
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Schmitz-Valckenberg S, Fleckenstein M, Zouache MA, Pfau M, Pappas C, Hageman JL, Agrón E, Malley C, Keenan TDL, Chew EY, Hageman GS. Progression of Age-Related Macular Degeneration Among Individuals Homozygous for Risk Alleles on Chromosome 1 (CFH-CFHR5) or Chromosome 10 (ARMS2/HTRA1) or Both. JAMA Ophthalmol 2022; 140:252-260. [PMID: 35113155 PMCID: PMC8814975 DOI: 10.1001/jamaophthalmol.2021.6072] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Age-related macular degeneration (AMD) is a common cause of irreversible vision loss among individuals older than 50 years. Although considerable advances have been made in our understanding of AMD genetics, the differential effects of major associated loci on disease manifestation and progression may not be well characterized. OBJECTIVE To elucidate the specific associations of the 2 most common genetic risk loci for AMD, the CFH-CFHR5 locus on chromosome 1q32 (Chr1) and the ARMS2/HTRA1 locus on chromosome 10q26 (Chr10)-independent of one another and in combination-with time to conversion to late-stage disease and to visual acuity loss. DESIGN, SETTING, AND PARTICIPANTS This case series study included 502 individuals who were homozygous for risk variants at both Chr1 and Chr10 (termed Chr1&10-risk) or at either Chr1 (Chr1-risk) or Chr10 (Chr10-risk) and who had enrolled in Genetic and Molecular Studies of Eye Diseases at the Sharon Eccles Steele Center for Translational Medicine between September 2009 and March 2020. Multimodal imaging data were reviewed for AMD staging, including grading of incomplete and complete retinal pigment epithelium and outer retinal atrophy. MAIN OUTCOMES AND MEASURES Hazard ratios and survival times for conversion to any late-stage AMD, atrophic or neovascular, and associated vision loss of 2 or more lines. RESULTS In total, 317 participants in the Chr1-risk group (median [IQR] age at first visit, 75.6 [69.5-81.7] years; 193 women [60.9%]), 93 participants in the Chr10-risk group (median [IQR] age at first visit, 77.5 [72.2-84.2] years; 62 women [66.7%]), and 92 participants in the Chr1&10-risk group (median [IQR] age at first visit, 71.7 [68.0-76.3] years; 62 women [67.4%]) were included in the analyses. After adjusting for age and AMD grade at first visit, compared with 257 participants in the Chr1-risk group, 56 participants in the Chr1&10-risk group (factor of 3.3 [95% CI, 1.6-6.8]; P < .001) and 58 participants in the Chr10-risk group (factor of 2.6 [95% CI, 1.3-5.2]; P = .007) were more likely to convert to a late-stage phenotype during follow-up. This difference was mostly associated with conversion to macular neovascularization, which occurred earlier in participants with Chr1&10-risk and Chr10-risk. Eyes in the Chr1&10-risk group (median [IQR] survival, 5.7 [2.1-11.1] years) were 2.1 (95% CI, 1.1-3.9; P = .03) times as likely and eyes in the Chr10-risk group (median [IQR] survival, 6.3 [2.7-11.3] years) were 1.8 (95% CI, 1.0-3.1; P = .05) times as likely to experience a visual acuity loss of 2 or more lines compared with eyes of the Chr1-risk group (median [IQR] survival, 9.4 [4.1-* (asterisk indicates event rate did not reach 75%)] years). CONCLUSIONS AND RELEVANCE These findings suggest differential associations of the 2 major AMD-related risk loci with structural and functional disease progression and suggest distinct underlying biological mechanisms associated with these 2 loci. These genotype-phenotype associations may warrant consideration when designing and interpreting AMD research studies and clinical trials.
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Affiliation(s)
- Steffen Schmitz-Valckenberg
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City
- Utah Retinal Reading (UREAD) Center, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Monika Fleckenstein
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City
- Utah Retinal Reading (UREAD) Center, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City
| | - Moussa A. Zouache
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City
| | - Maximilian Pfau
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Christian Pappas
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City
| | - Jill L. Hageman
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Claire Malley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Tiarnan D. L. Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Y. Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Gregory S. Hageman
- Sharon Eccles Steele Center for Translational Medicine, John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City
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23
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Holz FG, Schmitz-Valckenberg S, Wolf A, Agostini H, Lorenz K, Pielen A, Feltgen N, Guthoff R, Quiering C, Clemens A, Jaeger K. A randomized, open-label, multicenter study of switching to brolucizumab with or without a loading dose for patients with suboptimal anatomically controlled neovascular age-related macular degeneration-the FALCON study. Graefes Arch Clin Exp Ophthalmol 2022; 260:2695-2702. [PMID: 35188581 PMCID: PMC9325853 DOI: 10.1007/s00417-022-05591-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 01/06/2023] Open
Abstract
Background Treatment initiation with brolucizumab, a new potent anti-vascular endothelial growth factor (VEGF) agent, is typically performed with three monthly injections (loading dose) and has been well studied in treatment-naïve patients. However, no clinical data are available yet on whether or not anti-VEGF pretreated patients also benefit from a loading dose. In the clinical setting, different heterogeneous treatment patterns are used as no clinical trial has addressed this so far in a head-to-head comparison. Therefore, the FALCON study is investigating whether patients with unsatisfactory response to previous anti-VEGF treatments benefit from a loading dose at the switch to brolucizumab treatment. Methods FALCON is a 52-week, two-arm, randomized, open-label, multicenter, multinational study in patients with residually active neovascular age-related macular degeneration (nAMD) who will be randomized 1:1 and started with brolucizumab 6 mg loading (three monthly loading doses) or brolucizumab 6 mg non-loading (one initial injection) and consecutive treatment every 12 weeks, respectively. The primary objective is to demonstrate non-inferiority of the non-loading vs. loading arm in mean change of best-corrected visual acuity (BCVA) from baseline to the mean value at week 40 to week 52. Secondary objectives include the assessment of anatomical outcomes, treatment intervals, safety and tolerability. Results FALCON will be the first study to assess treatment initiation with an anti-VEGF agent in a switch situation with or without loading dose in patients with nAMD. Conclusions The results will support the optimization of treatment of patients with previous unsatisfactory anti-VEGF response. Therefore, we expect to see an impact on current clinical practice which has been established for more than a decade. Trial registration Clinicaltrials.gov: NCT04679935, date of registration—22-Dec 2020; EUDRACT number: 2019–004763-53, date of registration—03 Dec 2019.
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Affiliation(s)
- F G Holz
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology and GRADE Reading Center, University of Bonn, Bonn, Germany. .,Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, UT, 84312, USA.
| | - A Wolf
- Department of Ophthalmology, University of Ulm, Ulm, Germany
| | - H Agostini
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - K Lorenz
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - A Pielen
- University Eye Hospital, Medizinische Hochschule Hannover, Hannover, Germany
| | - N Feltgen
- Eye Center, Faculty of Medicine, University of Goettingen, Goettingen, Germany
| | - R Guthoff
- Eye Hospital, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - C Quiering
- Novartis Pharma GmbH, Nuernberg, Germany
| | - A Clemens
- Novartis Pharma AG, Basel, Switzerland.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center, University of Freiburg, Freiburg, Germany
| | - K Jaeger
- Novartis Pharma GmbH, Nuernberg, Germany
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24
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Künzel SH, Lindner M, Sassen J, Möller PT, Goerdt L, Schmid M, Schmitz-Valckenberg S, Holz FG, Fleckenstein M, Pfau M. Association of Reading Performance in Geographic Atrophy Secondary to Age-Related Macular Degeneration With Visual Function and Structural Biomarkers. JAMA Ophthalmol 2021; 139:1191-1199. [PMID: 34591067 DOI: 10.1001/jamaophthalmol.2021.3826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance As a disabling and frequent disease, geographic atrophy secondary to age-related macular degeneration (AMD) constitutes an important study subject. Emerging clinical trials require suitable end points. The characterization and validation of reading performance as a functional outcome parameter is warranted. Objective To prospectively evaluate reading performance in geographic atrophy and to assess its association with established visual function assessments and structural biomarkers. Design, Setting, and Participants The noninterventional, prospective natural history Directional Spread in Geographic Atrophy study included patients with geographic atrophy secondary to AMD who were recruited at the University Hospital in Bonn, Germany. Participants were enrolled from June 2013 to June 2016. Analysis began December 2019 and ended January 2021. Main Outcomes and Measures Reading acuity and reading speed were assessed using Radner charts. Longitudinal fundus autofluorescence and infrared reflectance images were semiautomatically annotated for geographic atrophy, followed by extraction of shape-descriptive variables. Linear mixed-effects models were applied to investigate the association of those variables with reading performance. Results A total of 150 eyes of 85 participants were included in this study (median [IQR] age, 77.9 [72.4-82.1] years; 51 women [60%]; 34 men [40%]). Reading performance was impaired with a median (IQR) monocular reading acuity of 0.9 (0.4-1.3) logarithm of the reading acuity determination and a reading speed of 52.8 (0-123) words per minute. In the multivariable cross-sectional analysis, best-corrected visual acuity, area of geographic atrophy in the central Early Treatment Diabetic Retinopathy Study (ETDRS) subfield, classification of noncenter vs center-involving geographic atrophy, and area of geographic atrophy in the inner-right ETDRS subfield showed strongest associations with reading acuity (cross-validated R2for reading acuity = 0.69). Regarding reading speed, the most relevant variables were best-corrected visual acuity, low-luminance visual acuity, area of geographic atrophy in the central ETDRS subfield, in the inner-right ETDRS subfield, and in the inner-upper ETDRS subfield (R2 for reading speed = 0.67). In the longitudinal analysis, a similar prediction accuracy for reading performance was determined (R2 for reading acuity = 0.73; R2 for reading speed = 0.70). Prediction accuracy did not improve when follow-up time was added as an independent variable. Binocular reading performance did not differ from reading performance in the better-seeing eye. Conclusions and Relevance The association of reading acuity and speed with visual functional and structural biomarkers supports the validity of reading performance as a meaningful end point in clinical trials. These findings suggest that measures in clinical and low-vision care for patients with geographic atrophy should focus primarily on the better-seeing eye.
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Affiliation(s)
| | - Moritz Lindner
- Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Institute for Physiology and Pathophysiology, Department of Neurophysiology, Philipps-University Marburg, Marburg, Germany
| | - Josua Sassen
- Institute for Numerical Simulation, University of Bonn, Bonn, Germany
| | | | - Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland
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25
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Pfau M, van Dijk EHC, van Rijssen TJ, Schmitz-Valckenberg S, Holz FG, Fleckenstein M, Boon CJF. Estimation of current and post-treatment retinal function in chronic central serous chorioretinopathy using artificial intelligence. Sci Rep 2021; 11:20446. [PMID: 34650220 PMCID: PMC8516921 DOI: 10.1038/s41598-021-99977-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/30/2021] [Indexed: 01/13/2023] Open
Abstract
Refined understanding of the association of retinal microstructure with current and future (post-treatment) function in chronic central serous chorioretinopathy (cCSC) may help to identify patients that would benefit most from treatment. In this post-hoc analysis of data from the prospective, randomized PLACE trial (NCT01797861), we aimed to determine the accuracy of AI-based inference of retinal function from retinal morphology in cCSC. Longitudinal spectral-domain optical coherence tomography (SD-OCT) data from 57 eyes of 57 patients from baseline, week 6-8 and month 7-8 post-treatment were segmented using deep-learning software. Fundus-controlled perimetry data were aligned to the SD-OCT data to extract layer thickness and reflectivity values for each test point. Point-wise retinal sensitivity could be inferred with a (leave-one-out) cross-validated mean absolute error (MAE) [95% CI] of 2.93 dB [2.40-3.46] (scenario 1) using random forest regression. With addition of patient-specific baseline data (scenario 2), retinal sensitivity at remaining follow-up visits was estimated even more accurately with a MAE of 1.07 dB [1.06-1.08]. In scenario 3, month 7-8 post-treatment retinal sensitivity was predicted from baseline SD-OCT data with a MAE of 3.38 dB [2.82-3.94]. Our study shows that localized retinal sensitivity can be inferred from retinal structure in cCSC using machine-learning. Especially, prediction of month 7-8 post-treatment sensitivity with consideration of the treatment as explanatory variable constitutes an important step toward personalized treatment decisions in cCSC.
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Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, P. O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, P. O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- John A. Moran Eye Center, University of Utah, Utah, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, P. O. Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
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26
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Rieck S, Kilgus S, Meyer JH, Huang H, Zhao L, Matthey M, Wang X, Schmitz-Valckenberg S, Fleischmann BK, Wenzel D. Inhibition of Vascular Growth by Modulation of the Anandamide/Fatty Acid Amide Hydrolase Axis. Arterioscler Thromb Vasc Biol 2021; 41:2974-2989. [PMID: 34615374 PMCID: PMC8608012 DOI: 10.1161/atvbaha.121.316973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Supplemental Digital Content is available in the text. Objective: Pathological angiogenesis is a hallmark of various diseases characterized by local hypoxia and inflammation. These disorders can be treated with inhibitors of angiogenesis, but current compounds display a variety of side effects and lose efficacy over time. This makes the identification of novel signaling pathways and pharmacological targets involved in angiogenesis a top priority. Approach and Results: Here, we show that inactivation of FAAH (fatty acid amide hydrolase), the enzyme responsible for degradation of the endocannabinoid anandamide, strongly impairs angiogenesis in vitro and in vivo. Both, the pharmacological FAAH inhibitor URB597 and anandamide induce downregulation of gene sets for cell cycle progression and DNA replication in endothelial cells. This is underscored by cell biological experiments, in which both compounds inhibit proliferation and migration and evoke cell cycle exit of endothelial cells. This prominent antiangiogenic effect is also of pathophysiological relevance in vivo, as laser-induced choroidal neovascularization in the eye of FAAH−/− mice is strongly reduced. Conclusions: Thus, elevation of endogenous anandamide levels by FAAH inhibition represents a novel antiangiogenic mechanism.
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Affiliation(s)
- Sarah Rieck
- Institute of Physiology I, Life&Brain Center, Medical Faculty (S.R., S.K., B.K.F., D.W.), University of Bonn, Germany
| | - Sofia Kilgus
- Institute of Physiology I, Life&Brain Center, Medical Faculty (S.R., S.K., B.K.F., D.W.), University of Bonn, Germany
| | - Johanna H Meyer
- Department of Ophthalmology (J.H.M., S.S.-V.), University of Bonn, Germany
| | - Hao Huang
- Department of Biomedical Sciences, City University of Hong Kong (H.H., L.Z., X.W.)
| | - Lan Zhao
- Department of Biomedical Sciences, City University of Hong Kong (H.H., L.Z., X.W.)
| | - Michaela Matthey
- Department of Systems Physiology, Institute of Physiology, Medical Faculty, Ruhr University of Bochum, Germany (M.M., D.W.)
| | - Xin Wang
- Department of Biomedical Sciences, City University of Hong Kong (H.H., L.Z., X.W.)
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology (J.H.M., S.S.-V.), University of Bonn, Germany.,John A. Moran Eye Center, Ophthalmology & Visual Science, University of Utah, Salt Lake City (S.S.-V.)
| | - Bernd K Fleischmann
- Institute of Physiology I, Life&Brain Center, Medical Faculty (S.R., S.K., B.K.F., D.W.), University of Bonn, Germany
| | - Daniela Wenzel
- Institute of Physiology I, Life&Brain Center, Medical Faculty (S.R., S.K., B.K.F., D.W.), University of Bonn, Germany.,Department of Systems Physiology, Institute of Physiology, Medical Faculty, Ruhr University of Bochum, Germany (M.M., D.W.)
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27
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Behning C, Fleckenstein M, Pfau M, Adrion C, Goerdt L, Lindner M, Schmitz-Valckenberg S, Holz FG, Schmid M. Modeling of atrophy size trajectories: variable transformation, prediction and age-of-onset estimation. BMC Med Res Methodol 2021; 21:170. [PMID: 34404346 PMCID: PMC8369742 DOI: 10.1186/s12874-021-01356-0] [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: 12/29/2020] [Accepted: 07/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background To model the progression of geographic atrophy (GA) in patients with age-related macular degeneration (AMD) by building a suitable statistical regression model for GA size measurements obtained from fundus autofluorescence imaging. Methods Based on theoretical considerations, we develop a linear mixed-effects model for GA size progression that incorporates covariable-dependent enlargement rates as well as correlations between longitudinally collected GA size measurements. To capture nonlinear progression in a flexible way, we systematically assess Box-Cox transformations with different transformation parameters λ. Model evaluation is performed on data collected for two longitudinal, prospective multi-center cohort studies on GA size progression. Results A transformation parameter of λ=0.45 yielded the best model fit regarding the Akaike information criterion (AIC). When hypertension and hypercholesterolemia were included as risk factors in the model, they showed an association with progression of GA size. The mean estimated age-of-onset in this model was 67.21±6.49 years. Conclusions We provide a comprehensive framework for modeling the course of uni- or bilateral GA size progression in longitudinal observational studies. Specifically, the model allows for age-of-onset estimation, identification of risk factors and prediction of future GA size. A square-root transformation of atrophy size is recommended before model fitting. Supplementary Information The online version contains supplementary material available at (10.1186/s12874-021-01356-0).
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Affiliation(s)
- Charlotte Behning
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany.
| | | | - Maximilian Pfau
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Bethesda, MD, USA
| | - Christine Adrion
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Lukas Goerdt
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Moritz Lindner
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany
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28
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Wintergerst MWM, Gorgi Zadeh S, Wiens V, Thiele S, Schmitz-Valckenberg S, Holz FG, Finger RP, Schultz T. Author Correction: Replication and Refinement of an Algorithm for Automated Drusen Segmentation on Optical Coherence Tomography. Sci Rep 2021; 11:15101. [PMID: 34282235 PMCID: PMC8289826 DOI: 10.1038/s41598-021-94752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Shekoufeh Gorgi Zadeh
- Department of Computer Science, University of Bonn, Endenicher Allee 19a, 53115, Bonn, Germany.,Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Vitalis Wiens
- Department of Computer Science, University of Bonn, Endenicher Allee 19a, 53115, Bonn, Germany.,TIB Leibniz Information Centre for Science and Technology, Hannover and Fraunhofer IAIS, St. Augustin, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
| | - Thomas Schultz
- Department of Computer Science, University of Bonn, Endenicher Allee 19a, 53115, Bonn, Germany.,Bonn-Aachen International Center for Information Technology, University of Bonn, Endenicher Allee 19a, 53115, Bonn, Germany
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29
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Pfau M, Sahu S, Rupnow RA, Romond K, Millet D, Holz FG, Schmitz-Valckenberg S, Fleckenstein M, Lim JI, de Sisternes L, Leng T, Rubin DL, Hallak JA. Probabilistic Forecasting of Anti-VEGF Treatment Frequency in Neovascular Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:30. [PMID: 34185055 PMCID: PMC8254013 DOI: 10.1167/tvst.10.7.30] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose To probabilistically forecast needed anti-vascular endothelial growth factor (anti-VEGF) treatment frequency using volumetric spectral domain-optical coherence tomography (SD-OCT) biomarkers in neovascular age-related macular degeneration from real-world settings. Methods SD-OCT volume scans were segmented with a custom deep-learning-based analysis pipeline. Retinal thickness and reflectivity values were extracted for the central and the four inner Early Treatment Diabetic Retinopathy Study (ETDRS) subfields for six retinal layers (inner retina, outer nuclear layer, inner segments [IS], outer segments [OS], retinal pigment epithelium-drusen complex [RPEDC] and the choroid). Machine-learning models were probed to predict the anti-VEGF treatment frequency within the next 12 months. Probabilistic forecasting was performed using natural gradient boosting (NGBoost), which outputs a full probability distribution. The mean absolute error (MAE) between the predicted versus actual anti-VEGF treatment frequency was the primary outcome measure. Results In a total of 138 visits of 99 eyes with neovascular AMD (96 patients) from two clinical centers, the prediction of future anti-VEGF treatment frequency was observed with an accuracy (MAE [95% confidence interval]) of 2.60 injections/year [2.25-2.96] (R2 = 0.390) using random forest regression and 2.66 injections/year [2.31-3.01] (R2 = 0.094) using NGBoost, respectively. Prediction intervals were well calibrated and reflected the true uncertainty of NGBoost-based predictions. Standard deviation of RPEDC-thickness in the central ETDRS-subfield constituted an important predictor across models. Conclusions The proposed, fully automated pipeline enables probabilistic forecasting of future anti-VEGF treatment frequency in real-world settings. Translational Relevance Prediction of a probability distribution allows the physician to inspect the underlying uncertainty. Predictive uncertainty estimates are essential to highlight cases where human-inspection and/or reversion to a fallback alternative is warranted.
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Affiliation(s)
- Maximilian Pfau
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Soumya Sahu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Rawan Allozi Rupnow
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen Romond
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Desiree Millet
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | | | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Joelle A Hallak
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Schmitz-Valckenberg S, Braun MD, Thiele S, Ferrara D, Honigberg L, Gao SS, Chen H, Steffen V, Holz FG, Saßmannshausen M. Conversion from Intermediate Age-Related Macular Degeneration to Geographic Atrophy in a Proxima B Subcohort Using a Multimodal Approach. Ophthalmologica 2021; 244:523-534. [PMID: 34348335 DOI: 10.1159/000517881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Steffen Schmitz-Valckenberg
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Martina D Braun
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sarah Thiele
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Lee Honigberg
- Genentech, Inc., South San Francisco, California, USA
| | - Simon S Gao
- Genentech, Inc., South San Francisco, California, USA
| | - Hao Chen
- Genentech, Inc., South San Francisco, California, USA
| | | | - Frank G Holz
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
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Fleckenstein M, Keenan TDL, Guymer RH, Chakravarthy U, Schmitz-Valckenberg S, Klaver CC, Wong WT, Chew EY. Age-related macular degeneration. Nat Rev Dis Primers 2021; 7:31. [PMID: 33958600 DOI: 10.1038/s41572-021-00265-2] [Citation(s) in RCA: 297] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Age-related macular degeneration (AMD) is the leading cause of legal blindness in the industrialized world. AMD is characterized by accumulation of extracellular deposits, namely drusen, along with progressive degeneration of photoreceptors and adjacent tissues. AMD is a multifactorial disease encompassing a complex interplay between ageing, environmental risk factors and genetic susceptibility. Chronic inflammation, lipid deposition, oxidative stress and impaired extracellular matrix maintenance are strongly implicated in AMD pathogenesis. However, the exact interactions of pathophysiological events that culminate in drusen formation and the associated degeneration processes remain to be elucidated. Despite tremendous advances in clinical care and in unravelling pathophysiological mechanisms, the unmet medical need related to AMD remains substantial. Although there have been major breakthroughs in the treatment of exudative AMD, no efficacious treatment is yet available to prevent progressive irreversible photoreceptor degeneration, which leads to central vision loss. Compelling progress in high-resolution retinal imaging has enabled refined phenotyping of AMD in vivo. These insights, in combination with clinicopathological and genetic correlations, have underscored the heterogeneity of AMD. Hence, our current understanding promotes the view that AMD represents a disease spectrum comprising distinct phenotypes with different mechanisms of pathogenesis. Hence, tailoring therapeutics to specific phenotypes and stages may, in the future, be the key to preventing irreversible vision loss.
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Affiliation(s)
- Monika Fleckenstein
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
| | - Tiarnán D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, VIC, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Usha Chakravarthy
- Department of Ophthalmology, Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Caroline C Klaver
- Department of Ophthalmology, Erasmus MC, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands.,Department of Ophthalmology, Radboud Medical Center, Nijmegen, Netherlands.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Wai T Wong
- Section on Neuron-Glia Interactions in Retinal Disease, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
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Holz FG, Oleksy P, Ricci F, Kaiser PK, Kiefer J, Schmitz-Valckenberg S. Efficacy and Safety of Biosimilar FYB201 Compared with Ranibizumab in Neovascular Age-Related Macular Degeneration. Ophthalmology 2021; 129:54-63. [PMID: 33957183 DOI: 10.1016/j.ophtha.2021.04.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 02/04/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This trial was conducted to investigate the clinical equivalence of the proposed biosimilar FYB201 and reference ranibizumab in patients with treatment-naive, subfoveal choroidal neovascularization caused by neovascular age-related macular degeneration (nAMD). DESIGN This was a prospective, multicenter, evaluation-masked, parallel-group, 48-week, phase III randomized study. PARTICIPANTS A total of 477 patients were randomly assigned to receive FYB201 (n = 238) or reference ranibizumab (n = 239). METHODS Patients received FYB201 or reference ranibizumab 0.5 mg by intravitreal (IVT) injection in the study eye every 4 weeks. MAIN OUTCOME MEASURES The primary end point was change from baseline in best-corrected visual acuity (BCVA) by Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 8 weeks before the third monthly IVT injection. Biosimilarity of FYB201 to its originator was assessed via a 2-sided equivalence test, with an equivalence margin in BCVA of 3 ETDRS letters. RESULTS The BCVA improved in both groups, with a mean improvement of +5.1 (FYB201) and +5.6 (reference ranibizumab) ETDRS letters at week 8. The analysis of covariance (ANCOVA) least squares mean difference for the change from baseline between FYB201 and reference ranibizumab was -0.4 ETDRS letters with a 90% confidence interval (CI) of -1.6 to 0.9. Primary end point was met as the 90% CI was within the predefined equivalence margin. Adverse events were comparable between treatment groups. CONCLUSIONS FYB201 is biosimilar to reference ranibizumab in terms of clinical efficacy and ocular and systemic safety in the treatment of patients with nAMD.
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Affiliation(s)
- Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
| | - Piotr Oleksy
- Department of Ophthalmology, Centrum Medyczne UNO-MED, Tarnów, Poland
| | - Federico Ricci
- UNIT Retina Diseases, Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | | | | | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, Utah
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33
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von der Emde L, Pfau M, Holz FG, Fleckenstein M, Kortuem K, Keane PA, Rubin DL, Schmitz-Valckenberg S. AI-based structure-function correlation in age-related macular degeneration. Eye (Lond) 2021; 35:2110-2118. [PMID: 33767409 PMCID: PMC8302753 DOI: 10.1038/s41433-021-01503-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/24/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
Sensitive and robust outcome measures of retinal function are pivotal for clinical trials in age-related macular degeneration (AMD). A recent development is the implementation of artificial intelligence (AI) to infer results of psychophysical examinations based on findings derived from multimodal imaging. We conducted a review of the current literature referenced in PubMed and Web of Science among others with the keywords ‘artificial intelligence’ and ‘machine learning’ in combination with ‘perimetry’, ‘best-corrected visual acuity (BCVA)’, ‘retinal function’ and ‘age-related macular degeneration’. So far AI-based structure-function correlations have been applied to infer conventional visual field, fundus-controlled perimetry, and electroretinography data, as well as BCVA, and patient-reported outcome measures (PROM). In neovascular AMD, inference of BCVA (hereafter termed inferred BCVA) can estimate BCVA results with a root mean squared error of ~7–11 letters, which is comparable to the accuracy of actual visual acuity assessment. Further, AI-based structure-function correlation can successfully infer fundus-controlled perimetry (FCP) results both for mesopic as well as dark-adapted (DA) cyan and red testing (hereafter termed inferred sensitivity). Accuracy of inferred sensitivity can be augmented by adding short FCP examinations and reach mean absolute errors (MAE) of ~3–5 dB for mesopic, DA cyan and DA red testing. Inferred BCVA, and inferred retinal sensitivity, based on multimodal imaging, may be considered as a quasi-functional surrogate endpoint for future interventional clinical trials in the future.
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Affiliation(s)
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Department of Biomedical Data Science, Radiology, and Medicine, Stanford University, Stanford, CA, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Karsten Kortuem
- Augenklinik, Universität Ulm, Ulm, Deutschland.,Augenarztpraxis Dres. Kortüm, Ludwigsburg, Deutschland
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Daniel L Rubin
- Department of Biomedical Data Science, Radiology, and Medicine, Stanford University, Stanford, CA, USA
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany. .,John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
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Saßmannshausen M, Zhou J, Pfau M, Thiele S, Steinberg J, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Longitudinal Analysis of Retinal Thickness and Retinal Function in Eyes with Large Drusen Secondary to Intermediate Age-Related Macular Degeneration. Ophthalmol Retina 2021; 5:241-250. [PMID: 32721592 DOI: 10.1016/j.oret.2020.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/18/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To assess the longitudinal association between outer retinal microstructure and mesopic as well as scotopic retinal sensitivity in patients with drusen secondary to intermediate age-related macular degeneration (iAMD). DESIGN Prospective, longitudinal natural history study. PARTICIPANTS Fifty-nine eyes of 54 patients with large drusen (> 125 μm) associated with iAMD and 27 age-matched healthy control eyes. METHODS Participants underwent spectral-domain OCT and both mesopic and scotopic fundus-controlled perimetry (FCP). Annual follow-up visits were performed over a 3-year period. MAIN OUTCOME MEASURES Pointwise correlation of retinal sensitivity stimuli to corresponding standardized (Z score) pointwise retinal thickness. Linear mixed-effect models were applied to analyze longitudinally the association of pointwise retinal thickness changes, follow-up time, or both with retinal function. RESULTS At baseline, mean pointwise sensitivity in patients was reduced by -1.67 dB (95% confidence interval [CI], -2.22 to -1.12) for mesopic and by -2.34 dB (95% CI, -2.85 to -1.84) for scotopic testing compared with controls with a pointwise sensitivity change of -0.35 dB/year (95% CI, -0.43 to -0.28) for mesopic and +0.20 dB/year (95% CI, 0.12-0.29) for scotopic testing, respectively (P < 0.001). Retinal thickness analysis in patients revealed a significantly thinner outer nuclear layer (ONL) by -0.49 standard deviation (SD; 95% CI, -0.70 to -0.28 SD) and a significant thicker retinal pigment epithelium-drusen complex (RPEDC) by +3.22 SD (95% CI, 2.27-4.17 SD) at baseline, respectively (P < 0.001). During follow-up, retinal thickness thickened further by +0.51 SD/year (RPEDC) and thinned by -0.03 SD/year (ONL; P = 0.045) and -0.34 SD/year (inner and outer photoreceptor segments) in patients, respectively (P < 0.001). Structure-function analysis showed a significant association of the ONL and the RPEDC thickness change with both types of FCP sensitivity testing (P < 0.001). Besides, follow-up time had a significant (independent) effect on mesopic and scotopic retinal sensitivity (P < 0.001). CONCLUSIONS The longitudinal structure-function correlation demonstrated a progressive quantifiable degeneration of the outer retina in iAMD associated with photoreceptor dysfunction. Because longitudinal sensitivity changes could not be explained by structural changes alone, an unmet need remains for additional refined parameters on retinal structure to predict retinal function.
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Affiliation(s)
- Marlene Saßmannshausen
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Jing Zhou
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Ophthalmology, Hospital of Nantong University, Nantong, China
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany; Department of Biomedical Data Science, Stanford University, Palo Alto, California
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Julia Steinberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
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Pfau M, von der Emde L, de Sisternes L, Hallak JA, Leng T, Schmitz-Valckenberg S, Holz FG, Fleckenstein M, Rubin DL. Progression of Photoreceptor Degeneration in Geographic Atrophy Secondary to Age-related Macular Degeneration. JAMA Ophthalmol 2021; 138:1026-1034. [PMID: 32789526 DOI: 10.1001/jamaophthalmol.2020.2914] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Sensitive outcome measures for disease progression are needed for treatment trials in geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Objective To quantify photoreceptor degeneration outside regions of GA in eyes with nonexudative AMD, to evaluate its association with future GA progression, and to characterize its spatio-temporal progression. Design, Setting, and Participants Monocenter cohort study (Directional Spread in Geographic Atrophy [NCT02051998]) and analysis of data from a normative data study at a tertiary referral center. One hundred fifty-eight eyes of 89 patients with a mean (SD) age of 77.7 (7.1) years, median area of GA of 8.87 mm2 (IQR, 4.09-15.60), and median follow-up of 1.1 years (IQR, 0.52-1.7 years), as well as 93 normal eyes from 93 participants. Exposures Longitudinal spectral-domain optical coherence tomography (SD-OCT) volume scans (121 B-scans across 30° × 25°) were segmented with a deep-learning pipeline and standardized in a pointwise manner with age-adjusted normal data (z scores). Outer nuclear layer (ONL), photoreceptor inner segment (IS), and outer segment (OS) thickness were quantified along evenly spaced contour lines surrounding GA lesions. Linear mixed models were applied to assess the association between photoreceptor-related imaging features and GA progression rates and characterize the pattern of photoreceptor degeneration over time. Main Outcomes and Measures Association of ONL thinning with follow-up time (after adjusting for age, retinal topography [z score], and distance to the GA boundary). Results The study included 158 eyes of 89 patients (51 women and 38 men) with a mean (SD) age of 77.7 (7.1) years. The fully automated B-scan segmentation was accurate (dice coefficient, 0.82; 95% CI, 0.80-0.85; compared with manual markings) and revealed a marked interpatient variability in photoreceptor degeneration. The ellipsoid zone (EZ) loss-to-GA boundary distance and OS thickness were prognostic for future progression rates. Outer nuclear layer and IS thinning over time was significant even when adjusting for age and proximity to the GA boundary (estimates of -0.16 μm/y; 95% CI, -0.30 to -0.02; and -0.17 μm/y; 95% CI, -0.26 to -0.09). Conclusions and Relevance Distinct and progressive alterations of photoreceptor laminae (exceeding GA spatially) were detectable and quantifiable. The degree of photoreceptor degeneration outside of regions of retinal pigment epithelium atrophy varied markedly between eyes and was associated with future GA progression. Macula-wide photoreceptor laminae thinning represents a potential candidate end point to monitor treatment effects beyond mere GA lesion size progression.
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Affiliation(s)
- Maximilian Pfau
- Department of Biomedical Data Science, Stanford University, Stanford, California.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Luis de Sisternes
- Research and Development, Carl Zeiss Meditec Inc, Dublin, California
| | - Joelle A Hallak
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, California
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Sassmannshausen M, Pfau M, Thiele S, Fimmers R, Steinberg JS, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Longitudinal Analysis of Structural and Functional Changes in Presence of Reticular Pseudodrusen Associated With Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2021; 61:19. [PMID: 32780863 PMCID: PMC7441376 DOI: 10.1167/iovs.61.10.19] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To examine longitudinal changes of retinal thickness and retinal sensitivity in patients with intermediate age-related macular degeneration (iAMD) and predominantly reticular pseudodrusen (RPD). Methods At baseline 30 eyes of 25 iAMD patients underwent optical coherence tomography imaging, mesopic and scotopic fundus-controlled perimetry (FCP) with follow-up examinations at month 12 (20 eyes), 24 (12 eyes), and 36 (11 eyes). Thicknesses of different retinal layers and results of FCP testing (n = 56 stimuli) were spatially and longitudinally analyzed using linear mixed-effects models. Results At baseline, the thickness of the partial outer retinal layer (pORL, 70.21 vs. 77.47 µm) and both mesopic (16.60 vs. 18.72 dB) and scotopic (12.14 vs. 18.67 dB) retinal sensitivity were decreased in areas with RPD compared with unremarkable areas (P < 0.001). Over three years, mean change of pORL was −0.66 normative standard deviation (SD; i.e., z-score, P < 0.001) for regions with existing RPD, −0.40 SD (P < 0.001) for regions with new occurring RPD, and −0.17 SD (P = 0.041) in unremarkable regions. Decrease of scotopic and mesopic sensitivity over three years was more pronounced in areas with existing (−3.51 and −7.76 dB) and new occurring RPD (−2.06 and −5.97 dB). Structure-function analysis revealed that 1 SD decrease of pORL thickness was associated with a sensitivity reduction of 3.47 dB in scotopic and 0.79 dB in mesopic testing. Conclusions This study demonstrates progressive outer retinal degeneration and impairment of photoreceptor function in eyes with iAMD and RPD over three years. Preservation of outer retinal thickness and reduction of RPD formation may constitute meaningful surrogate endpoints in interventional trials on eyes with AMD and RPD aiming to slow outer retinal degeneration.
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Affiliation(s)
- Marlene Sassmannshausen
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany.,Department of Biomedical Data Science, Stanford University, Stanford, California, United States
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Medical Faculty, Bonn, Germany
| | | | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
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37
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Jaffe GJ, Chakravarthy U, Freund KB, Guymer RH, Holz FG, Liakopoulos S, Monés JM, Rosenfeld PJ, Sadda SR, Sarraf D, Schmitz-Valckenberg S, Spaide RF, Staurenghi G, Tufail A, Curcio CA. Imaging Features Associated with Progression to Geographic Atrophy in Age-Related Macular Degeneration: Classification of Atrophy Meeting Report 5. Ophthalmol Retina 2020; 5:855-867. [PMID: 33348085 DOI: 10.1016/j.oret.2020.12.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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: 10/18/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To provide an image-based description of retinal features associated with risk for development of geographic atrophy (GA) in eyes with age-related macular degeneration (AMD), as visualized with multimodal imaging anchored by structural OCT. DESIGN Consensus meeting. PARTICIPANTS International group that included those with expertise in imaging and AMD basic science and histology, and those with Reading Center experience in AMD clinical trials. METHODS As part of the Classification of Atrophy Meeting program, an international group of experts analyzed and discussed retinal multimodal imaging features in eyes with AMD associated with GA, risk of progression to GA, or both. Attendees undertook premeeting grading exercises that were reviewed during the meeting sessions. Meeting presentations illustrated established and investigational multimodal imaging features and associated histologic features. Each of these different features were then discussed openly by the entire group to arrive at consensus definitions. These definitions were applied to 40 additional images that were graded independently by attendees to refine the consensus definitions and descriptions further. RESULTS Consensus was reached on images with descriptors for 12 features. These features included components of outer retinal atrophy (e.g., ellipsoid zone disruption), components of complete retinal pigment epithelium (RPE) and outer retinal atrophy (e.g., RPE perturbation with associated hypotransmission or hypertransmission), features frequently seen in eyes with atrophy (e.g., refractile drusen), and features conferring risk for atrophy development (e.g., hyperreflective foci, drusen, and subretinal drusenoid deposits). CONCLUSIONS An international consensus on terms and descriptions was reached on multimodal imaging features associated GA and with risk for GA progression in eyes with AMD. We believe this information will be useful to clinicians who manage patients with AMD, researchers who study AMD disease interventions and pathogenesis, and those who design clinical trials for therapies targeting earlier AMD stages than GA expansion.
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Affiliation(s)
- Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina.
| | - Usha Chakravarthy
- Center for Public Health, The Queen's University of Belfast, Belfast, United Kingdom
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sandra Liakopoulos
- Department of Ophthalmology, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Jordi M Monés
- Institut de la Màcula and Barcelona Macula Foundation, Barcelona, Spain
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Trust and Institute of Ophthalmology, University College London, London, United Kingdom
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Huss MB, Schmitz-Valckenberg S, Finger RP, Löffler KU, Fleckenstein M, Holz FG, Pfau M. The Willingness of Patients to Participate in an Eye Donation Registry for Research. Ophthalmologica 2020; 244:179-186. [PMID: 33316801 DOI: 10.1159/000513722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 12/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION For ophthalmologic research, the systematic correlation of clinical data with data obtained from postmortem tissue donation is of great benefit. In this respect, the establishment of an eye donation registry represents a prerequisite for the acquisition of such data. METHODS A total of 300 patients were interviewed at a tertiary referral center in Germany by means of a standardized questionnaire. Binary questions were evaluated by percentage; Likert-scaled questions (1 = does apply; 5 = does not apply) were analyzed by the median and 25th (Q25) and 75th (Q75) percentiles. RESULTS The majority of patients (77.0%) would agree to donate their eyes for research purposes. When asked about reasons against an eye donation, 60.9% of all patients only stated reasons in the category "addressable" (e.g., not enough awareness of the topic). The vast majority of patients considered it appropriate for an ophthalmologist to approach them on the issue of postmortem eye donation (median 1, Q25 1, Q75 1). CONCLUSION Overall, patients had a positive attitude towards postmortem eye donation for research purposes. Importantly, reasons given against postmortem eye donation were often related to misconceptions and were potentially addressable. These results underline the fundamental willingness of ophthalmological patients in Germany to donate their eyes postmortem for research purposes.
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Affiliation(s)
- Muriel B Huss
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany, .,GRADE Reading Center, Bonn, Germany, .,John A. Moran Eye Center, University of Utah, Salt Lake, Utah, USA,
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Karin U Löffler
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Monika Fleckenstein
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake, Utah, USA
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany.,GRADE Reading Center, Bonn, Germany.,Department of Biomedical Data Science, Stanford University, Stanford, California, USA
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39
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Terheyden JH, Schmitz-Valckenberg S, Crabb DP, Dunbar H, Luhmann UFO, Behning C, Schmid M, Silva R, Cunha-Vaz J, Tufail A, Weissgerber G, Leal S, Holz FG, Finger RP. Use of Composite End Points in Early and Intermediate Age-Related Macular Degeneration Clinical Trials: State-of-the-Art and Future Directions. Ophthalmologica 2020; 244:387-395. [PMID: 33285549 DOI: 10.1159/000513591] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
The slow progression of early age-related macular degeneration (AMD) stages to advanced AMD requires the use of surrogate end points in clinical trials. The use of combined end points may allow for shorter and smaller trials due to increased precision. We performed a literature search for the use of composite end points as primary outcome measures in clinical studies of early AMD stages. PubMed was searched for composite end points used in early/intermediate AMD studies published during the last 10 years. A total of 673 articles of interest were identified. After reviewing abstracts and applicable full-text articles, 33 articles were eligible and thus included in the qualitative synthesis. The main composite end point categories were: combined structural and functional end points, combined structural end points, combined functional end points and combined multicategorical end points. The majority of the studies included binary composite end points. There was a lack of sensitivity analyses of different end points against accepted outcomes (i.e., progression) in the literature. Various composite outcome measures have been used but there is a lack of standardization. To date no agreement on the optimal approach to implement combined end points in clinical studies of early stages of AMD exists, and no surrogate end points have been accepted for AMD progression.
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Affiliation(s)
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City University of London, London, United Kingdom
| | - Hannah Dunbar
- UCL Institute of Ophthalmology, London, United Kingdom
| | - Ulrich F O Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Pharma Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Rufino Silva
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, Coimbra, Portugal.,Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | | | | | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany,
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40
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Pfau M, Walther G, von der Emde L, Berens P, Faes L, Fleckenstein M, Heeren TFC, Kortüm K, Künzel SH, Müller PL, Maloca PM, Waldstein SM, Wintergerst MWM, Schmitz-Valckenberg S, Finger RP, Holz FG. [Artificial intelligence in ophthalmology : Guidelines for physicians for the critical evaluation of studies]. Ophthalmologe 2020; 117:973-988. [PMID: 32857270 DOI: 10.1007/s00347-020-01209-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Empirical models have been an integral part of everyday clinical practice in ophthalmology since the introduction of the Sanders-Retzlaff-Kraff (SRK) formula. Recent developments in the field of statistical learning (artificial intelligence, AI) now enable an empirical approach to a wide range of ophthalmological questions with an unprecedented precision. OBJECTIVE Which criteria must be considered for the evaluation of AI-related studies in ophthalmology? MATERIAL AND METHODS Exemplary prediction of visual acuity (continuous outcome) and classification of healthy and diseased eyes (discrete outcome) using retrospectively compiled optical coherence tomography data (50 eyes of 50 patients, 50 healthy eyes of 50 subjects). The data were analyzed with nested cross-validation (for learning algorithm selection and hyperparameter optimization). RESULTS Based on nested cross-validation for training, visual acuity could be predicted in the separate test data-set with a mean absolute error (MAE, 95% confidence interval, CI of 0.142 LogMAR [0.077; 0.207]). Healthy versus diseased eyes could be classified in the test data-set with an agreement of 0.92 (Cohen's kappa). The exemplary incorrect learning algorithm and variable selection resulted in an MAE for visual acuity prediction of 0.229 LogMAR [0.150; 0.309] for the test data-set. The drastic overfitting became obvious on comparison of the MAE with the null model MAE (0.235 LogMAR [0.148; 0.322]). CONCLUSION Selection of an unsuitable measure of the goodness-of-fit, inadequate validation, or withholding of a null or reference model can obscure the actual goodness-of-fit of AI models. The illustrated pitfalls can help clinicians to identify such shortcomings.
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Affiliation(s)
- Maximilian Pfau
- Department of Biomedical Data Science, Stanford University, Medical School Office Building (MSOB), 1265 Welch Road, 94305-5479, Stanford, CA, USA.
- Universitäts-Augenklinik Bonn, Bonn, Deutschland.
| | | | | | - Philipp Berens
- Forschungsinstitut für Augenheilkunde, Universität Tübingen, Tübingen, Deutschland
- Interfakultäres Institut für Bioinformatik und Medizininformatik, Universität Tübingen, Tübingen, Deutschland
| | - Livia Faes
- Augenklinik, Luzerner Kantonsspital, Luzern, Schweiz
- Moorfields Eye Hopsital NHS Foundation Trust, London, Großbritannien
| | | | - Tjebo F C Heeren
- Moorfields Eye Hopsital NHS Foundation Trust, London, Großbritannien
| | - Karsten Kortüm
- Augenklinik, Ludwig-Maximilians-Universität München, München, Deutschland
- Augenarztpraxis Dres. Kortüm, Ludwigsburg, Deutschland
| | | | - Philipp L Müller
- Universitäts-Augenklinik Bonn, Bonn, Deutschland
- Forschungsinstitut für Augenheilkunde, Universität Tübingen, Tübingen, Deutschland
| | - Peter M Maloca
- Moorfields Eye Hopsital NHS Foundation Trust, London, Großbritannien
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Schweiz
- OCTlab, Universitätsspital Basel, Basel, Schweiz
| | - Sebastian M Waldstein
- Univ.-Klinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Wien, Österreich
- Department of Ophthalmology, Westmead Hospital, University of Sydney, Sydney, Australien
| | | | - Steffen Schmitz-Valckenberg
- Universitäts-Augenklinik Bonn, Bonn, Deutschland
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | | | - Frank G Holz
- Universitäts-Augenklinik Bonn, Bonn, Deutschland
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41
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Thiele S, Isselmann B, Pfau M, Holz FG, Schmitz-Valckenberg S, Wu Z, Guymer RH, Luu CD. Validation of an Automated Quantification of Relative Ellipsoid Zone Reflectivity on Spectral Domain-Optical Coherence Tomography Images. Transl Vis Sci Technol 2020; 9:17. [PMID: 33133775 PMCID: PMC7581490 DOI: 10.1167/tvst.9.11.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/24/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Relative ellipsoid zone reflectivity (rEZR) represents a potential biomarker of photoreceptor health on spectral-domain optical coherence tomography (SD-OCT). Because manual quantification of rEZR is laborious and lacks of spatial resolution, automated quantification of the rEZR would be beneficial. The purpose of this study was to evaluate the reliability and reproducibility of an automated rEZR quantification method. Methods The rEZR was acquired using a manual and an automated approach in eyes with age-related macular degeneration (AMD) and healthy controls. The rEZR obtained from both methods was compared and the agreement between the methods and their reproducibility assessed. Results Forty eyes of 40 participants with a mean (± standard deviation) age of 65.2 ± 7.8 years were included. Both the manual and automated method showed that control eyes exhibit a greater rEZR than AMD eyes (P < 0.001). Overall, the limits of agreement between the manual and automated method were -7.5 to 7.3 arbitrary units (AU) and 95% of the data points had a difference in the rEZR between the methods of ±8.2%. An expected perfect reproducibility was observed for the automated method, whereas the manual method had a coefficient of repeatability of 6.3 arbitrary units. Conclusions The automated quantification of rEZR method is reliable and reproducible. Further studies of the rEZR as a novel biomarker for AMD severity and progression are warranted. Translational Relevance Automated quantification of SD-OCT-based rEZR allows for its comprehensive and longitudinal characterization evaluating its relevance as an in vivo biomarker of photoreceptor function and its prognostic value for AMD progression.
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Affiliation(s)
- Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Ben Isselmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany.,Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
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Pfau M, Jolly JK, Wu Z, Denniss J, Lad EM, Guymer RH, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Fundus-controlled perimetry (microperimetry): Application as outcome measure in clinical trials. Prog Retin Eye Res 2020; 82:100907. [PMID: 33022378 DOI: 10.1016/j.preteyeres.2020.100907] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 06/30/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Fundus-controlled perimetry (FCP, also called 'microperimetry') allows for spatially-resolved mapping of visual sensitivity and measurement of fixation stability, both in clinical practice as well as research. The accurate spatial characterization of visual function enabled by FCP can provide insightful information about disease severity and progression not reflected by best-corrected visual acuity in a large range of disorders. This is especially important for monitoring of retinal diseases that initially spare the central retina in earlier disease stages. Improved intra- and inter-session retest-variability through fundus-tracking and precise point-wise follow-up examinations even in patients with unstable fixation represent key advantages of these technique. The design of disease-specific test patterns and protocols reduces the burden of extensive and time-consuming FCP testing, permitting a more meaningful and focused application. Recent developments also allow for photoreceptor-specific testing through implementation of dark-adapted chromatic and photopic testing. A detailed understanding of the variety of available devices and test settings is a key prerequisite for the design and optimization of FCP protocols in future natural history studies and clinical trials. Accordingly, this review describes the theoretical and technical background of FCP, its prior application in clinical and research settings, data that qualify the application of FCP as an outcome measure in clinical trials as well as ongoing and future developments.
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Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, Stanford, USA
| | - Jasleen Kaur Jolly
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, USA.
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43
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Künzel SH, Möller PT, Lindner M, Goerdt L, Nadal J, Schmid M, Schmitz-Valckenberg S, Holz FG, Fleckenstein M, Pfau M. Determinants of Quality of Life in Geographic Atrophy Secondary to Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2020; 61:63. [PMID: 32462198 PMCID: PMC7405807 DOI: 10.1167/iovs.61.5.63] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose To longitudinally evaluate vision-related quality of life (VRQoL) in geographic atrophy (GA) secondary to age-related macular degeneration (AMD) and define its relation to visual function and structural biomarkers. Methods Patients with GA secondary to AMD were recruited in the context of the prospective, non-interventional, natural-history Directional Spread in Geographic-Atrophy study (NCT02051998). Fundus autofluorescence and infrared reflectance images were semi-automatically annotated for GA. Linear mixed-effects models were applied to investigate the association of putative determinants with the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) VRQoL. Results A total of 87 patients with a mean age ± SD of 77.07 ± 7.49 years were included in the analysis. At baseline, median (IQR) best-corrected visual acuity (BCVA) was 0.3 (0.51) for the better eye and 0.89 (0.76) for the worse eye; 46% of the patients showed binocular and 25.3% monocular non-central GA. The VRQoL composite score was impaired: 69.96 (24.03). Sixty-six patients with a median of 2 (2) follow-up visits after 1.08 (0.78) years were examined longitudinally. Conclusions Vision-related quality of life is significantly impaired in patients with GA secondary to AMD. The cross-sectional and longitudinal association of VRQoL with visual functional and structural biomarkers supports the validity of the NEI VFQ-25 VRQoL.
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Pfau M, von der Emde L, Dysli C, Möller PT, Thiele S, Lindner M, Schmid M, Rubin DL, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Determinants of Cone and Rod Functions in Geographic Atrophy: AI-Based Structure-Function Correlation. Am J Ophthalmol 2020; 217:162-173. [PMID: 32289293 DOI: 10.1016/j.ajo.2020.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 10/06/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the association between retinal microstructure and cone and rod function in geographic atrophy (GA) secondary to age-related macular degeneration (AMD) by using artificial intelligence (AI) algorithms. DESIGN Prospective, observational case series. METHODS A total of 41 eyes of 41 patients (75.8 ± 8.4 years old; 22 females) from a tertiary referral hospital were included. Mesopic, dark-adapted (DA) cyan and red sensitivities were assessed by using fundus-controlled perimetry ("microperimetry"); and retinal microstructure was assessed by using spectral-domain optical-coherence-tomography (SD-OCT), fundus autofluorescence (FAF), and near-infrared-reflectance (IR) imaging. Layer thicknesses and intensities and FAF and IR intensities were extracted for each test point. The cross-validated mean absolute error (MAE) was evaluated for random forest-based predictions of retinal sensitivity with and without patient-specific training data and percentage of increased mean-squared error (%IncMSE) as measurement of feature importance. RESULTS Retinal sensitivity was predicted with a MAE of 4.64 dB for mesopic, 4.89 dB for DA cyan, and 4.40 dB for DA red testing in the absence of patient-specific data. Partial addition of patient-specific sensitivity data to the training sets decreased the MAE to 2.89 dB, 2.86 dB, and 2.77 dB. For all 3 types of testing, the outer nuclear layer thickness constituted the most important predictive feature (35.0, 42.22, and 53.74 %IncMSE). Spatially resolved mapping of "inferred sensitivity" revealed regions with differential degrees of mesopic and DA cyan sensitivity loss outside of the GA lesions. CONCLUSIONS "Inferred sensitivity" accurately reflected retinal function in patients with GA. Mapping of "inferred sensitivity" could facilitate monitoring of disease progression and serve as "quasi functional" surrogate outcome in clinical trials, especially in consideration of retinal regions beyond areas of GA.
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Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany; Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | | | - Chantal Dysli
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Departments of Ophthalmology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Philipp T Möller
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Moritz Lindner
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Department of Neurophysiology, Institute of Physiology and Pathophysiology, Philipps University, Marburg, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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45
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Meyer JH, Marx J, Strack C, Holz FG, Schmitz-Valckenberg S. Imaging of Therapeutic Effects of Anti-Vascular Endothelial Growth Factor Inhibitors by Optical Coherence Tomography Angiography in a Rat Model. Transl Vis Sci Technol 2020; 9:29. [PMID: 32832234 PMCID: PMC7414645 DOI: 10.1167/tvst.9.7.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of the study was to investigate optical coherence tomography angiography (OCTA) as a high-resolution in vivo imaging modality for monitoring therapeutic response to different vascular endothelial growth factor inhibitors in the rat model of laser-induced choroidal neovascularization (CNV). Further, OCTA findings were compared with fluorescein angiography (FA) and fluorescence microscopy. Methods Laser treatment at day (D)0 was followed by intravitreal injection of aflibercept, AF564, and NaCl in dark agouti rats. Imaging with OCTA and FA was performed at D2, D7, D14, and D21. OCTA was compared to FA as well as confocal imaged flat mounts and analysis included quantification of CNV area, pixel intensity, vessel density, and number of vessel junctions. Results Within laser lesions, neovascularization were visible especially in deeper retinal layers on OCTA, but not on FA images. Using OCTA, mean CNV area (D21) at the level of the outer nuclear layer (ONL) was 0.017 mm² following aflibercept administration, 0.016 mm² following AF564 and 0.026 mm² following NaCl injection (P = 0.04 and P = 0.03). Similar differences between treatment groups were determined by FA and histology, although the overall CNV area was always larger on FA due to dye leakage (P ≤ 0.0001, all layers). Conclusions Compared to FA, OCTA imaging allows for a more precise and quantitative analysis of new blood vessel formation and therapeutic response to vascular endothelial growth factor (VEGF)-inhibitors, whereas it does not permit assessment of leakage. Translational Relevance These findings suggest that OCTA may be particularly useful for the investigation of new treatment targets in the animal model.
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Affiliation(s)
- Johanna H Meyer
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Janine Marx
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Claudine Strack
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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46
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Müller PL, Pfau M, Schmitz-Valckenberg S, Fleckenstein M, Holz FG. Optical Coherence Tomography-Angiography in Geographic Atrophy. Ophthalmologica 2020; 244:42-50. [PMID: 32772015 DOI: 10.1159/000510727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
Geographic atrophy (GA) represents the non-exudative late stage of age-related macular degeneration and constitutes a leading cause of legal blindness in the developed world. It is characterized by areas of loss of outer retinal layers including photoreceptors, degeneration of the retinal pigment epithelium, and rarefication of the choriocapillaris. As all three layers are functionally connected, the precise temporal sequence and relative contribution of these layers towards the development and progression of GA is unclear. The advent of optical coherence tomography angiography (OCT-A) has allowed for three-dimensional visualization of retinal blood flow. Using OCT-A, recent studies have demonstrated that choriocapillaris flow alterations are particularly associated with the development of GA, exceed atrophy boundaries spatially, and are a prognostic factor for future GA progression. Furthermore, OCT-A may be helpful to differentiate GA from mimicking diseases. Evidence for a potential protective effect of specific forms of choroidal neovascularization in the context of GA has been reported. This article aims to give a comprehensive review of the current literature concerning the application of OCT-A in GA, and summarizes the opportunities and limitations with regard to pathophysiologic considerations, differential diagnosis, study design, and patient assessment.
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Affiliation(s)
- Philipp L Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany, .,Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom,
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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47
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Schmitz-Valckenberg S, Pfau M, Fleckenstein M, Staurenghi G, Sparrow JR, Bindewald-Wittich A, Spaide RF, Wolf S, Sadda SR, Holz FG. Fundus autofluorescence imaging. Prog Retin Eye Res 2020; 81:100893. [PMID: 32758681 DOI: 10.1016/j.preteyeres.2020.100893] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
Abstract
Fundus autofluorescence (FAF) imaging is an in vivo imaging method that allows for topographic mapping of naturally or pathologically occurring intrinsic fluorophores of the ocular fundus. The dominant sources are fluorophores accumulating as lipofuscin in lysosomal storage bodies in postmitotic retinal pigment epithelium cells as well as other fluorophores that may occur with disease in the outer retina and subretinal space. Photopigments of the photoreceptor outer segments as well as macular pigment and melanin at the fovea and parafovea may act as filters of the excitation light. FAF imaging has been shown to be useful with regard to understanding of pathophysiological mechanisms, diagnostics, phenotype-genotype correlation, identification of prognostic markers for disease progression, and novel outcome parameters to assess efficacy of interventional strategies in chorio-retinal diseases. More recently, the spectrum of FAF imaging has been expanded with increasing use of green in addition to blue FAF, introduction of spectrally-resolved FAF, near-infrared FAF, quantitative FAF imaging and fluorescence life time imaging (FLIO). This article gives an overview of basic principles, FAF findings in various retinal diseases and an update on recent developments.
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Affiliation(s)
- Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, USA
| | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital University of Milan, Italy
| | - Janet R Sparrow
- Departments of Ophthalmology and Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Almut Bindewald-Wittich
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Augenheilkunde Heidenheim MVZ, Heidenheim, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
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48
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Raber FP, Reinking K, Schmitz-Valckenberg S, Althaus K, Kaut O, Witry M, Lang GE. Erfolgreiche systemische Lysetherapie bei akuten retinalen Arterienverschlüssen. Klin Monbl Augenheilkd 2020; 237:772-779. [DOI: 10.1055/a-1079-5635] [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: 10/24/2022]
Abstract
Zusammenfassung
Einleitung Retinale arterielle Verschlüsse (RAV) führen bei betroffenen Patienten häufig zu einer dramatischen und irreversiblen Visusreduktion. Bis dato existiert keine evidenzbasierte Standardtherapie. Die systemische Lysetherapie kann nach der Leitlinie zu retinalen arteriellen Verschlüssen der DOG, RG und BVA bis zu einem Zeitfenster von 4 h 30 min angewendet werden.
Methoden Wir berichten über 2 Patienten, bei denen ein RAV im Zeitfenster mit einer intravenösen Lysetherapie behandelt wurde.
Ergebnisse Bei Patient 1 wurde eine systemische Lysetherapie bei einem Verschluss der A. temporalis inferior 4 h 15 min nach Symptombeginn angewendet. Unmittelbar im Anschluss an die Therapie berichtete der Patient von einer deutlichen Symptombesserung. Drei Monate nach der Therapie bestand eine gute retinale Funktion bei dezenter Atrophie der neurosensorischen Netzhaut. Bei Patient 2 kam es 2 h 30 min nach Symptombeginn bei einem Verschluss der A. temporalis inferior zu einer weiteren Verschlechterung des Visus auf Lichtscheinwahrnehmung mit Zeichen eines Zentralarterienverschlusses (ZAV). Eine notfallmäßige Lysetherapie, die 3 h später durchgeführt wurde, ergab eine deutliche Visusbesserung mit Erhalt des Gesichtsfeldes im inferioren Bereich. Bei beiden Patienten kam es unmittelbar im Anschluss an die Lysetherapie zu einer deutlichen Befundbesserung: Patient 1, rechtes Auge: BCVA initial: 0,5; BCVA 3 Tage nach Lysetherapie: 1,0; keine Defekte im Goldmann-Gesichtsfeld. Patient 2, linkes Auge: BCVA initial: 0,4; dann beobachteter Visusabfall auf Lichtscheinwahrnehmung, BCVA 4 Wochen nach Lysetherapie: 0,6.
Schlussfolgerung Zwei Patienten mit akuten arteriellen retinalen Verschlüssen konnten mit einer systemischen Lysetherapie erfolgreich behandelt werden.
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Affiliation(s)
| | | | | | | | - Oliver Kaut
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn
| | - Max Witry
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn
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49
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Wintergerst MWM, Gorgi Zadeh S, Wiens V, Thiele S, Schmitz-Valckenberg S, Holz FG, Finger RP, Schultz T. Replication and Refinement of an Algorithm for Automated Drusen Segmentation on Optical Coherence Tomography. Sci Rep 2020; 10:7395. [PMID: 32355285 PMCID: PMC7192932 DOI: 10.1038/s41598-020-63924-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/03/2020] [Indexed: 11/09/2022] Open
Abstract
Here, we investigate the extent to which re-implementing a previously published algorithm for OCT-based drusen quantification permits replicating the reported accuracy on an independent dataset. We refined that algorithm so that its accuracy is increased. Following a systematic literature search, an algorithm was selected based on its reported excellent results. Several steps were added to improve its accuracy. The replicated and refined algorithms were evaluated on an independent dataset with the same metrics as in the original publication. Accuracy of the refined algorithm (overlap ratio 36-52%) was significantly greater than the replicated one (overlap ratio 25-39%). In particular, separation of the retinal pigment epithelium and the ellipsoid zone could be improved by the refinement. However, accuracy was still lower than reported previously on different data (overlap ratio 67-76%). This is the first replication study of an algorithm for OCT image analysis. Its results indicate that current standards for algorithm validation do not provide a reliable estimate of algorithm performance on images that differ with respect to patient selection and image quality. In order to contribute to an improved reproducibility in this field, we publish both our replication and the refinement, as well as an exemplary dataset.
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Affiliation(s)
| | - Shekoufeh Gorgi Zadeh
- Department of Computer Science, University of Bonn, Endenicher Allee 19a, 53115, Bonn, Germany
- Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Vitalis Wiens
- Department of Computer Science, University of Bonn, Endenicher Allee 19a, 53115, Bonn, Germany
- TIB Leibniz Information Centre for Science and Technology, Hannover and Fraunhofer IAIS, St. Augustin, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
| | - Thomas Schultz
- Department of Computer Science, University of Bonn, Endenicher Allee 19a, 53115, Bonn, Germany
- Bonn-Aachen International Center for Information Technology, University of Bonn, Endenicher Allee 19a, 53115, Bonn, Germany
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50
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Abstract
Degenerative vitreous opacities (also known as myodesopsia) can cause permanent and relevant visual impairment. Neodymium-YAG laser vitreolysis is an alternative treatment option to pars plana vitrectomy for the treatment of disturbing degenerative vitreous opacities. This article critically discusses the different causes of vitreous opacities, the symptoms and functional impairments as well as clinical patient management. The aim is to support patient-oriented care and counselling of patients with vitreous opacities.
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Affiliation(s)
- Steffen Schmitz-Valckenberg
- John A. Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, UT 84132, Salt Lake City, USA. .,GRADE Reading Center, Universitäts-Augenklinik Bonn, Bonn, Deutschland.
| | - Karl Brasse
- Praxis für Augenheilkunde, Butenwall 22, 48691, Vreden, Deutschland
| | - Hans Hoerauf
- Augenklinik der Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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