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Westwood J, Mayhook-Walker I, Simpkins C, Darby-Smith A, Morris D, Normando E. Retinal Vascular Changes in Response to Hypoxia: A High-Altitude Expedition Study. High Alt Med Biol 2024; 25:49-59. [PMID: 38011631 DOI: 10.1089/ham.2023.0084] [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] [Indexed: 11/29/2023] Open
Abstract
Westwood, Jessica, India Mayhook-Walker, Ciaran Simpkins, Andrew Darby-Smith, Dan Morris, and Eduardo Normando. Retinal vascular changes in response to hypoxia: a high-altitude expedition study. High Alt Med Biol. 25:49-59, 2024. Background: Increased tortuosity and engorgement of retinal vasculature are recognized physiological responses to hypoxia. This can lead to high-altitude retinopathy (HAR), but incidence reports are highly variable, and our understanding of the etiological mechanisms remains incomplete. This study quantitatively evaluated retinal vascular changes during an expedition to 4,167 m. Methods: Ten healthy participants summited Mount Toubkal, Morocco. Fundus images were taken predeparture, daily throughout the expedition, and 1 month postreturn. Diameter and tortuosity of four vessels were assessed, in addition to vessel density and features of HAR. Results: Significant (p ≤ 0.05) increases in tortuosity and diameter were observed in several vessels on high-altitude exposure days. There was a strong correlation between altitude and supratemporal retinal artery diameter on days 2, 3, and 6 of the expedition (r = 0.7707, 0.7951, 0.7401, respectively; p < 0.05). There was a significant increase in median vessel density from 6.7% at baseline to 10.0% on summit day. Notably there were no incidences of HAR. Conclusion: Physiological but not pathological changes were seen in this cohort, which gives insight into the state of the cerebral vasculature throughout this expedition. These results are likely attributable to relatively low altitude exposure, a conservative ascent profile, and the cohort's demographic. Future study must include daily retinal images at higher altitudes and take steps to mitigate environmental confounders. This study is relevant to altitude tourists, patients with diabetic retinopathy or retinal vein occlusion, and critically ill patients.
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Affiliation(s)
- Jessica Westwood
- Imperial College London Ophthalmology Research Group, Western Eye Hospital, London, United Kingdom
| | - India Mayhook-Walker
- Imperial College London Ophthalmology Research Group, Western Eye Hospital, London, United Kingdom
| | - Ciaran Simpkins
- Imperial College London Ophthalmology Research Group, Western Eye Hospital, London, United Kingdom
| | - Andrew Darby-Smith
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Dan Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Eduardo Normando
- Imperial College London Ophthalmology Research Group, Western Eye Hospital, London, United Kingdom
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Goel A, Soteriou I, Normando E. Treatment of asymptomatic carotid stenosis in SPACE-2. Lancet Neurol 2023; 22:197. [PMID: 36804081 DOI: 10.1016/s1474-4422(23)00025-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Akshit Goel
- Imperial College School of Medicine, Imperial College London, London SW7 2BX, UK.
| | - Iris Soteriou
- Imperial College School of Medicine, Imperial College London, London SW7 2BX, UK
| | - Eduardo Normando
- Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
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Normando E. What has
COVID
taught us about glaucoma management? Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.15539] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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4
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Normando E. Can we measure neuroprotection yet in glaucoma? Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.15341] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Mayhook‐Walker I, Westwood J, Simpkins C, Normando E, Morris D, Darby‐Smith A. Intraocular pressure changes at high altitude. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.0540] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- India Mayhook‐Walker
- Faculty of Medicine, Imperial College London National Heart and Lung Institute London UK
- University of Sheffield Sheffield University Medical School Sheffield UK
| | - Jessica Westwood
- Faculty of Medicine, Imperial College London National Heart and Lung Institute London UK
- Birmingham Medical School University of Birmingham Birmingham UK
| | - Ciaran Simpkins
- Faculty of Medicine, Imperial College London National Heart and Lung Institute London UK
- Birmingham Medical School University of Birmingham Birmingham UK
| | - Eduardo Normando
- Faculty of Medicine Imperial College London, Department of Surgery and Cancer London UK
- Department of Ophthalmology Imperial College NHS Healthcare Trust London UK
| | - Daniel Morris
- Cardiff Eye Centre University Hospital of Wales Cardiff UK
| | - Andrew Darby‐Smith
- Faculty of Medicine, Imperial College London National Heart and Lung Institute London UK
- Health Education Thames Valley School of Anaesthesia and Intensive Care Medicine Oxford UK
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Szymanska M, Normando E, Cordeiro MF. Delayed follow‐up of glaucoma patients due to COVID‐19 pandemic – impact on disease progression. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.109] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
| | - Eduardo Normando
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
- Imperial College Healthcare NHS Trust (ICHNT) The Western Eye Hospital London UK
| | - Maria F. Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG) Imperial College London London UK
- Imperial College Healthcare NHS Trust (ICHNT) The Western Eye Hospital London UK
- Glaucoma and Retinal Neurodegeneration Group Department of Visual Neuroscience UCL Institute of Ophthalmology London UK
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7
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Yap T, Abdulhussein D, Ahmed F, Francesca Cordeiro M, Normando E. Assessing the role of cross‐linked sodium hyaluronate in improving the quality of circumpapillary OCT scans. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.111] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Timothy Yap
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust London UK
| | - Dalia Abdulhussein
- Imperial College Ophthalmology Research Group Imperial College London London UK
| | - Faisal Ahmed
- Western Eye Hospital Imperial College Healthcare NHS Trust London UK
| | - M Francesca Cordeiro
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust London UK
- Glaucoma and Retinal Neurodegeneration Studies UCL Institute of Ophthalmology London UK
| | - Eduardo Normando
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust London UK
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Abdulhussein D, Margai G, Manzar H, Yap T, Bonetti J, Bonetti P, Miodragovic S, Normando E, Cordeiro F. The iVAN Project: an innovative solution to meet the challenges in trial recruitment during a global pandemic. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.117] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dalia Abdulhussein
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
| | - Gina Margai
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
| | - Haider Manzar
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
| | - Timothy Yap
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
| | - Jessica Bonetti
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
| | - Paolo Bonetti
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
| | - Serge Miodragovic
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
| | - Eduardo Normando
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
| | - Francesca Cordeiro
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust
- Department of Visual Neuroscience UCL Institute of Ophthalmology
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Yap T, Davis BM, Bloom P, Cordeiro MF, Normando E. Glaucoma rose plots: redesigning circumpapillary progression analysis. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.110] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Timothy Yap
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust London UK
| | | | - Philip Bloom
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust London UK
| | - M. Francesca Cordeiro
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust London UK
- Glaucoma and Retinal Neurodegeneration Group Department of Visual Neuroscience UCL Institute of Ophthalmology London UK
| | - Eduardo Normando
- Imperial College Ophthalmology Research Group Imperial College London London UK
- Western Eye Hospital Imperial College Healthcare NHS Trust London UK
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de Pennington N, Mole G, Lim E, Milne-Ives M, Normando E, Xue K, Meinert E. Safety and Acceptability of a Natural Language Artificial Intelligence Assistant to Deliver Clinical Follow-up to Cataract Surgery Patients: Proposal. JMIR Res Protoc 2021; 10:e27227. [PMID: 34319248 PMCID: PMC8367096 DOI: 10.2196/27227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Due to an aging population, the demand for many services is exceeding the capacity of the clinical workforce. As a result, staff are facing a crisis of burnout from being pressured to deliver high-volume workloads, driving increasing costs for providers. Artificial intelligence (AI), in the form of conversational agents, presents a possible opportunity to enable efficiency in the delivery of care. Objective This study aims to evaluate the effectiveness, usability, and acceptability of Dora agent: Ufonia’s autonomous voice conversational agent, an AI-enabled autonomous telemedicine call for the detection of postoperative cataract surgery patients who require further assessment. The objectives of this study are to establish Dora’s efficacy in comparison with an expert clinician, determine baseline sensitivity and specificity for the detection of true complications, evaluate patient acceptability, collect evidence for cost-effectiveness, and capture data to support further development and evaluation. Methods Using an implementation science construct, the interdisciplinary study will be a mixed methods phase 1 pilot establishing interobserver reliability of the system, usability, and acceptability. This will be done using the following scales and frameworks: the system usability scale; assessment of Health Information Technology Interventions in Evidence-Based Medicine Evaluation Framework; the telehealth usability questionnaire; and the Non-Adoption, Abandonment, and Challenges to the Scale-up, Spread and Suitability framework. Results The evaluation is expected to show that conversational technology can be used to conduct an accurate assessment and that it is acceptable to different populations with different backgrounds. In addition, the results will demonstrate how successfully the system can be delivered in organizations with different clinical pathways and how it can be integrated with their existing platforms. Conclusions The project’s key contributions will be evidence of the effectiveness of AI voice conversational agents and their associated usability and acceptability. International Registered Report Identifier (IRRID) PRR1-10.2196/27227
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Affiliation(s)
| | - Guy Mole
- Ufonia Ltd, Oxford, United Kingdom
| | | | - Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Kanmin Xue
- University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Milne-Ives M, de Cock C, Lim E, Shehadeh MH, de Pennington N, Mole G, Normando E, Meinert E. The Effectiveness of Artificial Intelligence Conversational Agents in Health Care: Systematic Review. J Med Internet Res 2020; 22:e20346. [PMID: 33090118 PMCID: PMC7644372 DOI: 10.2196/20346] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/12/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023] Open
Abstract
Background The high demand for health care services and the growing capability of artificial intelligence have led to the development of conversational agents designed to support a variety of health-related activities, including behavior change, treatment support, health monitoring, training, triage, and screening support. Automation of these tasks could free clinicians to focus on more complex work and increase the accessibility to health care services for the public. An overarching assessment of the acceptability, usability, and effectiveness of these agents in health care is needed to collate the evidence so that future development can target areas for improvement and potential for sustainable adoption. Objective This systematic review aims to assess the effectiveness and usability of conversational agents in health care and identify the elements that users like and dislike to inform future research and development of these agents. Methods PubMed, Medline (Ovid), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and the Association for Computing Machinery Digital Library were systematically searched for articles published since 2008 that evaluated unconstrained natural language processing conversational agents used in health care. EndNote (version X9, Clarivate Analytics) reference management software was used for initial screening, and full-text screening was conducted by 1 reviewer. Data were extracted, and the risk of bias was assessed by one reviewer and validated by another. Results A total of 31 studies were selected and included a variety of conversational agents, including 14 chatbots (2 of which were voice chatbots), 6 embodied conversational agents (3 of which were interactive voice response calls, virtual patients, and speech recognition screening systems), 1 contextual question-answering agent, and 1 voice recognition triage system. Overall, the evidence reported was mostly positive or mixed. Usability and satisfaction performed well (27/30 and 26/31), and positive or mixed effectiveness was found in three-quarters of the studies (23/30). However, there were several limitations of the agents highlighted in specific qualitative feedback. Conclusions The studies generally reported positive or mixed evidence for the effectiveness, usability, and satisfactoriness of the conversational agents investigated, but qualitative user perceptions were more mixed. The quality of many of the studies was limited, and improved study design and reporting are necessary to more accurately evaluate the usefulness of the agents in health care and identify key areas for improvement. Further research should also analyze the cost-effectiveness, privacy, and security of the agents. International Registered Report Identifier (IRRID) RR2-10.2196/16934
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Affiliation(s)
- Madison Milne-Ives
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Caroline de Cock
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ernest Lim
- Imperial College Healthcare NHS Trust, London, United Kingdom.,Ufonia Limited, Oxford, United Kingdom
| | | | - Nick de Pennington
- Ufonia Limited, Oxford, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Guy Mole
- Ufonia Limited, Oxford, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Edward Meinert
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.,Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
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12
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Vig N, Ameen S, Bloom P, Crawley L, Normando E, Porteous A, Ahmed F. Micropulse transscleral cyclophotocoagulation: initial results using a reduced energy protocol in refractory glaucoma. Graefes Arch Clin Exp Ophthalmol 2020; 258:1073-1079. [PMID: 32036425 DOI: 10.1007/s00417-020-04611-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study evaluates the 6-month safety and efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma/ocular hypertension using a reduced energy protocol. METHODS Retrospective analysis of patients undergoing MP-TSCPC from January-April 2018 was carried out. Patients received up to 90 s of laser with settings of 2000 mW/Cm2 and a duty cycle of 31.3%. RESULTS A total of 29 patients were included, with a mean age of 64.7 ± 15.1 years. The most common diagnosis was primary open angle glaucoma (41.4%) with a mean Logmar visual acuity of 1.5 ± 1.2. All subjects had either undergone intraocular surgery (58.6% filtration surgery) or continuous wave diode laser prior to micropulse treatment. Mean pre-laser IOP was 26.2 ± 11.1 mmHg. There was a significant reduction (p < 0.05) in IOP at 1 month to 15.8 ± 5.4 mmHg (39.7% reduction), at 3 months to 15.04 ± 5.25 mmHg (42.6% reduction) and at 6 months to 18.19 ± 7.47 mmHg (30.6% reduction). There was also a corresponding reduction (p < 0.05) in the number of topical agents required to control pressure from a baseline of 3.31 ± 0.97, to 2.72 ± 0.88 at 1 month, 2.76 ± 0.91 at 3 months and 2.90 ± 1.08 at 6 months. Requirements for oral acetazolamide reduced from 41.3% (1/29) at baseline to 3.4% (1/29) at 6 months. Success rates were 75.9% at 1 month, 79.3% at 3 months and 58.6% at 6 months. There was no drop in the visual acuity, no change in central retinal thickness and no cases of intraocular inflammation. CONCLUSIONS MP-TSCPC at a decreased duration is effective at reducing intraocular pressure in ethnically diverse glaucoma patients refractory to previous glaucoma laser or surgeries at 6 months follow-up, with no significant complications. Further work is needed to confirm efficacy in the long term and to determine optimal settings.
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Affiliation(s)
- Niten Vig
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Sally Ameen
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Philip Bloom
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Laura Crawley
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Eduardo Normando
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.,ICORG, Dept. of Surgery and Cancer, Imperial College, London, UK
| | - Alastair Porteous
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Faisal Ahmed
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
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Szymanska M, Yap T, Normando E, Cordeiro F. Diabetic retinopathy outcomes in patients undergoing pancreatic transplants in West London. Acta Ophthalmol 2019. [DOI: 10.1111/j.1755-3768.2019.5289] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Timothy Yap
- Imperial College Ophthalmology Research Group Western Eye Hospital London UK
| | - Eduardo Normando
- Imperial College Ophthalmology Research Group Western Eye Hospital London UK
| | - Francesca Cordeiro
- Imperial College Ophthalmology Research Group Western Eye Hospital London UK
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Ratnarajan G, Hirn C, Normando E, Poli M, Scott A, Munoz M, Karmiris T, Garway-Heath D, Anderson S, Beltran-Agullo L, Digiuni M, Ho T, Jayaram H, Mahave S, Matlach J, Mercieca K, Michelessi M, Abegão Pinto L, Prokosch-Willing V, Skonieczna K. Comparison of Risk Factor Profiles for Primary Open-Angle Glaucoma Subtypes Defined by Pattern of Visual Field Loss: True Risk Factors or Arbitrary Definition? Invest Ophthalmol Vis Sci 2015; 56:6531. [PMID: 26451680 DOI: 10.1167/iovs.15-17392] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gokulan Ratnarajan
- Oxford Eye Hospital Oxford, United Kingdom; 2UCL Institute of Ophthalmology, London, United Kingdom
| | | | - Eduardo Normando
- UCL Institute of Ophthalmology, London, United Kingdom; 4Western Eye Hospital, Imperial College NHS Trust, London, United Kingdom
| | | | - Andrew Scott
- NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology & Moorfields Eye Hospital, London, United Kingdom
| | | | | | - David Garway-Heath
- NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology & Moorfields Eye Hospital, London, United Kingdom
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15
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Bizrah M, Dakin SC, Guo L, Rahman F, Parnell M, Normando E, Nizari S, Davis B, Younis A, Cordeiro MF. A semi-automated technique for labeling and counting of apoptosing retinal cells. BMC Bioinformatics 2014; 15:169. [PMID: 24902592 PMCID: PMC4063694 DOI: 10.1186/1471-2105-15-169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/14/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Retinal ganglion cell (RGC) loss is one of the earliest and most important cellular changes in glaucoma. The DARC (Detection of Apoptosing Retinal Cells) technology enables in vivo real-time non-invasive imaging of single apoptosing retinal cells in animal models of glaucoma and Alzheimer's disease. To date, apoptosing RGCs imaged using DARC have been counted manually. This is time-consuming, labour-intensive, vulnerable to bias, and has considerable inter- and intra-operator variability. RESULTS A semi-automated algorithm was developed which enabled automated identification of apoptosing RGCs labeled with fluorescent Annexin-5 on DARC images. Automated analysis included a pre-processing stage involving local-luminance and local-contrast "gain control", a "blob analysis" step to differentiate between cells, vessels and noise, and a method to exclude non-cell structures using specific combined 'size' and 'aspect' ratio criteria. Apoptosing retinal cells were counted by 3 masked operators, generating 'Gold-standard' mean manual cell counts, and were also counted using the newly developed automated algorithm. Comparison between automated cell counts and the mean manual cell counts on 66 DARC images showed significant correlation between the two methods (Pearson's correlation coefficient 0.978 (p < 0.001), R Squared = 0.956. The Intraclass correlation coefficient was 0.986 (95% CI 0.977-0.991, p < 0.001), and Cronbach's alpha measure of consistency = 0.986, confirming excellent correlation and consistency. No significant difference (p = 0.922, 95% CI: -5.53 to 6.10) was detected between the cell counts of the two methods. CONCLUSIONS The novel automated algorithm enabled accurate quantification of apoptosing RGCs that is highly comparable to manual counting, and appears to minimise operator-bias, whilst being both fast and reproducible. This may prove to be a valuable method of quantifying apoptosing retinal cells, with particular relevance to translation in the clinic, where a Phase I clinical trial of DARC in glaucoma patients is due to start shortly.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - M Francesca Cordeiro
- Glaucoma and Retinal Neurodegeneration Group, UCL Institute of Ophthalmology, London, UK.
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Abstract
Dimethyl sulfoxide (DMSO) is an important aprotic solvent that can solubilize a wide variety of otherwise poorly soluble polar and nonpolar molecules. This, coupled with its apparent low toxicity at concentrations <10%, has led to its ubiquitous use and widespread application. Here, we demonstrate that DMSO induces retinal apoptosis in vivo at low concentrations (5 μl intravitreally dosed DMSO in rat from a stock concentration of 1, 2, 4, and 8% v/v). Toxicity was confirmed in vitro in a retinal neuronal cell line, at DMSO concentrations >1% (v/v), using annexin V, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), and AlamarBlue cell viability assays. DMSO concentrations >10% (v/v) have recently been reported to cause cellular toxicity through plasma membrane pore formation. Here, we show the mechanism by which low concentrations (2-4% DMSO) induce caspase-3 independent neuronal death that involves apoptosis-inducing factor (AIF) translocation from mitochondria to the nucleus and poly-(ADP-ribose)-polymerase (PARP) activation. These results highlight safety concerns of using low concentrations of DMSO as a solvent for in vivo administration and in biological assays. We recommend that methods other than DMSO are employed for solubilizing drugs but, where no alternative exists, researchers compute absolute DMSO final concentrations and include an untreated control group in addition to DMSO vehicle control to check for solvent toxicity.
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Affiliation(s)
- Joana Galvao
- 1Glaucoma and Retinal Neurodegeneration Research Group, Institute of Ophthalmology, University College London, London EC1V 9EL, UK.
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Micera A, Stampachiacchiere B, Normando E, Lambiase A, Bonini S, Bonini S. p75NTR Differentially Regulates TLR4/TLR9 Expression in Vernal Keratoconjunctivitis Derived Primary Cultures of Epithelial Cell and Fibroblasts exposed to NGF. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.179] [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] [Indexed: 10/19/2022]
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