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Wong MS, Wu CW, Chang YC, Chen HY. Spectralis Optical Coherence Tomography for Evaluating Ocular Hypertensive and Glaucoma Suspect Eyes: Real-World Data from Taiwan. Diagnostics (Basel) 2025; 15:1256. [PMID: 40428249 PMCID: PMC12110584 DOI: 10.3390/diagnostics15101256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2025] [Revised: 05/05/2025] [Accepted: 05/09/2025] [Indexed: 05/29/2025] Open
Abstract
Objectives: The aim of this research was to evaluate the diagnostic performance of Spectralis optical coherence tomography (OCT) parameters for ocular hypertensive (OH) and glaucoma suspect (GS) eyes in an Asian population from Taiwan. Methods: This retrospective cross-sectional study included 258 OH (mean deviation [MD]: -1.10 ± 1.75 dB), 380 GS (MD: -1.24 ± 2.63 dB), and 742 normal (MD: -1.47 ± 3.29 dB) eyes. The diagnostic performance of Spectralis OCT parameters, including optic nerve head (ONH) and macular parameters, was compared among groups. The area under the receiver operating characteristic curve (AUC) of each parameter signified its power to differentiate between normal and OH or GS eyes. Results: In various scanning protocols, circumpapillary retinal nerve fiber layer (NFL)-temporal (AUC = 0.538), macular NFL-outer temporal (AUC = 0.611), and retinal average thickness (RAT)_1.8 (AUC = 0.578) were the best parameters in distinguishing OH eyes from normal eyes. Moreover, minimum rim width (MRW)-mean global (AUC = 0.737), macular NFL-outer temporal (AUC = 0.558), and RAT_2.8 (AUC = 0.543) were the best parameters in distinguishing GS eyes from normal eyes. After adjusting for age and refraction effects, we determined that the AUCs for OH and GS were 0.694 and 0.646, respectively. Conclusions: Our real-world data indicate that Spectralis OCT parameters show some potential for early glaucoma detection and monitoring, but their current diagnostic effectiveness remains limited. When managing OH eyes, caution is required in evaluating macular retinal NFL thickness in addition to the ONH. Bruch's membrane opening-MRW is a potential objective indicator of ONH changes in GS eyes.
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Affiliation(s)
- Man-Sze Wong
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan;
| | - Chao-Wei Wu
- Ophthalmology, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung City 84247, Taiwan;
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80756, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 25137, Taiwan;
| | - Hsin-Yi Chen
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan;
- Department of Ophthalmology, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80756, Taiwan
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Ortiz M, Pueyo A, Dongil FJ, Boquete L, Sánchez-Morla EM, Barea R, Miguel-Jimenez JM, López-Dorado A, Vilades E, Rodrigo MJ, Cordon B, Garcia-Martin E. New Method of Early RRMS Diagnosis Using OCT-Assessed Structural Retinal Data and Explainable Artificial Intelligence. Transl Vis Sci Technol 2025; 14:14. [PMID: 39928305 PMCID: PMC11812612 DOI: 10.1167/tvst.14.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 01/03/2025] [Indexed: 02/11/2025] Open
Abstract
Purpose The purpose of this study was to provide the development of a method to classify optical coherence tomography (OCT)-assessed retinal data in the context of automatic diagnosis of early-stage multiple sclerosis (MS) with decision explanation. Methods The database used contains recordings from 79 patients with recently diagnosed relapsing-remitting multiple sclerosis (RRMS) and no history of optic neuritis and from 69 age-matched healthy control subjects. Analysis was performed on the thicknesses (average right and left eye value and inter-eye difference) of the macular retinal nerve fiber layer (mRNFL), macular ganglion cell layer (mGCL), macular inner plexiform layer (mIPL), and macular inner retinal complex layer (mIRL), dividing the macular area into six analysis zones. Recursive feature extraction (RFE) and Shapley additive explanations (SHAP) are combined to rank relevant features and select the subset that maximizes classifier (support vector machine [SVM]) performance. Results Of the initial 48 features, 20 were identified as maximizing classifier accuracy (n = 0.9257). The SHAP values indicate that average thickness has greater relevance than inter-eye difference, that the mGCL and mRNFL are the most influential structures, and that the peripheral papillomacular bundle and the supero-temporal quadrant are the zones most affected. Conclusions This approach improves the success rate of automatic diagnosis of early-stage RRMS and enhances clinical decision making transparency. Translational Relevance Retinal structure assessment using OCT data could constitute a noninvasive means of diagnosing early-stage MS. This new high-accuracy and high-explainability method of analysis can be implemented in most hospitals and healthcare centers.
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Affiliation(s)
- Miguel Ortiz
- School of Physics, University of Melbourne, Victoria, Australia
| | - Ana Pueyo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Zaragoza, Spain
| | - Francisco J. Dongil
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - Luciano Boquete
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - Eva M. Sánchez-Morla
- Institute of Psychiatry and Mental Health, Gregorio Marañón University Hospital, IiSGM, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
- CIBERSAM: Biomedical Research Networking Centre in Mental Health, Madrid, Spain
| | - Rafael Barea
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - Juan M. Miguel-Jimenez
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - Almudena López-Dorado
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - Elisa Vilades
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Zaragoza, Spain
| | - María J. Rodrigo
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Zaragoza, Spain
| | - Beatriz Cordon
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Zaragoza, Spain
| | - Elena Garcia-Martin
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Zaragoza, Spain
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Palazon-Cabanes A, Palazon-Cabanes B, Garcia-Medina JJ, Alvarez-Sarrion A, del-Rio-Vellosillo M. Normative Database of the Superior-Inferior Thickness Asymmetry for All Inner and Outer Macular Layers of Adults for the Posterior Pole Algorithm of the Spectralis SD-OCT. J Clin Med 2023; 12:7609. [PMID: 38137678 PMCID: PMC10743748 DOI: 10.3390/jcm12247609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND This study aims to establish a reference for the superior-inferior hemisphere asymmetry in thickness values for all macular layers for the posterior pole algorithm (PPA) available for the Spectralis SD-OCT device. METHODS We examined 300 eyes of 300 healthy Caucasian volunteers aged 18-84 years using the PPA, composed of a grid of 64 (8 × 8) cells, to analyze the thickness asymmetries of the following automatically segmented macular layers: retinal nerve fiber layer (RNFL); ganglion cell layer (GCL); inner plexiform layer (IPL); inner nuclear layer (INL); outer plexiform layer (OPL); outer nuclear layer (ONL); retinal pigment epithelium (RPE); inner retina; outer retina; complete retina. Mean ± standard deviation and the 2.5th and 97.5th percentiles of the thickness asymmetry values were obtained for all the corresponding cells. RESULTS All the macular layers had significant superior-inferior thickness asymmetries. GCL, IPL, INL, ONL and RPE showed significantly greater thicknesses in the superior than the inferior hemisphere, whereas RNFL and OPL were thicker in the inferior hemisphere. The largest differences between hemispheres were for RNFL and ONL. CONCLUSIONS This is the first normative database of macular thickness asymmetries for the PPA and should be considered to distinguish normal from pathological values when interpreting superior-inferior macular asymmetries.
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Affiliation(s)
- Ana Palazon-Cabanes
- Department of Ophthalmology, Hospital Virgen del Castillo, 30510 Murcia, Spain;
| | | | - Jose Javier Garcia-Medina
- Department of Ophthalmology, General University Hospital Morales Meseguer, 30008 Murcia, Spain
- Department of Ophthalmology and Optometry, University of Murcia, 30120 Murcia, Spain;
- Ophthalmic Research Unit “Santiago Grisolia”, 46010 Valencia, Spain
- Spanish Net of Inflammatory Diseases RICORS, Institute of Health Carlos III, 28029 Madrid, Spain
| | | | - Monica del-Rio-Vellosillo
- Department of Anesthesiology, University Hospital Virgen de la Arrixaca, 30120 Murcia, Spain;
- Department of Surgery, Obstetrics and Gynecology and Pediatrics, University of Murcia, 30120 Murcia, Spain
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Garcia-Martin E, Jimeno-Huete D, Dongil-Moreno FJ, Boquete L, Sánchez-Morla EM, Miguel-Jiménez JM, López-Dorado A, Vilades E, Fuertes MI, Pueyo A, Ortiz del Castillo M. Differential Study of Retinal Thicknesses in the Eyes of Alzheimer's Patients, Multiple Sclerosis Patients and Healthy Subjects. Biomedicines 2023; 11:3126. [PMID: 38137347 PMCID: PMC10740772 DOI: 10.3390/biomedicines11123126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Multiple sclerosis (MS) and Alzheimer's disease (AD) cause retinal thinning that is detectable in vivo using optical coherence tomography (OCT). To date, no papers have compared the two diseases in terms of the structural differences they produce in the retina. The purpose of this study is to analyse and compare the neuroretinal structure in MS patients, AD patients and healthy subjects using OCT. Spectral domain OCT was performed on 21 AD patients, 33 MS patients and 19 control subjects using the Posterior Pole protocol. The area under the receiver operating characteristic (AUROC) curve was used to analyse the differences between the cohorts in nine regions of the retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL) and outer nuclear layer (ONL). The main differences between MS and AD are found in the ONL, in practically all the regions analysed (AUROCFOVEAL = 0.80, AUROCPARAFOVEAL = 0.85, AUROCPERIFOVEAL = 0.80, AUROC_PMB = 0.77, AUROCPARAMACULAR = 0.85, AUROCINFERO_NASAL = 0.75, AUROCINFERO_TEMPORAL = 0.83), and in the paramacular zone (AUROCPARAMACULAR = 0.75) and infero-temporal quadrant (AUROCINFERO_TEMPORAL = 0.80) of the GCL. In conclusion, our findings suggest that OCT data analysis could facilitate the differential diagnosis of MS and AD.
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Affiliation(s)
- Elena Garcia-Martin
- Department of Ophthalmology, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (E.V.); (M.I.F.); (A.P.)
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), Biotech Vision SLP (Spin-Off Company), University of Zaragoza, 50009 Zaragoza, Spain
| | - Daniel Jimeno-Huete
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, 28871 Alcalá de Henares, Spain; (D.J.-H.); (F.J.D.-M.); (J.M.M.-J.); (A.L.-D.)
| | - Francisco J. Dongil-Moreno
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, 28871 Alcalá de Henares, Spain; (D.J.-H.); (F.J.D.-M.); (J.M.M.-J.); (A.L.-D.)
| | - Luciano Boquete
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, 28871 Alcalá de Henares, Spain; (D.J.-H.); (F.J.D.-M.); (J.M.M.-J.); (A.L.-D.)
| | - Eva M. Sánchez-Morla
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- School of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Juan M. Miguel-Jiménez
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, 28871 Alcalá de Henares, Spain; (D.J.-H.); (F.J.D.-M.); (J.M.M.-J.); (A.L.-D.)
| | - Almudena López-Dorado
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, 28871 Alcalá de Henares, Spain; (D.J.-H.); (F.J.D.-M.); (J.M.M.-J.); (A.L.-D.)
| | - Elisa Vilades
- Department of Ophthalmology, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (E.V.); (M.I.F.); (A.P.)
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), Biotech Vision SLP (Spin-Off Company), University of Zaragoza, 50009 Zaragoza, Spain
| | - Maria I. Fuertes
- Department of Ophthalmology, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (E.V.); (M.I.F.); (A.P.)
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), Biotech Vision SLP (Spin-Off Company), University of Zaragoza, 50009 Zaragoza, Spain
| | - Ana Pueyo
- Department of Ophthalmology, Miguel Servet University Hospital, 50009 Zaragoza, Spain; (E.V.); (M.I.F.); (A.P.)
- Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), Aragon Institute for Health Research (IIS Aragon), Biotech Vision SLP (Spin-Off Company), University of Zaragoza, 50009 Zaragoza, Spain
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Ahmed A, Jammal AA, Estrela T, Berchuck SI, Medeiros FA. Intraocular Pressure and Rates of Macular Thinning in Glaucoma. Ophthalmol Glaucoma 2023; 6:457-465. [PMID: 37037307 PMCID: PMC10523920 DOI: 10.1016/j.ogla.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the effect of intraocular pressure (IOP) on the rates of macular thickness (ganglion cell layer [GCL] and ganglion cell-inner plexiform layer [GCIPL]) change over time measured by spectral-domain (SD) OCT. DESIGN Retrospective cohort study. PARTICIPANTS Overall, 451 eyes of 256 patients with primary open-angle glaucoma. METHODS Data were extracted from the Duke Ophthalmic Registry, a database of electronic medical records of patients observed under routine clinical care at the Duke Eye Center, and satellite clinics. All records from patients with a minimum of 6 months of follow-up and at least 2 good-quality Spectralis SD-OCT macula scans were included. Linear mixed models were used to investigate the relationship between average IOP during follow-up and rates of GCL and GCIPL thickness change over time. MAIN OUTCOME MEASURES The effect of IOP on the rates of GCL and GCIPL thickness loss measured by SD-OCT. RESULTS Eyes had a mean follow-up of 1.8 ± 1.3 years, ranging from 0.5 to 10.2 years. The average rate of change for GCL thickness was -0.220 μm/year (95% confidence interval [CI], -0.268 to -0.172 μm/year) and for GCIPL thickness was -0.231 μm/year (95% CI, -0.302 to -0.160 μm/year). Each 1-mmHg higher mean IOP during follow-up was associated with an additional loss of -0.021 μm/year of GCL thickness (P = 0.001) and -0.032 μm/year of GCIPL thickness (P = 0.001) after adjusting for potentially confounding factors, such as baseline age, disease severity, sex, race, central corneal thickness, and follow-up time. CONCLUSIONS Higher IOP was significantly associated with faster rates of GCL and GCIPL loss over time measured by SD-OCT, even during relatively short follow-up times. These findings support the use of SD-OCT GCL and GCIPL thickness measurements as structural biomarkers for the evaluation of the efficacy of IOP-lowering therapies in slowing down the progression of glaucoma. 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)
- Abia Ahmed
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Biology, University of North Carolina, Chapel Hill, North Carolina
| | - Alessandro A Jammal
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Tais Estrela
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Samuel I Berchuck
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Statistical Science and Forge, Duke University, Durham, North Carolina
| | - Felipe A Medeiros
- Vision, Imaging, and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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Asrani S, Thompson AC. Which Optical Coherence Tomography Parameter, If Any, Identifies Glaucoma in High Myopia? JAMA Ophthalmol 2023; 141:639-640. [PMID: 37200010 DOI: 10.1001/jamaophthalmol.2023.1830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Sanjay Asrani
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Atalie C Thompson
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
- Atrium Health Wake Forest Baptist, Department of Surgical Ophthalmology, Winston-Salem, North Carolina
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Tirsi A, Shah PP, Gliagias V, Barmas-Alamdari D, Orshan D, Tsai J, Tello C. Posterior Pole Asymmetry Analysis as a Diagnostic Tool in Glaucoma Suspects: An Electrophysiological Approach. Clin Ophthalmol 2023; 17:1777-1787. [PMID: 37366515 PMCID: PMC10290849 DOI: 10.2147/opth.s411647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Spectral domain optical coherence tomography (SD-OCT) with posterior pole asymmetry analysis (PPAA) provides a mapping of posterior pole retinal thickness with asymmetry analysis between hemispheres of each eye. We investigated whether these structural abnormalities were correlated with functional retinal ganglion cell (RGC) loss, quantified by steady state pattern electroretinogram (ssPERG), in glaucoma suspects (GS). Methods Twenty GS (34 eyes) were enrolled in a prospective study at the Manhattan Eye, Ear, and Throat Hospital. All subjects underwent ophthalmological examination, including Humphrey visual field, Spectralis Glaucoma Module Premium Edition (GMPE) SD-OCT PPAA, and ssPERG testing. The ability of ssPERG parameters (Magnitude [Mag, µv], MagnitudeD [MagD, µv], and MagD/Mag ratio) to predict PPAA thickness (total, superior, and inferior thickness, [µm]) was tested via adjusted multivariate linear regression analysis. Results Mag explained 8% of variance in total PPAA change (F(1,29)=6.33, B=6.86, 95% CI: 1.29-12.44, p=0.018), 8% in superior PPAA change (F(1,29)=5.57, B=6.92, 95% CI: 0.92-12.92, p=0.025), and 7.1% in inferior PPAA change (F(1,29)=5.83, B=6.80, 95% CI: 1.04-12.56, p=0.022). Similarly, MagD explained 9.7% of variance in total PPAA change (F(1,29)=8.09, B=6.47, 95% CI: 1.82-11.13, p=0.008), 10% in superior PPAA change (F(1,29)=7.33, B=6.63, 95% CI: 1.62-11.63, p=0.011), and 8.5% in inferior PPAA change (F(1,29)=7.25, B=6.36, 95% CI: 1.53-11.18, p=0.012). MagD/Mag ratio and PPAA were not significantly associated. Conclusion To the best of our knowledge, this is the first study demonstrating a positive relationship between RGC dysfunction and retinal thickness changes between the superior and inferior hemispheres. The detection of asymmetrical structural loss, combined with functional RGC assessment using ssPERG, may be an informative tool for early glaucoma diagnosis.
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Affiliation(s)
- Andrew Tirsi
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
| | - Paras P Shah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
| | - Vasiliki Gliagias
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
| | - Daniel Barmas-Alamdari
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
| | - Derek Orshan
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
| | - Joby Tsai
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
| | - Celso Tello
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York City, NY, 10065, USA
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Ortiz M, Mallen V, Boquete L, Sánchez-Morla EM, Cordón B, Vilades E, Dongil-Moreno FJ, Miguel-Jiménez JM, Garcia-Martin E. Diagnosis of multiple sclerosis using optical coherence tomography supported by artificial intelligence. Mult Scler Relat Disord 2023; 74:104725. [PMID: 37086637 DOI: 10.1016/j.msard.2023.104725] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Current procedures for diagnosing multiple sclerosis (MS) present a series of limitations, making it critically important to identify new biomarkers. The aim of the study was to identify new biomarkers for the early diagnosis of MS using spectral-domain optical coherence tomography (OCT) and artificial intelligence. METHODS Spectral domain OCT was performed on 79 patients with relapsing-remitting multiple sclerosis (RRMS) (disease duration ≤ 2 years, no history of optic neuritis) and on 69 age-matched healthy controls using the posterior pole protocol that incorporates the anatomic Positioning System. Median retinal thickness values in both eyes and inter-eye difference in healthy controls and patients were evaluated by area under the receiver operating characteristic (AUROC) curve analysis in the foveal, parafoveal and perifoveal areas and in the overall area spanned by the three rings. The structures with the greatest discriminant capacity - retinal thickness and inter-eye difference - were used as inputs to a convolutional neural network to assess the diagnostic capability. RESULTS Analysis of retinal thickness and inter-eye difference in RRMS patients revealed that greatest alteration occurred in the ganglion cell (GCL), inner plexiform (IPL), and inner retinal (IRL) layers. By using the average thickness of the GCL (AUROC = 0.82) and the inter-eye difference in the IPL (AUROC = 0.71) as inputs to a two-layer convolutional neural network, automatic diagnosis attained accuracy = 0.87, sensitivity = 0.82, and specificity = 0.92. CONCLUSION This study adds weight to the argument that neuroretinal structure analysis could be incorporated into the diagnostic criteria for MS.
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Affiliation(s)
- Miguel Ortiz
- School of Physics, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Victor Mallen
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (IIS Aragon). Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Spain
| | - Luciano Boquete
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | | | - Beatriz Cordón
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (IIS Aragon). Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Spain
| | - Elisa Vilades
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (IIS Aragon). Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Spain
| | - Francisco J Dongil-Moreno
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - Juan M Miguel-Jiménez
- Biomedical Engineering Group, Department of Electronics, University of Alcalá, Alcalá de Henares, Spain
| | - Elena Garcia-Martin
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain; Aragon Institute for Health Research (IIS Aragon). Miguel Servet Ophthalmology Innovation and Research Group (GIMSO), University of Zaragoza, Spain.
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Mathews B, Le PH, Budenz DL, Mwanza JC. Agreement of Diagnostic Classification Between Structural Parameters in Pre-Perimetric and Early Perimetric Glaucoma. J Glaucoma 2023; 32:301-306. [PMID: 36477025 DOI: 10.1097/ijg.0000000000002157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
PRCIS In both pre-perimetric and early perimetric glaucoma, the diagnostic agreements between optic disk, retinal nerve fiber layer, and ganglion cell-inner plexiform layer parameters based on Cirrus HD-OCT normative database classification were mostly fair, suggesting that abnormal classification in 1 anatomic area may suffice for the diagnosis of glaucoma in early stages. PURPOSE To evaluate the agreement of normative database diagnostic classification between optic disk, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCIPL) in patients with early glaucoma. METHODS Retrospective cross-sectional study involving 66 eyes (66 patients) with pre-perimetric and 97 eyes (97 patients) with early perimetric glaucoma. Normative database diagnostic classifications were retrieved from Cirrus HD-OCT scans of 1 eye per participant. An eye was considered abnormal if any of the optic disk, RNFL, or GCIPL was abnormal (yellow or red color-coded classification). For combined parameters, the eye had to be flagged as abnormal by both classifications, regardless of the parameters that were abnormal (global or sectorial). The agreement was assessed with Cohen's Kappa statistics. RESULTS The agreement between RNFL and GCIPL was fair in both pre-perimetric (κ=0.25) and perimetric glaucoma (κ=0.21). Agreements between RNFL or GCIPL and optic nerve head parameters (rim area and vertical cup-to-disk ratio; VCDR) were inconclusive due to insufficient data ( P >0.05). Combining GCIPL and rim area agreed fairly with RNFL both in pre-perimetric (κ=0.21) and perimetric glaucoma (κ=0.33). The best classification agreement (moderate) was achieved with the comparison of RNFL-rim area versus VCDR (κ=0.48 in pre-perimetric, 0.45 in perimetric glaucoma). There were no significant differences between pre-perimetric and perimetric glaucoma coefficients of classification agreement. CONCLUSIONS The normative database diagnostic agreements between optic disk, RNFL, and GCIPL were mostly fair in both pre-perimetric and early perimetric glaucoma. Clinicians should not wait for multiple structures to show abnormality on OCT to diagnose early glaucoma.
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Affiliation(s)
- Basil Mathews
- Department of Ophthalmology, Kittner Eye Center, University of North Carolina, NC
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10
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Onyekaba NAE, Estrela T, Naithani R, McCarthy KM, Jammal AA, Medeiros FA. Comparison of 10-2 and 24-2 Perimetry to Diagnose Glaucoma Using OCT as an Independent Reference Standard. Ophthalmol Glaucoma 2023; 6:187-197. [PMID: 36084839 PMCID: PMC10281760 DOI: 10.1016/j.ogla.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/02/2022] [Accepted: 08/30/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare the performance of the 10-2 test versus 24-2 standard automated perimetry (SAP) test for the diagnosis of glaucoma using OCT as an independent standard for glaucomatous damage. DESIGN Cross-sectional study. PARTICIPANTS A total of 1375 pairs of 10-2 and 24-2 SAP tests from 569 eyes of 339 subjects were used for the analysis. A total of 440 (77%) eyes had a diagnosis of glaucoma, and 129 (23%) eyes were normal. All participants underwent 10-2 and 24-2 SAP tests within 30 days. METHODS Glaucomatous severity was quantified based on OCT macula ganglion cell layer (mGCL) and circumpapillary retinal nerve fiber layer. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare 10-2 and 24-2 metrics for discriminating healthy eyes from those of glaucoma, at different levels of disease severity. MAIN OUTCOME MEASURES Areas under the ROC curves and sensitivities at fixed specificities of 80% and 95%. RESULTS The overall AUC for mean deviation (MD) for the 24-2 test (0.808) was significantly higher than that of the 10-2 test (0.742; P < 0.001). When compared at different stages of the disease, the 24-2 test performed generally better than the 10-2 test, notably in the earlier stages of the disease. For early damage (first quartile), the 24-2 MD had an AUC of 0.658 versus 0.590 for 10-2 MD (P = 0.018). For advanced damage (fourth quartile), corresponding values were 0.954 vs. 0.903 (P = 0.013). Similar trends were observed when glaucoma severity was defined based on structural macular damage with mGCL thickness. CONCLUSIONS The 24-2 SAP test had better diagnostic accuracy compared with that of the 10-2 test for detecting equivalent levels of glaucomatous damage, as measured by quantitative assessment of retinal nerve fiber layer and macula by OCT. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ndidi-Amaka E Onyekaba
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Tais Estrela
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Rizul Naithani
- Campbell University School of Medicine, Lillington, North Carolina
| | | | - Alessandro A Jammal
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Felipe A Medeiros
- Vision, Imaging and Performance Laboratory, Duke Eye Center and Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina.
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Ganglion Cell Complex Analysis: Correlations with Retinal Nerve Fiber Layer on Optical Coherence Tomography. Diagnostics (Basel) 2023; 13:diagnostics13020266. [PMID: 36673076 PMCID: PMC9858609 DOI: 10.3390/diagnostics13020266] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of this review is to analyze the correlations between the changes in the ganglion cell complex (GCC) and the retinal nerve fiber layer (RNFL) on optical coherence tomography in different possible situations, especially in eyes with glaucoma. For glaucoma evaluation, several studies have suggested that in the early stages, GCC analysis, especially the thickness of the infero and that of the inferotemporal GCC layers, is a more sensitive examination than circumpapillary RNFL (pRNFL). In the moderate stages of glaucoma, inferior pRNFL thinning is better correlated with the disease than in advanced cases. Another strategy for glaucoma detection is to find any asymmetry of the ganglion cell-inner plexiform layers (GCIPL) between the two macular hemifields, because this finding is a valuable indicator for preperimetric glaucoma, better than the RNFL thickness or the absolute thickness parameters of GCIPL. In preperimetric and suspected glaucoma, GCC and pRNFL have better specificity and are superior to the visual field. In advanced stages, pRNFL and later, GCC reach the floor effect. Therefore, in this stage, it is more useful to evaluate the visual field for monitoring the progression of glaucoma. In conclusion, GCC and pRNFL are parameters that can be used for glaucoma diagnosis and monitoring of the progression of the disease, with each having a higher accuracy depending on the stage of the disease.
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12
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Macular thickness variation and interocular symmetry by gestational age in preterm school-age children. J AAPOS 2022; 26:311.e1-311.e8. [PMID: 36328300 DOI: 10.1016/j.jaapos.2022.08.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To determine changes in macular thickness profile according to gestational age (GA) and to assess interocular symmetry in the macula of children born very preterm. METHODS In this cross-sectional study of preterm (n = 106) and term-born (n = 49) children 5-8 years of age at time of examination, optical coherence tomography was used to measure macula thickness as described in the ETDRS study. Statistical analyses included stratified and multivariable analyses. RESULTS Foveal minimum thickness increased with decreasing GA (P for trend, <0.001; 254.7 ± 32.8 μm for children born at 24-25 weeks and 193.2 ± 32.8 μm in term-born children). Inner and outer area thickness differed for term and preterm children, but did not vary with the degree of prematurity (inner area, 267.0 ± 11.0 μm for 24-25 weeks' GA and 305.4 ± 11.8 μm for term children [P < 0.01]; outer ring, 305.5 ± 10.4 μm in extreme preterm and 271.0 ± 10.4 μm in term children [P < 0.01]). Interocular asymmetry in preterm children was not significant for most areas; the largest interocular difference was found in the central zone (16.3 ±16.6 μm). CONCLUSIONS In our study cohort, children born very preterm examined at school age compared to term born children had greater central thickness with decreased foveal pit, decreased inner ring, and increased thickness of the outer ring. They did not show greater interocular asymmetry.
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Choovuthayakorn J, Chokesuwattanaskul S, Phinyo P, Hansapinyo L, Pathanapitoon K, Chaikitmongkol V, Watanachai N, Kunavisarut P, Patikulsila D. Reference Database of Inner Retinal Layer Thickness and Thickness Asymmetry in Healthy Thai Adults as Measured by the Spectralis Spectral-Domain Optical Coherence Tomography. Ophthalmic Res 2022; 65:668-677. [PMID: 35709686 DOI: 10.1159/000525512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The study aimed to determine a reference database of the thickness and intraocular thickness asymmetry of total retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) in healthy Thai subjects measured by the Spectralis spectral-domain optical coherence tomography. METHODS This cross-sectional study recruited the healthy subjects age ≥18 years, having spherical refraction within ±6 diopters and cylindrical refraction ±3 diopters, from a hospital's personnel and the people visiting the ophthalmology department. Only 1 eye of each subject was randomly selected for an analysis. Macular images were obtained using posterior pole thickness scan protocol over a 24° × 24° area at the center of the fovea. The automated retinal thickness segmentation values of total retina and three inner retinal layers were calculated for the mean and the mean intraocular thickness difference between superior and inferior retinal hemispheres. The influence of age, gender, and axial length on thickness and thickness asymmetry of individualized retinal layer was evaluated. RESULTS 252 subjects were included in study with a mean (SD) age of 46.7 (15.8) years, and 120 (47.6%) were males. According to the Early Treatment Diabetic Retinopathy Study map, the inner ring area was the thickest location of the total retina (range; 326.0-341.5 µm), GCL (range; 47.7-52.7 µm), and IPL (range; 39.9-42.1 µm), whereas the thickest location of RNFL was at the outer ring area (range; 18.8-47.5 µm). For posterior pole intraocular thickness asymmetry, the greatest mean ± SD difference was observed for total retina (9.0 ± 2.2 µm), followed by RNFL (9.9 ± 3.2 µm) and GCL (2.7 ± 0.6 µm), and the lowest mean difference was noted for IPL (2.4 ± 0.5 µm). The thickness and thickness asymmetry of each retinal layer were variably influenced by age, gender, and axial length; however, these factors had a minimal influence on the thickness asymmetry maps of GCL and RNFL. CONCLUSION The reference database of the macular thickness and thickness asymmetry from this study would be beneficial in determining physiologic variations of the OCT parameters in the healthy Thai population.
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Affiliation(s)
- Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Susama Chokesuwattanaskul
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Cornea and Refractive Surgery Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, Thailand.,Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Linda Hansapinyo
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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BARMAN KAKİL Ş, ERDEM E, HARBİYELİ İİ, YAĞMUR M. Predictive values of lamina cribrosa depth and ganglion cell complex thickness in early diagnosis of glaucoma. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1029547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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15
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Nouri-Mahdavi K, Mohammadzadeh V, Rabiolo A, Edalati K, Caprioli J, Yousefi S. Prediction of Visual Field Progression from OCT Structural Measures in Moderate to Advanced Glaucoma. Am J Ophthalmol 2021; 226:172-181. [PMID: 33529590 DOI: 10.1016/j.ajo.2021.01.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE To test the hypothesis that visual field (VF) progression can be predicted from baseline and longitudinal optical coherence tomography (OCT) structural measurements. DESIGN Prospective cohort study. METHODS A total of 104 eyes (104 patients) with ≥3 years of follow-up and ≥5 VF examinations were enrolled. We defined VF progression based on pointwise linear regression on 24-2 VF (≥3 locations with slope less than or equal to -1.0 dB/year and P < .01). We used elastic net logistic regression (ENR) and machine learning to predict VF progression with demographics, baseline circumpapillary retinal nerve fiber layer (RNFL), macular ganglion cell/inner plexiform layer (GCIPL) thickness, and RNFL and GCIPL change rates at central 24 superpixels and 3 eccentricities, 3.4°, 5.5°, and 6.8°, from fovea and hemimaculas. Areas-under-ROC curves (AUC) were used to compare models. RESULTS Average ± SD follow-up and VF examinations were 4.5 ± 0.9 years and 8.7 ± 1.6, respectively. VF progression was detected in 23 eyes (22%). ENR selected rates of change of superotemporal RNFL sector and GCIPL change rates in 5 central superpixels and at 3.4° and 5.6° eccentricities as the best predictor subset (AUC = 0.79 ± 0.12). Best machine learning predictors consisted of baseline superior hemimacular GCIPL thickness and GCIPL change rates at 3.4° eccentricity and 3 central superpixels (AUC = 0.81 ± 0.10). Models using GCIPL-only structural variables performed better than RNFL-only models. CONCLUSIONS VF progression can be predicted with clinically relevant accuracy from baseline and longitudinal structural data. Further refinement of proposed models would assist clinicians with timely prediction of functional glaucoma progression and clinical decision making.
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Nouri-Mahdavi K, Weiss RE. Detection of Glaucoma Deterioration in the Macular Region with Optical Coherence Tomography: Challenges and Solutions. Am J Ophthalmol 2021; 222:277-284. [PMID: 32950510 DOI: 10.1016/j.ajo.2020.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Macular imaging with optical coherence tomography (OCT) measures the most critical retinal ganglion cells (RGCs) in the human eye. The goal of this perspective is to review the challenges to detection of glaucoma progression with macular OCT imaging and propose ways to enhance its performance. DESIGN Perspective with review of relevant literature. METHODS Review of challenges and issues related to detection of change on macular OCT images in glaucoma eyes. The primary outcome measures were confounding factors affecting the detection of change on macular OCT images. RESULTS The main challenges to detection of structural progression in the macula consist of the magnitude of and the variable amount of test-retest variability among patients, the confounding effect of aging, lack of a reliable and easy-to-measure functional outcome or external standard, the confounding effects of concurrent macular conditions including myopia, and the measurement floor of macular structural outcomes. Potential solutions to these challenges include controlling head tilt or torsion during imaging, estimating within-eye variability for individual patients, improved data visualization, the use of artificial intelligence methods, and the implementation of statistical approaches suitable for multidimensional longitudinal data. CONCLUSIONS Macular OCT imaging is a crucial structural imaging modality for assessing central RGCs. Addressing the current shortcomings in acquisition and analysis of macular volume scans can enhance its utility for measuring the health of central RGCs and therefore assist clinicians with timely institution of appropriate treatment.
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Affiliation(s)
- Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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17
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Mahmudi T, Kafieh R, Rabbani H, Mehri A, Akhlaghi MR. Evaluation of Asymmetry in Right and Left Eyes of Normal Individuals Using Extracted Features from Optical Coherence Tomography and Fundus Images. JOURNAL OF MEDICAL SIGNALS & SENSORS 2021; 11:12-23. [PMID: 34026586 PMCID: PMC8043121 DOI: 10.4103/jmss.jmss_67_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/14/2020] [Accepted: 03/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Asymmetry analysis of retinal layers in right and left eyes can be a valuable tool for early diagnoses of retinal diseases. To determine the limits of the normal interocular asymmetry in retinal layers around macula, thickness measurements are obtained with optical coherence tomography (OCT). METHODS For this purpose, after segmentation of intraretinal layer in threedimensional OCT data and calculating the midmacular point, the TM of each layer is obtained in 9 sectors in concentric circles around the macula. To compare corresponding sectors in the right and left eyes, the TMs of the left and right images are registered by alignment of retinal raphe (i.e. diskfovea axes). Since the retinal raphe of macular OCTs is not calculable due to limited region size, the TMs are registered by first aligning corresponding retinal raphe of fundus images and then registration of the OCTs to aligned fundus images. To analyze the asymmetry in each retinal layer, the mean and standard deviation of thickness in 9 sectors of 11 layers are calculated in 50 normal individuals. RESULTS The results demonstrate that some sectors of retinal layers have signifcant asymmetry with P < 0.05 in normal population. In this base, the tolerance limits for normal individuals are calculated. CONCLUSION This article shows that normal population does not have identical retinal information in both eyes, and without considering this reality, normal asymmetry in information gathered from both eyes might be interpreted as retinal disorders.
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Affiliation(s)
- Tahereh Mahmudi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Medical Image and Signal Processing Research Center, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Kafieh
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Rabbani
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mehri
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Akhlaghi
- Department of Ophthalmology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Ha A, Kim YK, Kim JS, Jeoung JW, Park KH. Temporal Raphe Sign in Elderly Patients With Large Optic Disc Cupping: Its Evaluation as a Predictive Factor for Glaucoma Conversion. Am J Ophthalmol 2020; 219:205-214. [PMID: 32652053 DOI: 10.1016/j.ajo.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine baseline clinical features associated with conversion to glaucoma in elderly patients with large optic-disc cupping. DESIGN Retrospective cohort study. METHODS Seventy-two eyes of 72 untreated elderly (≥65-year-old) patients with large vertical cup-to-disc ratio (CDR ≥0.7) and without any other glaucomatous findings were included. They had undergone a full ophthalmologic examination twice per year for at least 5 years. The optic nerve head (ONH), peripapillary retinal nerve fiber layer (RNFL), and macular ganglion cell-inner plexiform layer (GCIPL) were imaged with Cirrus high-definition optical coherence tomography (OCT). Presence of temporal raphe sign on the OCT's GCIPL thickness map was assessed as one of the morphologic factors. Conversion to normal-tension glaucoma (NTG) was defined as structural or functional deterioration on either red-free RNFL photography or standard automated perimetry, respectively. The utility of the baseline factors associated with conversion to NTG were identified. RESULTS During the 5.5-year follow-up, 19 eyes (26.4%) converted to NTG. There were no significant differences in demographics, systemic factors, intraocular pressure factors, or OCT parameters between the nonconverters and converters. Interestingly, the temporal raphe sign was observed in the converters (18/19, 94.7%) much more frequently than in the nonconverters (3/53, 5.7%, P < .001) at baseline. A Cox proportional hazards model indicated the significant influences of temporal raphe sign positivity (hazard ratio 6.823, 95% confidence interval 2.574, 18.088, P < .001) on conversion to NTG. CONCLUSIONS In elderly subjects with large CDR, temporal raphe sign positivity on the baseline macular GCIPL thickness map was associated with faster conversion to NTG.
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Affiliation(s)
- Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, Republic of Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Soo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea.
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Mohammadzadeh V, Fatehi N, Yarmohammadi A, Lee JW, Sharifipour F, Daneshvar R, Caprioli J, Nouri-Mahdavi K. Macular imaging with optical coherence tomography in glaucoma. Surv Ophthalmol 2020; 65:597-638. [PMID: 32199939 PMCID: PMC7423773 DOI: 10.1016/j.survophthal.2020.03.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
Abstract
With the advent of spectral-domain optical coherence tomography, imaging of the posterior segment of the eye can be carried out rapidly at multiple anatomical locations, including the optic nerve head, circumpapillary retinal nerve fiber layer, and macula. There is now ample evidence to support the role of spectral-domain optical coherence tomography imaging of the macula for detection of early glaucoma. Macular spectral-domain optical coherence tomography measurements demonstrate high reproducibility, and evidence on its utility for detection of glaucoma progression is accumulating. We present a comprehensive review of macular spectral-domain optical coherence tomography imaging emerging as an essential diagnostic tool in glaucoma.
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Affiliation(s)
- Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Nima Fatehi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA; Saint Mary Medical Center - Dignity Health, Long Beach, California, USA
| | - Adeleh Yarmohammadi
- Shiley Eye Institute, University of California, San Diego, La Jolla, California, United States
| | - Ji Woong Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, Korea
| | - Farideh Sharifipour
- Department of Ophthalmology, Shahid Beheshti university of Medical Sciences, Tehran, Iran
| | - Ramin Daneshvar
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
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Normative Database for All Retinal Layer Thicknesses Using SD-OCT Posterior Pole Algorithm and the Effects of Age, Gender and Axial Lenght. J Clin Med 2020; 9:jcm9103317. [PMID: 33076558 PMCID: PMC7602827 DOI: 10.3390/jcm9103317] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 12/20/2022] Open
Abstract
Our aim was to provide, for the first time, reference thickness values for the SD-OCT posterior pole algorithm (PPA) available for Spectralis OCT device (Heidelberg Engineering, Heidelberg, Germany) and to analyze the correlations with age, gender and axial length. We recruited 300 eyes of 300 healthy Caucasian subjects between 18 and 84 years. By PPA, composed of 64 (8 × 8) cells, we analyzed the thickness of the following macular layers: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), inner retina, outer retina and full retina. Mean ± SD, 1st, 5th, 95th percentiles were obtained for each cell at all macular layers. Significant negative correlations were found between age and thickness for most macular layers. The mean thickness of most macular layers was thicker for men than women, except for RNFL, OPL and RPE, with no gender differences. GCL, IPL and INL thicknesses positively correlated with axial length in central cells, and negatively in the cells near the optic disk. The mean RNFL thickness was positively associated with axial length. This is the first normative database for PPA. Age, gender and axial length should be taken into account when interpreting PPA results.
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Asymmetry analysis of optical coherence tomography angiography macular perfusion density measurements in preperimetric and perimetric glaucoma. Sci Rep 2020; 10:14781. [PMID: 32901074 PMCID: PMC7479593 DOI: 10.1038/s41598-020-71757-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022] Open
Abstract
Macular retinal layer thickness asymmetry indices, particularly for the ganglion cell layer, are promising early indicators of glaucomatous damage. We evaluated macular perfusion density asymmetry (MPDA) among normal, preperimetric glaucoma (PPG), and perimetric glaucoma (PG) eyes, and we tested the performance of MPDA in differentiating between control and glaucoma eyes with or without visual field (VF) defects. In this study, 116 eyes (39 normal, 27 PPG, and 50 PG eyes) with optical coherence tomography angiography images of the macula were analysed. No significant difference was found in outer and inner MPDA between the control and PPG groups. However, outer MPDA was significantly higher in the PG group than in the PPG group (p = 0.009). Asymmetry of perfusion density and structural parameters was compared; no significant difference was found between controls and glaucoma patients. Outer MPDA had significantly higher discrimination ability between PPG and PG than did macular ganglion cell layer–inner plexiform layer thickness asymmetry (p = 0.039). In conclusion, the discriminant capability of MPDA for discriminating between glaucoma patients with and without VF defects is significantly higher than that of structural asymmetry. MPDA may be helpful in monitoring glaucoma progression in clinical practice.
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Yoo YJ, Hwang JM, Yang HK, Joo JD, Kim YH, Kim CY. Prognostic value of macular ganglion cell layer thickness for visual outcome in parasellar tumors. J Neurol Sci 2020; 414:116823. [PMID: 32302803 DOI: 10.1016/j.jns.2020.116823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Optic nerve compression by mass lesions at the optic chiasm leads to loss of visual function which can be recovered after decompression surgery. In this study, we evaluated the prognostic ability of macular ganglion cell layer (mGCL) thickness measured with spectral-domain optical coherence tomography (SD-OCT) for predicting postoperative visual outcome of compressive optic neuropathy (CON) related to parasellar tumors. METHODS This observational cohort study used data from the Department of Neurosurgery and Ophthalmology, Seoul National University Bundang Hospital between 2013 and 2018. Seventy-nine eyes from 79 patients with CON due to parasellar tumors who underwent surgery were included. Patients were divided into either a visual recovery group or a non-recovery group according to the degree of postoperative visual field (VF) impairment. SD-OCT scanning with automated segmentation was performed to measure the circumpapillary retinal nerve fiber layer (cpRNFL) and the mGCL thickness in the nine macular subfields as defined by the ETDRS and 8 × 8 posterior pole grid. Correlations between preoperative cpRNFL thickness, mGCL thickness and postoperative VF sensitivity were assessed. The prognostic ability of mGCL thickness for predicting visual recovery after surgical decompression in each ETDRS subfield and posterior pole grid quadrant was evaluated. RESULTS The central inferonasal and superonasal quadrant mGCL thicknesses measured by the 8 × 8 posterior pole grid showed the best predictability of postoperative visual outcome (AUROC = 0.963 and 0.953, respectively), which was superior to the prognostic power of the average cpRNFL. The central inferonasal quadrant mGCL thickness significantly correlated with the superotemporal quadrant VF sensitivity (R2 = 0.589). CONCLUSIONS The mGCL thickness in the central nasal quadrants measured by SD-OCT is an excellent predictor of visual recovery after chiasmal decompression.
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Affiliation(s)
- Yung Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Jin-Deok Joo
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Lee J, Kim YK, Ha A, Sun S, Kim YW, Kim JS, Jeoung JW, Park KH. Macular Ganglion Cell-Inner Plexiform Layer Thickness Prediction from Red-free Fundus Photography using Hybrid Deep Learning Model. Sci Rep 2020; 10:3280. [PMID: 32094401 PMCID: PMC7039950 DOI: 10.1038/s41598-020-60277-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/09/2020] [Indexed: 12/15/2022] Open
Abstract
We developed a hybrid deep learning model (HDLM) algorithm that quantitatively predicts macular ganglion cell-inner plexiform layer (mGCIPL) thickness from red-free retinal nerve fiber layer photographs (RNFLPs). A total of 789 pairs of RNFLPs and spectral domain-optical coherence tomography (SD-OCT) scans for 431 eyes of 259 participants (183 eyes of 114 healthy controls, 68 eyes of 46 glaucoma suspects, and 180 eyes of 99 glaucoma patients) were enrolled. An HDLM was built by combining a pre-trained deep learning network and support vector machine. The correlation coefficient and mean absolute error (MAE) between the predicted and measured mGCIPL thicknesses were calculated. The measured (OCT-based) and predicted (HDLM-based) average mGCIPL thicknesses were 73.96 ± 8.81 µm and 73.92 ± 7.36 µm, respectively (P = 0.844). The predicted mGCIPL thickness showed a strong correlation and good agreement with the measured mGCIPL thickness (Correlation coefficient r = 0.739; P < 0.001; MAE = 4.76 µm). Even when the peripapillary area (diameter: 1.5 disc diameters) was masked, the correlation (r = 0.713; P < 0.001) and agreement (MAE = 4.87 µm) were not changed significantly (P = 0.378 and 0.724, respectively). The trained HDLM algorithm showed a great capability for mGCIPL thickness prediction from RNFLPs.
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Affiliation(s)
- Jinho Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Sukkyu Sun
- Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul, Korea
| | - Yong Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Jin-Soo Kim
- Department of Ophthalmology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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Scuderi G, Fragiotta S, Scuderi L, Iodice CM, Perdicchi A. Ganglion Cell Complex Analysis in Glaucoma Patients: What Can It Tell Us? Eye Brain 2020; 12:33-44. [PMID: 32099501 PMCID: PMC6999543 DOI: 10.2147/eb.s226319] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/15/2020] [Indexed: 12/15/2022] Open
Abstract
Glaucoma is a group of optic neuropathies characterized by a progressive degeneration of retina ganglion cells (RGCs) and their axons that precedes functional changes detected on the visual field. The macular ganglion cell complex (GCC), available in commercial Fourier-domain optical coherence tomography, allows the quantification of the innermost retinal layers that are potentially involved in the glaucomatous damage, including the retinal nerve fiber (RNFL), ganglion cell and inner plexiform layers. The average GCC thickness and its related parameters represent a reliable biomarker in detecting preperimetric glaucomatous damage. The most accurate GCC parameters are represented by average and inferior GCC thicknesses, and they can be associated with progressive visual field loss. Although the diagnostic accuracy increases with more severe glaucomatous damage and higher signal strength values, it is not affected by increasing axial length, resulting in a more accurate discrimination of glaucomatous damage in myopic eyes with respect to the traditional RNFL thickness. The analysis of the structure-function relationship revealed a good agreement between the loss in retinal sensitivity and GCC thickness. The use of a 10-2° visual field grid, adjusted for the anatomical RGCs displacement, describes more accurately the relationship between RGCs thickness and visual field sensitivity loss.
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Affiliation(s)
- Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Department of Sense Organs, Azienda Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | | | - Andrea Perdicchi
- NESMOS Department, Ophthalmology Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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Abstract
PURPOSE To develop a new structural algorithm derived from optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness and asymmetry and validate it as a discriminate among normal, suspect, and early primary open-angle glaucoma (POAG). STUDY DESIGN A case-controlled observational clinical study. MATERIALS AND METHODS In total, 150 subjects (299 eyes) were selected, 61 normal, 46 suspect, and 43 early glaucoma, from Al-Azhar University Hospitals. They were in fifth decade and free from any ocular or systemic diseases affecting the retinal nerve fiber layer. They were investigated by two consecutive perimetry (1 month apart), and three scans of circumpapillary retinal nerve fiber layer (cpRNFL) by using Nidek spectral domain (SD)-OCT 3000 Lite. The cpRNFL thickness (cpRNFLT) and inter-eye asymmetry parameters were analyzed among the three groups. Then some selected parameters were selected and analyzed using a binary logistic regression analysis for developing the new algorithm. The new algorithm was tested for the best fitting, accuracy, and diagnostic ability among the three groups and was validated in the suspect group. RESULTS The new algorithm model [early glaucoma discrimination index (EGDI)] works well with only four variables; whole cpRNFLT, inferior quadrant cpRNFLT, inferotemporal clock hour (CH) cpRNFLT, and absolute inter-eye inferior quadrants asymmetry. The highest area under the curve (AUC) obtained from the EGDI among the three groups was 0.854. The validation analysis in the suspect group revealed a higher diagnostic ability in discrimination of early glaucoma with AUC of 0.989 (0.976-1.003). CONCLUSION The EGDI showed better diagnostic ability for diagnosis of glaucoma in the pre-perimetric stage. The new OCT algorithm is simple and can be run in any SD-OCT device without dependence on normative data. HOW TO CITE THIS ARTICLE Safwat H, Nassar E, Rashwan A. Early Glaucoma Discrimination Index. J Curr Glaucoma Pract 2020;14(1):16-24.
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Affiliation(s)
- Hend Safwat
- Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Elaraby Nassar
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Afaf Rashwan
- Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Nouri-Mahdavi K, Fatehi N, Caprioli J. Longitudinal Macular Structure-Function Relationships in Glaucoma and Their Sources of Variability. Am J Ophthalmol 2019; 207:18-36. [PMID: 31078529 PMCID: PMC6842082 DOI: 10.1016/j.ajo.2019.04.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To review central structure-function (SF) relationships in glaucoma; to compare contributions of within-session and between-session variability to total variability of macular optical coherence tomography (OCT) thickness measurements; and to test the hypothesis that longitudinal within-eye variability of central SF relationships is smaller than between-individual variability. METHODS We reviewed the pertinent literature on central SF relationships in glaucoma. Thirty-eight eyes (20 normal or glaucoma subjects) had ×3 macular images per session over 3 sessions, and superpixels thickness measurements for ganglion cell layer (GCL), ganglion cell/inner plexiform layer (GCIPL), ganglion cell complex (GCC), and full macular thickness (FMT) were exported. Linear mixed models were used for estimating contributions of between- and within-session variability to total thickness variability. One hundred twenty eyes with ≥3 10° visual fields (VFs)/OCT images were enrolled for the longitudinal study. We investigated within-eye longitudinal SF relationships (GCIPL thickness vs VF total deviations) with a change-point regression model and compared within-eye to between-individual variabilities with components-of-variance models. RESULTS In the cross-sectional study, the between-session component contributed 8%, 11%, 11%, and 36% of total variability for GCL, GCIPL, GCC, and FMT, respectively. In the longitudinal study, between-individual variability explained 78%, 77%, and 67% of total SF variability at 3.4°, 5.6°, and 6.8° eccentricities, respectively (P < .05). SF relationships remained stable over time within individual eyes. CONCLUSIONS Within-session variability accounts for most of macular thickness variability over time. Longitudinal within-eye SF variability is smaller than between-individual variability. Study of within-eye SF relationships could help clinicians better understand SF linking in glaucoma and help refine progression algorithms. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
| | - Nima Fatehi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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The Fovea-BMO Axis Angle and Macular Thickness Vertical Asymmetry Across The Temporal Raphe. J Glaucoma 2019; 27:993-998. [PMID: 30180019 DOI: 10.1097/ijg.0000000000001077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To test the hypothesis that the fovea-Bruch's membrane opening (FoBMO) axis angle influences the thickness symmetry of the macular ganglion cell/inner plexiform layer (GCIPL) across the temporal horizontal meridian in normal subjects. DESIGN Cross-sectional diagnostic study at a tertiary academic center. METHODS One hundred sixteen eyes of 60 normal subjects aged 40 to 85 years underwent spectral domain optical coherence tomography(SD-OCT) imaging. The FoBMO angle was estimated on en face infrared SD-OCT images. Posterior Pole algorithm images acquired with Spectralis SD-OCT were used to define vertical asymmetry as follows. The average thickness difference between the 3 most temporal superpixels above and below the horizontal meridian, the second row of superpixels from the horizontal meridian, and 3 central superpixels above and below the horizontal meridian were calculated. Factors influencing GCIPL thickness asymmetry were explored and changes in thickness asymmetry as a function of FoBMO angle were investigated. RESULTS No demographic or clinical factors affected temporal GCIPL asymmetry (P>0.05 for all). A more (negatively) tilted FoBMO angle was associated with relatively thinner inferior compared with superior GCIPL thickness in superpixels immediately adjacent to the temporal raphe (P<0.001). The second row of temporal superpixels from the horizontal meridian (P=0.349) or central superpixels (P=0.292) did not show this tendency. CONCLUSIONS Vertical GCIPL symmetry across the horizontal meridian is influenced by the FoBMO angle. SD-OCT algorithms using vertical asymmetry as a diagnostic index should be adjusted for the FoBMO angle.
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Enhanced Grid-Based Visual Analysis of Retinal Layer Thickness with Optical Coherence Tomography. INFORMATION 2019. [DOI: 10.3390/info10090266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Optical coherence tomography enables high-resolution 3D imaging of retinal layers in the human eye. The thickness of the layers is commonly assessed to understand a variety of retinal and systemic disorders. Yet, the thickness data are complex and currently need to be considerably reduced prior to further processing and analysis. This leads to a loss of information on localized variations in thickness, which is important for early detection of certain retinal diseases. We propose an enhanced grid-based reduction and exploration of retinal thickness data. Alternative grids are computed, their representation quality is rated, and best fitting grids for given thickness data are suggested. Selected grids are then visualized, adapted, and compared at different levels of granularity. A visual analysis tool bundles all computational, visual, and interactive means in a flexible user interface. We demonstrate the utility of our tool in a complementary analysis procedure, which eases the evaluation of ophthalmic study data. Ophthalmologists successfully applied our solution to study localized variations in thickness of retinal layers in patients with diabetes mellitus.
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Zha Y, Huang W, Zhuang J, Cai J. Posterior pole asymmetry analysis and retinal nerve fibre layer thickness measurements in primary angle-closure suspect patients. BMC Ophthalmol 2019; 19:36. [PMID: 30691419 PMCID: PMC6350334 DOI: 10.1186/s12886-019-1034-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/08/2019] [Indexed: 11/15/2022] Open
Abstract
Purpose To measure peripapillary retinal nerve fiber layer (RNFL) thickness and posterior pole retinal thickness in primary angle-closure suspects (PACS) by Spectral domain optical coherence tomography (SD-OCT) and to be compared with normal subjects. Methods Thirty five primary angle-closure suspect patients and thirty normal subjects were enrolled in this study. Peripapillary RNFL and posterior pole retinal thickness by posterior pole asymmetry analysis (PPAA) in SD-OCT were measured. Results No significant difference was found in both groups on age, sex distribution, refractive error, intraocular pressure (IOP) and axial length. The PACS group exhibited significantly thinner macular retinal thickness and larger asymmetry on posterior pole region compared with the control group. Yet no significant difference of peripapillary RNFL parameters was found between PACS group and normal control group. A negative correlation was observed between the total retinal thickness on posterior pole region and age when all the PACS participants were analyzed. Conclusions Posterior pole retinal thickness measurements obtained by Heidelberg Spectralis SD-OCT using PPAA showed significant thinner change in PACS group than healthy controls. Only age seemed to be an indicator in the occurrence of glaucomatous damage in PACS patients.
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Affiliation(s)
- Yi Zha
- Department of Ophthalmology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Wei Huang
- Department of Ophthalmology, The first People's Hospital of Shaoyang, Shaoyang, 422000, Hunan, China
| | - Jinfei Zhuang
- Department of Ophthalmology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
| | - Jianqiu Cai
- Department of Ophthalmology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.
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Chen MJ, Yang HY, Chang YF, Hsu CC, Ko YC, Liu CJL. Diagnostic ability of macular ganglion cell asymmetry in Preperimetric Glaucoma. BMC Ophthalmol 2019; 19:12. [PMID: 30621639 PMCID: PMC6325869 DOI: 10.1186/s12886-018-1019-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background To evaluate the diagnostic ability of macular ganglion cell asymmetry to diagnose preperimetric glaucoma (PPG), using Cirrus spectral domain optical coherence tomography (OCT). Methods This prospective study included 67 eyes of 67 patients with PPG and 67 eyes of 67 age- and refractive error-matched controls. We measured circumpapillary RNFL (cpRNFL) thickness, macular ganglion cell-inner plexiform layer (GCIPL) thickness and optic nerve head (ONH) parameters using OCT. Macular ganglion cell asymmetries were expressed as absolute difference and ratios between inferior hemisphere and superior hemisphere, inferotemporal (IT) and superotemporal (ST), IT and superonasal (SN), IT and inferonasal (IN), ST and IN as well as temporal and nasal. An asymmetry index was assigned by taking the absolute value of log10 of the ratio. The area under the receiver operating characteristics curve (AUROC), partial AUROC (pAUROC) ≥ specificities 90 and 95%, cutoff values and sensitivities at specificities 90 and 95% was analyzed. Results Parameters with largest AUROCs were IT GCIPL thickness (0.784), average RNFL thickness (0.767), and average C/D (0.746). For macular asymmetry parameters, log IT/SN index had the largest AUROC (0.734), followed by log IT/IN index (0.725), and absolute difference of IT−SN GCIPL thickness (0.715). Performance was comparable between the best measures of asymmetry analysis (log IT/SN index) and those of cpRNFL, GCIPL, and ONH parameters (all P > 0.05). The IT/SN asymmetry index not only had the largest pAUROC based on the pAUROCs ≥90 and 95% specificity (0.044 and 0.019) but also had the highest diagnostic sensitivity at 90 and 95% specificities (52.2 and 46.3%). Conclusions GCIPL asymmetry measurements have diagnostic ability comparable to cpRNFL, GCIPL, and ONH analysis for PPG. The best macular ganglion cell asymmetry parameter was IT/SN asymmetry index, which could be a new parameter to detect early structural changes in PPG. Electronic supplementary material The online version of this article (10.1186/s12886-018-1019-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Yu Yang
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Yu-Fan Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Lee J, Kim YK, Ha A, Kim YW, Baek SU, Kim JS, Lee HJ, Kim DW, Jeoung JW, Kim SJ, Park KH. Temporal Raphe Sign for Discrimination of Glaucoma from Optic Neuropathy in Eyes with Macular Ganglion Cell-Inner Plexiform Layer Thinning. Ophthalmology 2018; 126:1131-1139. [PMID: 30576683 DOI: 10.1016/j.ophtha.2018.12.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/20/2018] [Accepted: 12/12/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the potential of the temporal raphe sign on the macular ganglion cell-inner plexiform layer (mGCIPL) thickness map for discriminating glaucomatous from nonglaucomatous optic neuropathy (NGON) in eyes with mGCIPL thinning. DESIGN Cross-sectional study. PARTICIPANTS A total of 175 eyes of 175 patients with mGCIPL thinning on Cirrus (Carl Zeiss Meditec, Dublin, CA) high-definition OCT were retrospectively included. Glaucoma specialists and neuro-ophthalmology specialists evaluated the patients' medical records for diagnosis of glaucomatous optic neuropathy (GON) or NGON. Finally, by consensus, 67 eyes with GON and 73 eyes with NGON were enrolled. METHODS A positive temporal raphe sign was declared in patients in whom there was a straight line longer than one-half of the length between the inner and outer annulus in the temporal elliptical area of the mGCIPL thickness map. Decision tree analysis was performed to formulate a diagnostic model. MAIN OUTCOME MEASURES Area under receiver operating characteristic curve (AUC) with sensitivity and specificity. RESULTS The temporal raphe sign was observed in 61 of 67 GON eyes (91.0%), but in only 21 of 73 NGON eyes (28.8%) (P < 0.001; chi-square test). On this basis, the diagnostic ability of the temporal raphe sign for discriminating GON from NGON was judged to be good (AUC, 0.811; 95% confidence interval, 0.749-0.874; sensitivity, 91.0%; specificity, 71.2%). The diagnostic performance of the decision tree-based model (AUC 0.879; 95% confidence interval, 0.824-0.933; sensitivity, 88.1%; specificity, 87.7%) was better than that of the temporal raphe sign or the relative afferent pupillary defect (RAPD) alone (P = 0.005, P < 0.001, respectively; DeLong's test). The decision tree model revealed the following: (1) If the temporal raphe sign is positive and the RAPD is absent, the case should be diagnosed as GON; (2) if the temporal raphe sign is absent regardless of the presence or absence of the RAPD, or both the temporal raphe sign and the RAPD are present, the case should be diagnosed as NGON. CONCLUSIONS In clinical practice, determining whether the temporal raphe sign appears on OCT macular scans can be a useful tool for discrimination of glaucomatous from nonglaucomatous mGCIPL thinning.
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Affiliation(s)
- Jinho Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Glaucoma, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Glaucoma, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Glaucoma, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Yong Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Glaucoma, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Sung Uk Baek
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Glaucoma, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Jin-Soo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Glaucoma, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Haeng Jin Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Neuro-Ophthalmology, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Dai Woo Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea; Division of Glaucoma, Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Glaucoma, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Neuro-Ophthalmology, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Division of Glaucoma, Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
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Abstract
SIGNIFICANCE Measurements of the macula have been increasingly used to diagnose and manage patients with glaucoma. Asymmetry analysis was clinically introduced to assess damage to the macular ganglion cells in patients with glaucoma, but its effectiveness is limited by high normal between-subject variability. PURPOSE We aimed to reduce the high normal between-subject variability and improve the potential of asymmetry analysis to identify glaucomatous damage to the macula. METHODS Twenty patients with glaucoma (aged 57 to 85 years) and 30 age-similar control subjects (aged 53 to 89 years) were recruited from a longitudinal glaucoma study. Participants were imaged with the Spectralis OCT using the posterior pole protocol; measurements of the averaged retinal thickness and ganglion cell layer (GCL) thickness were obtained. We established three zones per hemifield within the central ±9°, based on the lowest between-subject variability that we previously found and the course of retinal nerve fiber layer projections. The criteria for flagging abnormality were at least two contiguous zones when P < 5% or one zone when P < 1% with two-tailed tests. RESULTS Between-subject variability of the asymmetry analysis for both retinal and GCL thicknesses remained lower than that of the average thickness across each zone in control subjects (F > 2.52, P < .01). Asymmetry analysis of retinal and GCL thicknesses flagged 16 and 18 of 20 patients, respectively. CONCLUSIONS Between-subject variability was reduced in control subjects using the three zones; our criteria identified glaucomatous damage to the macula in most of the patients. We used high-density B-scans to confirm the patterns of the glaucomatous damage we found in this study.
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Yang HY, Chang YF, Hsu CC, Ko YC, Liu CJL, Chen MJ. Macular ganglion cell asymmetry for detecting paracentral scotoma in early glaucoma. Clin Ophthalmol 2018; 12:2253-2260. [PMID: 30464386 PMCID: PMC6223398 DOI: 10.2147/opth.s181551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We evaluated macular ganglion cell asymmetry as a tool for diagnosing paracentral scotoma (PCS) in early glaucoma. Patients and methods This prospective study compared 58 patients with early glaucoma and PCS to 58 age-matched control individuals. All glaucomatous eyes had scotoma within the central 12 degrees of fixation and confined to one hemifield. We measured circumpapillary retinal nerve fiber layer (cpRNFL) thickness, macular ganglion cell-inner plexiform layer (GCIPL) thickness, and optic nerve head (ONH) parameters with Cirrus spectral domain optical coherence tomography. Macular ganglion cell asymmetry was expressed as the absolute differences and the ratios between the inferior and superior hemispheres, inferotemporal (IT) and superotemporal (ST) areas, IT and superonasal (SN) areas, IT and inferonasal (IN) areas, and ST and IN areas. The asymmetry index was the absolute log10 of the ratio. The area under the receiver operating characteristics curve (AUROC) and partial AUROC (pAUROC, specificities ≥90%) were analyzed for each parameter. Results All GCIPL parameters and most cpRNFL parameters were significantly lower in early glaucoma than in controls. The best discriminating parameters were inferior RNFL thickness, average RNFL thickness, and minimum GCIPL thickness. The macular ganglion cell asymmetry parameters with the largest AUROCs were the log IT/ST index, the absolute difference in IT−ST GCIPL thicknesses, and the log IT/SN index. Performance was comparable between the log IT/ST index and the cpRNFL (inferior RNFL thickness, P=0.129), GCIPL (minimum GCIPL thickness, P=0.358), and ONH parameters (vertical cup-to-disc ratio, P=0.475). Conclusion The IT/ST asymmetry index may be useful as a new parameter for detecting structural changes in glaucoma patients with PCS.
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Affiliation(s)
- Hsin-Yu Yang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan,
| | - Yu-Fan Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, .,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan,
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, .,School of Medicine, National Yang-Ming University, Taipei, Taiwan,
| | - Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, .,School of Medicine, National Yang-Ming University, Taipei, Taiwan,
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Chen TC, Hoguet A, Junk AK, Nouri-Mahdavi K, Radhakrishnan S, Takusagawa HL, Chen PP. Spectral-Domain OCT: Helping the Clinician Diagnose Glaucoma. Ophthalmology 2018; 125:1817-1827. [DOI: 10.1016/j.ophtha.2018.05.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 10/28/2022] Open
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Deng J, He X, Zhang B, Xiong S, Zhu J, Wang L, Wang M, Xu X. Increased Vertical Asymmetry of Macular Retinal Layers in Myopic Chinese Children. Curr Eye Res 2018; 44:225-235. [PMID: 30335521 DOI: 10.1080/02713683.2018.1530360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Junjie Deng
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangui He
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Bo Zhang
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Shuyu Xiong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Ling Wang
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China
| | - Mingjin Wang
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Xun Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Altan C, Arman BH, Arici M, Urdem U, Solmaz B, Pasaoglu I, Basarir B, Onmez F, Taskapili M. Normative posterior pole asymmetry analysis data in healthy Caucasian population. Eur J Ophthalmol 2018; 29:386-393. [PMID: 30178682 DOI: 10.1177/1120672118795062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study is to evaluate the variability of central retinal thickness asymmetry in healthy Caucasian adults with the posterior pole asymmetry analysis to serve as a reference. METHODS In total, 404 eyes of 202 subjects who aged between 18 and 80 years, who had no ocular pathology, were included in this cross-sectional observational study. Retinal thickness maps with posterior pole asymmetry analysis mode were taken with the optical coherence tomography (SPECTRALIS SD-OCT; Heidelberg Engineering). Superior and inferior hemifields were divided into five zones resembling to the strategy in Glaucoma Hemifield Test. Mean retinal thickness in each of the five zones was compared with the thickness of the corresponding zone in each eye (paired-samples t-test), and differences in retinal thickness (DRT1-5) and ganglion cell layer thickness between reciprocal locations were measured. Differences in retinal thickness values of two eyes of each subject were also compared (independent-samples t-test). RESULTS The intra-eye asymmetry was statistically significant in zones 4 and 5. The highest mean intraocular differences in retinal thickness were 5.8 µm (zone 5) in all eyes, 5.8 µm (zone 5) in the right eyes, and 5.9 µm (zones 4 and 5) in the left eyes. The only statistically significant interocular local differences in retinal thickness asymmetries were found in zone 3. The intraocular asymmetry in retinal thickness was found to be the lowest in zone 1. The differences of ganglion cell layer thickness (GCLTs) were not statistically significant. CONCLUSION There were statistically significant physiological inter-eye asymmetry in zone 3 and intra-eye asymmetries in zones 4 and 5. These measurements must be considered during screening for glaucoma with posterior pole asymmetry analysis in the Caucasian population.
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Affiliation(s)
- Cigdem Altan
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Berkay Hasan Arman
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Murat Arici
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Urdem
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Banu Solmaz
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Isil Pasaoglu
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Berna Basarir
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Funda Onmez
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Muhittin Taskapili
- University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Lin PW, Chang HW, Lai IC, Tsai JC, Poon YC. Intraocular retinal thickness asymmetry in early stage of primary open angle glaucoma and normal tension glaucoma. Int J Ophthalmol 2018; 11:1342-1351. [PMID: 30140639 DOI: 10.18240/ijo.2018.08.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/05/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the intraocular retinal thickness asymmetry of peripapillary retinal nerve fiber layer (pRNFL) and macular layers measured by spectral-domain optical coherence tomography (SD-OCT) in patients with early stage of primary open angle glaucoma (POAG) and normal tension glaucoma (NTG). METHODS A total of 117 patients with early stage of glaucoma (54 patients with POAG and 63 patients with NTG) and 32 normal subjects were recruited for the study. The pRNFL thickness, total macular layer (TML) thickness, and isolated inner macular layer (IML) thickness were measured by SD-OCT. Hemisphere TML thickness asymmetry measured by the posterior pole asymmetry scan was evaluated. Thickness differences of pRNFL and IML between superior and inferior quadrants were calculated. Asymmetry indices (AIs) of the pRNFL, TML and isolated IML were also computed. Areas under the receiver-operating characteristic curves (AROCs) were generated to determine the diagnostic capabilities of different parameters. RESULTS Intraocular pRNFL thickness differences and AIs between the superior and inferior quadrants were significantly different between normal and NTG groups (P=0.009 and P<0.001, respectively). Intraocular pRNFL thickness differences and AIs between the temporal-superior and temporal-inferior sectors were also significantly different between normal and NTG groups (P=0.035 and P<0.001, respectively). The thickness differences and AIs of TML between superior and inferior hemispheres were significantly different between normal and NTG groups (P=0.001 and P=0.001, respectively) and between normal and POAG groups (P=0.032 and P=0.020, respectively). The thickness differences and AIs of macular ganglion cell layer (mGCL) between superior and inferior quadrants were significantly different between normal and NTG groups (P=0.013 and P=0.004, respectively), and between NTG and POAG groups (P=0.015 and P=0.012, respectively). The thickness difference of TML between superior and inferior hemispheres showed the highest diagnostic capability for early NTG eyes (AROC=0.832). CONCLUSION Intraocular retinal thickness asymmetry in pRNFL, TML and mGCL are found in early stage of NTG. Hemisphere TML thickness asymmetry is also found in POAG eyes. Asymmetry analysis of retinal thickness can be an adjunctive modality for early detection of glaucoma.
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Affiliation(s)
- Pei-Wen Lin
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Hsueh-Wen Chang
- Department of Biological Sciences, Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Ing-Chou Lai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Jen-Chia Tsai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Yi-Chieh Poon
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
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García-Medina JJ, Del-Rio-Vellosillo M, Palazón-Cabanes A, Tudela-Molino M, Gómez-Molina C, Guardiola-Fernández A, Villegas-Pérez MP. Mapping the thickness changes on retinal layers segmented by spectral-domain optical coherence tomography using the posterior pole program in glaucoma. ACTA ACUST UNITED AC 2018; 93:263-273. [PMID: 29555383 DOI: 10.1016/j.oftal.2018.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate changes in retinal layers of the macula (mRLs) using OCT posterior pole program (PPP) in primary open-angle glaucoma (POAG). MATERIAL AND METHODS The study included 128 patients with POAG and 103 healthy controls who had PPP maps (macular grid 8×8) drawn by SD-OCT. Only one eye per patient was studied. The 9 mRLs were automatically segmented by prototype software, obtaining: a macular retinal nerve fibre layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform+nuclear layer, photoreceptor layer, retinal pigment epithelium (RPE), outer retina and RPE+outer retina. Thickness values were obtained on 64 cells of the grid for each mRL, and mean thickness of superior and inferior hemispheres were calculated. Comparisons of mean thickness of these hemispheres and thickness of each cell between groups were determined. Differences in the cell by cell comparisons were represented quantitatively by heat maps for each mRL. RESULTS Photoreceptors and RPE were found in POAG group when comparing thickness of hemispheres, thinning of mRNFL, GCL, IPL, and thickening of INL. Heat maps showed symmetrical thinning patters between superior and inferior hemispheres in inner retinal layers (except for INL) and asymmetrical thickening patters in outer retinal layers in GPAA group. CONCLUSIONS There are thickness changes in all mRLs in POAG, when studied by PPP. Thinning of inner layers (except for INL), and thickening of outer layers in POAG show different symmetry patterns in relation to horizontal meridian.
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Affiliation(s)
- J J García-Medina
- Departamento de Oftalmología, Hospital General Universitario Reina Sofía, Murcia, España; Departamento de Oftalmología, Hospital General Universitario Morales Meseguer, Murcia, España; Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Murcia, España; Red Temática de Patología Ocular OFTARED, Instituto de Salud Carlos III, Madrid, España; Instituto Murciano de Investigación Biosanitaria, Hospital Virgen de la Arrixaca (IMIB-Virgen de la Arrixaca), Murcia, España; Unidad de Investigación Oftalmológica Santiago Grisolía, Valencia, España.
| | - M Del-Rio-Vellosillo
- Departamento de Anestesiología, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - A Palazón-Cabanes
- Departamento de Oftalmología, Hospital General Universitario Reina Sofía, Murcia, España
| | - M Tudela-Molino
- Departamento de Oftalmología, Hospital General Universitario Reina Sofía, Murcia, España
| | - C Gómez-Molina
- Departamento de Oftalmología, Hospital General Universitario Reina Sofía, Murcia, España
| | - A Guardiola-Fernández
- Departamento de Oftalmología, Hospital General Universitario Reina Sofía, Murcia, España
| | - M P Villegas-Pérez
- Departamento de Oftalmología, Hospital General Universitario Reina Sofía, Murcia, España; Departamento de Oftalmología, Optometría, Otorrinolaringología y Anatomía Patológica, Facultad de Medicina, Universidad de Murcia, Murcia, España; Red Temática de Patología Ocular OFTARED, Instituto de Salud Carlos III, Madrid, España; Instituto Murciano de Investigación Biosanitaria, Hospital Virgen de la Arrixaca (IMIB-Virgen de la Arrixaca), Murcia, España
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Lavinsky F, Benfica CZ, Castoldi N, Cruz do Carmo Chaves AE, Mello PADA. Measurement of the hypotenuse of the vertical optic nerve head cup with spectral-domain optical coherence tomography for the structural diagnosis of glaucoma. Clin Ophthalmol 2018; 12:215-225. [PMID: 29416313 PMCID: PMC5789042 DOI: 10.2147/opth.s152772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the hypotenuse of the vertical optic nerve head cup (HVOC), measured using the length and depth of the cup obtained with enhanced depth imaging spectral-domain optic coherence tomography (SD-OCT), as a biomarker for glaucoma diagnosis. Methods This was a prospective cross-sectional study of patients with glaucoma and controls. SD-OCT was performed in all participants to assess average circumpapillary retinal nerve fiber layer (RNFL) thickness. A vertical B-scan of the optic nerve head (ONH) was obtained for HVOC measurement. The length and depth of the optic nerve cup formed the sides of a right triangle that were used to calculate the HVOC. Participants also underwent standard automated perimetry. Results One hundred and fifty-six eyes were divided into three groups: mean deviation (MD) <−7 dB (60 eyes); MD ≥−7 dB (74 eyes); and healthy subjects (22 eyes). The mean (SD) HVOC in these groups was 1,419.8 (347.2) µm, 1,234.6 (258.8) µm, and 685.79 (315.4) µm (P<0.01), respectively. In the secondary structure–function analysis, only discs with a vertical diameter of 1.51–2.00 mm were included (120 eyes). The HVOCs were divided into four percentile groups, with the following means: 940, 1,128, 1,390, and 1,662 µm. There was a significant difference in MD between percentile groups 1 and 3 (P<0.03), 1 and 4 (P<0.001), 2 and 3 (P<0.02), and 2 and 4 (P<0.001). RNFL thickness differed among all percentile groups (P<0.001). Conclusion HVOC may provide an additional morphometric biomarker for the structural evaluation of ONH remodeling in glaucoma.
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Affiliation(s)
- Fabio Lavinsky
- Department of Ophthalmology, Paulista School of Medicine, São Paulo Hospital, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Department of Ophthalmology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Camila Zanella Benfica
- Department of Ophthalmology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Nédio Castoldi
- Department of Ophthalmology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Paulo Augusto de Arruda Mello
- Department of Ophthalmology, Paulista School of Medicine, São Paulo Hospital, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Peripapillary and Macular Vessel Density in Patients with Primary Open-Angle Glaucoma and Unilateral Visual Field Loss. Ophthalmology 2017; 125:578-587. [PMID: 29174012 DOI: 10.1016/j.ophtha.2017.10.029] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/06/2017] [Accepted: 10/23/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To characterize OCT angiography (OCT-A) vessel density of patients with primary open-angle glaucoma (POAG) with unilateral visual field (VF) loss. DESIGN Cross-sectional study. PARTICIPANTS A total of 33 patients with POAG with a VF defect in 1 eye (mean VF mean deviation [MD], -3.9±3.1 decibels [dB]) and normal VF in the other eye (mean VF MD, -0.2±0.9 dB) and 33 healthy eyes. METHODS All subjects underwent OCT-A imaging, spectral-domain (SD)-OCT imaging, and VF testing. OCT-A retinal vascular measurements were summarized as whole image vessel density (wiVD), circumpapillary vessel density (cpVD), and parafoveal vessel density (pfVD). Inter-eye differences in vascular measures, as well as SD OCT retinal nerve fiber layer (RNFL), macular ganglion cell complex (mGCC) thickness, and rim area measurements in glaucoma and healthy eyes were compared. Areas under the receiver operating characteristic curves (AUROCs) were used to evaluate diagnostic accuracy for differentiating between unaffected eyes of patients with POAG and healthy eyes. MAIN OUTCOME MEASURES Difference in OCT-A vessel density and SD OCT structural parameters between unaffected eyes of patients with POAG with the fellow affected eyes and healthy controls. RESULTS Mean wiVD in unaffected eyes of patients with POAG (52.0%) was higher than in their fellow affected eyes (48.8%) but lower than in healthy eyes (55.9%; P < 0.001). Mean circumpapillary RNFL (cpRNFL) thickness, mGCC thickness, and rim area measurement in unaffected eyes of patients with POAG (87.5 μm, 87.7 μm, and 1.0 mm2) were also higher than those measurements in their fellow eyes (76.5 μm, 79.5 μm, and 0.8 mm2; P < 0.001) and lower than in healthy eyes (98.0 μm, 94.5 μm, and 1.4 mm2; P < 0.001). The AUROCs for differentiating unaffected eyes of patients with POAG from healthy eyes were highest for wiVD (0.84), followed by mGCC (0.78), cpRNFL (0.77), and pfVD (0.69). CONCLUSIONS OCT-A measures detect changes in retinal microvasculature before VF damage is detectable in patients with POAG, and these changes may reflect damage to tissues relevant to the pathophysiology of glaucoma. Longitudinal studies are needed to determine whether OCT-A measures can improve the detection or prediction of the onset and progression of glaucoma.
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Sharifipour F, Morales E, Lee JW, Giaconi J, Afifi AA, Yu F, Caprioli J, Nouri-Mahdavi K. Vertical Macular Asymmetry Measures Derived From SD-OCT for Detection of Early Glaucoma. Invest Ophthalmol Vis Sci 2017; 58:4310–4317. [PMID: 28800651 PMCID: PMC5555252 DOI: 10.1167/iovs.17-21961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To test the hypothesis that vertical asymmetry in macular ganglion cell/inner plexiform layer (GCIPL) thickness can improve detection of early glaucoma. Methods Sixty-nine normal eyes and 101 glaucoma eyes had macular imaging with spectral-domain optical coherence tomography (OCT; 200 × 200 cube). The resulting GCIPL thickness matrix was grouped into a 20 × 20 superpixel array and superior superpixels were compared to their inferior counterparts. A global asymmetry index (AI) was defined as the grand mean of the asymmetry ratios. To measure local asymmetry, the corresponding thickness measurements of three rows above and below the horizontal raphe were compared individually and in combinations. Global and local AIs were compared to the best-performing GCIPL thickness parameters with area under the receiver operating curves (AUC) and sensitivity/specificities. Results Age or axial length did not influence AIs in normal subjects (P ≥ 0.08). Global and local AIs were significantly higher in the glaucoma group compared to normal eyes. Minimum (AUC = 0.962, 95% confidence interval [CI]: 0.936-0.989) and inferotemporal thickness (AUC = 0.944, 95% CI: 0.910-0.977; P = 0.122) performed best for detection of early glaucoma. The AUC for global AI was 0.851 (95% CI: 0.792-0.909) compared to 0.916 (95% CI: 0.874-0.958) for the best local AI. Combining minimum or inferotemporal GCIPL thickness and the best local AI led to higher partial AUCs (0.088 and 0.085, 90% specificity, P = 0.120 and 0.130, respectively) than GCIPL thickness measures. Conclusions Macular vertical thickness asymmetry measures did not perform better than sectoral or minimum GCIPL thickness for detection of early glaucoma. Combining local asymmetry parameters with the best sectoral GCIPL thickness measures enhanced this task.
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Affiliation(s)
- Farideh Sharifipour
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, California, United States.,Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Esteban Morales
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, California, United States
| | - Ji Woong Lee
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, California, United States.,Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
| | - JoAnn Giaconi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, California, United States
| | - Abdelmonem A Afifi
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
| | - Fei Yu
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, California, United States.,Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, California, United States
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, California, United States
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Tanabe F, Matsumoto C, McKendrick AM, Okuyama S, Hashimoto S, Shimomura Y. The interpretation of results of 10-2 visual fields should consider individual variability in the position of the optic disc and temporal raphe. Br J Ophthalmol 2017; 102:323-328. [DOI: 10.1136/bjophthalmol-2016-309669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 04/27/2017] [Accepted: 05/27/2017] [Indexed: 11/04/2022]
Abstract
AimsTo clarify the anatomical relation between the optic disc and temporal raphe and to examine how these are related to test points in the 10-2 visual field test pattern.Subjects and methodsFor 22 eyes of volunteers with normal vision (+0.75 D spherical equivalent 7.88 D), a volume scan was used to obtain en-face images from a plane fitted to the inner limiting membrane using optical coherence tomography (OCT). The clearest en-face retinal nerve fibre (RNF) image was chosen for each subject and superimposed on fundus photographs using blood vessels for alignment. Individual landmarks (disc, fovea and visual field blind spot) were then used to superimpose the Humphrey Field Analyzer 10-2 visual field on the OCT image to compare with the RNF image.ResultsThe average disc–fovea–raphe angle was 169.4°±3.2°. Both the disc and temporal raphe were located above the horizontal midline (ie, were inferior in visual field space). For the 10-2 test pattern superimposed on the OCT image, in 54.5% of eyes, the temporal inferior test points adjacent to the horizontal midline mapped to the anatomical inferior hemifield. In 22.7% of eyes, nasal inferior test points adjacent to the horizontal midline mapped to the anatomical inferior hemifield. This mapping is opposite to typically assumed.ConclusionThe position of the disc and raphe affects the mapping between structure and function with respect to superior and inferior hemifields. Individual differences in the position of the temporal raphe should be considered when mapping between structure and function for the 10-2 test pattern.
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Dong ZM, Wollstein G, Schuman JS. Clinical Utility of Optical Coherence Tomography in Glaucoma. Invest Ophthalmol Vis Sci 2017; 57:OCT556-67. [PMID: 27537415 PMCID: PMC4991023 DOI: 10.1167/iovs.16-19933] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Optical coherence tomography (OCT) has established itself as the dominant imaging modality in the management of glaucoma and retinal diseases, providing high-resolution visualization of ocular microstructures and objective quantification of tissue thickness and change. This article reviews the history of OCT imaging with a specific focus on glaucoma. We examine the clinical utility of OCT with respect to diagnosis and progression monitoring, with additional emphasis on advances in OCT technology that continue to facilitate glaucoma research and inform clinical management strategies.
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Affiliation(s)
- Zachary M Dong
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States
| | - Gadi Wollstein
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States 2Departmen
| | - Joel S Schuman
- University of Pittsburgh Medical Center (UPMC) Eye Center Eye and Ear Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Ophthalmology and Visual Science Research Center, Pittsburgh, Pennsylvania, United States 2Departmen
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Lateral thinking - Interocular symmetry and asymmetry in neurovascular patterning, in health and disease. Prog Retin Eye Res 2017; 59:131-157. [PMID: 28457789 DOI: 10.1016/j.preteyeres.2017.04.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/24/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023]
Abstract
No biological system or structure is likely to be perfectly symmetrical, or have identical right and left forms. This review explores the evidence for eye and visual pathway asymmetry, in health and in disease, and attempts to provide guidance for those studying the structure and function of the visual system, where recognition of symmetry or asymmetry may be essential. The principal question with regards to asymmetry is not 'are the eyes the same?', for some degree of asymmetry is pervasive, but 'when are they importantly different?'. Knowing if right and left eyes are 'importantly different' could have significant consequences for deciding whether right or left eyes are included in an analysis or for examining the association between a phenotype and ocular parameter. The presence of significant asymmetry would also have important implications for the design of normative databases of retinal and optic nerve metrics. In this review, we highlight not only the universal presence of asymmetry, but provide evidence that some elements of the visual system are inherently more asymmetric than others, pointing to the need for improved normative data to explain sources of asymmetry and their impact on determining associations with genetic, environmental or health-related factors and ultimately in clinical practice.
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Normal-Tension Glaucoma Masqueraders: Detection Using Optical Coherence Tomography. J Glaucoma 2017; 26:e153-e156. [DOI: 10.1097/ijg.0000000000000578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dave P, Shah J. Diagnostic accuracy of posterior pole asymmetry analysis parameters of spectralis optical coherence tomography in detecting early unilateral glaucoma. Indian J Ophthalmol 2016; 63:837-42. [PMID: 26669335 PMCID: PMC4730695 DOI: 10.4103/0301-4738.171965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To report the diagnostic ability of posterior pole asymmetry analysis (PPAA) parameters of spectralis optical coherence tomography (OCT) in detecting early unilateral glaucoma. Methods: A prospective, cross-sectional study which included 80 eyes of 80 normal subjects and 76 eyes of 76 patients with unilateral early primary open-angle glaucoma by Hodapp-Anderson-Parrish classification. All subjects were of age more than 18 years, best-corrected visual acuity 20/40 or better, and a refractive error within ± 5 diopter (D) sphere and ± 3 D cylinder. Control subjects had a normal ocular examination, intraocular pressure (IOP) <22 mmHg, no past history of high IOP, no family history of glaucoma, normal optic disc morphology, and visual field in both eyes. One eye of the control subject was randomly included. All eyes underwent OCT for retinal nerve fiber layer (RNFL) analysis and PPAA. The number of continuous black squares was noted in the asymmetry analysis (right-left + hemisphere asymmetry). The area under curve (AUC) was calculated for all OCT parameters. Results: The best value for AUC for RNFL analysis was 0.858 for the inferotemporal quadrant thickness. This was similar to the best value for AUC for PPAA which was 0.833 for the inferior macular thickness parameter (P = 0.5). The AUC for the right-left and the hemisphere asymmetry part of PPAA was 0.427 and 0.499, respectively. Conclusion: The macular thickness PPAA parameters were equally good as the RNFL parameters. However, the asymmetry analysis parameters performed poorly and need further refinement before its use in early unilateral glaucoma diagnosis.
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Affiliation(s)
- Paaraj Dave
- Department of Glaucoma, Dr. T V Patel Eye Institute; Dave Eye Clinic, Vadodara, Gujarat, India
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Lee SY, Lee EK, Park KH, Kim DM, Jeoung JW. Asymmetry Analysis of Macular Inner Retinal Layers for Glaucoma Diagnosis: Swept-Source Optical Coherence Tomography Study. PLoS One 2016; 11:e0164866. [PMID: 27764166 PMCID: PMC5072638 DOI: 10.1371/journal.pone.0164866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report an asymmetry analysis of macular inner retinal layers using swept-source optical coherence tomography (OCT) and to evaluate the utility for glaucoma diagnosis. DESIGN Observational, cross-sectional study. PARTICIPANTS Seventy normal healthy subjects and 62 glaucoma patients. METHODS Three-dimensional scans were acquired from 70 normal subjects and 62 open angle glaucoma patients by swept-source OCT. The thickness of the retinal nerve fiber layer, ganglion cell-inner plexiform layer (GCIPL), ganglion cell complex, and total retina were calculated within a 6.2×6.2 mm macular area divided into a 31×31 grid of 200×200 μm superpixels. For each of the corresponding superpixels, the thickness differences between the subject eyes and contra-lateral eyes and between the upper and lower macula halves of the subject eyes were determined. The negative differences were displayed on a gray-scale asymmetry map. Black superpixels were defined as thickness decreases over the cut-off values. RESULTS The negative inter-ocular and inter-hemisphere differences in GCIPL thickness (mean ± standard deviation) were -2.78 ± 0.97 μm and -3.43 ± 0.71 μm in the normal group and -4.26 ± 2.23 μm and -4.88 ± 1.46 μm in the glaucoma group. The overall extent of the four layers' thickness decrease was larger in the glaucoma group than in the normal group (all Ps<0.05). The numbers of black superpixels on all of the asymmetry maps were larger in the glaucoma group than in the normal group (all Ps<0.05). The area under receiver operating characteristic curves of average negative thickness differences in macular inner layers for glaucoma diagnosis ranged from 0.748 to 0.894. CONCLUSIONS The asymmetry analysis of macular inner retinal layers showed significant differences between the normal and glaucoma groups. The diagnostic performance of the asymmetry analysis was comparable to that of previous methods. These findings suggest that the asymmetry analysis can be a potential ancillary diagnostic tool.
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Affiliation(s)
- Sang-Yoon Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Jeju National University Hospital, Jeju-si, South Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Dong Myung Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
- * E-mail:
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Shoughy SS, Kozak I. Selective and complementary use of Optical Coherence Tomography and Fluorescein Angiography in retinal practice. EYE AND VISION 2016; 3:26. [PMID: 27833927 PMCID: PMC5066300 DOI: 10.1186/s40662-016-0058-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/27/2016] [Indexed: 01/15/2023]
Abstract
The current field of posterior pole and retinal imaging of the human eye has expanded into detailed analyses of the macula, retinal periphery, individual retinal layers, vitreoretinal interface, imaging of the choroid and the optic nerve head. The challenge in retinal imaging is the enduring pursuit of deeper penetration into tissues, increased resolution to the cellular level, and interpretation of observations. How much deeper can we go and with what resolution and reproducibility? These are fundamental questions for experts in search of novel imaging modalities. New discoveries may resolve existing controversies, but inevitably stimulate new questions. Emerging technologies in retinal imaging include adaptive optics retinal imaging and optical coherence tomography-based retinal angiography. In this review, the focus of our discussion will be the discrepancy between the findings (interpretation) of one imaging technology that do not agree or are not even found with a complementary technology. If a clearly seen abnormality is present with one technology but absent in another, what are the possible explanations? Following is a summary of key concepts of retinal and optic nerve imaging modalities and current controversies regarding their interpretation and/or limitations.
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Affiliation(s)
- Samir S Shoughy
- The Eye Center and The Eye Foundation for Research in Ophthalmology, PO Box 55307, Riyadh, 11534 Saudi Arabia
| | - Igor Kozak
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Segmental Analysis of Macular Layers in Patients With Unilateral Primary Open-Angle Glaucoma. J Glaucoma 2016; 25:e401-7. [PMID: 26550975 DOI: 10.1097/ijg.0000000000000336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To measure the thicknesses of the inner layers of the macula in both eyes of patients with unilateral primary open-angle glaucoma (POAG) and compare them with normal control eyes. METHODS This prospective, cross-sectional pilot study enrolled patients with unilateral POAG, who had visual field defect in only 1 eye, and controls with a normal eye examination. Horizontal and vertical B-scan images centered on the fovea were obtained using spectral domain optical coherence. Semiautomatic delineation and segmentation of the inner layers of the retina were performed to evaluate macular retinal nerve fiber layer (mRNFL), ganglion cell complex (GCC) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses. Mean, superior, inferior, nasal, and temporal inner macular layer thicknesses were compared between affected eyes, fellow eyes without visual field defect, and control eyes. RESULTS Nineteen patients with unilateral POAG and 14 normal control eyes were enrolled. In the affected POAG eyes, thinning of the mRNFL, GCC, and GC-IPL layers on horizontal and vertical scans were significant when compared with controls (P<0.05), particularly on vertical scans (P<0.001). The mean regional macular GCC and GC-IPL were most severely thinned in the inferior and temporal perifoveal regions. The unaffected eye of patients with unilateral POAG showed significant thinning of the mRNFL only in the vertical scan when compared with normal controls (P<0.05). CONCLUSIONS Spectral domain optical coherence tomography detected significant thinning of the mRNFL, GCC, and GC-IPL in the affected eyes of patients with unilateral POAG. Fellow eyes showed early structural changes only in the vertical mRNFL scans when compared with normal controls.
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Optical coherence tomography platforms and parameters for glaucoma diagnosis and progression. Curr Opin Ophthalmol 2016; 27:102-10. [PMID: 26569530 DOI: 10.1097/icu.0000000000000231] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Optical coherence tomography (OCT) aids in the diagnosis and long-term monitoring of various ocular diseases, including glaucoma. Initially, the retinal nerve fiber layer was the only OCT structural parameter used in glaucoma. Subsequent research has resulted in more retinal and optic nerve head parameters. In addition, OCT is being investigated for its ability to assess ocular hemodynamics. This review summarizes these spectral domain-optical coherence tomography (SDOCT) parameters in the context of glaucoma. RECENT FINDINGS Several new SDOCT retinal nerve fiber layer, optic nerve head, and macular parameters with good glaucoma diagnostic ability have been added to existing ones recently. The combination of SDOCT and Doppler or angiography has also resulted in hemodynamic parameters that may prove to be useful in the functional assessment in glaucoma. SUMMARY OCT technology is advancing not only as a tool for structural assessment, but also as a multimodality tool to assess both structure and function to enhance our understanding of glaucoma, and ultimately clinical decisions.
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