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Chu Z, Shi Y, Zhou X, Wang L, Zhou H, Laiginhas R, Zhang Q, Cheng Y, Shen M, de Sisternes L, Durbin MK, Feuer W, Gregori G, Rosenfeld PJ, Wang RK. Optical Coherence Tomography Measurements of the Retinal Pigment Epithelium to Bruch Membrane Thickness Around Geographic Atrophy Correlate With Growth. Am J Ophthalmol 2022; 236:249-260. [PMID: 34780802 DOI: 10.1016/j.ajo.2021.10.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/07/2021] [Accepted: 10/30/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The retinal pigment epithelium (RPE) to Bruch membrane (BM) distance around geographic atrophy (GA) was measured using an optical attenuation coefficient (OAC) algorithm to determine whether this measurement could serve as a clinical biomarker to predict the annual square root enlargement rate (ER) of GA. DESIGN A retrospective analysis of a prospective, observational case series. METHODS Eyes with GA secondary to age-related macular degeneration (AMD) were imaged with swept-source OCT (SS-OCT) using a 6 × 6-mm scan pattern. GA lesions were identified and measured using customized en face OCT images, and GA annual square root ERs were calculated. At baseline, the OACs were calculated from OCT datasets to generate customized en face OAC images for GA visualization. RPE-BM distances were measured using OAC data from different subregions around the GA. RESULTS A total of 38 eyes from 27 patients were included in this study. Measured RPE-BM distances were the highest in the region closest to GA. The RPE-BM distances immediately around the GA were significantly correlated with GA annual square root ERs (r = 0.595, P < .001 for a 0- to 300-µm rim around the GA). No correlations were found between RPE-BM distances and previously published choriocapillaris (CC) flow deficits in any subregions. CONCLUSIONS RPE-BM distances from regions around the GA significantly correlate with the annual ERs of GA. These results suggest that an abnormally thickened RPE/BM complex contributes to GA growth and that this effect is independent of CC perfusion deficits.
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Velaga SB, Nittala MG, Hariri A, Sadda SR. Correlation between Fundus Autofluorescence and En Face Optical Coherence Tomography Measurements of Geographic Atrophy. Ophthalmol Retina 2022; 6:676-683. [PMID: 35338026 DOI: 10.1016/j.oret.2022.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the correlation between fundus autofluorescence (FAF) and en face spectral-domain optical coherence tomography (SDOCT) measurements of geographic atrophy (GA) associated with age-related macular degeneration (AMD). DESIGN Retrospective, cross-sectional study. PARTICIPANTS 270 eyes from 172 subjects with GA associated with AMD. METHODS Subjects with atrophic AMD with both fundus autofluorescence (FAF; Heidelberg HRA + Spectralis) and dense volume (128 B-scans over 6x6mm) spectral domain optical coherence tomography (SDOCT; Cirrus OCT) imaging were included in this retrospective analysis. The borders of all areas of definite decreased autofluorescence (DDAF) corresponding to GA were manually outlined on FAF images by certified graders at the Doheny Image Reading Center (DIRC) using validated planimetric grading tools. GA was also delineated automatically from en face OCT (at the level of the choroid) using instrument software (Cirrus v.6.2), and segmentation errors were manually corrected prior to computation of GA area. FAF and SDOCT derived measurements were correlated. MAIN OUTCOME MEASURES Correlation between SD-OCT and FAF measurements of GA area. RESULTS The mean GA area measured from FAF images was 8.1 ± 5.04 mm2, compared with an automated, uncorrected SDOCT GA area of 6.82 ± 3.84 mm2. Despite the presence of apparent OCT segmentation errors, there was a significant correlation between FAF and uncorrected SDOCT measurements (r = 0.80; P < 0.001). Following manual correction of SDOCT GA segmentation errors, the measured GA area increased to 7.29 ± 4.18 mm2, and the correlation with the FAF-determined GA area significantly improved (r = 0.98; P < 0.001). CONCLUSIONS SDOCT-derived measurements of GA correlate well with areas of DDAF obtained from FAF images. Manual correction of SDOCT segmentation errors can further improve this correlation. These observations may support the use of SDOCT-based measurements of GA in clinical research and clinical trials.
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Affiliation(s)
- Swetha Bindu Velaga
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles
| | - Muneeswar G Nittala
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles
| | - Amirhossein Hariri
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles
| | - Srinivas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles
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Pankova N, Baek DSH, Zhao X, Wang H, Reyad MM, Liang H, Joshi R, Boyd SR. Evolving Patterns of Hyperfluorescent Fundus Autofluorescence Accompany Retinal Atrophy in the Rat and Mimic Atrophic Age-Related Macular Degeneration. Transl Vis Sci Technol 2022; 11:3. [PMID: 35254423 PMCID: PMC8914569 DOI: 10.1167/tvst.11.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Complex two-dimensional (2D) patterns of hyperfluorescent short-wave fundus autofluorescence (FAF) at the border of geographic atrophy (GA) can predict its expansion in patients with late non-exudative “dry” AMD. However, preclinical models do not phenocopy this important feature of disease. We sought to describe the spatiotemporal changes in hyperfluorescent FAF patterns that occur following acute oxidative stress, potentially in association with GA expansion. Methods Sprague Dawley rats (n = 54) received systemic sodium iodate (25–45 mg/kg, n = 90 eyes) or saline (n = 18 eyes) and underwent serial full fundus imaging by confocal scanning laser ophthalmoscopy, including blue FAF and delayed near-infrared analysis. Composite images of the fundus were assembled, and the 2D patterns were described qualitatively and quantitatively. A subset of eyes underwent tissue analysis, and four underwent optical coherence tomography (OCT) imaging. Results Reproducibly changing, complex patterns of hyperfluorescent FAF emerge at the borders of toxin-induced damage; however, in the absence of GA expansion, they percolate inward within the region of retinal pigment epithelium loss, evolving, maturing, and senescing in situ over time. Unexpectedly, the late FAF patterns most closely resemble the diffuse tricking form of clinical disease. A five-stage classification system is presented. Conclusions Longitudinal, full-fundus imaging of outer retinal atrophy in the rat eye identifies evolving, complex patterns of hyperfluorescent FAF that phenocopy aspects of disease. Translational Relevance This work provides a novel tool to assess hyperfluorescent FAF in association with progressive retinal atrophy, a therapeutic target in late AMD.
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Affiliation(s)
- Natalie Pankova
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - David Sung Hyeon Baek
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Xu Zhao
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Hai Wang
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Matthew-Mina Reyad
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Huiyuan Liang
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Rahul Joshi
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Shelley Romayne Boyd
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Ganjdanesh A, Zhang J, Chew EY, Ding Y, Huang H, Chen W. LONGL-Net: temporal correlation structure guided deep learning model to predict longitudinal age-related macular degeneration severity. PNAS NEXUS 2022; 1:pgab003. [PMID: 35360552 PMCID: PMC8962776 DOI: 10.1093/pnasnexus/pgab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/15/2021] [Indexed: 01/28/2023]
Abstract
Age-related macular degeneration (AMD) is the principal cause of blindness in developed countries, and its prevalence will increase to 288 million people in 2040. Therefore, automated grading and prediction methods can be highly beneficial for recognizing susceptible subjects to late-AMD and enabling clinicians to start preventive actions for them. Clinically, AMD severity is quantified by Color Fundus Photographs (CFP) of the retina, and many machine-learning-based methods are proposed for grading AMD severity. However, few models were developed to predict the longitudinal progression status, i.e. predicting future late-AMD risk based on the current CFP, which is more clinically interesting. In this paper, we propose a new deep-learning-based classification model (LONGL-Net) that can simultaneously grade the current CFP and predict the longitudinal outcome, i.e. whether the subject will be in late-AMD in the future time-point. We design a new temporal-correlation-structure-guided Generative Adversarial Network model that learns the interrelations of temporal changes in CFPs in consecutive time-points and provides interpretability for the classifier's decisions by forecasting AMD symptoms in the future CFPs. We used about 30,000 CFP images from 4,628 participants in the Age-Related Eye Disease Study. Our classifier showed average 0.905 (95% CI: 0.886-0.922) AUC and 0.762 (95% CI: 0.733-0.792) accuracy on the 3-class classification problem of simultaneously grading current time-point's AMD condition and predicting late AMD progression of subjects in the future time-point. We further validated our model on the UK Biobank dataset, where our model showed average 0.905 accuracy and 0.797 sensitivity in grading 300 CFP images.
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Affiliation(s)
- Alireza Ganjdanesh
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Jipeng Zhang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ying Ding
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Heng Huang
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Wei Chen
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15219, USA
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A common finding in foveal-sparing extensive macular atrophy with pseudodrusen (EMAP) implicates basal laminar deposits. Retina 2022; 42:1319-1329. [DOI: 10.1097/iae.0000000000003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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56
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Sacconi R, Battista M, Borrelli E, Senni C, Tombolini B, Grosso D, Querques L, Bandello F, Querques G. CHOROIDAL VASCULARITY INDEX IS ASSOCIATED WITH GEOGRAPHIC ATROPHY PROGRESSION. Retina 2022; 42:381-387. [PMID: 34561405 DOI: 10.1097/iae.0000000000003305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the correlation between choroidal vascularity index and the enlargement of geographic atrophy (GA) lesion secondary to age-related macular degeneration during the 2-year follow-up. METHODS In this longitudinal observational study, 26 eyes (26 patients, mean age 75.7 ± 8.8 years) affected by GA were included. Choroidal vascularity index was calculated in the subfoveal 3000-µm area. The main outcome measure included correlation analysis between baseline choroidal vascularity index and the rate of GA enlargement. RESULTS During the 2-year follow-up, the mean GA area increased from 6.99 ± 5.28 mm2 to 10.69 ± 6.61 mm2(P < 0.001), accounting for a growth rate of 0.35 ± 0.20 and 0.31 ± 0.17 mm/year after the square root transformation in the first and second year of follow-up, respectively. Stromal choroidal area significantly decreased during the 2-year follow-up (P = 0.002). Interestingly, there was a significant correlation between the baseline choroidal vascularity index and the rate of GA enlargement (r=-0.432, P = 0.027) and between stromal choroidal area and the rate of GA enlargement (r = 0.422, P = 0.032). No other significant relationship was disclosed among choroidal parameters with the rate of GA enlargement. CONCLUSION Choroidal vascularity index impairment is strictly related to the rate of GA enlargement during the 1-year and 2-year follow-up in patients affected by GA. For this reason, choroidal vascularity index could be considered a predictor of GA progression in the clinical setting, and it could be considered as a new potential biomarker in the efficacy evaluation of new GA interventions.
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Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Carlotta Senni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Domenico Grosso
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Lea Querques
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;
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Retinal Progression Biomarkers of Early and Intermediate Age-Related Macular Degeneration. Life (Basel) 2021; 12:life12010036. [PMID: 35054429 PMCID: PMC8779095 DOI: 10.3390/life12010036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/21/2023] Open
Abstract
Early and intermediate AMD patients represent a heterogeneous population with an important but variable risk of progression to more advanced stages of the disease. The five-year progression from early and intermediate AMD to late disease is known to range from 0.4% to 53%. This wide variation explains the particular interest in searching predictive AMD biomarkers. Clinical parameters such as drusen size, presence of pigmentary abnormalities, and fellow eye status were, traditionally, the more important predictive elements. Multimodal retinal assessment (Color Fundus Photography, Optical Coherence Tomography, Optical Coherence Angiography and Fundus Autofluorescence) is providing new and accurate image biomarkers, useful in research and in daily practice. If individual progression risk could be anticipated, then management plans should be adapted accordingly, considering follow-up intervals and therapeutic interventions. Here, we reviewed the most important image progression biomarkers of early and intermediate AMD with relevant interest in clinical practice.
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Lincke JB, Dysli C, Jaggi D, Solberg Y, Wolf S, Zinkernagel MS. LONGITUDINAL FOVEAL FLUORESCENCE LIFETIME CHARACTERISTICS IN GEOGRAPHIC ATROPHY USING FLUORESCENCE LIFETIME IMAGING OPHTHALMOSCOPY. Retina 2021; 41:2391-2398. [PMID: 34282069 DOI: 10.1097/iae.0000000000003222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Short foveal fluorescence lifetimes (fFLT) in geographic atrophy are typically found in eyes with foveal sparing (FS) but may also occur in eyes without FS. We investigated whether short fFLT could serve as a functional biomarker for disease progression in geographic atrophy. METHODS Thirty three eyes were followed over the course of 4 to 6 years. Foveal sparing was assessed using fluorescence lifetime imaging ophthalmoscopy, optical coherence tomography, fundus Autofluorescence, and macular pigment optical density. RESULTS Eyes with FS exhibited shorter fFLT compared with eyes without FS. Short fFLT (<600 ps) were measured in all eyes with FS and half of the eyes without FS. Eyes with FS showed a bigger increase in fFLT per year (+39/+30 ps (short spectral channel/long spectral channel) in FS versus +29/+22 ps (short spectral channel/long spectral channel) in non FS). The best-corrected distance visual acuity correlated significantly with fFLT (P = 0.018 and P = 0.005 for short spectral channel/long spectral channel). Macular pigment optical density measurements correlated significantly with fFLT but not in all spectral channels (P ranging from 0.018 to 0.077). CONCLUSION In geographic atrophy, shorter fFLT are associated with FS but they can also be observed in eyes without FS. Our longitudinal data suggest that shorter fFLT features in eyes with loss of FS represent an earlier stage of disease and may be more prone to loss of the visual acuity.
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Affiliation(s)
- Joel-Benjamin Lincke
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland ; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland ; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Damian Jaggi
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland ; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Yasmin Solberg
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland ; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland ; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland ; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
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Shen LL, Sun M, Ahluwalia A, Park MM, Young BK, Del Priore LV. Local Progression Kinetics of Geographic Atrophy Depends Upon the Border Location. Invest Ophthalmol Vis Sci 2021; 62:28. [PMID: 34709347 PMCID: PMC8558522 DOI: 10.1167/iovs.62.13.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose To assess the influence of lesion morphology and location on geographic atrophy (GA) growth rate. Methods We manually delineated GA on color fundus photographs of 237 eyes in the Age-Related Eye Disease Study. We calculated local border expansion rate (BER) as the linear distance that a point on the GA border traveled over 1 year based on a Euclidean distance map. Eye-specific BER was defined as the mean local BER of all points on the GA border in an eye. The percentage area affected by GA was defined as the GA area divided by the total retinal area in the region. Results GA enlarged 1.51 ± 1.96 mm2 in area and 0.13 ± 0.11 mm in distance over 1 year. The GA area growth rate (mm2/y) was associated with the baseline GA area (P < 0.001), perimeter (P < 0.001), lesion number (P < 0.001), and circularity index (P < 0.001); in contrast, eye-specific BER (mm/y) was not significantly associated with any of these factors. As the retinal eccentricity increased from 0 to 3.5 mm, the local BER increased from 0.10 to 0.24 mm/y (P < 0.001); in contrast, the percentage of area affected by GA decreased from 49.3% to 2.3%. Conclusions Using distance-based measurements allows GA progression evaluation without significant confounding effects from baseline GA morphology. Local GA progression rates increased as a function of retinal eccentricity within the macula which is opposite of the trend for GA distribution, suggesting that GA initiation and enlargement may be mediated by different biological processes.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Mengyuan Sun
- Institute of Cardiovascular Diseases, Gladstone Institute, San Francisco, California, United States
| | - Aneesha Ahluwalia
- Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Michael M Park
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Lucian V Del Priore
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, United States
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You JI, Kim DG, Yu SY, Kim ES, Kim K. Correlation between Topographic Progression of Geographic Atrophy and Visual Acuity Changes. KOREAN JOURNAL OF OPHTHALMOLOGY 2021; 35:448-454. [PMID: 34488258 PMCID: PMC8666263 DOI: 10.3341/kjo.2021.0037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To analyze topographic progression of geographic atrophy with different concentric circles centered on the fovea in correlation with decrease of visual acuity. Methods We retrospectively analyzed 36 eyes of 26 patients diagnosed with geographic atrophy and followed at least 1 year. One millimeter circular area at the foveal center were defined as zone 1, and doughnut shape areas from between 1 and 2 mm to between 5 and 6 mm were defined as zone 2 to 6. Then, changes of geographic atrophy area in each zone were measured with semi-automatic software. Correlation analysis and regression analysis were performed to determine the relationship between changes in visual acuity and atrophic area in each zone. Results Mean age was 76.9 years and follow-up period were 3.38 years. The mean atrophic area increased from 8.09 to 16.34 mm2 and visual acuity decreased from 0.39 to 0.69 on logarithm of the minimal angle of resolution. Mean change of total geographic atrophy area was not significantly correlated with visual acuity decrease. While geographic atrophy progression within zone 1, 2, and 3 showed significant causal relationship with decrease of visual acuity (all, p < 0.05). Conclusions In contrast to the total geographic atrophy area, progression of geographic atrophy in parafoveal area was significantly correlated with decrease of visual acuity.
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Affiliation(s)
- Jong In You
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Do Gyun Kim
- Department of Ophthalmology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Peripheral Manifestations in Age Related Macular Degeneration: A Review of Imaging and Findings. J Clin Med 2021; 10:jcm10173993. [PMID: 34501441 PMCID: PMC8432448 DOI: 10.3390/jcm10173993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/11/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: To review novel findings in research with ultra-widefield imaging for analysis of peripheral manifestations in macular degeneration (AMD). We introduce the evolving widefield imaging modalities while summarizing the analytical techniques used in data collection of peripheral retinal findings thus far. Our review provides a summary of advancements to date and a commentary on future direction for AMD research. Methods: This is a literature review of all significant publications focused on the relationship between AMD and the retinal periphery conducted within the last two decades. Results and Conclusion: Promising research has been undertaken to elucidate peripheral retinal manifestations in macular degeneration using novel methodology. Advancements in ultra-widefield imaging and fundus autofluorescence have allowed us to elucidate peripheral retinal pigmentary changes, drusen deposition, and much more. Novel grid overlay techniques have been introduced to aid in analyzing these changes for pattern recognition and grouping of findings. This review discusses these findings in detail, providing evidence for the pan-retinal manifestations of AMD. Inter-study discordance in analytical approach highlights a need for more systematic future study.
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Hammer M, Jakob-Girbig J, Schwanengel L, Curcio CA, Hasan S, Meller D, Schultz R. Progressive Dysmorphia of Retinal Pigment Epithelium in Age-Related Macular Degeneration Investigated by Fluorescence Lifetime Imaging. Invest Ophthalmol Vis Sci 2021; 62:2. [PMID: 34491262 PMCID: PMC8431975 DOI: 10.1167/iovs.62.12.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study was to observe changes of the retinal pigment epithelium (RPE) on the transition from dysmorphia to atrophy in age-related macular degeneration (AMD) by fluorescence lifetime imaging ophthalmoscopy (FLIO). Methods Multimodal imaging including color fundus photography (CFP), optical coherence tomography (OCT), fundus autofluorescence (FAF) imaging, and FLIO was performed in 40 eyes of 37 patients with intermediate AMD and no evidence for geographic atrophy or macular neovascularization (mean age = 74.2 ± 7.0 years). Twenty-three eyes were followed for 28.3 ± 18.3 months. Seven eyes had a second follow-up after 46.6 ± 9.0 months. Thickened RPE on OCT, hyperpigmentation on CFP, hyper-reflective foci (HRF) on OCT, attributed to single or clustered intraretinal RPE, were identified. Fluorescence lifetimes in two spectral channels (short-wavelength spectral channel [SSC] = 500–560 nm, long-wavelength spectral channel [LSC] = 560–720 nm) as well as emission spectrum intensity ratio (ESIR) of the lesions were measured by FLIO. Results As hyperpigmented areas form and RPE migrates into the retina, FAF lifetimes lengthen and ESRI of RPE cells increase. Thickened RPE showed lifetimes of 256 ± 49 ps (SSC) and 336 ± 35 ps (LSC) and an ESIR of 0.552 ± 0.079. For hyperpigmentation, these values were 317 ± 68 ps (p < 0.001), 377 ± 56 ps (P < 0.001), and 0.609 ± 0.081 (P = 0.001), respectively, and for HRF 337 ± 79 ps (P < 0.001), 414 ± 50 ps (P < 0.001), and 0.654 ± 0.075 (P < 0.001). Conclusions In the process of RPE degeneration, comprising different steps of dysmorphia, hyperpigmentation, and migration, lengthening of FAF lifetimes and a hypsochromic shift of emission spectra can be observed by FLIO. Thus, FLIO might provide early biomarkers for AMD progression and contribute to our understanding of RPE pathology.
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Affiliation(s)
- Martin Hammer
- Department of Ophthalmology, University Hospital Jena, Jena, Germany.,Center for Medical Optics and Photonics, Univ. of Jena, Jena, Germany
| | | | - Linda Schwanengel
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Somar Hasan
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Daniel Meller
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Rowena Schultz
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
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63
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Fang V, Gomez-Caraballo M, Lad EM. Biomarkers for Nonexudative Age-Related Macular Degeneration and Relevance for Clinical Trials: A Systematic Review. Mol Diagn Ther 2021; 25:691-713. [PMID: 34432254 DOI: 10.1007/s40291-021-00551-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 01/05/2023]
Abstract
TOPIC The purpose of the review was to identify structural, functional, blood-based, and other types of biomarkers for early, intermediate, and late nonexudative stages of age-related macular degeneration (AMD) and summarize the relevant data for proof-of-concept clinical trials. CLINICAL RELEVANCE AMD is a leading cause of blindness in the aging population, yet no treatments exist for its most common nonexudative form. There are limited data on the diagnosis and progression of nonexudative AMD compared to neovascular AMD. Our objective was to provide a comprehensive, systematic review of recently published biomarkers (molecular, structural, and functional) for early AMD, intermediate AMD, and geographic atrophy and to evaluate the relevance of these biomarkers for use in future clinical trials. METHODS A literature search of PubMed, ScienceDirect, EMBASE, and Web of Science from January 1, 1996 to November 30, 2020 and a patent search were conducted. Search terms included "early AMD," "dry AMD," "intermediate AMD," "biomarkers for nonexudative AMD," "fundus autofluorescence patterns," "color fundus photography," "dark adaptation," and "microperimetry." Articles were assessed for bias and quality with the Mixed-Methods Appraisal Tool. A total of 94 articles were included (61,842 individuals). RESULTS Spectral-domain optical coherence tomography was superior at highlighting detailed structural changes in earlier stages of AMD. Fundus autofluorescence patterns were found to be most important in estimating progression of geographic atrophy. Delayed rod intercept time on dark adaptation was the most widely recommended surrogate functional endpoint for early AMD, while retinal sensitivity on microperimetry was most relevant for intermediate AMD. Combinational studies accounting for various patient characteristics and machine/deep-learning approaches were best suited for assessing individualized risk of AMD onset and progression. CONCLUSION This systematic review supports the use of structural and functional biomarkers in early AMD and intermediate AMD, which are more reproducible and less invasive than the other classes of biomarkers described. The use of deep learning and combinational algorithms will gain increasing importance in future clinical trials of nonexudative AMD.
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Affiliation(s)
- Vivienne Fang
- Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611, USA
| | - Maria Gomez-Caraballo
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Rd, DUMC 3802, Durham, NC, 27705, USA
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Rd, DUMC 3802, Durham, NC, 27705, USA
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Behning C, Fleckenstein M, Pfau M, Adrion C, Goerdt L, Lindner M, Schmitz-Valckenberg S, Holz FG, Schmid M. Modeling of atrophy size trajectories: variable transformation, prediction and age-of-onset estimation. BMC Med Res Methodol 2021; 21:170. [PMID: 34404346 PMCID: PMC8369742 DOI: 10.1186/s12874-021-01356-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background To model the progression of geographic atrophy (GA) in patients with age-related macular degeneration (AMD) by building a suitable statistical regression model for GA size measurements obtained from fundus autofluorescence imaging. Methods Based on theoretical considerations, we develop a linear mixed-effects model for GA size progression that incorporates covariable-dependent enlargement rates as well as correlations between longitudinally collected GA size measurements. To capture nonlinear progression in a flexible way, we systematically assess Box-Cox transformations with different transformation parameters λ. Model evaluation is performed on data collected for two longitudinal, prospective multi-center cohort studies on GA size progression. Results A transformation parameter of λ=0.45 yielded the best model fit regarding the Akaike information criterion (AIC). When hypertension and hypercholesterolemia were included as risk factors in the model, they showed an association with progression of GA size. The mean estimated age-of-onset in this model was 67.21±6.49 years. Conclusions We provide a comprehensive framework for modeling the course of uni- or bilateral GA size progression in longitudinal observational studies. Specifically, the model allows for age-of-onset estimation, identification of risk factors and prediction of future GA size. A square-root transformation of atrophy size is recommended before model fitting. Supplementary Information The online version contains supplementary material available at (10.1186/s12874-021-01356-0).
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Affiliation(s)
- Charlotte Behning
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany.
| | | | - Maximilian Pfau
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Bethesda, MD, USA
| | - Christine Adrion
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Lukas Goerdt
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Moritz Lindner
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany
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65
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Corvi F, Sadda SR. Progression of geographic atrophy. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1951231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Federico Corvi
- Doheny Eye Institute, United States, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - SriniVas R. Sadda
- Doheny Eye Institute, United States, California, United States
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Mahmoudzadeh R, Salabati M, Khan MA, Garg SJ, Hsu J. Manual Versus Semi-Automated Measurement of Geographic Atrophy Area in Eyes With Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:33. [PMID: 34436542 PMCID: PMC8399398 DOI: 10.1167/tvst.10.9.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the agreement between and correlation of manual and semi-automated area measurements of geographic atrophy (GA) in eyes with age-related macular degeneration (AMD) using Heidelberg Eye Explorer and ImageJ software. Methods Fundus autofluorescence (FAF) images of eyes with GA secondary to AMD were analyzed. Two graders measured the atrophic area using Heidelberg Eye Explorer manual and semi-automated (RegionFinder) software, as well as ImageJ manual and semi-automated (Color Threshold) software. Results Fifty-four FAF images were analyzed. The mean (SD) areas were 10.55 (11.4) mm2 and 9.6 (9.8) mm2 using the Heidelberg manual and semi-automated tools, respectively. The mean (SD) areas were 11.04 (12.25) mm2 and 9.75 (10.3) mm2 using ImageJ manual and semi-automated tools, respectively. Compared with the semi-automated Heidelberg RegionFinder (gold standard) area measurements, Bland-Altman plots showed mean differences of 0.96 mm2, 1.4 mm2, and 0.16 mm2 with manual Heidelberg, manual ImageJ, and semi-automated ImageJ measurements, respectively. Homogeneous GA lesions showed less disparity in area measurements across modalities compared with non-homogeneous lesions. Conclusions ImageJ appears to be a reliable tool for GA area measurements when proprietary OCT software is unavailable. Manual measurements with Heidelberg Eye Explorer and ImageJ were comparable, as were semi-automated measurements with Heidelberg RegionFinder and ImageJ Color Threshold. Translational Relevance Novel GA measurement techniques using open-source software appear to be comparable to established techniques using proprietary platform-specific software, which may permit more widespread analysis of GA progression from multiple platforms and databases.
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Affiliation(s)
- Raziyeh Mahmoudzadeh
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Mirataollah Salabati
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - M Ali Khan
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Sunir J Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Jason Hsu
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
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67
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Pole C, Ameri H. Fundus Autofluorescence and Clinical Applications. J Ophthalmic Vis Res 2021; 16:432-461. [PMID: 34394872 PMCID: PMC8358768 DOI: 10.18502/jovr.v16i3.9439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/01/2021] [Indexed: 12/20/2022] Open
Abstract
Fundus autofluorescence (FAF) has allowed in vivo mapping of retinal metabolic derangements and structural changes not possible with conventional color imaging. Incident light is absorbed by molecules in the fundus, which are excited and in turn emit photons of specific wavelengths that are captured and processed by a sensor to create a metabolic map of the fundus. Studies on the growing number of FAF platforms has shown each may be suited to certain clinical scenarios. Scanning laser ophthalmoscopes, fundus cameras, and modifications of these each have benefits and drawbacks that must be considered before and after imaging to properly interpret the images. Emerging clinical evidence has demonstrated the usefulness of FAF in diagnosis and management of an increasing number of chorioretinal conditions, such as age-related macular degeneration, central serous chorioretinopathy, retinal drug toxicities, and inherited retinal degenerations such as retinitis pigmentosa and Stargardt disease. This article reviews commercial imaging platforms, imaging techniques, and clinical applications of FAF.
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Affiliation(s)
- Cameron Pole
- Retina Division, USC Roski Eye Institute, Keck School of Medicine, University of South California, Los Angeles, CA, USA
| | - Hossein Ameri
- Retina Division, USC Roski Eye Institute, Keck School of Medicine, University of South California, Los Angeles, CA, USA
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68
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Gallagher D, Kalra G, Rasheed MA, Vupparaboina KK, Singh SR, Chhablani J. Long-term retinal changes in progressive geographic atrophy. Eur J Ophthalmol 2021; 32:1687-1693. [PMID: 34308667 DOI: 10.1177/11206721211035636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is one of the leading causes of blindness with loss of retinal layers over long term. We aim to evaluate these changes in eyes with progressive non-exudative AMD with geographic atrophy (GA). METHODS This retrospective study included patients with GA with a minimum of 4 years follow up. Retinal layers on spectral domain optical coherence tomography (SD-OCT) were segmented based on their reflectivity patterns using validated semi-automated segmentation algorithm. The thickness of the segmented retinal layers was measured. Horizontal length of GA at baseline and last follow-up were also measured. Regression analysis was performed to correlate changes in RPE layer thickness with other retinal layers and the length of GA on OCT. RESULTS A total of 351-line scans including 17 foveal scans showing presence of GA at final visit that is, a total of 2457 retinal layer bands were analyzed. Outer nuclear layer (ONL) (p = 0.02), outer segment layers (OSL) (p = 0.01), and retinal pigment epithelium (RPE) (p = 0.01) showed a statistically significant variation between baseline and final visit. Regression analysis showed the change in ONL (r = 0.72; p = 0.01) and OSL (r = 0.93, p < 0.01) correlated significantly with change in RPE thickness whereas rest of the layers failed to show significant correlation. CONCLUSION Outer retinal layers (ONL and OSL) show more significant and widespread changes in retinal thickness and correlated most significantly with RPE thickness changes in eyes with GA due to AMD. Assessment of various retinal layer bands can be used as surrogate quantitative parameters to study eyes with GA.
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Affiliation(s)
| | - Gagan Kalra
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | | | | | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Institute, University of California, San Diego, La Jolla, CA, USA
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
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Corradetti G, Byon I, Corvi F, Cozzi M, Staurenghi G, Sadda SR. Retro mode illumination for detecting and quantifying the area of geographic atrophy in non-neovascular age-related macular degeneration. Eye (Lond) 2021; 36:1560-1566. [PMID: 34262164 PMCID: PMC9307798 DOI: 10.1038/s41433-021-01670-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the ability of retro mode illumination imaging for quantifying atrophy compared to confocal color fundus photography (c-CFP), green light fundus autofluorescence (G-FAF), blue light fundus autofluorescence (B-FAF) using the scanning laser ophthalmoscope (SLO) Mirante device by Nidek (Nidek Co., Ltd, Gamogori, Japan). METHODS Eyes with clinical evidence of geographic atrophy (GA) associated with non-neovascular age-related macular degeneration, evaluated at the Doheny Eye Centers-UCLA and Hospital Sacco Milan, were included in this prospective, cross-sectional study. All eyes were imaged with multiple retinal imaging modalities using the SLO Nidek Mirante device: c-CFP, G-FAF, B-FAF, retro mode illumination deviated-right (RMDR), and deviated-left (RMDL). Masked graders measured the GA lesion on each modality and inter-modality and inter-grader repeatability were assessed. RESULTS The mean (SD) area of GA measured 9.76 (3.82) mm2, 9.75 (3.91) mm2, 9.76 (3.92) mm2, 9.82 (3.87) mm2, and 9.81 (3.86) mm2 using c-CFP, G-FAF, B-FAF, RMDR, and RMDL, respectively (p = 0.2). Inter-modality correlation was high (Pearson's r > 0.9 and p < 0.0001). Agreement between graders was excellent for all modalities. CONCLUSIONS Retro mode imaging demonstrated good agreement for measuring GA compared to other imaging modalities, with a high level of repeatability. Given that retro mode imaging uses infrared light and is comfortable, it may prove to be a useful tool for the assessment of GA in the clinic.
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Affiliation(s)
- Giulia Corradetti
- Doheny Eye Institute, Los Angeles, CA, USA.,Retina Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California-Los Angeles, Los Angeles, CA, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Iksoo Byon
- Doheny Eye Institute, Los Angeles, CA, USA.,Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
| | - Federico Corvi
- Doheny Eye Institute, Los Angeles, CA, USA.,Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Sacco Hospital, University of Milan, Milan, Italy
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, USA. .,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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INVESTIGATING A GROWTH PREDICTION MODEL IN ADVANCED AGE-RELATED MACULAR DEGENERATION WITH SOLITARY GEOGRAPHIC ATROPHY USING QUANTITATIVE AUTOFLUORESCENCE. Retina 2021; 40:1657-1664. [PMID: 31584560 DOI: 10.1097/iae.0000000000002653] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate geographic atrophy (GA) progression using quantitative autofluorescence (qAF) in eyes with solitary GA. METHODS Forty-three eyes of 26 patients (age 79.7 ± 7.2 years; 28 women; 16 pseudophakic) underwent spectral-domain optical coherence tomography and qAF imaging at baseline and after 12 months. The junctional zone (AJZ) and a nonaffected 300-µm-wide control area (AC) were delineated on spectral-domain optical coherence tomography scans and transferred to the qAF image. Linear mixed models were calculated to investigate the association between GA progression and qAF, age, and baseline GA area. Mixed model analyses of variance were used to investigate differences in qAF between areas. RESULTS Quantitative autofluorescence of the three inferior sections of both the AJZ (P = 0.028; P = 0.014 and P = 0.032) and the AC (P = 0.043; P = 0.02 and P = 0.028) were significantly associated with GA progression after 12 months. However, qAF measurements were not associated with GA progression in the overall model (P > 0.05). Mean qAF was significantly lower in the AJZ and growth area (AG12) than in the AC (both P ≤ 0.001). CONCLUSION The authors report a statistically significant association between GA growth area and qAF measurements at specific retinal locations and a significant difference in qAF between the GA border and unaffected areas outside the lesion. Quantitative autofluorescence measurements may be limitedly useful for predicting GA progression.
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71
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Colijn JM, Liefers B, Joachim N, Verzijden T, Meester-Smoor MA, Biarnés M, Monés J, de Jong PTVM, Vingerling JR, Mitchell P, Sánchez CI, Wang JJ, Klaver CCW. Enlargement of Geographic Atrophy From First Diagnosis to End of Life. JAMA Ophthalmol 2021; 139:743-750. [PMID: 34014262 DOI: 10.1001/jamaophthalmol.2021.1407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Treatments for geographic atrophy (GA), a late stage of age-related macular degeneration (AMD), are currently under development. Understanding the natural course is needed for optimal trial design. Although enlargement rates of GA and visual acuity (VA) in the short term are known from clinical studies, knowledge of enlargement in the long term, life expectancy, and visual course is lacking. Objective To determine long-term enlargement of GA. Design, Setting, and Participants In this study, participant data were collected from 4 population-based cohort studies, with up to 25 years of follow-up and eye examinations at 5-year intervals: the Rotterdam Study cohorts 1, 2, and 3 and the Blue Mountains Eye Study. Data were collected from 1990 to 2015, and data were analyzed from January 2019 to November 2020. Main Outcomes and Measures Area of GA was measured pixel by pixel using all available imaging. Area enlargement and enlargement of the square root-transformed area, time until GA reached the central fovea, and time until death were assessed, and best-corrected VA, smoking status, macular lesions according to the Three Continent AMD Consortium classification, a modified version of the Wisconsin age-related maculopathy grading system, and AMD genetic variants were covariates in Spearman, Pearson, or Mann-Whitney analyses. Results Of 171 included patients, 106 (62.0%) were female, and the mean (SD) age at inclusion was 82.6 (7.1) years. A total of 147 of 242 eyes with GA (60.7%) were newly diagnosed in our study. The mean area of GA at first presentation was 3.74 mm2 (95% CI, 3.11-4.67). Enlargement rate varied widely between persons (0.02 to 4.05 mm2 per year), with a mean of 1.09 mm2 per year (95% CI, 0.89-1.30). Stage of AMD in the other eye was correlated with GA enlargement (Spearman ρ = 0.34; P = .01). Foveal involvement was already present in incident GA in 55 of 147 eyes (37.4%); 23 of 42 eyes (55%) developed this after a mean (range) period of 5.6 (3-12) years, and foveal involvement did not develop before death in 11 of 42 eyes (26%). After first diagnosis, 121 of 171 patients with GA (70.8%) died after a mean (SD) period of 6.4 (5.4) years. Visual function was visually impaired (less than 20/63) in 47 of 107 patients (43.9%) at last visit before death. Conclusions and Relevance In this study, enlargement of GA appeared to be highly variable in the general population. More than one-third of incident GA was foveal at first presentation; those with extrafoveal GA developed foveal GA after a mean of 5.6 years. Future intervention trials should focus on recruiting those patients who have a high chance of severe visual decline within their life expectancy.
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Affiliation(s)
- Johanna M Colijn
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bart Liefers
- Department of Radiology and Nuclear Medicine, RadboudUMC, Nijmegen, the Netherlands
| | - Nichole Joachim
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Timo Verzijden
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Magda A Meester-Smoor
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc Biarnés
- Barcelona Macula Foundation, Barcelona, Spain.,Institut de la Màcula, Hospital Quirón Teknon, Barcelona, Spain
| | - Jordi Monés
- Barcelona Macula Foundation, Barcelona, Spain.,Institut de la Màcula, Hospital Quirón Teknon, Barcelona, Spain
| | - Paulus T V M de Jong
- Department of Retinal Signal Processing, Netherlands Institute of Neurosciences, KNAW, Department of Ophthalmology, Amsterdam University Medical Centre, Leiden University Medical Centre, Leiden, the Netherlands
| | - Johannes R Vingerling
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Clara I Sánchez
- Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jie J Wang
- Centre for Vision Research, Department of Ophthalmology, The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia.,Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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Şahinoğlu Keşkek N, Şermet F. The Use of Fundus Autofluorescence in Dry Age-Related Macular Degeneration. Turk J Ophthalmol 2021; 51:169-176. [PMID: 34187152 PMCID: PMC8251671 DOI: 10.4274/tjo.galenos.2020.49107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/26/2020] [Indexed: 12/01/2022] Open
Abstract
Fundus autofluorescence (FAF) has been a well-known imaging method for quite some time. However, with developing technologies and novel imaging devices, FAF is being used more often to diagnose and monitor retinal diseases. The density of lipofuscin (LF) and other fluorophores in the retina have a determining role in FAF images. In dry age-related macular degeneration (AMD), hyperautofluorescence is seen in cases of increasing LF in the retina pigment epithelium, whereas hypoautofluorescence is detected in decreasing LF resulting from geographic atrophy. In recent years, studies have shown that FAF images provide prognostic information in patients with AMD. This review aims to highlight the importance of FAF imaging in dry AMD.
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Affiliation(s)
- Nedime Şahinoğlu Keşkek
- Başkent University Faculty of Medicine, Adana Training and Research Center, Department of Ophthalmology, Adana, Turkey
| | - Figen Şermet
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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73
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Moult EM, Hwang Y, Shi Y, Wang L, Chen S, Waheed NK, Gregori G, Rosenfeld PJ, Fujimoto JG. Growth Modeling for Quantitative, Spatially Resolved Geographic Atrophy Lesion Kinetics. Transl Vis Sci Technol 2021; 10:26. [PMID: 34156431 PMCID: PMC8237082 DOI: 10.1167/tvst.10.7.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To demonstrate the applicability of a growth modeling framework for quantifying spatial variations in geographic atrophy (GA) lesion kinetics. Methods Thirty-eight eyes from 27 patients with GA secondary to age-related macular degeneration were imaged with a commercial swept source optical coherence tomography instrument at two visits separated by 1 year. Local GA growth rates were computed at 6-µm intervals along each lesion margin using a previously described growth model. Corresponding margin eccentricities, margin angles, and growth angles were also computed. The average GA growth rates conditioned on margin eccentricity, margin angle, growth angle, and fundus position were estimated via kernel regression. Results A total of 88,356 GA margin points were analyzed. The average GA growth rates exhibited a hill-shaped dependency on eccentricity, being highest in the 0.5 mm to 1.6 mm range and lower on either side of that range. Average growth rates were also found to be higher for growth trajectories oriented away from (smaller growth angle), rather than toward (larger growth angle), the foveal center. The dependency of average growth rate on margin angle was less pronounced, although lesion segments in the superior and nasal aspects tended to grow faster. Conclusions Our proposed growth modeling framework seems to be well-suited for generating accurate, spatially resolved GA growth rate atlases and should be confirmed on larger datasets. Translational Relevance Our proposed growth modeling framework may enable more accurate measurements of spatial variations in GA growth rates.
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Affiliation(s)
- Eric M Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Health Sciences and Technology, Harvard & Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Yunchan Hwang
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Siyu Chen
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Schmitz-Valckenberg S, Braun MD, Thiele S, Ferrara D, Honigberg L, Gao SS, Chen H, Steffen V, Holz FG, Saßmannshausen M. Conversion from Intermediate Age-Related Macular Degeneration to Geographic Atrophy in a Proxima B Subcohort Using a Multimodal Approach. Ophthalmologica 2021; 244:523-534. [PMID: 34348335 DOI: 10.1159/000517881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Steffen Schmitz-Valckenberg
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Martina D Braun
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sarah Thiele
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Lee Honigberg
- Genentech, Inc., South San Francisco, California, USA
| | - Simon S Gao
- Genentech, Inc., South San Francisco, California, USA
| | - Hao Chen
- Genentech, Inc., South San Francisco, California, USA
| | | | - Frank G Holz
- GRADE Reading Center and Department of Ophthalmology, University of Bonn, Bonn, Germany
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Rajagopalan L, Ghosn C, Tamhane M, Almazan A, Andrews-Jones L, Kulkarni A, Christie LA, Burke J, López FJ, Engles M. A nonhuman primate model of blue light-induced progressive outer retina degeneration showing brimonidine drug delivery system-mediated cyto- and neuroprotection. Exp Eye Res 2021; 209:108678. [PMID: 34153289 DOI: 10.1016/j.exer.2021.108678] [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: 02/16/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) characterized by atrophy of the retinal pigment epithelium (RPE), loss of photoreceptors, and disruption of choriocapillaris. Excessive light exposure is toxic to the retina and is a known risk factor for AMD. We first investigated the effects of blue light-induced phototoxicity on RPE and photoreceptors in nonhuman primates (NHPs, a model of progressive retinal degeneration) and then evaluated the potential cyto- and neuroprotective effects of the brimonidine drug delivery system (Brimo DDS). In the first set of experiments related to model development, parafoveal lesions of varying severity were induced using blue light irradiation of the retina of cynomolgus monkeys to evaluate the level of phototoxicity in the RPE and photoreceptors. RPE damage was assessed using fundus autofluorescence imaging to quantify areas of hypofluorescence, while thinning of the outer nuclear layer (ONL, photoreceptor nuclei) was quantified using optical coherence tomography (OCT). Photoreceptor function was assessed using multifocal electroretinography (mfERG). RPE damage progressively increased across all lesion severities from 2 to 12 weeks, as did the extent of ONL thinning. Lesions of high severity continued to show reduction in mfERG amplitude, reaching a statistically significant maximum reduction at 12 weeks. Collectively, the first set of experiments showed that blue light irradiation of the NHP eye resulted in progressive retinal degeneration identified by damage to RPE, ONL thinning, and disrupted photoreceptor function - hallmarks of GA in humans. We then used the model to evaluate the cyto- and neuroprotective effects of Brimo DDS, administered as a therapeutic after allowing the lesions to develop for 5 weeks. Placebo DDS or Brimo DDS were administered intravitreally and a set of untreated animals were used as an additional control. In the placebo DDS group, hypofluorescence area continued to increase from baseline, indicating progressive RPE damage, while progression was significantly slowed in eyes receiving Brimo DDS. Likewise, ONL thinning continued to progress over time in eyes that received the placebo DDS, but was reduced in Brimo DDS-treated eyes. Pharmacologically relevant brimonidine concentrations were sustained in the retina for up to 26 weeks following Brimo DDS administration. In summary, Brimo DDS demonstrated cyto- and neuroprotective effects in a novel NHP GA model of progressive retinal degeneration.
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Affiliation(s)
| | - Corine Ghosn
- Allergan (an AbbVie company), 2525 Dupont Drive, Irvine, CA, 92612, USA
| | - Mitalee Tamhane
- Allergan (an AbbVie company), 2525 Dupont Drive, Irvine, CA, 92612, USA
| | - Alexandra Almazan
- Allergan (an AbbVie company), 2525 Dupont Drive, Irvine, CA, 92612, USA
| | | | - Ashutosh Kulkarni
- Allergan (an AbbVie company), 2525 Dupont Drive, Irvine, CA, 92612, USA
| | - Lori-Ann Christie
- Allergan (an AbbVie company), 2525 Dupont Drive, Irvine, CA, 92612, USA
| | - James Burke
- Allergan (an AbbVie company), 2525 Dupont Drive, Irvine, CA, 92612, USA
| | - Francisco J López
- Allergan (an AbbVie company), 2525 Dupont Drive, Irvine, CA, 92612, USA
| | - Michael Engles
- Allergan (an AbbVie company), 2525 Dupont Drive, Irvine, CA, 92612, USA.
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Călin EF, Patoni Popescu SI, Coman Cernat CC, Patoni C, Popescu MN, Mușat O. Lipofuscin: a key compound in ophthalmic practice. Rom J Ophthalmol 2021; 65:109-113. [PMID: 34179573 PMCID: PMC8207864 DOI: 10.22336/rjo.2021.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Lipofuscin is an intracellular aging pigment with fluorescent properties, found in retinal pigment epithelium cells of the eye. It is the main fluorophore used in fundus autofluorescence imaging techniques to diagnose, describe, and follow retinal disease. Lipofuscin forms by incomplete lysosomal degradation of cellular material previously subjected to oxidative changes. A2E is the most studied fluorescent component of lipofuscin, but most of its composition remains unknown. Lipofuscin is photoreactive, generating reactive oxygen species, which may explain its role in disease development. Further knowledge is needed concerning lipofuscin genesis, biochemical composition, fluorescent compounds, and role in pathogenesis of retinal degenerative disease.
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Affiliation(s)
- Edward Florian Călin
- Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | | | - Corina Cristina Coman Cernat
- Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania.,"Victor Babeş" University of Medicine and Pharmacy, Timișoara, Romania
| | - Cristina Patoni
- Department of Gastroenterology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | | | - Ovidiu Mușat
- Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
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77
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Goerdt L, Sauer L, Vitale AS, Modersitzki NK, Fleckenstein M, Bernstein PS. Comparing Fluorescence Lifetime Imaging Ophthalmoscopy in Atrophic Areas of Retinal Diseases. Transl Vis Sci Technol 2021; 10:11. [PMID: 34110387 PMCID: PMC8196421 DOI: 10.1167/tvst.10.7.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Fluorescence lifetime imaging ophthalmoscopy (FLIO) is a non-invasive imaging modality to investigate the human retina. This study compares FLIO lifetimes in different degenerative retinal diseases. Methods Included were eyes with retinal pigment epithelium (RPE) and/or photoreceptor atrophy due to Stargardt disease (n = 66), pattern dystrophy (n = 18), macular telangiectasia type 2 (n = 49), retinitis pigmentosa (n = 28), choroideremia (n = 26), and geographic atrophy (n = 32) in age-related macular degeneration, as well as 37 eyes of 37 age-matched healthy controls. Subjects received Heidelberg Engineering FLIO, autofluorescence intensity, and optical coherence tomography imaging. Amplitude-weighted mean FLIO lifetimes (τm) were calculated and analyzed. Results Retinal FLIO lifetimes show significant differences depending on the disease. Atrophic areas in geographic atrophy and choroideremia showed longest mean FLIO lifetimes. τm values within areas of RPE and outer nuclear layer atrophy were significantly longer than within areas with preserved outer nuclear layer (P < 0.001) or non-atrophic areas (P < 0.001). Conclusions FLIO is able to contribute additional information regarding differences in chronic degenerative retinal diseases. Although it cannot replace conventional autofluorescence imaging, FLIO adds to the knowledge in these diseases and may help with the correct differentiation between them. This may lead to a more in-depth understanding of the pathomechanisms related to atrophy and types of progression. Translational Relevance Differences between atrophic retinal diseases highlighted by FLIO may indicate separate pathomechanisms leading to atrophy and disease progression.
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Affiliation(s)
- Lukas Goerdt
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Lydia Sauer
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Paul S Bernstein
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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George SM, Lu F, Rao M, Leach LL, Gross JM. The retinal pigment epithelium: Development, injury responses, and regenerative potential in mammalian and non-mammalian systems. Prog Retin Eye Res 2021; 85:100969. [PMID: 33901682 DOI: 10.1016/j.preteyeres.2021.100969] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/23/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022]
Abstract
Diseases that result in retinal pigment epithelium (RPE) degeneration, such as age-related macular degeneration (AMD), are among the leading causes of blindness worldwide. Atrophic (dry) AMD is the most prevalent form of AMD and there are currently no effective therapies to prevent RPE cell death or restore RPE cells lost from AMD. An intriguing approach to treat AMD and other RPE degenerative diseases is to develop therapies focused on stimulating endogenous RPE regeneration. For this to become feasible, a deeper understanding of the mechanisms underlying RPE development, injury responses and regenerative potential is needed. In mammals, RPE regeneration is extremely limited; small lesions can be repaired by the expansion of adjacent RPE cells, but large lesions cannot be repaired as remaining RPE cells are unable to functionally replace lost RPE tissue. In some injury paradigms, RPE cells proliferate but do not regenerate a morphologically normal monolayer, while in others, proliferation is pathogenic and results in further disruption to the retina. This is in contrast to non-mammalian vertebrates, which possess tremendous RPE regenerative potential. Here, we discuss what is known about RPE formation during development in mammalian and non-mammalian vertebrates, we detail the processes by which RPE cells respond to injury, and we describe examples of RPE-to-retina and RPE-to-RPE regeneration in non-mammalian vertebrates. Finally, we outline barriers to RPE-dependent regeneration in mammals that could potentially be overcome to stimulate a regenerative response from the RPE.
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Affiliation(s)
- Stephanie M George
- Department of Ophthalmology, Louis J. Fox Center for Vision Restoration, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Fangfang Lu
- Department of Ophthalmology, Louis J. Fox Center for Vision Restoration, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Mishal Rao
- Department of Ophthalmology, Louis J. Fox Center for Vision Restoration, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Lyndsay L Leach
- Department of Ophthalmology, Louis J. Fox Center for Vision Restoration, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Jeffrey M Gross
- Department of Ophthalmology, Louis J. Fox Center for Vision Restoration, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA; Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
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Thibaut M, Tran T, Szaffarczyk S, Boucart M. Impact of age‐related macular degeneration on object searches in realistic panoramic scenes. Clin Exp Optom 2021; 101:372-379. [DOI: 10.1111/cxo.12644] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/10/2017] [Accepted: 10/24/2017] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Thi‐ha‐chau Tran
- SCALab, University of Lille, CNRS, Lille, France,
- Department of Ophthalmology, Lille Group Hospitals, Lille Catholic University, Lille, France,
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Geographic atrophy severity and mortality in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2021; 259:2643-2651. [PMID: 33742280 DOI: 10.1007/s00417-021-05145-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/28/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To examine the association between geographic atrophy (GA) disease characteristics and mortality risk. METHODS We manually delineated color fundus photographs of 209 Age-Related Eye Disease Study (AREDS) participants with GA secondary to age-related macular degeneration to identify total area of atrophy, GA effective radius growth rate, disease laterality, and the presence of foveal center involvement. Associations between GA characteristics and mortality were assessed with Cox proportional hazards models adjusted for health status indicators. RESULTS During a median follow-up of 6.8 years, 48 (23.0%) participants with GA died. In adjusted models, accounting for age, sex, and health status, participants with total GA area in the highest quartile had a significantly increased risk of all-cause mortality compared to those with total GA area in the lowest quartile (hazard ratio [HR], 3.42; 95% confidence interval [CI], 1.32-8.86; P = 0.011). GA effective radius growth rate, bilateral disease, and the presence of foveal center involvement were not significantly associated with mortality. In a multivariable model, including health status indicators and all GA characteristics, total area of atrophy in the highest quartile remained significantly associated with mortality (HR, 4.65; 95% CI, 1.29-16.70; P = 0.019). CONCLUSIONS More extensive GA, as indicated by a greater total area of atrophy, was associated with an increased risk of all-cause mortality in our cohort. The extent of GA may reflect the extent of underlying disease processes that contribute to greater mortality risk, further suggesting that GA may be part of a systemic rather than purely ocular disease process.
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81
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Romano F, Airaldi M, Cozzi M, Oldani M, Riva E, Bertoni AI, Dautaj A, Bertelli M, Staurenghi G, Salvetti AP. Progression of Atrophy and Visual Outcomes in Extensive Macular Atrophy with Pseudodrusen-like Appearance. OPHTHALMOLOGY SCIENCE 2021; 1:100016. [PMID: 36246010 PMCID: PMC9559088 DOI: 10.1016/j.xops.2021.100016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/02/2022]
Abstract
Purpose Design Participants Methods Main Outcome Measures Results Conclusions
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82
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Pfau M, von der Emde L, de Sisternes L, Hallak JA, Leng T, Schmitz-Valckenberg S, Holz FG, Fleckenstein M, Rubin DL. Progression of Photoreceptor Degeneration in Geographic Atrophy Secondary to Age-related Macular Degeneration. JAMA Ophthalmol 2021; 138:1026-1034. [PMID: 32789526 DOI: 10.1001/jamaophthalmol.2020.2914] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Sensitive outcome measures for disease progression are needed for treatment trials in geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Objective To quantify photoreceptor degeneration outside regions of GA in eyes with nonexudative AMD, to evaluate its association with future GA progression, and to characterize its spatio-temporal progression. Design, Setting, and Participants Monocenter cohort study (Directional Spread in Geographic Atrophy [NCT02051998]) and analysis of data from a normative data study at a tertiary referral center. One hundred fifty-eight eyes of 89 patients with a mean (SD) age of 77.7 (7.1) years, median area of GA of 8.87 mm2 (IQR, 4.09-15.60), and median follow-up of 1.1 years (IQR, 0.52-1.7 years), as well as 93 normal eyes from 93 participants. Exposures Longitudinal spectral-domain optical coherence tomography (SD-OCT) volume scans (121 B-scans across 30° × 25°) were segmented with a deep-learning pipeline and standardized in a pointwise manner with age-adjusted normal data (z scores). Outer nuclear layer (ONL), photoreceptor inner segment (IS), and outer segment (OS) thickness were quantified along evenly spaced contour lines surrounding GA lesions. Linear mixed models were applied to assess the association between photoreceptor-related imaging features and GA progression rates and characterize the pattern of photoreceptor degeneration over time. Main Outcomes and Measures Association of ONL thinning with follow-up time (after adjusting for age, retinal topography [z score], and distance to the GA boundary). Results The study included 158 eyes of 89 patients (51 women and 38 men) with a mean (SD) age of 77.7 (7.1) years. The fully automated B-scan segmentation was accurate (dice coefficient, 0.82; 95% CI, 0.80-0.85; compared with manual markings) and revealed a marked interpatient variability in photoreceptor degeneration. The ellipsoid zone (EZ) loss-to-GA boundary distance and OS thickness were prognostic for future progression rates. Outer nuclear layer and IS thinning over time was significant even when adjusting for age and proximity to the GA boundary (estimates of -0.16 μm/y; 95% CI, -0.30 to -0.02; and -0.17 μm/y; 95% CI, -0.26 to -0.09). Conclusions and Relevance Distinct and progressive alterations of photoreceptor laminae (exceeding GA spatially) were detectable and quantifiable. The degree of photoreceptor degeneration outside of regions of retinal pigment epithelium atrophy varied markedly between eyes and was associated with future GA progression. Macula-wide photoreceptor laminae thinning represents a potential candidate end point to monitor treatment effects beyond mere GA lesion size progression.
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Affiliation(s)
- Maximilian Pfau
- Department of Biomedical Data Science, Stanford University, Stanford, California.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Luis de Sisternes
- Research and Development, Carl Zeiss Meditec Inc, Dublin, California
| | - Joelle A Hallak
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, California
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Lynn SA, Johnston DA, Scott JA, Munday R, Desai RS, Keeling E, Weaterton R, Simpson A, Davis D, Freeman T, Chatelet DS, Page A, Cree AJ, Lee H, Newman TA, Lotery AJ, Ratnayaka JA. Oligomeric Aβ 1-42 Induces an AMD-Like Phenotype and Accumulates in Lysosomes to Impair RPE Function. Cells 2021; 10:413. [PMID: 33671133 PMCID: PMC7922851 DOI: 10.3390/cells10020413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease-associated amyloid beta (Aβ) proteins accumulate in the outer retina with increasing age and in eyes of age-related macular degeneration (AMD) patients. To study Aβ-induced retinopathy, wild-type mice were injected with nanomolar human oligomeric Aβ1-42, which recapitulate the Aβ burden reported in human donor eyes. In vitro studies investigated the cellular effects of Aβ in endothelial and retinal pigment epithelial (RPE) cells. Results show subretinal Aβ-induced focal AMD-like pathology within 2 weeks. Aβ exposure caused endothelial cell migration, and morphological and barrier alterations to the RPE. Aβ co-localized to late-endocytic compartments of RPE cells, which persisted despite attempts to clear it through upregulation of lysosomal cathepsin B, revealing a novel mechanism of lysosomal impairment in retinal degeneration. The rapid upregulation of cathepsin B was out of step with the prolonged accumulation of Aβ within lysosomes, and contrasted with enzymatic responses to internalized photoreceptor outer segments (POS). Furthermore, RPE cells exposed to Aβ were identified as deficient in cargo-carrying lysosomes at time points that are critical to POS degradation. These findings imply that Aβ accumulation within late-endocytic compartments, as well as lysosomal deficiency, impairs RPE function over time, contributing to visual defects seen in aging and AMD eyes.
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Affiliation(s)
- Savannah A. Lynn
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - David A. Johnston
- Biomedical Imaging Unit, University of Southampton, MP12, Tremona Road, Southampton SO16 6YD, UK; (D.A.J.); (D.S.C.); (A.P.)
| | - Jenny A. Scott
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Rosie Munday
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Roshni S. Desai
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Eloise Keeling
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Ruaridh Weaterton
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Alexander Simpson
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Dillon Davis
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Thomas Freeman
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - David S. Chatelet
- Biomedical Imaging Unit, University of Southampton, MP12, Tremona Road, Southampton SO16 6YD, UK; (D.A.J.); (D.S.C.); (A.P.)
| | - Anton Page
- Biomedical Imaging Unit, University of Southampton, MP12, Tremona Road, Southampton SO16 6YD, UK; (D.A.J.); (D.S.C.); (A.P.)
| | - Angela J. Cree
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Helena Lee
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Tracey A. Newman
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
| | - Andrew J. Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - J. Arjuna Ratnayaka
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, MP 806, Tremona Road, Southampton SO16 6YD, UK; (S.A.L.); (J.A.S.); (R.M.); (R.S.D.); (E.K.); (R.W.); (A.S.); (D.D.); (T.F.); (A.J.C.); (H.L.); (T.A.N.); (A.J.L.)
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Miura M, Makita S, Yasuno Y, Iwasaki T, Azuma S, Mino T, Yamaguchi T. Evaluation of retinal pigment epithelium changes in serous pigment epithelial detachment in age-related macular degeneration. Sci Rep 2021; 11:2764. [PMID: 33531591 PMCID: PMC7854605 DOI: 10.1038/s41598-021-82563-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/21/2021] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to quantitatively evaluate retinal pigment epithelium (RPE) changes in serous pigment epithelial detachment (PED) among patients with age-related macular degeneration by means of prototype multi-contrast optical coherence tomography (OCT), which is capable of simultaneous collection of OCT angiography, polarization-sensitive OCT, and standard OCT images. We evaluated 26 eyes of 21 patients with serous PED. RPE-melanin OCT images were calculated from the multi-contrast OCT dataset and compared with near-infrared autofluorescence images. An active RPE lesion was defined as an area of thickened RPE-melanin (≥ 70 μm; RPE70) on RPE-melanin OCT. Each PED area was divided into peak and slope regions. RPE70 area ratios were compared with the maximum PED height, PED area, PED volume, and slope area ratio (area of slope region/area of whole PED). RPE-melanin OCT images were consistent with near-infrared autofluorescence images. The RPE70 area ratio in the slope region was significantly negatively correlated with the slope area ratio. Development of active RPE lesions in the slope region was correlated with the PED configuration. Multi-contrast OCT is useful for objective evaluation of changes in the RPE in patients with age-related macular degeneration.
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Affiliation(s)
- Masahiro Miura
- Department of Ophthalmology, Tokyo Medical University, Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300395, Japan.
| | - Shuichi Makita
- Computational Optics Group, University of Tsukuba, Tsukuba, Japan
| | - Yoshiaki Yasuno
- Computational Optics Group, University of Tsukuba, Tsukuba, Japan
| | - Takuya Iwasaki
- Department of Ophthalmology, Tokyo Medical University, Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300395, Japan
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Enlargement rate of geographic atrophy before and after secondary CNV conversion with associated anti-VEGF treatment. BMC Ophthalmol 2021; 21:4. [PMID: 33402147 PMCID: PMC7784328 DOI: 10.1186/s12886-020-01766-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background To study the enlargement rate of primary geographic atrophy (GA) before and after diagnosis of a secondary choroidal neovascularization (CNV) treated with anti-vascular endothelial growth factor (VEGF) therapy. Methods Five hundred twenty-two consecutive eyes with primary GA were screened for the development of a complicating secondary CNV. Geographic atrophy was measured on blue autofluorescence (BAF) by two readers and calculated into mean growth rate before and after CNV diagnosis. Results Ten eyes of six patients were included in the study (six study eyes with GA complicated by CNV, four GA only partner eyes). Follow-up was 1.42 ± 0.48 years before and 3.64 ± 2.73 years after CNV. There was no significant difference between mean growth rate before and after CNV (1.58 ± 0.99 vs. 1.39 ± 0.65 mm2/year; p = 0.44) or between study and partner eyes (p = 0.86). Over a mean time of 3.64 ± 2.73 years, a mean of 8.3 ± 2.8 anti-VEGF injections were given. No correlation between the amount of anti-VEGF injections and change in growth rate could be observed (r = 0.58; p = 0.23). Conclusion In this pilot study, primary GA enlargement did not seem to be influenced by a secondary CNV. No association between the intensity of anti-VEGF treatment and changes in atrophy enlargement rates were found. Further studies with larger sample sizes are warranted.
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Sahinoglu-Keskek N, Sermet F. Impact of ocular and systemic risk factors on progression of geographic atrophy in age-related macular degeneration. Photodiagnosis Photodyn Ther 2021; 33:102171. [PMID: 33401025 DOI: 10.1016/j.pdpdt.2020.102171] [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: 08/31/2020] [Revised: 12/05/2020] [Accepted: 12/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Geographic atrophy (GA) corresponds to an end-stage form of age-related macular degeneration and the leading cause of irreversible vision loss. The aim of this study was to investigate the role of fundus autofluorescence (FAF) patterns surrounding GA, baseline GA size, the presence of reticular pseudodrusen (RPD), the condition of the fellow eye and the presence of systemic vascular diseases (diabetes, atherosclerosis, systemic hypertension) on the progression of GA due to age-related macular degeneration. METHODS Seventy-five eyes of 52 patients with GA were included into this retrospective study. Digital FAF images were achieved using scanning laser ophthalmoscopy. Areas of GA were measured with the Region Finder software program on an Heidelberg Retinal Angiograph 2. FAF patterns around GA were classified and the presence of RPD and systemic diseases were noted. The median follow-up of the patients was 2.6 years (interquartile range, 1-9.2). RESULTS The median progression rate of the banded pattern (median 0.97 mm2/year) was significantly higher than the other patterns (median 0.85 mm2/year) (p = 0.03). Eyes with RPD had a significantly higher progression rate (median 1.21 mm2/year) than those without RPD (median 0.79 mm2/year) (p = 0.007). The presence of systemic diseases was not related with lesion progression rates. CONCLUSIONS The results demonstrate that the banded pattern and the presence of RPD accelerate the progression of GA and function as predictive factors.
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Affiliation(s)
- Nedime Sahinoglu-Keskek
- Baskent University Faculty of Medicine, Adana Research and Training Center, Department of Ophthalmology, Adana, Turkey.
| | - Figen Sermet
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Batabyal S, Kim S, Wright W, Mohanty S. Laser-assisted targeted gene delivery to degenerated retina improves retinal function. JOURNAL OF BIOPHOTONICS 2021; 14:e202000234. [PMID: 33026157 DOI: 10.1002/jbio.202000234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
Delivery of therapeutic genes into retina is proving to reverse degeneration and restore vision, however, viral vector-based gene delivery is prone to immunorejection, inflammatory/immune-response and nontargeted. Here, we report nonviral gene delivery and expression of opsin encoding genes in mouse retina in-vitro and in-vivo by use of pulsed femtosecond laser microbeam. In-vitro patch-clamp recording of the opsin-sensitized retinal cells and visually evoked in-vivo electrical recording from laser-transfected eye of mouse with degenerated retina showed functional response. The ultrafast laser-based naked gene delivery showed minimal damage and reliable expression of therapeutic opsin in cell membrane of the selected cells and in targeted retinal region. Laser-based "naked DNA gene therapy" in a spatially targeted manner will pave the way for treatment of inherited retinal diseases.
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Ocular Imaging for Enhancing the Understanding, Assessment, and Management of Age-Related Macular Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:33-66. [PMID: 33847997 DOI: 10.1007/978-3-030-66014-7_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Age-related macular degeneration (AMD) is a progressive neuro-retinal disease and the leading cause of central vision loss among elderly individuals in the developed countries. Modern ocular imaging technologies constitute an essential component of the evaluation of these patients and have contributed extensively to our understanding of the disease. A challenge with any review of ocular imaging technologies is the rapid pace of progress and evolution of these instruments. Nonetheless, for proper and optimal use of these technologies, it is essential for the user to understand the technical principles underlying the imaging modality and their role in assessing the disease in various settings. Indeed, AMD, like many other retinal diseases, benefits from a multimodal imaging approach to optimally characterize the disease. In this chapter, we will review the various imaging technologies currently used in the assessment and management of AMD.
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Age-Related Macular Degeneration: Epidemiology and Clinical Aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:1-31. [PMID: 33847996 DOI: 10.1007/978-3-030-66014-7_1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Age-related macular degeneration (AMD) is a degenerative disease of the human retina affecting individuals over the age of 55 years. This heterogeneous condition arises from a complex interplay between age, genetics, and environmental factors including smoking and diet. It is the leading cause of blindness in industrialized countries. Worldwide, the number of people with AMD is predicted to increase from 196 million in 2020 to 288 million by 2040. By this time, Asia is predicted to have the largest number of people with the disease. Distinct patterns of AMD prevalence and phenotype are seen between geographical areas that are not explained fully by disparities in population structures. AMD is classified into early, intermediate, and late stages. The early and intermediate stages, when visual symptoms are typically absent or mild, are characterized by macular deposits (drusen) and pigmentary abnormalities. Through risk prediction calculators, grading these features helps predict the risk of progression to late AMD. Late AMD is divided into neovascular and atrophic forms, though these can coexist. The defining lesions are macular neovascularization and geographic atrophy, respectively. At this stage, visual symptoms are often severe and irreversible, and can comprise profoundly decreased central vision in both eyes. For these reasons, the condition has major implications for individuals and society, as affected individuals may experience substantially decreased quality of life and independence. Recent advances in retinal imaging have led to the recognition of an expanded set of AMD phenotypes, including reticular pseudodrusen, nonexudative macular neovascularization, and subtypes of atrophy. These developments may lead to refinements in current classification systems.
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Cleland SC, Konda SM, Danis RP, Huang Y, Myers DJ, Blodi BA, Domalpally A. Quantification of Geographic Atrophy Using Spectral Domain OCT in Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2021; 5:41-48. [DOI: 10.1016/j.oret.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/23/2020] [Accepted: 07/08/2020] [Indexed: 01/16/2023]
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Yeong JL, Loveman E, Colquitt JL, Royle P, Waugh N, Lois N. Visual cycle modulators versus placebo or observation for the prevention and treatment of geographic atrophy due to age-related macular degeneration. Cochrane Database Syst Rev 2020; 12:CD013154. [PMID: 33331670 PMCID: PMC10726984 DOI: 10.1002/14651858.cd013154.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a highly prevalent condition in an ever-increasing elderly population. Although insidious in the early stages, advanced AMD (neovascular and atrophic forms) can cause significant visual disability and economic burden on health systems worldwide. The most common form, geographic atrophy, has no effective treatment to date, whereas neovascular AMD can be treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Geographic atrophy has a slow disease progression and patients tend to have preserved central vision until the final stages. This tendency, coupled with the use of modern imaging modalities, provides a large window of opportunity to intervene with validated methods to assess treatment efficacy. As geographic atrophy is an increasingly common condition with no effective intervention, many treatments are under investigation, one of which is visual cycle modulators. These medications have been shown to reduce lipofuscin accumulation in pre-clinical studies that have led to several clinical trials, reviewed herein. OBJECTIVES To assess the efficacy and safety of visual cycle modulators for the prevention and treatment of geographic atrophy secondary to AMD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2020, Issue 1); MEDLINE Ovid; Embase Ovid; Web of Science Core Collection; Scopus; Association for Research in Vision and Ophthalmology (ARVO) website; ClinicalTrials.gov and the WHO ICTRP to 11 January 2020 with no language restrictions. We also searched using the reference lists of reviews and existing studies and the Cited Reference Search function in Web of Science to identify further relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-randomised clinical studies (if available) that compared visual cycle modulators to placebo or no treatment (observation) in people diagnosed with AMD (early, intermediate or geographic atrophy). DATA COLLECTION AND ANALYSIS Two authors independently assessed risk of bias in the included studies and extracted data. Both authors entered data into RevMan 5. We resolved discrepancies through discussion. We graded the certainty of the evidence using the GRADE approach. MAIN RESULTS We included three RCTs from the USA; one of these had clinical sites in Germany. Two studies compared emixustat to placebo while the other compared fenretinide to placebo. All assigned one study eye per participant and, combined, have a total of 821 participants with a majority white ethnicity (97.6%). All participants were diagnosed with geographic atrophy due to AMD based on validated imaging modalities. All three studies have high risk of attrition bias mainly due to ocular adverse effects of emixustat and fenretinide. We considered only one study to be adequately conducted and reported with high risk of bias in only one domain (attrition bias). We considered the other two studies to be poorly reported and to have high risk of attrition bias and reporting bias. People with geographic atrophy treated with emixustat may not experience a clinically important change in best-corrected visual acuity (BCVA) between baseline and 24 months compared to people treated with placebo (mean difference (MD) 1.9 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, 95% confidence interval (CI) -2.34 to 6.14, low-certainty evidence). Emixustat may also result in little or no difference in loss of 15 ETDRS letters or more of BCVA compared with placebo at 24 months (16.4% versus 18%) (risk ratio (RR) 0.91, 95% CI 0.59 to 1.4, low-certainty evidence). In terms of disease progression, emixustat may result in little or no difference in the annual growth rate of geographic atrophy compared with placebo (mean difference MD 0.09 mm2/year (95% CI -0.26 to 0.44, low-certainty evidence). All three studies reported adverse events of both drugs (emixustat: moderate-certainty evidence; fenretinide: low-certainty evidence). The main adverse events were ocular in nature and associated with the mechanism of action of the drugs. Delayed dark adaptation (emixustat: 54.5%; fenretinide: 39.3%) and chromatopsia (emixustat: 22.6%; fenretinide: 25.2%) were the most common adverse events reported, and were the most prevalent reasons for study dropout in emixustat trials. These effects were dose-dependent and resolved after drug cessation. No specific systemic adverse events were considered related to emixustat; only pruritus and rash were considered to be due to fenretinide. One emixustat study reported six deaths, none deemed related to the drug. None of the included RCTs reported the other pre-specified outcomes, including proportion of participants losing 10 letters or more, and mean change in macular sensitivity. We planned to investigate progression to advanced AMD (geographic atrophy or neovascular AMD) in prevention studies, including participants with early or intermediate AMD, but we identified no such studies. Two of the included studies reported an additional outcome - incidence of choroidal neovascularisation (CNV) - that was not in our published protocol. CNV onset may be reduced in those treated with emixustat but the evidence was uncertain (risk ratio (RR) 0.67, 95% CI 0.27 to 1.65, low-certainty evidence), or fenretinide (RR 0.5, 95% CI 0.26 to 0.98, low-certainty evidence) compared to placebo. A dose-dependent relationship was observed with emixustat. AUTHORS' CONCLUSIONS There is limited evidence to support the use of visual cycle modulators (emixustat and fenretinide) for the treatment of established geographic atrophy due to AMD. The possible reduction in the incidence of CNV observed with fenretinide, and to a lesser extent, emixustat, requires formal assessment in focused studies.
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Affiliation(s)
- Jian Lee Yeong
- Belfast and Social Care Trust, Royal Victoria Hospital, Belfast, UK
| | | | | | - Pamela Royle
- Warwick Evidence, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Norman Waugh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
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Optical Coherence Tomography Angiography in Intermediate and Late Age-Related Macular Degeneration: Review of Current Technical Aspects and Applications. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10248865] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Optical coherence tomography angiography (OCTA) is a non-invasive diagnostic instrument that has become indispensable for the management of age-related macular degeneration (AMD). OCTA allows quickly visualizing retinal and choroidal microvasculature, and in the last years, its use has increased in clinical practice as well as for research into the pathophysiology of AMD. This review provides a discussion of new technology and application of OCTA in intermediate and late AMD.
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93
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Shen LL, Sun M, Ahluwalia A, Young BK, Park MM, Del Priore LV. Geographic Atrophy Growth Is Strongly Related to Lesion Perimeter: Unifying Effects of Lesion Area, Number, and Circularity on Growth. Ophthalmol Retina 2020; 5:868-878. [PMID: 33307218 DOI: 10.1016/j.oret.2020.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the underlying reason for the previously observed impact of baseline lesion size, number, and circularity on geographic atrophy (GA) growth rate. DESIGN Retrospective analysis of a multicenter, prospective, randomized controlled trial. PARTICIPANTS Age-Related Eye Disease Study participants with GA secondary to nonexudative age-related macular degeneration. METHODS We manually delineated atrophic lesions on color fundus photographs of 318 eyes with GA followed up over at least 2 visits (mean follow-up duration, 5.1 ± 3.0 years). We calculated GA area growth rate for each eye based on the first and last visit. GA perimeter-adjusted growth rate was defined as the ratio between GA area growth rate and mean GA perimeter between the first and last visit for each eye. MAIN OUTCOME MEASURES GA area growth rate, growth rate of the square root of GA area, and GA perimeter-adjusted growth rate. RESULTS GA area growth rate was correlated strongly with mean GA perimeter (r2 = 0.66). GA area growth rate was associated with baseline GA area (r2 = 0.39; P < 0.001), lesion number (r2 = 0.10; P < 0.001), and circularity index (r2 = 0.28; P < 0.001). The use of the square root of GA area reduced the influence of baseline GA area (but not lesion number or circularity) on GA growth rate. In comparison, GA perimeter-adjusted growth rate (0.098 ± 0.062 mm/year) was not correlated with baseline GA area (r2 = 0.005; P = 0.20), lesion number (r2 = 0.00009; P = 0.86), or circularity index (r2 = 0.007; P = 0.14). GA perimeter-adjusted growth rate was 50.0% higher in eyes whose fellow eyes showed GA at any visit (0.102 ± 0.062 mm/year) than in eyes whose fellow eyes never demonstrated GA during follow-up (0.068 ± 0.049 mm/year). CONCLUSIONS The growth rate of GA area is associated strongly with lesion perimeter. This relationship explains the previously observed influences of baseline GA size, lesion number, and circularity on GA growth rate. GA perimeter-adjusted growth rate is uncorrelated with the 3 morphologic factors and may serve as a surrogate outcome measure to monitor GA progression in future studies.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Mengyuan Sun
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Michael M Park
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Lucian V Del Priore
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.
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Spooner KL, Fraser-Bell S, Cozzi M, Staurenghi G, Invernizzi A, Monteduro D, Munk MR, Hong T, Chang AA. Macular Atrophy Incidence and Progression in Eyes with Neovascular Age-Related Macular Degeneration Treated with Vascular Endothelial Growth Factor Inhibitors Using a Treat-and-Extend or a Pro Re Nata Regimen. Ophthalmology 2020; 127:1663-1673. [DOI: 10.1016/j.ophtha.2020.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/12/2023] Open
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Julien‐Schraermeyer S, Illing B, Tschulakow A, Taubitz T, Guezguez J, Burnet M, Schraermeyer U. Penetration, distribution, and elimination of remofuscin/soraprazan in Stargardt mouse eyes following a single intravitreal injection using pharmacokinetics and transmission electron microscopic autoradiography: Implication for the local treatment of Stargardt's disease and dry age-related macular degeneration. Pharmacol Res Perspect 2020; 8:e00683. [PMID: 33164337 PMCID: PMC7649431 DOI: 10.1002/prp2.683] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of blindness in older people in the developed world while Stargardt's disease (SD) is a juvenile macular degeneration and an orphan disease. Both diseases are untreatable and are marked by accumulation of lipofuscin advancing to progressive deterioration of the retinal pigment epithelium (RPE) and retina and subsequent vision loss till blindness. We discovered that a small molecule belonging to the tetrahydropyridoether class of compounds, soraprazan renamed remofuscin, is able to remove existing lipofuscin from the RPE. This study investigated the drug penetration, distribution, and elimination into the eyes of a mouse model for increased lipofuscinogenesis, following a single intravitreal injection. We measured the time course of concentrations of remofuscin in different eye tissues using high-performance liquid chromatography combined with mass spectroscopy (HPLC-MS). We also visualized the penetration and distribution of 3 H-remofuscin in eye sections up to 20 weeks post-injection using transmission electron microscopic (TEM) autoradiography. The distribution of silver grains revealed that remofuscin accumulated specifically in the RPE by binding to the RPE pigments (melanin, lipofuscin and melanolipofuscin) and that it was still detected after 20 weeks. Importantly, the melanosomes in choroidal melanocytes only rarely bind remofuscin emphasizing its potential to serve as an active ingredient in the RPE for the treatment of SD and dry AMD. In addition, our study highlights the importance of electron microscopic autoradiography as it is the only method able to show drug binding with a high intracellular resolution.
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Affiliation(s)
- Sylvie Julien‐Schraermeyer
- Division of Experimental Vitreoretinal SurgeryCentre for OphthalmologyUniversity of TuebingenTübingenGermany
- STZ Ocutox ‐ Preclinical Drug AssessmentHechingenGermany
| | - Barbara Illing
- Division of Experimental Vitreoretinal SurgeryCentre for OphthalmologyUniversity of TuebingenTübingenGermany
| | - Alexander Tschulakow
- Division of Experimental Vitreoretinal SurgeryCentre for OphthalmologyUniversity of TuebingenTübingenGermany
- STZ Ocutox ‐ Preclinical Drug AssessmentHechingenGermany
| | - Tatjana Taubitz
- Division of Experimental Vitreoretinal SurgeryCentre for OphthalmologyUniversity of TuebingenTübingenGermany
| | | | | | - Ulrich Schraermeyer
- Division of Experimental Vitreoretinal SurgeryCentre for OphthalmologyUniversity of TuebingenTübingenGermany
- STZ Ocutox ‐ Preclinical Drug AssessmentHechingenGermany
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96
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RECLASSIFICATION OF FUNDUS AUTOFLUORESCENCE PATTERNS SURROUNDING GEOGRAPHIC ATROPHY BASED ON PROGRESSION RATE: A Systematic Review and Meta-Analysis. Retina 2020; 39:1829-1839. [PMID: 30829988 DOI: 10.1097/iae.0000000000002480] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To reclassify fundus autofluorescence (FAF) patterns around geographic atrophy (GA) based on GA progression rates. METHODS MEDLINE, EMBASE, Cochrane Library, Clinicaltrials.gov, and PubMed were searched for studies reporting GA progression rates among different FAF patterns, such as "None," "Focal," "Banded," "Patchy," "Diffuse Nontrickling," and "Diffuse Trickling." The GA radius growth rate among different FAF patterns was compared, and a GA growth function for each group was derived. To account for the patients' different entry times, a horizontal translation factor was introduced to shift each data subset from "time after enrollment" to "duration of GA." RESULTS Seven studies with 496 eyes were included. Based on GA radius growth rates, the six FAF patterns were clustered into four groups with a high correlation coefficient within each group: Group 1, None, 0.061 mm/year (r = 0.996), Group 2, Focal, 0.105 mm/year (r = 0.987), Group 3, Banded, Patchy, and Diffuse Nontrickling, 0.149 mm/year (r = 0.993), and Group 4, "Diffuse Trickling, 0.245 mm/year (r = 0.997). CONCLUSION This meta-analysis suggested that the six FAF patterns can be coalesced into four groups based on lesion progression rates. Simplification of the reclassified FAF patterns may shed light on the GA natural history and assist in the design of clinical trials.
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97
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Zhang Y, Zhang X, Ji Z, Niu S, Leng T, Rubin DL, Yuan S, Chen Q. An integrated time adaptive geographic atrophy prediction model for SD-OCT images. Med Image Anal 2020; 68:101893. [PMID: 33260118 DOI: 10.1016/j.media.2020.101893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 05/15/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022]
Abstract
The automated prediction of geographic atrophy (GA) lesion growth can help ophthalmologists understand how the GA progresses, and assess the efficiency of current treatment and the prognosis of the disease. We developed an integrated time adaptive prediction model for identifying the location of future GA growth. The proposed model was comprised of bi-directional long short-term memory (BiLSTM) network-based prediction module and convolutional neural network (CNN)-based refinement module. Considering the discontinuity of time intervals among sequential follow-up visits, we integrated time factors into BiLSTM-based prediction module to control the time attribute expediently. Then, the results from prediction module were refined by a CNN-based strategy to obtain the final locations of future GA growth. The 10 scenarios were designed to evaluate the prediction accuracy of our proposed model. The 1-6th scenarios demonstrated the importance of the prior information similarity, the 7-8th scenarios verified the effect of time factors and refinement methods respectively and the 9th scenario compared the prediction results between those using a single follow-up visit for training and using 2 sequential follow-up visits for training. The 10th scenario showed the model generalization performance across regions. The average dice indexes (DI) of the predicted GA regions in the 1-6th scenarios are 0.86, 0.89, 0.89, 0.92 and 0.88, 0.90, respectively. By integrating time factors to the BiLSTM models, the prediction accuracy was improved by almost 10%. The CNN-based refinement strategy can remove the wrong GA regions effectively to preserve the actual GA regions and improve the prediction accuracy further. The prediction results based on 2 sequential follow-up visits showed higher correlations than that based on single follow-up visit. The proposed model presented a good generalization performance while training patients and testing patients were from different regions. Experimental results demonstrated the importance of prior information to the prediction accuracy. We demonstrate the feasibility of creating a model for disease prediction.
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Affiliation(s)
- Yuhan Zhang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, China
| | - Xiwei Zhang
- School of Computer Science and Engineering, Nanjing University of Science and Technology, China
| | - Zexuan Ji
- School of Computer Science and Engineering, Nanjing University of Science and Technology, China
| | - Sijie Niu
- School of Information Science and Engineering, University of Jinan, China
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA 94303, United States
| | - Daniel L Rubin
- Department of Radiology, Stanford University, Stanford, CA 94305, United States; Medicine (Biomedical Informatics Research), Stanford University, Stanford, CA 94305, United States
| | - Songtao Yuan
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, China
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, China.
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98
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Kaarniranta K, Uusitalo H, Blasiak J, Felszeghy S, Kannan R, Kauppinen A, Salminen A, Sinha D, Ferrington D. Mechanisms of mitochondrial dysfunction and their impact on age-related macular degeneration. Prog Retin Eye Res 2020; 79:100858. [PMID: 32298788 PMCID: PMC7650008 DOI: 10.1016/j.preteyeres.2020.100858] [Citation(s) in RCA: 258] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 12/21/2022]
Abstract
Oxidative stress-induced damage to the retinal pigment epithelium (RPE) is considered to be a key factor in age-related macular degeneration (AMD) pathology. RPE cells are constantly exposed to oxidative stress that may lead to the accumulation of damaged cellular proteins, lipids, nucleic acids, and cellular organelles, including mitochondria. The ubiquitin-proteasome and the lysosomal/autophagy pathways are the two major proteolytic systems to remove damaged proteins and organelles. There is increasing evidence that proteostasis is disturbed in RPE as evidenced by lysosomal lipofuscin and extracellular drusen accumulation in AMD. Nuclear factor-erythroid 2-related factor-2 (NFE2L2) and peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) are master transcription factors in the regulation of antioxidant enzymes, clearance systems, and biogenesis of mitochondria. The precise cause of RPE degeneration and the onset and progression of AMD are not fully understood. However, mitochondria dysfunction, increased reactive oxygen species (ROS) production, and mitochondrial DNA (mtDNA) damage are observed together with increased protein aggregation and inflammation in AMD. In contrast, functional mitochondria prevent RPE cells damage and suppress inflammation. Here, we will discuss the role of mitochondria in RPE degeneration and AMD pathology focused on mtDNA damage and repair, autophagy/mitophagy signaling, and regulation of inflammation. Mitochondria are putative therapeutic targets to prevent or treat AMD.
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Affiliation(s)
- Kai Kaarniranta
- Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland and Kuopio University Hospital, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Hannu Uusitalo
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland and Tays Eye Centre, Tampere University Hospital, P.O.Box 2000, 33521 Tampere, Finland
| | - Janusz Blasiak
- Department of Molecular Genetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236, Lodz, Poland
| | - Szabolcs Felszeghy
- Department of Biomedicine, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Ram Kannan
- The Stephen J. Ryan Initiative for Macular Research (RIMR), Doheny Eye Institute, 1355 San Pablo St, Los Angeles, CA, 90033, USA
| | - Anu Kauppinen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Antero Salminen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Debasish Sinha
- Glia Research Laboratory, Department of Ophthalmology, University of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, PA 15224, USA; Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Room M035 Robert and Clarice Smith Bldg, 400 N Broadway, Baltimore, MD, 21287, USA
| | - Deborah Ferrington
- Department of Ophthalmology and Visual Neurosciences, 2001 6th St SE, University of Minnesota, Minneapolis, MN 55455, USA
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Deep Learning-Based Classification of Inherited Retinal Diseases Using Fundus Autofluorescence. J Clin Med 2020; 9:jcm9103303. [PMID: 33066661 PMCID: PMC7602508 DOI: 10.3390/jcm9103303] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/13/2023] Open
Abstract
Background. In recent years, deep learning has been increasingly applied to a vast array of ophthalmological diseases. Inherited retinal diseases (IRD) are rare genetic conditions with a distinctive phenotype on fundus autofluorescence imaging (FAF). Our purpose was to automatically classify different IRDs by means of FAF images using a deep learning algorithm. Methods. In this study, FAF images of patients with retinitis pigmentosa (RP), Best disease (BD), Stargardt disease (STGD), as well as a healthy comparable group were used to train a multilayer deep convolutional neural network (CNN) to differentiate FAF images between each type of IRD and normal FAF. The CNN was trained and validated with 389 FAF images. Established augmentation techniques were used. An Adam optimizer was used for training. For subsequent testing, the built classifiers were then tested with 94 untrained FAF images. Results. For the inherited retinal disease classifiers, global accuracy was 0.95. The precision-recall area under the curve (PRC-AUC) averaged 0.988 for BD, 0.999 for RP, 0.996 for STGD, and 0.989 for healthy controls. Conclusions. This study describes the use of a deep learning-based algorithm to automatically detect and classify inherited retinal disease in FAF. Hereby, the created classifiers showed excellent results. With further developments, this model may be a diagnostic tool and may give relevant information for future therapeutic approaches.
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100
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Kabanarou SA, Bontzos G, Xirou T, Kapsala Z, Dimitriou E, Theodossiadis P, Chatziralli I. Multimodal Imaging for the Assessment of Geographic Atrophy in Patients with "Foveal" and "No-Foveal" Sparing. Ophthalmic Res 2020; 64:675-683. [PMID: 33027784 DOI: 10.1159/000512103] [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: 06/12/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate the applicability of optical coherence tomography (OCT) angiography (OCTA) for measuring geographic atrophy (GA) areas in age-related macular degeneration (AMD) patients with "foveal" and "no-foveal" sparing disease and compare it to other imaging modalities. METHODS A multimodal imaging protocol was applied, using infrared (IR) imaging, fundus autofluorescence (FAF), OCTA, and en-face OCT in 35 eyes of 23 AMD patients with GA. Patients were classified into 2 groups, with and without foveal sparing disease. GA area measurements for all imaging modalities were compared for each group separately. RESULTS The measured GA area was estimated to be 6.68 ± 3.18 mm2 using IR; 6.99 ± 3.09 mm2 using FAF; 6.56 ± 3.11 mm2 using OCTA, and 6.65 ± 3.14 mm2 using en-face OCT. There was no statistically significant difference in the GA area between different modalities (p = 0.977). When separate analysis was conducted for patients with "foveal" and "no-foveal" sparing disease, although GA measurements in FAF imaging displayed higher numerical values than the other modalities, especially in patients with foveal sparing, no statistically significant difference in the GA area was found between the different imaging modalities in either group (p = 0.816 for foveal sparing; p = 0.992 for no-foveal sparing group). CONCLUSIONS OCTA can be reliably used in the assessment of GA in AMD patients with and without foveal sparing disease. For both groups, measurements are comparable to IR, en-face OCT, and FAF, despite the fact that the latter recorded larger area of GA, mainly in the foveal sparing cases.
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Affiliation(s)
| | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio Benakio Hospital, Athens, Greece
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio Benakio Hospital, Athens, Greece
| | - Zoi Kapsala
- Department of Ophthalmology, Hippokration General Hospital, Athens, Greece
| | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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