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PROGRESSION OF MACULAR ATROPHY IN EYES WITH TYPE 1 NEOVASCULARIZATION AND AGE-RELATED MACULAR DEGENERATION RECEIVING LONG-TERM INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY: An Optical Coherence Tomographic Angiography Analysis. Retina 2018; 38:1276-1288. [PMID: 28723848 DOI: 10.1097/iae.0000000000001766] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the size and location of macular atrophy in eyes with Type-1 neovascularization (NV) and age-related macular degeneration receiving chronic intravitreal anti-vascular endothelial growth factor therapy. METHODS A retrospective review of a case series of 27 eyes with Type-1 NV and retinal pigment epithelial detachment (PED) having a minimum of 12 months follow-up was performed. Demographic information and visual acuity at baseline and the final follow-up were collected. Spectral-domain optical coherence tomography (OCT) and near-infrared reflectance were analyzed at 6-month intervals to detect and measure macular atrophy. Location and area (in square millimeter) of macular atrophy were measured using Heidelberg software tools. Also, OCT angiography was used to colocalize the area of Type-1 NV flow versus the location of atrophy. RESULTS Twenty-seven eyes of 27 patients were included in this analysis. The median visual acuity was 20/50, mean age was 82.7 years, and mean number of injections was 29.5. A larger percentage of eyes (59.3%) developed atrophy predominantly eccentric to the PED versus predominantly overlying the PED (11.1%) when measured with spectral-domain OCT and near-infrared imaging. At the final follow-up, there was a larger area of atrophy surrounding the fibrovascular PED (mean, 3.326 mm) than overlying it (mean, 0.542 mm), and this was statistically significant (P = 0.0118). En-face OCT images were overlaid with OCT angiography in 11 eyes, and a predominantly eccentric pattern of atrophy was identified in 9 of 11 eyes. Using this method, the mean area of atrophy predominantly overlying the Type-1 NV was 1.652 mm (range of 0-10.464 mm), whereas the area of atrophy predominantly eccentric to the neovascular complex was 4.345 mm (range of 0.705-13.758 mm), and this was statistically significant (P = 0.0465). The average rate of atrophy progression was 1.04 mm/year (SD 0.938). CONCLUSION With long-term anti-vascular endothelial growth factor therapy for eyes with Type-1 NV secondary to age-related macular degeneration, macular atrophy tends to develop predominantly eccentric to the PED and the neovascular flow imaged on OCT angiography. With chronic vascular endothelial growth factor suppression, Type-1 NV may evolve into a multilayered PED that may confer a protective effect to the overlying retinal pigment epithelium and outer retina.
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Ying GS, Maguire MG, Pan W, Grunwald JE, Daniel E, Jaffe GJ, Toth CA, Hagstrom SA, Martin DF. Baseline Predictors for Five-Year Visual Acuity Outcomes in the Comparison of AMD Treatment Trials. Ophthalmol Retina 2018; 2:525-530. [PMID: 29938247 DOI: 10.1016/j.oret.2017.10.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose To determine baseline predictors of visual acuity (VA) outcomes at 5 years after initiating treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). Design Secondary analysis of data from a cohort study. Participants Patients enrolled in the Comparison of AMD Treatments Trials (CATT) who completed a 5-year follow-up visit. Methods Participants were randomly assigned to ranibizumab or bevacizumab and to 1 of 3 dosing regimens. After two years, patients were released from the clinical trial protocol, and were recalled for examination at 5 years. Trained readers evaluated baseline lesion features, fluid and thickness. Baseline predictors were determined using univariate and multivariate regression analysis. Main Outcome Measures VA score and change from baseline, ≥3-line gain, and VA 20/200 or worse at 5 years. Results Among 647 patients with VA measured at 5 years, mean VA score in the study eye was 58.9 letters (≈20/63), mean decrease from baseline was 3.3 letters, 17.6% eyes gained ≥3 lines, and 19.9% had VA of 20/200 or worse. In multivariate analysis, worse baseline VA was associated with worse VA, more VA gain, higher percentage with ≥3-line gain, and higher percentage with 20/200 or worse at 5 years (all p<0.001). Larger baseline CNV lesion area was associated with worse VA, greater VA loss, and higher percentage with 20/200 or worse at 5 years (all p<0.05). Absence of baseline subretinal fluid was associated with worse VA (p=0.03) and more VA loss (p=0.03). Female gender, bevacizumab treatment in the first 2 years, and absence of RPE elevation were associated with higher percentage with ≥3-line gain. Cigarette smoking was associated with a higher percentage with 20/200 or worse. None of the 21 SNPs evaluated were associated with VA outcomes. Conclusions Five years after initiating treatment with ranibizumab or bevacizumab in CATT participants, worse baseline VA, larger baseline CNV lesion area, and presence of baseline RPE elevation remained independently associated with worse VA at 5 years. In addition, male gender, cigarette smoking, absence of subretinal fluid and treatment with ranibizumab in the first 2 years were independently associated with worse vision outcomes at 5 years.
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Affiliation(s)
- Gui-Shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Wei Pan
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Juan E Grunwald
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Kanadani TCM, Veloso CE, Nehemy MB. Subfoveal Choroidal Thickness in Eyes with Neovascular Age-Related Macular Degeneration Treated with Anti-Vascular Endothelial Growth Factor Agents. Ophthalmologica 2018; 240:200-207. [PMID: 29768266 DOI: 10.1159/000488254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/07/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE We aimed to assess the subfoveal choroidal thickness (SFChT) and the effect of treatment with anti-vascular endothelial growth factor (anti-VEGF) agents on the SFChT in age-related macular degeneration (AMD) subtypes. METHODS We enrolled 128 eyes of 107 patients with neovascular AMD (60 women; 47 men; mean age, 73.6 ± 8.9 years), and prospectively evaluated the best-corrected visual acuity (BCVA) and SFChT at baseline and at 3, 6, and 12 months after treatment with anti-VEGF agents. Patients were assigned to the typical AMD, polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP) subgroups. RESULTS In total, 85 (66.4%), 31 (24.2%), and 12 (9.4%) eyes were assigned to the typical AMD, PCV, and RAP subgroups, respectively. The baseline mean BCVA was 0.75 ± 0.26, 0.72 ± 0.21, and 0.77 ± 0.24 logMAR in the typical AMD, PCV, and RAP subgroups, respectively (p = 0.774). The mean baseline SFChT was 203.20 ± 35.80, 271.80 ± 24.50, and 182.93 ± 31.31 µm, respectively (p < 0.001). Mean SFChT significantly decreased from baseline to 3, 6, and 12 months after treatment. The RAP subtype presented a significantly higher decrease in SFChT compared to the other subtypes (p = 0.01). The percentage reduction in SFChT was not significantly correlated with the number of injections (r = -0.02; p = 0.823). No association was observed between baseline SFChT and final visual acuity at 12 months (r = 0.0; p = 0.586). CONCLUSIONS SFChT was greatest in eyes with PCV and least in eyes with RAP. The reduction in SFChT after treatment was greater in the RAP cases. The decrease in SFChT after 12 months of anti-VEGF treatment was not associated with the number of injections and there was no correlation between the baseline SFChT and visual acuity in all AMD subtypes.
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Asano S, Azuma K, Shimizu K, Yamamoto R, Lee J, Murata H, Inoue T, Asaoka R, Obata R. Choroidal structure as a biomarker for visual acuity in intravitreal aflibercept therapy for polypoidal choroidal vasculopathy. PLoS One 2018; 13:e0197042. [PMID: 29746511 PMCID: PMC5945009 DOI: 10.1371/journal.pone.0197042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/25/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the relationship between choroidal structure and visual acuity after intravitreal aflibercept therapy for polypoidal choroidal vasculopathy (PCV). METHODS We conducted a retrospective, single-centre and observational study including 18 eyes of 18 patients with PCV (73.8 ± 10.2 years of age) who were treated with three monthly intravitreal aflibercept injections followed by additional treatments in a treat-and-extend protocol. The cross-sectional images of the macula were obtained with enhanced depth imaging optical coherence tomography at baseline, at 3 months, and at 12 months. The choroidal layer was divided into luminal or stromal segments by applying binarization processing to calculate these areas. The relationships between age, spherical equivalent, best-corrected visual acuity (BCVA), baseline value, or changes in the luminal or the stromal areas, and the BCVA change at 12 months were analysed using multiple regression analyses and model selection procedures. RESULTS Both stromal and luminal areas were decreased at 3 and 12 months compared to baseline areas (5% and 9% at 3 months, 6% and 12% at 12 months, p < 0.0001, p < 0.0001, p < 0.0001 and p < 0.0001, respectively). Greater improvement of visual acuity (VA) at 12 months was significantly associated with younger age, greater spherical equivalent, worse baseline BCVA, greater baseline luminal area, and smaller baseline stromal area. CONCLUSIONS Choroidal structure might be useful as a new biomarker for potential Visual outcomes after intravitreal aflibercept therapy for PCV.
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Affiliation(s)
- Shotaro Asano
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kimiko Shimizu
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Risako Yamamoto
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Hiroshi Murata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
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Cheung CMG, Lai TY, Ruamviboonsuk P, Chen SJ, Chen Y, Freund KB, Gomi F, Koh AH, Lee WK, Wong TY. Polypoidal Choroidal Vasculopathy. Ophthalmology 2018; 125:708-724. [DOI: 10.1016/j.ophtha.2017.11.019] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022] Open
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Hanumunthadu D, Ruiz-Medrano J, Dumpala S, Jabeen A, Jabeen A, Goud A, Ruiz-Moreno JM, Chhablani J. Comparison of choroidal vessel thickness in children and adult eyes by enhanced-depth imaging optical coherence tomography imaging. Int J Ophthalmol 2018; 11:681-686. [PMID: 29675391 DOI: 10.18240/ijo.2018.04.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 02/07/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate choroidal thickness, medium choroidal vessel thickness (MCVT) and large choroidal vessel thickness (LCVT) in normal children and adult subjects. METHODS Manual measurements of subfoveal choroidal thickness (SFCT), MCVT and LCVT at subfoveal and 750 µm nasal and temporal to fovea locations were completed on enhanced-depth imaging optical coherence tomography (EDI-OCT) scans of normal children and adult subjects. RESULTS Fifty adult and fifty-seven child subjects were included in the study (including 80 adult and 103 child eyes). Mean (±SD) SFCT of adult and children eyes in the study was 309.3±95.7 µm and 279.3±50.4 µm respectively. SFCT and subfoveal MCVT in adult eyes were significantly more than children (P=0.01 and P≤0.0001 respectively). CONCLUSION There is choroidal thickening with associated thickening of medium choroidal vessels in adults, suggesting that there is alteration in choroidal vasculature with ageing.
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Affiliation(s)
- Daren Hanumunthadu
- Moorfields Eye Hospital National Health Service Foundation Trust, London, EC1V 2PD, United Kingdom
| | - Jorge Ruiz-Medrano
- Ophthalmology Unit, Clínico San Carlos University Hospital, Madrid 28040, Spain.,Alicante Institute of Ophthalmology, Vissum Corporation, Alicante 03016, Spain
| | - Sunila Dumpala
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Ayesha Jabeen
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Asiya Jabeen
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Abhilash Goud
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad 500034, India
| | - José M Ruiz-Moreno
- Alicante Institute of Ophthalmology, Vissum Corporation, Alicante 03016, Spain.,Department of Ophthalmology, Castilla La Mancha University, Albacete 13071, Spain
| | - Jay Chhablani
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad 500034, India
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Inter- and intraobserver repeatability and reproducibility of choroidal thickness measurements using two different methods. Int Ophthalmol 2018; 39:1061-1069. [DOI: 10.1007/s10792-018-0909-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
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Zhao J, Wang YX, Zhang Q, Wei WB, Xu L, Jonas JB. Macular Choroidal Small-Vessel Layer, Sattler's Layer and Haller's Layer Thicknesses: The Beijing Eye Study. Sci Rep 2018. [PMID: 29535365 PMCID: PMC5849687 DOI: 10.1038/s41598-018-22745-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
To study macular choroidal layer thickness, 3187 study participants from the population-based Beijing Eye Study underwent spectral-domain optical coherence tomography with enhanced depth imaging for thickness measurements of the macular small-vessel layer, including the choriocapillaris, medium-sized choroidal vessel layer (Sattler’s layer) and large choroidal vessel layer (Haller’s layer). In multivariate analysis, greater thickness of all three choroidal layers was associated (all P < 0.05) with higher prevalence of age-related macular degeneration (AMD) (except for geographic atrophy), while it was not significantly (all P > 0.05) associated with the prevalence of open-angle glaucoma or diabetic retinopathy. There was a tendency (0.07 > P > 0.02) toward thinner choroidal layers in chronic angle-closure glaucoma. The ratio of small-vessel layer thickness to total choroidal thickness increased (P < 0.001; multivariate analysis) with older age and longer axial length, while the ratios of Sattler’s layer and Haller’s layer thickness to total choroidal thickness decreased. A higher ratio of small-vessel layer thickness to total choroidal thickness was significantly associated with a lower prevalence of AMD (early type, intermediate type, late geographic type). Axial elongation-associated and aging-associated choroidal thinning affected Haller’s and Sattler’s layers more markedly than the small-vessel layer. Non-exudative and exudative AMD, except for geographic atrophy, was associated with slightly increased choroidal thickness.
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Affiliation(s)
- Jing Zhao
- Beijing Institute of Ophthalmology and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Qi Zhang
- Beijing Institute of Ophthalmology and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Liang Xu
- Beijing Institute of Ophthalmology and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Jost B Jonas
- Beijing Institute of Ophthalmology and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Wei X, Ting DSW, Ng WY, Khandelwal N, Agrawal R, Cheung CMG. CHOROIDAL VASCULARITY INDEX: A Novel Optical Coherence Tomography Based Parameter in Patients With Exudative Age-Related Macular Degeneration. Retina 2018; 37:1120-1125. [PMID: 27632714 DOI: 10.1097/iae.0000000000001312] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate choroidal structural changes in exudative age-related macular degeneration (AMD) using choroidal vascularity index computed from image binarization on spectral domain optical coherence tomography with enhanced depth imaging. METHODS This prospective case series included 42 consecutive patients with unilateral exudative AMD. Choroidal images were segmented into luminal area and stromal area. Choroidal vascularity index was defined as the ratio of luminal area to total choroid area. Mean choroidal vascularity index and mean choroidal thickness between study and fellow eyes of the same patient with dry AMD were compared using Student's t-test. RESULTS There was a significantly lower choroidal vascularity index in eyes with exudative AMD (60.14 ± 4.55 vs. 62.75 ± 4.82, P < 0.01). Luminal area (P < 0.01) was decreased in eyes with exudative AMD but there was no significant difference in total choroid area (P = 0.05) and choroidal thickness (P = 0.93) between study and fellow eyes. CONCLUSION Eyes with exudative AMD demonstrated reduced choroidal vascularity index but insignificant differences in choroidal thickness compared with their fellow eyes. Choroidal vascularity index may be a potential noninvasive tool for studying structural changes in choroid and monitoring choroidal disease in exudative AMD.
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Affiliation(s)
- Xin Wei
- *National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; †Singapore Eye Research Institute, Singapore, Singapore; and ‡Singapore National Eye Centre, Singapore, Singapore
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Ashraf M, Souka A, Adelman RA. ASSOCIATION BETWEEN THE VITREOMACULAR INTERFACE AND OPTICAL COHERENCE TOMOGRAPHY CHARACTERISTICS IN WET AGE-RELATED MACULAR DEGENERATION. Retina 2018; 37:1738-1745. [PMID: 28005632 DOI: 10.1097/iae.0000000000001423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To study the effect of the vitreomacular interface on various wet age-related macular degeneration (AMD) characteristics including the size and type of choroidal neovascularization (CNV), choroidal thickness, and activity of the CNV. METHODS This was a retrospective observational cross-sectional study. The study included 43 patients (51 eyes) with treatment-naive age-related macular degeneration. Twenty-six patients with wet AMD in one eye and dry AMD in the other eye were included in a paired-eye analysis. Patients underwent optical coherence tomography examination using Heidelberg Spectralis (spectral domain optical coherence tomography) at presentation to determine the type of CNV and the vitreomacular status. In addition, various parameters were measured including the choroidal thickness and horizontal width and vertical height measurements of the CNV. RESULTS There was no correlation between the height, width, activity or type of the CNV, and the presence or absence of vitreomacular adhesion. The mean choroidal thickness (using enhanced depth imaging) in cases with vitreomacular adhesion was 272.57 μm compared with 197.32 μm in cases with no vitreomacular adhesion, a statistically significant difference (P = 0.003). In the paired-eye study (21 patients), there was no significant difference between the eyes with wet AMD and dry AMD with regard to vitreomacular status or the choroidal thickness. In a subgroup analysis, patients with Type 1 CNV had a significantly higher percentage of vitreomacular adhesion compared with the other eye with dry AMD (P = 0.034). CONCLUSION In conclusion, the vitreomacular interface does seem to be associated with an increased choroidal thickness in cases of wet AMD. Furthermore, the association between the vitreomacular interface and wet AMD is more significant for Type 1 CNV.
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Affiliation(s)
- Mohammed Ashraf
- *Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; and †Department of Ophthalmology and Visual Studies, Yale Medical School, European Vitreo-retinal Society (EVRS)
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Ting DSW, Cheung CYL, Lim G, Tan GSW, Quang ND, Gan A, Hamzah H, Garcia-Franco R, San Yeo IY, Lee SY, Wong EYM, Sabanayagam C, Baskaran M, Ibrahim F, Tan NC, Finkelstein EA, Lamoureux EL, Wong IY, Bressler NM, Sivaprasad S, Varma R, Jonas JB, He MG, Cheng CY, Cheung GCM, Aung T, Hsu W, Lee ML, Wong TY. Development and Validation of a Deep Learning System for Diabetic Retinopathy and Related Eye Diseases Using Retinal Images From Multiethnic Populations With Diabetes. JAMA 2017; 318:2211-2223. [PMID: 29234807 PMCID: PMC5820739 DOI: 10.1001/jama.2017.18152] [Citation(s) in RCA: 1106] [Impact Index Per Article: 158.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE A deep learning system (DLS) is a machine learning technology with potential for screening diabetic retinopathy and related eye diseases. OBJECTIVE To evaluate the performance of a DLS in detecting referable diabetic retinopathy, vision-threatening diabetic retinopathy, possible glaucoma, and age-related macular degeneration (AMD) in community and clinic-based multiethnic populations with diabetes. DESIGN, SETTING, AND PARTICIPANTS Diagnostic performance of a DLS for diabetic retinopathy and related eye diseases was evaluated using 494 661 retinal images. A DLS was trained for detecting diabetic retinopathy (using 76 370 images), possible glaucoma (125 189 images), and AMD (72 610 images), and performance of DLS was evaluated for detecting diabetic retinopathy (using 112 648 images), possible glaucoma (71 896 images), and AMD (35 948 images). Training of the DLS was completed in May 2016, and validation of the DLS was completed in May 2017 for detection of referable diabetic retinopathy (moderate nonproliferative diabetic retinopathy or worse) and vision-threatening diabetic retinopathy (severe nonproliferative diabetic retinopathy or worse) using a primary validation data set in the Singapore National Diabetic Retinopathy Screening Program and 10 multiethnic cohorts with diabetes. EXPOSURES Use of a deep learning system. MAIN OUTCOMES AND MEASURES Area under the receiver operating characteristic curve (AUC) and sensitivity and specificity of the DLS with professional graders (retinal specialists, general ophthalmologists, trained graders, or optometrists) as the reference standard. RESULTS In the primary validation dataset (n = 14 880 patients; 71 896 images; mean [SD] age, 60.2 [2.2] years; 54.6% men), the prevalence of referable diabetic retinopathy was 3.0%; vision-threatening diabetic retinopathy, 0.6%; possible glaucoma, 0.1%; and AMD, 2.5%. The AUC of the DLS for referable diabetic retinopathy was 0.936 (95% CI, 0.925-0.943), sensitivity was 90.5% (95% CI, 87.3%-93.0%), and specificity was 91.6% (95% CI, 91.0%-92.2%). For vision-threatening diabetic retinopathy, AUC was 0.958 (95% CI, 0.956-0.961), sensitivity was 100% (95% CI, 94.1%-100.0%), and specificity was 91.1% (95% CI, 90.7%-91.4%). For possible glaucoma, AUC was 0.942 (95% CI, 0.929-0.954), sensitivity was 96.4% (95% CI, 81.7%-99.9%), and specificity was 87.2% (95% CI, 86.8%-87.5%). For AMD, AUC was 0.931 (95% CI, 0.928-0.935), sensitivity was 93.2% (95% CI, 91.1%-99.8%), and specificity was 88.7% (95% CI, 88.3%-89.0%). For referable diabetic retinopathy in the 10 additional datasets, AUC range was 0.889 to 0.983 (n = 40 752 images). CONCLUSIONS AND RELEVANCE In this evaluation of retinal images from multiethnic cohorts of patients with diabetes, the DLS had high sensitivity and specificity for identifying diabetic retinopathy and related eye diseases. Further research is necessary to evaluate the applicability of the DLS in health care settings and the utility of the DLS to improve vision outcomes.
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Affiliation(s)
- Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Carol Yim-Lui Cheung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gilbert Lim
- School of Computing, National University of Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Nguyen D. Quang
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Alfred Gan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Haslina Hamzah
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | | | - Ian Yew San Yeo
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Edmund Yick Mun Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Farah Ibrahim
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ngiap Chuan Tan
- Duke-NUS Medical School, National University of Singapore, Singapore
- SingHealth Polyclinic, Singapore Health Service, Singapore
| | - Eric A. Finkelstein
- Lien Center for Palliative Care, Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore
| | - Ecosse L. Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ian Y. Wong
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China
| | | | - Sobha Sivaprasad
- Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Rohit Varma
- University of Southern California Gayle and Edward Roski Eye Institute, Los Angeles, California
| | - Jost B. Jonas
- Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Ming Guang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yatsen University, Guangzhou, China
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Gemmy Chui Ming Cheung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Wynne Hsu
- School of Computing, National University of Singapore
| | - Mong Li Lee
- School of Computing, National University of Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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Abstract
PURPOSE To assess the choroidal thickness in advanced primary open-angle glaucoma (POAG) comparing patients affected by advanced glaucoma and normal subject using spectral domain optical coherence tomography (SD-OCT). METHODS In total, 35 eyes of 35 patients affected by POAG with advanced perimetric defect (mean deviation worse than -12 dB) were prospectively enrolled and underwent a complete ophthalmologic examination, including enhanced depth imaging SD-OCT. One eye of 35 healthy subjects served as control group. Choroidal thickness was measured at the subfoveal location, at 0.5, 1.0, and 2.0 mm nasal and temporal to the fovea. Primary outcome measure was the identification of different choroidal thickness between advanced glaucoma patients and normal subjects. RESULTS Glaucoma and control group were homogenous for age, sex, and axial length (P>0.05 in all cases). A significant difference was found in the subfoveal choroidal thickness (SFCT) adjusted for age and axial length between glaucoma and control eyes (P=0.042); in glaucoma patients the mean adjusted SFCT was 209.90 μm compared with 234.78 μm in control subjects. Both temporal and nasal choroidal thickness measurements followed the same SFCT trend, even if only temporal ones were statistically significant. We also found that SFCT decreased with age and increased axial length (P=0.007 and 0.001, respectively). Sex and intraocular pressure did not significantly influence the choroidal thickness (P=0.87 and 0.35, respectively). CONCLUSIONS Patients affected by advanced POAG damage have a thinner choroidal thickness compared with normal subjects, using SD-OCT. We also confirmed that age and axial length were the main factors affecting choroidal thickness in these patients.
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DETAILED CHARACTERIZATION OF CHOROIDAL MORPHOLOGIC AND VASCULAR FEATURES IN AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY. Retina 2017; 37:2269-2280. [DOI: 10.1097/iae.0000000000001481] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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64
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Cheung CMG, Gan A, Fan Q, Chee ML, Apte RS, Khor CC, Yeo I, Mathur R, Cheng CY, Wong TY, Tai ES. Plasma lipoprotein subfraction concentrations are associated with lipid metabolism and age-related macular degeneration. J Lipid Res 2017; 58:1785-1796. [PMID: 28698208 PMCID: PMC5580892 DOI: 10.1194/jlr.m073684] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 07/06/2017] [Indexed: 01/09/2023] Open
Abstract
Disturbance in lipid metabolism has been suggested as a major pathogenic factor for age-related macular degeneration (AMD). Conventional lipid measures have been inconsistently associated with AMD. Other factors that can alter lipid metabolism include lipoprotein phenotype and genetic mutations. We performed a case-control study to examine the association between lipoprotein profile and neovascular AMD (nAMD) and whether the cholesterylester transfer protein (CETP) D442G mutation modulates these associations. Patients with nAMD had significantly higher concentrations of HDL and IDL compared with controls. The increase in HDL particles in nAMD patients was driven by an excess of medium-sized particles. Concurrently, patients with nAMD also had lower Apo A-1, lower VLDL and chylomicron lipoprotein. Many of these associations showed a dose-dependent association between controls, early AMD cases, and nAMD cases. Adjustment for the presence of the D442G mutation at the CETP locus did not significantly alter the increased AMD risk associated with HDL particle concentration. AMD is associated with variation in many lipoprotein subclasses, including increased HDL and IDL particles and decreased Apo A-1, VLDL, and chylomicron particles. These data suggest widespread systemic disturbance in lipid metabolism in the pathogenesis of AMD, including possible alterations in lipoprotein carrier capacity.
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Affiliation(s)
- Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Program, Duke-NUS Medical School, National University of Singapore, Singapore.
| | - Alfred Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Qiao Fan
- Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Miao Ling Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Rajendra S Apte
- Ophthalmology and Visual Sciences, Developmental Biology and Medicine, Washington University School of Medicine, St. Louis, MO
| | | | - Ian Yeo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ranjana Mathur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - E Shyong Tai
- Department of Medicine, Cardiovascular and Metabolic Disorders Programme, National University of Singapore, Singapore
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65
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Ting DSW, Yanagi Y, Agrawal R, Teo HY, Seen S, Yeo IYS, Mathur R, Chan CM, Lee SY, Wong EYM, Wong D, Wong TY, Cheung GCM. Choroidal Remodeling in Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: A 12-month Prospective Study. Sci Rep 2017; 7:7868. [PMID: 28801615 PMCID: PMC5554201 DOI: 10.1038/s41598-017-08276-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/10/2017] [Indexed: 12/23/2022] Open
Abstract
Choroid thinning occurs in age-related macular degeneration (AMD). However, it remains unclear whether the reduction is due to reduction in choroidal vessels or shrinkage of choroidal stroma, or both. The purpose of this study was to evaluate the changes of the choroidal vascular and stromal area in 118 patients with typical AMD (t-AMD) and polypoidal choroidal vasculopathy (PCV) over a 12-month period. We used spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode to measure the subfoveal choroidal thickness (CT), central retinal thickness (CRT) and choroidal vascularity index (CVI - ratio of luminal area to total choroidal area). At baseline, PCV eyes had higher CRT (471.6 µm vs 439.1 µm, p = 0.02), but comparable subfoveal CT and CVI, compared to t-AMD. Eyes with high CVI at baseline showed marked reduction in stromal area compared with eyes with average or low CVI. Over 12 months, CRT and subfoveal CT significantly decreased (p < 0.001) in both subtypes. Eyes with high baseline CVI showed significant CVI reduction from baseline to month 12 (p < 0.001), whereas eyes with average to low baseline CVI showed increase in CVI. These differences in choroidal vascularity may reflect different predominant pathogenic processes and remodeling in AMD eyes with varying spectrum.
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Affiliation(s)
- Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, 168751, Singapore
| | - Yasuo Yanagi
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, 168751, Singapore
| | - Rupesh Agrawal
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore.,Nanyang Technology University, Singapore, Singapore
| | - Hwei Yee Teo
- National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sophia Seen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ian Yew San Yeo
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, 168751, Singapore
| | - Ranjana Mathur
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, 168751, Singapore
| | - Choi Mun Chan
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, 168751, Singapore
| | - Edmund Yick Mun Wong
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, 168751, Singapore
| | - Doric Wong
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, 168751, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Duke-NUS Medical School, Singapore, 168751, Singapore
| | - Gemmy Chui Ming Cheung
- Singapore Eye Research Institute, Singapore National Eye Center 11 Third Hospital Avenue, Singapore, 168751, Singapore. .,Duke-NUS Medical School, Singapore, 168751, Singapore.
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66
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Choroidal structures in polypoidal choroidal vasculopathy, neovascular age-related maculopathy, and healthy eyes determined by binarization of swept source optical coherence tomographic images. Graefes Arch Clin Exp Ophthalmol 2017; 255:935-943. [PMID: 28150038 DOI: 10.1007/s00417-017-3591-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/27/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate quantitatively the choroidal vascularity in polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (AMD) patients compared to healthy controls. METHODS All eyes underwent swept source optical coherence tomography (OCT), and choroidal images were binarized into blood vessels lumen and stroma. The choroidal vascular index (CVI) was defined as the ratio of luminal area (LA) over total choroidal area of the subfoveal region with a width of 1500 μm. RESULTS The study included 73 patients with neovascular AMD or PCV with mean ± standard deviation (SD) age of 71.8 ± 9.3 years, which was older than the mean age of 65.1 ± 10.8 years of 72 healthy eyes from control group (p < 0.01). The 44 PCV eyes had significantly higher mean SFCT of 214.23 ± 95.21 μm than neovascular AMD eyes (172.74 ± 96.48 μm, p = 0.03) and greater luminal area (0.23 ± 0.09 mm2 vs. 0.19 ± 0.08 mm2, p = 0.05). After adjusting for age, axial length, and gender in multivariate regression analysis, the SFCT of PCV and neovascular AMD eyes were not significantly different from healthy eyes (195.55 ± 93.11 μm), but the CVI of both PCV (64.94 ± 5.43%, p = 0.01) and neovascular AMD (62.54 ± 5.57%, p = <0.01) were significantly lower than control (68.53 ± 5.91%). CONCLUSION Despite physiological changes of choroidal vasculature due to aging, the choroidal morphology is different in PCV, neovascular AMD and healthy eyes, which has implication on disease pathogenesis.
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67
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Phadikar P, Saxena S, Ruia S, Lai TYY, Meyer CH, Eliott D. The potential of spectral domain optical coherence tomography imaging based retinal biomarkers. Int J Retina Vitreous 2017; 3:1. [PMID: 28078103 PMCID: PMC5220620 DOI: 10.1186/s40942-016-0054-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/07/2016] [Indexed: 01/01/2023] Open
Abstract
Background Biomarker”, a merged word of “biological marker”, refers to a broad subcategory of medical signs that objectively indicate the state of health, and well-being of an individual. Biomarkers hold great promise for personalized medicine as information gained from diagnostic or progression markers can be used to tailor treatment to the individual for highly effective intervention in the disease process. Optical coherence tomography (OCT) has proved useful in identifying various biomarkers in ocular and systemic diseases. Main body Spectral domain optical coherence tomography imaging-based biomarkers provide a valuable tool for detecting the earlier stages of the disease, tracking progression, and monitoring treatment response. The aim of this review article is to analyze various OCT based imaging biomarkers and their potential to be considered as surrogate endpoints for diabetic retinopathy, age related macular degeneration, retinitis pigmentosa and vitreomacular interface disorder. These OCT based surrogate markers have been classified as retinal structural alterations (macular central subfield thickness and cube average thickness); retinal ultrastructural alterations (disruption of external limiting membrane and ellipsoid zone, thinning of retinal nerve fiber layer and ganglion cell layer); intraretinal microangiopathic changes; choroidal surrogate endpoints; and vitreoretinal interface endpoints. Conclusion OCT technology is changing very quickly and throughout this review there are some of the multiple possibilities that OCT based imaging biomarkers will be more useful in the near future for diagnosis, prognosticating disease progression and as endpoint in clinical trials.
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Affiliation(s)
- Prateep Phadikar
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Sandeep Saxena
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Surabhi Ruia
- Department of Ophthalmology, King George's Medical University, Lucknow, U.P. 226003 India
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carsten H Meyer
- Department of Ophthalmology, Pallas Klinik, Aarau, Switzerland
| | - Dean Eliott
- Harvard Medical School, Massachusetts Eye and Ear, Boston, MA USA
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Ranjbar M, Kurz M, Holzhey A, Melchert C, Rades D, Grisanti S. Stereotactic radiotherapy in neovascular age-related macular degeneration: Real-life efficacy and morphological evaluation of the outer retina-choroid complex. Medicine (Baltimore) 2016; 95:e5729. [PMID: 28033280 PMCID: PMC5207576 DOI: 10.1097/md.0000000000005729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/18/2016] [Accepted: 11/23/2016] [Indexed: 01/09/2023] Open
Abstract
Stereotactic radiotherapy (SRT) is a new approach to treat neovascular age-related macular degeneration (nAMD). The INTREPID trial suggested that SRT could reduce the frequency of regular intravitreal injections (IVIs) with antivascular endothelial growth factor drugs, which are necessary to control disease activity. However, the efficacy of SRT in nAMD and resulting morphological changes have not been validated under real-life circumstances, an issue, which we would like to address in this retrospective analysis.Patients who met the INTREPID criteria for best responders were eligible for SRT. A total of 32 eyes of 32 patients were treated. Thereafter, patients were examined monthly for 12 months and received pro re nata IVI of aflibercept or ranibizumab. Outcome measures were: mean number of injections, best-corrected visual acuity, and morphological changes of the outer retina-choroid complex as well as patient safety.Mean number of IVI decreased by almost 50% during the 12 months after SRT compared to the year before, whereas visual acuity increased by one line (logMAR). Morphological evaluation showed that most changes affect outer retinal layers.Stereotactic radiotherapy significantly reduced IVI retreatment in nAMD patients under real-life circumstances. Therefore, SRT might be the first step to stop visual loss as a result of IVI undertreatment, which is a major risk.
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Affiliation(s)
- Mahdy Ranjbar
- Department of Ophthalmology
- Laboratory for Angiogenesis & Ocular Cell Transplantation
| | - Maximilian Kurz
- Department of Ophthalmology
- Laboratory for Angiogenesis & Ocular Cell Transplantation
| | | | - Corinna Melchert
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Vuong VS, Moisseiev E, Cunefare D, Farsiu S, Moshiri A, Yiu G. Repeatability of Choroidal Thickness Measurements on Enhanced Depth Imaging Optical Coherence Tomography Using Different Posterior Boundaries. Am J Ophthalmol 2016; 169:104-112. [PMID: 27345731 DOI: 10.1016/j.ajo.2016.06.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the reliability of manual choroidal thickness measurements by comparing different posterior boundary definitions of the choroidal-scleral junction on enhanced depth imaging optical coherence tomography (EDI-OCT). DESIGN Reliability analysis. METHODS Two graders marked the choroidal-scleral junction with segmentation software using different posterior boundaries: (1) the outer border of the choroidal vessel lumen, (2) the outer border of the choroid stroma, and (3) the inner border of the sclera, to measure the vascular choroidal thickness (VCT), stromal choroidal thickness (SCT), and total choroidal thickness (TCT), respectively. Measurements were taken at 0.5-mm intervals from 1.5 mm nasal to 1.5 mm temporal to the fovea, and averaged continuously across the central 3 mm of the macula. Intraclass correlation coefficient (ICC) and coefficient of reliability (CR) were compared to assess intergrader and intragrader reliability. RESULTS Choroidal thickness measurements varied significantly with different posterior boundaries (P < .001 for all). Intergrader ICCs were greater for SCT (0.959-0.980) than for TCT (0.928-0.963) and VCT (0.750-0.869), even in eyes where choroidal-scleral junction visibility was <75%. Intergrader CRs were lower for SCT (41.40-62.31) than for TCT (61.13-74.24) or VCT (72.44-115.11). ICCs and CRs showed greater reliability for averaged VCT, SCT, or TCT measurements than at individual locations. Intragrader ICCs and CRs were comparable to intergrader values. CONCLUSIONS Choroidal thickness measurements are more reproducible when measured to the border of the choroid stroma (SCT) than the vascular lumen (VCT) or sclera (TCT).
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Affiliation(s)
- Vivian S Vuong
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California; School of Medicine, University of California, Davis, Sacramento, California
| | - Elad Moisseiev
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California
| | - David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California.
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Govetto A, Sarraf D, Figueroa MS, Pierro L, Ippolito M, Risser G, Bandello F, Hubschman JP. Choroidal thickness in non-neovascular versus neovascular age-related macular degeneration: a fellow eye comparative study. Br J Ophthalmol 2016; 101:764-769. [PMID: 27587716 DOI: 10.1136/bjophthalmol-2016-309281] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 08/07/2016] [Accepted: 08/14/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate the possible differences in choroidal thickness (CT) between non-neovascular (NNV) and neovascular (NV) age-related macular degeneration (AMD). METHODS A retrospective, observational chart review of consecutive patients diagnosed with NNV AMD in one eye and with NV AMD in the fellow eye was carried out. NNV AMD was classified into four subgroups according to the Beckman Initiative for Macular Research AMD Classification Committee Meeting. CT was manually assessed using enhanced depth imaging optical coherence tomography from 1500 µm nasal to 1500 µm temporal to the fovea. Parametric and non-parametric tests were used to compare quantitative variables, a χ2 test was used to compare categorical variables and logistic regression was used to evaluate associations of CT with other variables of interest. RESULTS In this study, 322 eyes from 161 patients were included and 102 (63.35%) were female and 59 (36.65%) were male, with a mean age of 80.80±8.45 years (range 58-99 years). Mean follow-up was 11.2±10.8 months (range 1-38 months). In NNV AMD eyes, the choroid was significantly thicker in the subfoveal and temporal regions of the macula, if compared with NV AMD fellow eyes. Differences in CT between NNV AMD and NV AMD fellow eyes were higher at earlier stages of NNV AMD. CONCLUSIONS Subfoveal and temporal choroid was significantly thicker in NNV AMD compared with NV AMD fellow eyes. There was a significant choroidal thinning at advanced stages of NNV AMD.
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Affiliation(s)
- Andrea Govetto
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, USA
| | - Marta S Figueroa
- Ophthalmology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Luisa Pierro
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Mario Ippolito
- Ophthalmology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Grégoire Risser
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
| | - Francesco Bandello
- Ophthalmology Department, San Raffaele University Hospital, Milan, Italy
| | - Jean Pierre Hubschman
- Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California, USA
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