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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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Al-Khuzaei S, Shah M, Foster CR, Yu J, Broadgate S, Halford S, Downes SM. The role of multimodal imaging and vision function testing in ABCA4-related retinopathies and their relevance to future therapeutic interventions. Ther Adv Ophthalmol 2021; 13:25158414211056384. [PMID: 34988368 PMCID: PMC8721514 DOI: 10.1177/25158414211056384] [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] [Received: 06/19/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this review article is to describe the specific features of Stargardt disease and ABCA4 retinopathies (ABCA4R) using multimodal imaging and functional testing and to highlight their relevance to potential therapeutic interventions. Standardised measures of tissue loss, tissue function and rate of change over time using formal structured deep phenotyping in Stargardt disease and ABCA4R are key in diagnosis, and prognosis as well as when selecting cohorts for therapeutic intervention. In addition, a meticulous documentation of natural history will be invaluable in the future to compare treated with untreated retinas. Despite the familiarity with the term Stargardt disease, this eponymous classification alone is unhelpful when evaluating ABCA4R, as the ABCA4 gene is associated with a number of phenotypes, and a range of severity. Multimodal imaging, psychophysical and electrophysiologic measurements are necessary in diagnosing and characterising these differing retinopathies. A wide range of retinal dystrophy phenotypes are seen in association with ABCA4 mutations. In this article, these will be referred to as ABCA4R. These different phenotypes and the existence of phenocopies present a significant challenge to the clinician. Careful phenotypic characterisation coupled with the genotype enables the clinician to provide an accurate diagnosis, associated inheritance pattern and information regarding prognosis and management. This is particularly relevant now for recruiting to therapeutic trials, and in the future when therapies become available. The importance of accurate genotype-phenotype correlation studies cannot be overemphasised. This approach together with segregation studies can be vital in the identification of causal mutations when variants in more than one gene are being considered as possible. In this article, we give an overview of the current imaging, psychophysical and electrophysiological investigations, as well as current therapeutic research trials for retinopathies associated with the ABCA4 gene.
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Affiliation(s)
- Saoud Al-Khuzaei
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mital Shah
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - Stephanie Halford
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Susan M. Downes
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6 John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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53
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Vujosevic S, Toma C, Nucci P, Brambilla M, De Cillà S. Quantitative Color Fundus Autofluorescence in Patients with Diabetes Mellitus. J Clin Med 2020; 10:E48. [PMID: 33375699 PMCID: PMC7796312 DOI: 10.3390/jcm10010048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/19/2020] [Indexed: 01/09/2023] Open
Abstract
A new short wavelength confocal blue-light 450 nm-fundus autofluorescence (color-FAF) allows for visualization of minor fluorophores (e.g., advanced glycation end products, AGEs), besides lipofuscin. The aim of the present pilot study was to quantitatively evaluate color-FAF in patients with diabetes mellitus (DM) and to correlate these data with different stages of retinal disease severity. Optical coherence tomography and color-FAF images of 193 patients/eyes and 18 controls were analyzed using a custom software for quantification of the long (red) and short (green) wavelength components of the emission spectrum (REFC/GEFC). Measurements were performed in nine quadrants of the 6-mm ETDRS macular grid. Foveal GEFC and REFC intensities were higher in patients with DM compared to controls (p = 0.015 and p = 0.006 respectively) and in eyes with center involving diabetic macular edema (DME) compared to eyes without DME (p < 0.001). A positive correlation was found between GEFC and REFC intensities and central retinal thickness, r = 0.37 (p < 0.001) and r = 0.42 (p < 0.001), respectively. No differences were found in color-FAF among different DR severity groups. Quantitative color-FAF could become helpful for the metabolic evaluation of retina in patients with DM and in DME; however, further histologic and immunohistochemical studies on distribution of different retinal fluorophores in DM are needed to better understand its role.
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Affiliation(s)
- Stela Vujosevic
- Eye Clinic, IRCCS MultiMedica, 20123 Milan, Italy
- University Hospital Maggiore della Carità, Eye Clinic, 28100 Novara, Italy; (C.T.); (S.D.C.)
| | - Caterina Toma
- University Hospital Maggiore della Carità, Eye Clinic, 28100 Novara, Italy; (C.T.); (S.D.C.)
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy;
| | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore della Carità, 28100 Novara, Italy;
| | - Stefano De Cillà
- University Hospital Maggiore della Carità, Eye Clinic, 28100 Novara, Italy; (C.T.); (S.D.C.)
- Department of Health Sciences, University East Piedmont “A. Avogadro”, 28100 Novara, Italy
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Bermond K, Wobbe C, Tarau IS, Heintzmann R, Hillenkamp J, Curcio CA, Sloan KR, Ach T. Autofluorescent Granules of the Human Retinal Pigment Epithelium: Phenotypes, Intracellular Distribution, and Age-Related Topography. Invest Ophthalmol Vis Sci 2020; 61:35. [PMID: 32433758 PMCID: PMC7405767 DOI: 10.1167/iovs.61.5.35] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The human retinal pigment epithelium (RPE) accumulates granules significant for autofluorescence imaging. Knowledge of intracellular accumulation and distribution is limited. Using high-resolution microscopy techniques, we determined the total number of granules per cell, intracellular distribution, and changes related to retinal topography and age. Methods RPE cells from the fovea, perifovea, and near-periphery of 15 human RPE flat mounts were imaged using structured illumination microscopy (SIM) and confocal fluorescence microscopy in young (≤51 years, n = 8) and older (>80 years, n = 7) donors. Using custom FIJI plugins, granules were marked with computer assistance, classified based on morphological and autofluorescence properties, and analyzed with regard to intracellular distribution, total number per cell, and granule density. Results A total of 193,096 granules in 450 RPE cell bodies were analyzed. Based on autofluorescence properties, size, and composition, the RPE granules exhibited nine different phenotypes (lipofuscin, two; melanolipofuscin, five; melanosomes, two), distinguishable by SIM. Overall, lipofuscin (low at the fovea but increases with eccentricity and age) and melanolipofuscin (equally distributed at all three locations with no age-related changes) were the major granule types. Melanosomes were under-represented due to suboptimal visualization of apical processes in flat mounts. Conclusions Low lipofuscin and high melanolipofuscin content within foveal RPE cell bodies and abundant lipofuscin at the perifovea suggest a different genesis, plausibly related to the population of overlying photoreceptors (fovea, cones only; perifovea, highest rod density). This systematic analysis provides further insight into RPE cell and granule physiology and links granule load to cell autofluorescence, providing a subcellular basis for the interpretation of clinical fundus autofluorescence.
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Hernández Da Mota SE, Béjar Cornejo F, Esquivel Velázquez M, Lima Gómez V, González Saldívar G, Rodríguez Ayala E, Vélez-Montoya R. Autofluorescence indexes as biomarkers for antiangiogenic loading dose outcome in diabetic macular edema. Ther Adv Ophthalmol 2020; 12:2515841420942662. [PMID: 32923937 PMCID: PMC7450463 DOI: 10.1177/2515841420942662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: To evaluate the combination of fundus autofluorescence results with several
clinical and structural variables into mathematical indexes to enhance their
ability to predict visual and anatomical changes after the antivascular
endothelial growth factor loading dose. Methods: Patients with diabetic macular edema were enrolled. Each patient had a
comprehensive ophthalmological examination, contrast sensitivity, optical
coherence tomography, and fundus autofluorescence assessment. All patients
received three monthly doses of ziv-aflibercept and were followed each month
for response assessment. Autofluorescence was classified according to its
level into five grades. The grades were combined with other variables
(best-corrected visual acuity, contrast sensitivity, central macular
thickness, macular cube volume, and macular cube average thickness) into
normalized indexes. Statistical assessment was done using a Spearman’s rank
correlation coefficient, linear regression, and interobserver-agreement
analysis. Results: There was a strong correlation between the fundus autofluorescence/baseline
best-corrected visual acuity index and the fundus
autofluorescence/contrast-sensitivity index at baseline with the
best-corrected visual acuity after the third dose of ziv-aflibercept
(rs = −0.78, p = .000
and rs = −0.68, p = .0009
respectively). The fundus autofluorescence/baseline best-corrected visual
acuity index and the fundus autofluorescence/contrast-sensitivity index,
both at baseline had a mild correlation with the macular volume at 1 month
of follow-up (rs = 0.56,
p = .008 and (rs = 0.64,
p = .002, respectively). Conclusion: This study suggests that it is possible to combine fundus autofluorescence
results with functional and structural variables into normalized indexes
that could potentially predict outcomes after antivascular endothelial
growth factor loading dose in patients with diabetic macular edema.
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Affiliation(s)
- Sergio E Hernández Da Mota
- Retina Department, Clínica David, Unidad oftalmológica y Facultad de Medicina, Universidad Michoacana de San Nicolás de Hidalgo, García de León 598-2, Colonia Nueva Chapultepec, CP 58280, Morelia, Michoacán, Mexico
| | | | - Marcela Esquivel Velázquez
- Laboratorio de Proteómica y Metabolómica, División de investigación, Hospital General de Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico
| | | | | | | | - Raul Vélez-Montoya
- Retina Department, Asociacion para Evitar la Ceguera en Mexico IAP, Mexico City, Mexico
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Soomro T, Shah N, Niestrata-Ortiz M, Yap T, Normando EM, Cordeiro MF. Recent advances in imaging technologies for assessment of retinal diseases. Expert Rev Med Devices 2020; 17:1095-1108. [PMID: 32885710 DOI: 10.1080/17434440.2020.1816167] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Retinal imaging is a key investigation in ophthalmology. New devices continue to be created to keep up with the demand for better imaging modalities in this field. This review looks to highlight current trends and the future of retinal imaging. AREAS COVERED This review looks at the advances in topographical imaging, photoacoustic microscopy, optical coherence tomography and molecular imaging. There is future scoping on further advances in retinal imaging. EXPERT OPINION Retinal imaging continues to develop at a rapid pace to improve diagnosis and management of patients. We will see the development of big data to gain powerful insights and new technologies such as teleophthalmology mature in the future.
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Affiliation(s)
- Taha Soomro
- Imperial College Ophthalmology Research Group, Western Eye Hospital , 153-173 Marylebone Road, London, UK
| | - Neil Shah
- Imperial College Ophthalmology Research Group, Western Eye Hospital , 153-173 Marylebone Road, London, UK
| | - Magdalena Niestrata-Ortiz
- Imperial College Ophthalmology Research Group, Western Eye Hospital , 153-173 Marylebone Road, London, UK
| | - Timothy Yap
- Imperial College Ophthalmology Research Group, Western Eye Hospital , 153-173 Marylebone Road, London, UK
| | - Eduardo M Normando
- Imperial College Ophthalmology Research Group, Western Eye Hospital , 153-173 Marylebone Road, London, UK
| | - M Francesca Cordeiro
- Imperial College Ophthalmology Research Group, Western Eye Hospital , 153-173 Marylebone Road, London, UK
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Reichel C, Berlin A, Radun V, Tarau IS, Hillenkamp J, Kleefeldt N, Sloan KR, Ach T. Quantitative Fundus Autofluorescence in Systemic Chloroquine/Hydroxychloroquine Therapy. Transl Vis Sci Technol 2020; 9:42. [PMID: 32934892 PMCID: PMC7463177 DOI: 10.1167/tvst.9.9.42] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To investigate the effect of systemic chloroquine/hydroxychloroquine (CQ/HCQ) on outer retinal health using quantitative fundus autofluorescence (QAF) imaging. Methods For this prospective, cross-sectional study, 44 CQ/HCQ patients and 25 age-matched controls underwent multimodal retinal imaging including QAF (488 nm) and spectral-domain optical coherence tomography (SD-OCT) in addition to the recommended CQ/HCQ screening procedures. Custom written FIJI plugins enabled detailed QAF analysis and correlation with retinal thickness and comparison to the healthy controls. Results Out of 44 patients, 29 (mean age 43.5 ± 12.2, range 22–59 years) exposed to CQ/HCQ (mean cumulative dose 724.2 ± 610.4 g, median 608.0 g, range 18.6–2171.0 g) met eligibility criteria. Four of these 29 patients had bull's-eye maculopathy (BEM). Mean QAF values were significantly higher in CQ/HCQ patients than in healthy controls. QAF increase started early after treatment onset, remained high even years after treatment cessation, and was not accompanied by pathologies in the other screening methods, including retinal thicknesses (except in BEM patients). Conclusions QAF might be a useful tool in retinal imaging and in verifying systemic CQ/HCQ intake. The early onset and preserved high levels of QAF parallel findings of CQ deposition in the retina in animal models. Whether QAF can be used as a screening tool to detect early CQ/HCQ related maculopathy is the subject of long-term ongoing studies. Translation Relevance Experimental QAF imaging in systemic CQ/HCQ therapy monitoring might be a useful tool to indicate the drug or its metabolites and to detect metabolic retinal changes.
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Affiliation(s)
- Clara Reichel
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Andreas Berlin
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Victoria Radun
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Ioana-Sandra Tarau
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Jost Hillenkamp
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Nikolai Kleefeldt
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Kenneth R Sloan
- University of Alabama at Birmingham, Department of Ophthalmology, Birmingham, AL, USA
| | - Thomas Ach
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany.,University Hospital Bonn, Department of Ophthalmology, Bonn, Germany
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Cozzi M, Viola F, Belotti M, Cigada M, Cherepanoff S, Staurenghi G, Invernizzi A. The In Vivo Correlation between Retinal Pigment Epithelium Thickness and Quantitative Fundus Autofluorescence in a White Population. Ophthalmol Retina 2020; 5:365-373. [PMID: 32763425 DOI: 10.1016/j.oret.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the influence of age on the thickness of the retinal pigment epithelium (RPE)/Bruch's membrane (BM) complex and the quantitative autofluorescence (qAF) and to study the possible correlation existing between these 2 parameters in a healthy White population. DESIGN Cross-sectional, observational study. PARTICIPANTS Healthy White volunteers aged 18 to 65 years. METHODS All subjects underwent spectral domain OCT (SD-OCT) and qAF imaging with the Heidelberg HRA-Spectralis (Heidelberg Engineering, Heidelberg, Germany). Spectral domain OCT images were analyzed using the in-built graph-based automatic segmentation algorithm for single retinal layer identification to assess RPE/BM complex thickness in vivo. The thickness values of both inner and outer rings of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid, generated by the software using the "RPE" segmentation, were averaged to obtain a single RPE/BM complex thickness value in each eye. Quantitative autofluorescence images were also evaluated using a dedicated software. The qAF values of 8 subfields forming a ring centered onto the fovea were collected and averaged to obtain a single qAF value (qAF8) in each eye. The correlation among the RPE/BM complex thickness, the qAF value, and the age of the subjects was investigated. MAIN OUTCOME MEASURES The in vivo correlation between RPE/BM complex thickness and qAF. RESULTS A total of 105 eyes from 105 subjects (mean age, 42.1 ± 13.9 years; range, 18-65) were included in the analysis. The mean RPE/BM complex thickness significantly increased with age (r = 0.33, P = 0.0006). The values of qAF also positively increased with age (P < 0.0001). A significant correlation was found between qAF and RPE/BM complex thickness (r = 0.27, P = 0.004). After adjusting for age, iris color, and gender, the correlation remained significant only for subjects aged less than 40 years (P = 0.009). CONCLUSIONS BM complex thickness was significantly co/BM complex thickness increased with age in a healthy White population. A similar increase was found for qAF values. After adjusting for age and iris color, qAF and RPE/BM complex thickness were still correlated in subjects aged less than 40 years. The RPE/BM complex thickness could reflect the lipofuscin/melanolipofuscin accumulation in normal subjects, adding great interest in RPE cell biology.
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Affiliation(s)
- Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-C à Granda Foundatione Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Belotti
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Mario Cigada
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Svetlana Cherepanoff
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy; The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia.
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Schmitz-Valckenberg S, Pfau M, Fleckenstein M, Staurenghi G, Sparrow JR, Bindewald-Wittich A, Spaide RF, Wolf S, Sadda SR, Holz FG. Fundus autofluorescence imaging. Prog Retin Eye Res 2020; 81:100893. [PMID: 32758681 DOI: 10.1016/j.preteyeres.2020.100893] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
Abstract
Fundus autofluorescence (FAF) imaging is an in vivo imaging method that allows for topographic mapping of naturally or pathologically occurring intrinsic fluorophores of the ocular fundus. The dominant sources are fluorophores accumulating as lipofuscin in lysosomal storage bodies in postmitotic retinal pigment epithelium cells as well as other fluorophores that may occur with disease in the outer retina and subretinal space. Photopigments of the photoreceptor outer segments as well as macular pigment and melanin at the fovea and parafovea may act as filters of the excitation light. FAF imaging has been shown to be useful with regard to understanding of pathophysiological mechanisms, diagnostics, phenotype-genotype correlation, identification of prognostic markers for disease progression, and novel outcome parameters to assess efficacy of interventional strategies in chorio-retinal diseases. More recently, the spectrum of FAF imaging has been expanded with increasing use of green in addition to blue FAF, introduction of spectrally-resolved FAF, near-infrared FAF, quantitative FAF imaging and fluorescence life time imaging (FLIO). This article gives an overview of basic principles, FAF findings in various retinal diseases and an update on recent developments.
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Affiliation(s)
- Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, USA
| | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital University of Milan, Italy
| | - Janet R Sparrow
- Departments of Ophthalmology and Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Almut Bindewald-Wittich
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Augenheilkunde Heidenheim MVZ, Heidenheim, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
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60
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Kleefeldt N, Bermond K, Tarau IS, Hillenkamp J, Berlin A, Sloan KR, Ach T. Quantitative Fundus Autofluorescence: Advanced Analysis Tools. Transl Vis Sci Technol 2020; 9:2. [PMID: 32855849 PMCID: PMC7422829 DOI: 10.1167/tvst.9.8.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/18/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose To use multimodal retinal images (including quantitative fundus autofluorescence [QAF]) for spectral-domain optical coherence tomography (SD-OCT)-based image registration and alignment. For each age decade of healthy adults, normative fine-grained QAF retinal maps are generated and advanced methods for QAF image analysis are applied. Methods Multimodal retinal images were obtained from 103 healthy subjects (age 19–77 years; unremarkable retina/macula, age-appropriate clear optic media). Custom written FIJI plugins enabled: (1) determination of the fovea in SD-OCT and the edge of the optic disc in infrared (IR) images; (2) alignment and superimposition of multimodal retinal images based on foveal and optic disc position; (3) plotting of normative QAF retinal maps for each decade; and (4) comparison of individual retinas with normative retinas of different decades using newly introduced analysis patterns (QAF97, freehand tool). Results SD-OCT based image registration enables easy image registration, alignment, and analysis of different modalities (QAF, IR, and SD-OCT here reported). In QAF, intensities significantly increase with age with two major inclines between the third/fourth and seventh/eighth decades. With aging, the parafoveal area of maximum QAF intensity slightly shifts from temporal-superior to temporal. Compared with standard QAF analysis, refined QAF analysis patterns reveal a more detailed analysis of QAF, especially in the diseased retina. Conclusions Age-related QAF normative retinal maps can be used to directly compare and classify individual's QAF intensities. Advanced QAF analysis tools will further help to interpret autofluorescence changes in normal aging and in the diseased retina in a multimodal imaging setting. Translational Relevance Advanced methods for QAF analysis link basic findings with clinical observations in normal aging and in the diseased macula.
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Affiliation(s)
- Nikolai Kleefeldt
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Katharina Bermond
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Ioana-Sandra Tarau
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Berlin
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Kenneth R Sloan
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas Ach
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
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Chen Y, Laotaweerungsawat S, Zhao T, Haq Z, Liu X, Psaras C, Yang D, Stewart JM. Discordant vascular parameter measurements in diabetic and non-diabetic eyes detected by different optical coherence tomography angiography devices. PLoS One 2020; 15:e0234664. [PMID: 32544179 PMCID: PMC7297376 DOI: 10.1371/journal.pone.0234664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/30/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To compare quantitative changes in macular parameters in diabetic patients detected by two optical coherence tomography angiography (OCTA) instruments. METHODS 80 phakic eyes were classified as no diabetes, diabetes without diabetic retinopathy (DR), mild non-proliferative diabetic retinopathy (NPDR), and severe NPDR or proliferative DR (PDR). OCTA was performed using devices from two manufacturers (Zeiss and Heidelberg). Superficial and deeper vascular skeleton density (SVSD, DVSD), superficial and deeper vessel area density (SVAD, DVAD), choriocapillaris flow voids (CCFV), and choroidal flow voids (CFV) were calculated. Inter-device comparisons were performed using the size comparison index (SCI) and the discrepancy index (DI). RESULTS The two devices were inconsistent in SVSD, DVSD, DVAD, CCFV and CFV parameters (all P < 0.05). In addition, the SCI was positive for DVAD (all P < 0.001) and negative for SVSD, DVSD, CCFV and CFV in all groups (all P <0.001), except for DVSD in severe NPDR or PDR. The discrepancy index was not significantly different among groups for SVD, SPD, DVD, DPD and CFV (all P> 0.05). The mean DI of CCFV was statistically different between the four groups (P < 0.001). CONCLUSIONS The two instruments were largely inconsistent in the measurement of macular parameters relevant to DR. The choice of imaging device can impact OCTA analytics and should be taken into account when drawing conclusions about DR-related changes.
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Affiliation(s)
- Yi Chen
- Department of Ophthalmology, University of California, San Francisco, CA, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States of America
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, China
| | - Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, CA, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States of America
- Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Tong Zhao
- Department of Ophthalmology, University of California, San Francisco, CA, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States of America
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Zeeshan Haq
- Department of Ophthalmology, University of California, San Francisco, CA, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States of America
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, CA, United States of America
| | - Catherine Psaras
- Department of Ophthalmology, University of California, San Francisco, CA, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States of America
| | - Daphne Yang
- Department of Ophthalmology, University of California, San Francisco, CA, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States of America
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, CA, United States of America
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, United States of America
- * E-mail:
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Vienola KV, Zhang M, Snyder VC, Sahel JA, Dansingani KK, Rossi EA. Microstructure of the retinal pigment epithelium near-infrared autofluorescence in healthy young eyes and in patients with AMD. Sci Rep 2020; 10:9561. [PMID: 32533046 PMCID: PMC7293312 DOI: 10.1038/s41598-020-66581-x] [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: 10/27/2019] [Accepted: 05/21/2020] [Indexed: 01/18/2023] Open
Abstract
Retinal pigmented epithelial (RPE) cells are essential for maintaining normal visual function, especially in their role in the visual cycle, and are thought to be one of the first cell classes affected by age-related macular degeneration (AMD). Clinical imaging systems routinely evaluate the structure of the RPE at the tissue level, but cellular level information may provide valuable RPE biomarkers of health, aging and disease. In this exploratory study, participants were imaged with 795 nm excitation in adaptive optics scanning laser ophthalmoscopy (AOSLO) to observe the microstructure of the near-infrared autofluorescence (AO-IRAF) from the RPE layer in healthy retinas and patients with AMD. The expected hexagonal mosaic of RPE cells was only sometimes seen in normal eyes, while AMD patients exhibited highly variable patterns of altered AO-IRAF. In some participants, AO-IRAF structure corresponding to cones was observed, as we have demonstrated previously. In some AMD patients, marked alterations in the pattern of AO-IRAF could be seen even in areas where the RPE appeared relatively normal in clinical imaging modalities, such as spectral domain optical coherence tomography (SD-OCT). AO-IRAF imaging using AOSLO offers promise for better detection and understanding of early RPE changes in the course of AMD, potentially before clinical signs appear.
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Affiliation(s)
- Kari V Vienola
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
| | - Min Zhang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Valerie C Snyder
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, 15213, USA
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63
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Orellanos-Rios J, Yokoyama S, Bhuiyan A, Gao L, Otero-Marquez O, Smith RT. Translational Retinal Imaging. Asia Pac J Ophthalmol (Phila) 2020; 9:269-277. [PMID: 32487917 PMCID: PMC7299229 DOI: 10.1097/apo.0000000000000292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/03/2020] [Indexed: 11/25/2022] Open
Abstract
The diagnosis and treatment of medical retinal disease is now inseparable from retinal imaging in all its multimodal incarnations. The purpose of this article is to present a selection of very different retinal imaging techniques that are truly translational, in the sense that they are not only new, but can guide us to new understandings of disease processes or interventions that are not accessible by present methods. Quantitative autofluorescence imaging, now available for clinical investigation, has already fundamentally changed our understanding of the role of lipofuscin in age-related macular degeneration. Hyperspectral autofluorescence imaging is bench science poised not only to unravel the molecular basis of retinal pigment epithelium fluorescence, but also to be translated into a clinical camera for earliest detection of age-related macular degeneration. The ophthalmic endoscope for vitreous surgery is a radically new retinal imaging system that enables surgical approaches heretofore impossible while it captures subretinal images of living tissue. Remote retinal imaging coupled with deep learning artificial intelligence will transform the very fabric of future medical care.
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Affiliation(s)
| | - Sho Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Aichi, Japan
| | | | - Liang Gao
- Department of Biomedical Engineering, UCLA, LA, Los Angeles, CA, USA
| | - Oscar Otero-Marquez
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R. Theodore Smith
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Cremers FPM, Lee W, Collin RWJ, Allikmets R. Clinical spectrum, genetic complexity and therapeutic approaches for retinal disease caused by ABCA4 mutations. Prog Retin Eye Res 2020; 79:100861. [PMID: 32278709 PMCID: PMC7544654 DOI: 10.1016/j.preteyeres.2020.100861] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022]
Abstract
The ABCA4 protein (then called a “rim protein”) was first
identified in 1978 in the rims and incisures of rod photoreceptors. The
corresponding gene, ABCA4, was cloned in 1997, and variants
were identified as the cause of autosomal recessive Stargardt disease (STGD1).
Over the next two decades, variation in ABCA4 has been
attributed to phenotypes other than the classically defined STGD1 or fundus
flavimaculatus, ranging from early onset and fast progressing cone-rod dystrophy
and retinitis pigmentosa-like phenotypes to very late onset cases of mostly mild
disease sometimes resembling, and confused with, age-related macular
degeneration. Similarly, analysis of the ABCA4 locus uncovered
a trove of genetic information, including >1200 disease-causing mutations
of varying severity, and of all types – missense, nonsense, small
deletions/insertions, and splicing affecting variants, of which many are located
deep-intronic. Altogether, this has greatly expanded our understanding of
complexity not only of the diseases caused by ABCA4 mutations,
but of all Mendelian diseases in general. This review provides an in depth
assessment of the cumulative knowledge of ABCA4-associated retinopathy –
clinical manifestations, genetic complexity, pathophysiology as well as current
and proposed therapeutic approaches.
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Affiliation(s)
- Frans P M Cremers
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9104, 6500 HE, Nijmegen, the Netherlands.
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, NY, 10032, USA; Department of Genetics & Development, Columbia University, New York, NY, 10032, USA
| | - Rob W J Collin
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9104, 6500 HE, Nijmegen, the Netherlands
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY, 10032, USA; Department of Pathology & Cell Biology, Columbia University, New York, NY, 10032, USA.
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Gliem M, Müller PL, Birtel J, Herrmann P, McGuinness MB, Holz FG, Charbel Issa P. Quantitative Fundus Autofluorescence and Genetic Associations in Macular, Cone, and Cone-Rod Dystrophies. Ophthalmol Retina 2020; 4:737-749. [PMID: 32646556 DOI: 10.1016/j.oret.2020.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate quantitatively lipofuscin-associated fundus autofluorescence in patients with macular and cone/cone-rod dystrophies (MD/CCRDs). DESIGN Prospective, single-center, case-control study. PARTICIPANTS Two hundred thirty patients with MD/CCRDs who had undergone genetic testing and 110 control participants without any eye disease. METHODS Participants were examined using quantitative fundus autofluorescence (qAF) imaging with a modified confocal scanning laser ophthalmoscope equipped with an internal fluorescent reference (modified Spectralis HRA-OCT; Heidelberg Engineering, Heidelberg, Germany). Mean qAF values were obtained by averaging measurements from an 8-segment ring centered on the fovea (qAF8) and compared with controls. MAIN OUTCOME MEASURES The qAF8 levels. RESULTS Elevated qAF8 values were a frequent finding (n = 105 [45%]) and associated with ABCA4 (n = 73 [70%]), PRPH2 (n = 9 [9%]), CERKL (n = 3 [3%]), PROM1 (n = 2 [2%]), CRX (n = 1 [1%]), and CDHR1 (n = 1 [1%]) mutations. Reduced qAF8 values were rare (n = 15 [7%]) and found predominantly among patients with MERTK (n = 3 [20%]) and RDH5 (n = 2 [13%]) mutations. Patients with normal qAF8 values (n = 110 [48%]) showed high genotypic heterogeneity. For various genes including ABCA4, PRPH2, CDHR1, and PROM1, higher qAF8 measures were associated with specific phenotypes and genotypes. For instance, qAF8 values were normal in PRPH2-related central areolar chorioretinal dystrophy but increased in PRPH2-related Stargardt-like retinopathy. Accordingly, high qAF8 levels were associated with specific genetic causes and mutation detection rates in characteristic but genetically heterogenous clinical phenotypes, such as a Stargardt-like flecked fundus, bull's eye maculopathy, or pattern dystrophy. In genetically unsolved cases (16 with elevated, 35 with normal, 7 with reduced qAF values), qAF8 was used to support or reject ambiguous results of genetic testing, to suggest underlying pathogenic pathways, and to predict disease in otherwise healthy participants. CONCLUSIONS Quantitative fundus autofluorescence imaging revealed characteristic qAF levels in association with certain gene mutations and in participants without detected mutations. These findings indicate that qAF may facilitate differential diagnostics of MD/CCRDs and may offer novel pathogenetic insights that may be of particular value for the assessment of future treatment approaches.
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Affiliation(s)
- Martin Gliem
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, and Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany; Centre for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Philipp L Müller
- Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany; Centre for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Johannes Birtel
- Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany; Centre for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Philipp Herrmann
- Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany; Centre for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Frank G Holz
- Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany; Centre for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, and Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
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Nafar Z, Wen R, Guan Z, Li Y, Jiao S. Quantifying lipofuscin in retinal pigment epithelium in vivo by visible-light optical coherence tomography-based multimodal imaging. Sci Rep 2020; 10:2942. [PMID: 32076069 PMCID: PMC7031367 DOI: 10.1038/s41598-020-59951-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/05/2020] [Indexed: 11/09/2022] Open
Abstract
Lipofuscin in the retinal pigment epithelium (RPE) is the major source of fundus autofluorescence (FAF). A technical challenge to accurately quantify the FAF intensities, thus the lipofuscin concentration, is to compensate the light attenuation of RPE melanin. We developed the VIS-OCT-FAF technology to accomplish optical coherence tomography (OCT) and FAF simultaneously with a single broadband visible light source. We demonstrated that light attenuation by RPE melanin can be assessed and corrected using the depth-resolved OCT signals. FAF images from albino and pigmented rats showed that without compensation, FAF signals from pigmented rats are lower than that from albinos. After compensation, however, FAF signals from pigmented rats are higher. This finding is supported by measurements of lipofuscin fluorophore A2E in the RPE using liquid chromatography/mass spectrometry (LC/MS) showing that compensated FAF intensities correlate linearly with A2E contents. The present work represents an important step toward accurately assessing RPE lipofuscin concentrations by FAF.
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Affiliation(s)
- Zahra Nafar
- Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL, 33174, USA
| | - Rong Wen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10 Ave, Miami, FL, 33136, USA.
| | - Ziqiang Guan
- Department of Biochemistry, Duke University School of Medicine, 307 Research Dr, Durham, NC, 27710, USA
| | - Yiwen Li
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10 Ave, Miami, FL, 33136, USA
| | - Shuliang Jiao
- Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL, 33174, USA.
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Long-Term Effect of Half-Fluence Photodynamic Therapy on Fundus Autofluorescence in Acute Central Serous Chorioretinopathy. J Ophthalmol 2020; 2020:8491712. [PMID: 32148947 PMCID: PMC7049425 DOI: 10.1155/2020/8491712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate normalized short-wavelength fundus autofluorescence (SW-FAF) imaging changes over time as a predictive parameter for the retinal pigment epithelium (RPE) function in eyes compromised by acute central serous chorioretinopathy (CSCR) after indocyanine green angiography-guided verteporfin (Visudyne®, Novartis Pharma, Basel, Switzerland) photodynamic therapy (PDT) with a half-fluence rate (25 J/cm2). Methods Quantitative data of SW-FAF grey values (SW-FAF GV) from a 350 μm (SW-350) and 1200 μm (SW-350) and 1200 t-test was calculated to explore the differences of SW-350 and SW-1200 between one month and the long-term follow-up. Results Mean differences (95% CI) in SW-FAF GV between 1 month and 7 years after half-fluence PDT were 0.07 ± 0.11 for SW-350 ([95% CI: −0.002; 0.14], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], p=0.06) and 0.11 ± 0.15 for SW-1200 ([95% CI: 0.01; 0.21], Conclusion After 7 years, normalized SW-FAF GV were significantly lower in eyes with resolved acute CSCR treated with reduced-fluence PDT compared to the follow-up after 1 month without correlation to explicit pattern changes or structural damages. Half-fluence PDT remains a safe and considerable treatment option in acute CSCR.
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Bindewald-Wittich A, Kellner U. [Fundus Autofluorescence Imaging: Clinical Application and Diagnostic Relevance]. Klin Monbl Augenheilkd 2020; 236:e1-e22. [PMID: 32016932 DOI: 10.1055/a-1090-5733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Non-invasive fundus autofluorescence (FAF) imaging visualizes fluorophores at the level of the photoreceptors, the subneurosensory space and the retinal pigment epithelium. It gives important information over and above other imaging techniques. FAF imaging has improved the pathophysiological understanding of various retinal diseases. In combination with fundus photography, fluorescence angiography, optical coherence tomography, and electrophysiological examinations, FAF imaging is useful with regard to diagnostics and monitoring both during the natural course and after therapies. This review highlights basic principles of FAF and its clinical application in various retinal diseases.
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69
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Bindewald-Wittich A, Swenshon T, Carasco E, Dreyhaupt J, Willerding GD. Blue-Light Fundus Autofluorescence Imaging following Ruthenium-106 Brachytherapy for Choroidal Melanoma. Ophthalmologica 2020; 243:303-315. [PMID: 31940652 DOI: 10.1159/000504715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe changes in blue-light fundus autofluorescence (FAF) and corresponding alterations in optical coherence tomography (OCT) within the irradiation field after ruthenium-106 brachytherapy (RBT) for choroidal melanoma. METHODS Consecutive patients with choroidal melanoma were included in a retrospective case series. Patients were treated with RBT at a single institution. As part of their routine examination patients underwent multimodal imaging including ultrasonography, fundus photography, OCT, and FAF imaging (excitation = 488 nm). FAF images were analysed for changes within the irradiation field. RESULTS 31 patients (mean age 65.7 years) were treated with RBT for unilateral choroidal melanoma. Mean tumour height before therapy was 2.7 mm (SD 1.0). Mean follow-up time was 23.3 months (SD 13.3). Main FAF characteristics attributable to RBT emerged as increased FAF with speckled decreased FAF (FAF mottling) within the irradiation field and a rim of increased FAF at its border. OCT scans demonstrated loss of the ellipsoid zone and the external limiting membrane, thinning of the neurosensory retina, and alterations of the retinal pigment epithelium like clumping, migration, and atrophy. CONCLUSIONS FAF changes in the irradiation field after RBT of choroidal melanomas follow a characteristic pattern that correlates with distinct OCT alterations. FAF and OCT imaging give additional information to monitor effects of RBT and, therefore, complement multimodal imaging techniques after plaque therapy.
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Affiliation(s)
- Almut Bindewald-Wittich
- Augenheilkunde Heidenheim MVZ GmbH, Heidenheim, Germany.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Tomasz Swenshon
- Department of Ophthalmology, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Eva Carasco
- Department of Ophthalmology, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Oishi A, Miyata M, Numa S, Otsuka Y, Oishi M, Tsujikawa A. Wide-field fundus autofluorescence imaging in patients with hereditary retinal degeneration: a literature review. Int J Retina Vitreous 2019; 5:23. [PMID: 31890285 PMCID: PMC6907101 DOI: 10.1186/s40942-019-0173-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Inherited retinal degeneration (IRD) refers to a heterogenous group of progressive diseases that cause death of photoreceptor cells and subsequent vision loss. These diseases often affect the peripheral retina, objective evaluation of which has been difficult until recently. Fundus autofluorescence (FAF) is a non-invasive retinal imaging technique that depicts the distribution of intrinsic fluorophores in the retina. The primary source of retinal autofluorescence is lipofuscin, which is contained in the retinal pigment epithelium (RPE). Excessive accumulation of lipofuscin and a window defect attributable to loss of photoreceptor pigment result in increased FAF whereas loss of the RPE results in decreased FAF. These changes can be seen during the course of IRD. Mainbody While conventional modalities are limited in their angle of view, recent technologic advances, known as wide-field and ultra-widefield FAF imaging, have enabled visualization of the far peripheral retina. Although clinical application of this technique in patients with IRD is still in its infancy, some studies have already indicated its usefulness. For example, an area with decreased FAF correlates well with a visual field defect in an eye with retinitis pigmentosa (RP) or cone-rod dystrophy. An abnormal FAF pattern may help in the diagnosis of IRD and associated diseases. In addition, female carriers of X-linked RP and female choroideremia show characteristic appearance. Conversely, absence of abnormal FAF despite severe retinal degeneration helps differentiation of cancer-associated retinopathy. Conclusion This paper reviews the principles of FAF, wide-field imaging, and findings in specific diseases. Wide-field imaging, particularly wide-field FAF, will provide further information for the characteristics, prognosis, and pathogenesis of IRD.
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Affiliation(s)
- Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara-cho 54, Sakyo-ku, Kyoto, Japan
| | - Manabu Miyata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara-cho 54, Sakyo-ku, Kyoto, Japan
| | - Shogo Numa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara-cho 54, Sakyo-ku, Kyoto, Japan
| | - Yuki Otsuka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara-cho 54, Sakyo-ku, Kyoto, Japan
| | - Maho Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara-cho 54, Sakyo-ku, Kyoto, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Shogoin Kawahara-cho 54, Sakyo-ku, Kyoto, Japan
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Gambril JA, Sloan KR, Swain TA, Huisingh C, Zarubina AV, Messinger JD, Ach T, Curcio CA. Quantifying Retinal Pigment Epithelium Dysmorphia and Loss of Histologic Autofluorescence in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2019; 60:2481-2493. [PMID: 31173079 PMCID: PMC6557619 DOI: 10.1167/iovs.19-26949] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose Lipofuscin and melanolipofuscin organelles in retinal pigment epithelium (RPE) cells are signal sources for clinical fundus autofluorescence (AF). To elucidate the subcellular basis of AF imaging, we identified, characterized, and quantified the frequency of RPE morphology and AF phenotypes in donor eyes with age-related macular degeneration (AMD). Methods In 25 RPE-Bruch's membrane flat mounts from 25 eyes, we analyzed 0.4-μm z-stack epifluorescence images of RPE stained with phalloidin for actin cytoskeleton. Using a custom ImageJ plugin, we classified cells selected in a systematic unbiased fashion in six phenotypes representing increasing degrees of pathology. For each cell, area, AF intensity, and number of Voronoi neighbors were compared with phenotype 1 (uniform AF, polygonal morphology) via generalized estimating equations. We also analyzed each cell's neighborhood. Results In 29,323 cells, compared with phenotype 1, all other phenotypes, in order of increasing pathology, had significantly larger area, reduced AF, and more variable number of neighbors. Neighborhood area and AF showed similar, but subtler, trends. Cells with highly autofluorescent granule aggregates are no more autofluorescent than others and are in fact lower overall in AF. Pre-aggregates were found in phenotype 1. Phenotype 2, which exhibited degranulation despite normal cytoskeleton, was the most numerous nonhealthy phenotype (16.23%). Conclusions Despite aggregation of granules that created hyperAF aggregates within cells, overall AF on a per cell basis decreased with increasing severity of dysmorphia (abnormal shape). Data motivate further development of subcellular resolution in clinical fundus AF imaging and inform an ongoing reexamination of the role of lipofuscin in AMD.
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Affiliation(s)
- J Alan Gambril
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Kenneth R Sloan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Thomas A Swain
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Carrie Huisingh
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Anna V Zarubina
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Jeffrey D Messinger
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Thomas Ach
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
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Peterson SM, McGill TJ, Puthussery T, Stoddard J, Renner L, Lewis AD, Colgin LMA, Gayet J, Wang X, Prongay K, Cullin C, Dozier BL, Ferguson B, Neuringer M. Bardet-Biedl Syndrome in rhesus macaques: A nonhuman primate model of retinitis pigmentosa. Exp Eye Res 2019; 189:107825. [PMID: 31589838 DOI: 10.1016/j.exer.2019.107825] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 11/15/2022]
Abstract
The development of therapies for retinal disorders is hampered by a lack of appropriate animal models. Higher nonhuman primates are the only animals with retinal structure similar to humans, including the presence of a macula and fovea. However, few nonhuman primate models of genetic retinal disease are known. We identified a lineage of rhesus macaques with a frameshift mutation in exon 3 of the BBS7 gene c.160delG (p.Ala54fs) that is predicted to produce a non-functional protein. In humans, mutations in this and other BBS genes cause Bardet-Biedl syndrome, a ciliopathy and a syndromic form of retinitis pigmentosa generally occurring in conjunction with kidney dysfunction, polydactyly, obesity, and/or hypogonadism. Three full- or half-sibling monkeys homozygous for the BBS7 c.160delG variant, at ages 3.5, 4 and 6 years old, displayed a combination of severe photoreceptor degeneration and progressive kidney disease. In vivo retinal imaging revealed features of severe macular degeneration, including absence of photoreceptor layers, degeneration of the retinal pigment epithelium, and retinal vasculature atrophy. Electroretinography in the 3.5-year-old case demonstrated loss of scotopic and photopic a-waves and markedly reduced and delayed b-waves. Histological assessments in the 4- and 6-year-old cases confirmed profound loss of photoreceptors and inner retinal neurons across the posterior retina, with dramatic thinning and disorganization of all cell layers, abundant microglia, absent or displaced RPE cells, and significant gliosis in the subretinal space. Retinal structure, including presence of photoreceptors, was preserved only in the far periphery. Ultrasound imaging of the kidneys revealed deranged architecture, and renal histopathology identified distorted contours with depressed, fibrotic foci and firmly adhered renal capsules; renal failure occurred in the 6-year-old case. Magnetic resonance imaging obtained in one case revealed abnormally low total brain volume and unilateral ventricular enlargement. The one male had abnormally small testes at 4 years of age, but polydactyly and obesity were not observed. Thus, monkeys homozygous for the BBS7 c.160delG variant closely mirrored several key features of the human BBS syndrome. This finding represents the first identification of a naturally-occurring nonhuman primate model of BBS, and more broadly the first such model of retinitis pigmentosa and a ciliopathy with an associated genetic mutation. This important new preclinical model will provide the basis for better understanding of disease progression and for the testing of new therapeutic options, including gene and cell-based therapies, not only for BBS but also for multiple forms of photoreceptor degeneration.
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Affiliation(s)
- Samuel M Peterson
- Division of Genetics, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA.
| | - Trevor J McGill
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA; Casey Eye Institute, Oregon Health & Sciences University, Portland, OR, 97239, USA.
| | - Teresa Puthussery
- School of Optometry & Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA.
| | - Jonathan Stoddard
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA.
| | - Lauren Renner
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA.
| | - Anne D Lewis
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA.
| | - Lois M A Colgin
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA.
| | - Jacqueline Gayet
- School of Optometry & Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, 94720, USA.
| | - Xiaojie Wang
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA; Advanced Imaging Research Center, Oregon Health & Sciences University, Portland, OR, 97239, USA.
| | - Kamm Prongay
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA.
| | - Cassandra Cullin
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA.
| | - Brandy L Dozier
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA.
| | - Betsy Ferguson
- Division of Genetics, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA; Department of Molecular and Medical Genetics, Oregon Health & Sciences University, Portland, OR, 97239, USA.
| | - Martha Neuringer
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Sciences University, Beaverton, OR, 97006, USA; Casey Eye Institute, Oregon Health & Sciences University, Portland, OR, 97239, USA.
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Lessons learned from quantitative fundus autofluorescence. Prog Retin Eye Res 2019; 74:100774. [PMID: 31472235 DOI: 10.1016/j.preteyeres.2019.100774] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 12/12/2022]
Abstract
Quantitative fundus autofluorescence (qAF) is an approach that is built on a confocal scanning laser platform and used to measure the intensity of the inherent autofluorescence of retina elicited by short-wavelength (488 nm) excitation. Being non-invasive, qAF does not interrupt tissue architecture, thus allowing for structural correlations. The spectral features, cellular origin and topographic distribution of the natural autofluorescence of the fundus indicate that it is emitted from retinaldehyde-adducts that form in photoreceptor cells and accumulate, under most conditions, in retinal pigment epithelial cells. The distributions and intensities of fundus autofluorescence deviate from normal in many retinal disorders and it is widely recognized that these changing patterns can aid in the diagnosis and monitoring of retinal disease. The standardized protocol employed by qAF involves the normalization of fundus grey levels to a fluorescent reference installed in the imaging instrument. Together with corrections for magnification and anterior media absorption, this approach facilitates comparisons with serial images and images acquired within groups of patients. Here we provide a comprehensive summary of the principles and practice of qAF and we highlight recent efforts to elucidate retinal disease processes by combining qAF with multi-modal imaging.
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Abstract
BACKGROUND Optic disc drusen (ODD) are seen in up to 2.4% of the general population, but the etiology and pathophysiology of the condition is still unknown. The purpose of this study was to determine the prevalence of ODD in a population-based child cohort and to determine if scleral canal diameter and fetal birth and pubertal parameters are associated with the presence of ODD. METHODS This observational, longitudinal population-based birth cohort study, with a nested case-control, included 1,406 children. Eye examinations were performed when the children were between 11 and 12 years of age. Assessment was performed of optical coherence tomography (OCT) scans from 1,304 children with gradable enhanced depth imaging scans of the optic disc. RESULTS ODD in one or both eyes were found in 13 (1.0%) of all children. All but one of the cases were found in children with scleral canal diameter in the lowest quartile (1,182-1,399 μm) in the nested case-control study. Children with ODD had a mean disc diameter of 1,339 μm (interquartile range, 30 μm), whereas it was 1,508 μm (interquartile range, 196 μm) in the 130 controls without ODD (P < 0.001). No differences in sex, birth weight, refractive error, and Tanner stages (of puberty) were found between children with and without ODD. CONCLUSIONS The prevalence of ODD was 1% in a large child cohort examined by OCT. ODD was found only in eyes with a narrow scleral canal, which is consistent with the hypothesis that ODD might arise as a consequence of retinal nerve fiber congestion in the scleral canal.
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Wang Y, Tran T, Firl K, Huang N, Yasin O, van Kuijk FJ, Montezuma SR. Quantitative fundus autofluorescence in smokers compared to non-smokers. Exp Eye Res 2019; 184:48-55. [DOI: 10.1016/j.exer.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 01/29/2023]
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Reiter GS, Told R, Baratsits M, Hecht A, Schlanitz FG, Sacu S, Schmidt‐Erfurth U. Repeatability and reliability of quantitative fundus autofluorescence imaging in patients with early and intermediate age-related macular degeneration. Acta Ophthalmol 2019; 97:e526-e532. [PMID: 30549203 DOI: 10.1111/aos.13987] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 11/09/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Quantification of fundus autofluorescence has only recently become available. We report our findings on the evaluation of the repeatability and reliability of quantitative fundus autofluorescence (qAF) measurements in patients with early and intermediate age-related macular degeneration (AMD), using the first approved and commercially available instrument. METHODS A total of 43 eyes of 22 patients (aged between 52 and 84 years) diagnosed with early and intermediate AMD were included. All eyes were imaged at day 1, 3 months and 6 months using a modified scanning laser ophthalmoscope, equipped with an internal fluorescent reference. Mean qAF values were calculated for the fovea and for each concentric ring of the Delori pattern. Repeatability and reliability were calculated using Bland-Altman analysis and intraclass correlation (ICC). RESULTS The mean patient age was 73.5 ± 7.9 years. Sixteen patients (73%) were female. qAF repeatability of the eight segments in the middle ring of the Delori pattern (qAFM 8 ) for between sessions was ±8.2%. Agreement at 3- and 6-month follow-up in eyes without retinal changes was ±8.3% and ±9.8%, respectively. Reliability of qAFM 8 was high for all images acquired [ICC = 0.98 (CI: 0.96-0.99), 0.97 (0.93-0.99) and 0.98 (0.92-0.99)]. Agreement at 3- and 6-month follow-up in eyes with retinal changes was ±18.1% and ±20.2%, respectively. Intraclass correlation (ICC) was slightly lower in eyes with retinal changes at 0.93 (0.84-0.97) and 0.96 (0.91-0.98), respectively. CONCLUSIONS Quantitative autofluorescence shows excellent repeatability and reliability as well as follow-up agreement in patients with early and intermediate AMD without retinal changes. This is relevant when conducting longitudinal studies using qAF.
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Affiliation(s)
- Gregor Sebastian Reiter
- Department of Ophthalmology and Optometry Vienna Trial Center (VTC) Medical University of Vienna Vienna Austria
| | - Reinhard Told
- Department of Ophthalmology and Optometry Vienna Trial Center (VTC) Medical University of Vienna Vienna Austria
| | - Magdalena Baratsits
- Department of Ophthalmology and Optometry Vienna Trial Center (VTC) Medical University of Vienna Vienna Austria
| | - Alexander Hecht
- Department of Ophthalmology and Optometry Vienna Trial Center (VTC) Medical University of Vienna Vienna Austria
| | - Ferdinand Georg Schlanitz
- Department of Ophthalmology and Optometry Vienna Trial Center (VTC) Medical University of Vienna Vienna Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry Vienna Trial Center (VTC) Medical University of Vienna Vienna Austria
| | - Ursula Schmidt‐Erfurth
- Department of Ophthalmology and Optometry Vienna Trial Center (VTC) Medical University of Vienna Vienna Austria
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Allen P, Calcagni A, Robson AG, Claridge E. Investigating the potential of Zernike polynomials to characterise spatial distribution of macular pigment. PLoS One 2019; 14:e0217265. [PMID: 31125363 PMCID: PMC6534297 DOI: 10.1371/journal.pone.0217265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 05/09/2019] [Indexed: 11/24/2022] Open
Abstract
It has been postulated that particular patterns of macular pigment (MP) distribution may be associated with the risk for eye diseases such as age-related macular degeneration (AMD). This work investigates the potential of Zernike polynomials (ZP) to characterise the level and distribution of MP, and their suitability as a representation for analysis of the effects of age and AMD on MP patterns. As the case study, MP distribution maps computed using an experimental method based on fundus reflectance (MRIA) were obtained for ninety volunteers representing three groups: under-fifty without AMD, fifty and over without AMD, and fifty and over with AMD. ZP with 105 coefficients were fitted to the maps using least-squares optimisation and found to represent MP maps accurately (RMSE<10−1). One-way MANOVA analysis carried out on ZP representations showed that the three subject groups have significantly different means (Wilk’s Lambda 0.125, p<0.0001). Linear discriminant analysis with leave-one-out scheme resulted in accuracy, sensitivity and specificity of classification according to, respectively, disease status regardless of age (81% all); disease status in the age-matched groups (87%, 88%, 86%); age irrespective of disease status (81%, 83%, 73%); and age for subjects without AMD (83%, 88%, 80%). Mean MP distributions computed from ZP coefficients for the three groups showed more elevated and more peaked MP for the healthy under-fifty group; more irregular and more elevated peripheral levels in over-fifty AMD group than in over-fifty non-AMD group; and moderate radial asymmetry in non-AMD over-50 group. The results suggest that ZP coefficients are capable of accurately representing MP in a way that captures certain spatial patterns of its distribution. Using the ZP representation MP maps could be classified according to both age and disease status with accuracy significantly greater than chance, with peak elevation, pattern irregularity and radial asymmetry identified as important features.
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Affiliation(s)
- Piers Allen
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | - Antonio Calcagni
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
- Aston University, Ophthalmic Research Group, School of Life and Health Sciences, Aston Triangle, Birmingham, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, Department of Electrophysiology, London, United Kingdom
| | - Anthony G. Robson
- Moorfields Eye Hospital NHS Foundation Trust, Department of Electrophysiology, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Ela Claridge
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
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Reiter GS, Told R, Schlanitz FG, Bogunovic H, Baumann L, Sacu S, Schmidt-Erfurth U, Pollreisz A. Impact of Drusen Volume on Quantitative Fundus Autofluorescence in Early and Intermediate Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2019; 60:1937-1942. [DOI: 10.1167/iovs.19-26566] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Gregor Sebastian Reiter
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Reinhard Told
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ferdinand Georg Schlanitz
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Lukas Baumann
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Vienna Reading Center, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Orellana-Rios J, Yokoyama S, Agee JM, Challa N, Freund KB, Yannuzzi LA, Smith RT. Quantitative Fundus Autofluorescence in Non-Neovascular Age-Related Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina 2019; 49:S34-S42. [PMID: 30339266 DOI: 10.3928/23258160-20180814-06] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/03/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE To use quantitative fundus autofluorescence (qAF) to analyze different stages of non-neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS In this cohort study, 38 pseudophakic patients and 36 age-matched controls participated. We performed near-infrared, spectral-domain optical coherence tomography and qAF imaging on 31 pseudophakic eyes and controls of participants older than 60 years with non-neovascular AMD phenotypes using the Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany). RESULTS The patients included in this study had a mean age of 83.9 years, and 35.7% patients were men. Mean qAF was higher in control participants than in all patients with AMD (P < .001). According to non-neovascular AMD phenotype, mean qAF levels were significantly lower in eyes with subretinal drusenoid deposits than in control eyes (P < .05). The lowest mean qAF was in patients with geographic atrophy. CONCLUSION Quantitative fundus autofluorescence of non-neovascular AMD decreases from normal to early to late AMD, suggesting that loss of lipofuscin fluorophores, not increase, signifies AMD progression. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S34-S42.].
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Klemm M, Sauer L, Klee S, Link D, Peters S, Hammer M, Schweitzer D, Haueisen J. Bleaching effects and fluorescence lifetime imaging ophthalmoscopy. BIOMEDICAL OPTICS EXPRESS 2019; 10:1446-1461. [PMID: 30891358 PMCID: PMC6420301 DOI: 10.1364/boe.10.001446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/02/2018] [Accepted: 12/02/2018] [Indexed: 05/13/2023]
Abstract
This study investigates the influence of photopigment bleaching on autofluorescence lifetimes in the fundus in 21 young healthy volunteers. Three measurements of 30° retinal fields in two spectral channels (SSC: 498-560 nm, LSC: 560-720 nm) were obtained for each volunteer using fluorescence lifetime imaging ophthalmoscopy (FLIO). After dark-adaptation by wearing a custom-made lightproof mask for 30 minutes, the first FLIO-measurement was recorded (dark-adapted state). Subsequently, the eye was bleached for 1 minute (luminance: 3200 cd/m2), followed by a second FLIO-measurement (bleached state). Following an additional 10 minute dark adaptation using the mask, a final FLIO-measurement was recorded (recovered state). Average values of the fluorescence lifetimes were calculated from within different areas of a standardized early treatment diabetic retinopathy study (ETDRS) grid (central area, inner and outer rings). The acquisition time in the bleached state was significantly shortened by approximately 20%. The SSC did not show any significant changes in fluorescence lifetimes with photopigment bleaching, only the LSC showed small but significant bleaching-related changes in the fluorescence lifetimes τ1 and τ2 from all regions, as well as the mean fluorescence lifetime in the central area. The fluorescence lifetime differences caused by bleaching were by far less significant than pathological changes caused by eye diseases. The magnitudes of fluorescence lifetime changes are <10% and do not interfere with healthy or disease related FLIO patterns. Thus, we conclude that bleaching is not a relevant confounder in current clinical applications of FLIO.
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Affiliation(s)
- Matthias Klemm
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, POB 100565, 98694 Ilmenau, Germany
| | - Lydia Sauer
- University Hospital Jena, Department of Ophthalmology, Am Klinikum 1, 07743 Jena, Germany
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Sascha Klee
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, POB 100565, 98694 Ilmenau, Germany
| | - Dietmar Link
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, POB 100565, 98694 Ilmenau, Germany
| | - Sven Peters
- University Hospital Jena, Department of Ophthalmology, Am Klinikum 1, 07743 Jena, Germany
| | - Martin Hammer
- University Hospital Jena, Department of Ophthalmology, Am Klinikum 1, 07743 Jena, Germany
- University of Jena, Center for Biomedical Optics and Photonics, 07740 Jena, Germany
| | - Dietrich Schweitzer
- University Hospital Jena, Department of Ophthalmology, Am Klinikum 1, 07743 Jena, Germany
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, POB 100565, 98694 Ilmenau, Germany
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Paavo M, Zhao J, Kim HJ, Lee W, Zernant J, Cai C, Allikmets R, Tsang SH, Sparrow JR. Mutations in GPR143/OA1 and ABCA4 Inform Interpretations of Short-Wavelength and Near-Infrared Fundus Autofluorescence. Invest Ophthalmol Vis Sci 2019; 59:2459-2469. [PMID: 29847651 PMCID: PMC5959512 DOI: 10.1167/iovs.18-24213] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose We sought to advance interpretations and quantification of short-wavelength fundus autofluorescence (SW-AF) emitted from bisretinoid lipofuscin and near-infrared autofluoresence (NIR-AF) originating from melanin. Methods Carriers of mutations in X-linked GPR143/OA1, a common form of ocular albinism; patients with confirmed mutations in ABCA4 conferring increased SW-AF; and subjects with healthy eyes were studied. SW-AF (488 nm excitation, 500–680 nm emission) and NIR-AF (excitation 787 nm, emission >830 nm) images were acquired with a confocal scanning laser ophthalmoscope. SW-AF images were analyzed for quantitative autofluoresence (qAF). Analogous methods of image acquisition and analysis were performed in albino and pigmented Abca4−/− mice and wild-type mice. Results Quantitation of SW-AF (qAF), construction of qAF color-coded maps, and examination of NIR-AF images from GPR143/OA1 carriers revealed mosaics in which patches of fundus exhibiting NIR-AF signal had qAF levels within normal limits whereas the hypopigmented areas in the NIR-AF image corresponded to foci of elevated qAF. qAF also was increased in albino versus pigmented mice. Although melanin contributes to fundus infrared reflectance, the latter appeared to be uniform in en face reflectance images of GPR143/OA1-carriers. In patients diagnosed with ABCA4-associated disease, NIR-AF increased in tandem with increased qAF originating in bisretinoid lipofuscin. Similarly in Abca4−/− mice having increased SW-AF, NIR-AF was more pronounced than in wild-type mice. Conclusions These studies corroborate RPE melanin as the major source of NIR-AF but also indicate that bisretinoid lipofuscin, when present at sufficient concentrations, contributes to the NIR-AF signal. Ocular melanin attenuates the SW-AF signal.
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Affiliation(s)
- Maarjaliis Paavo
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Jin Zhao
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Hye Jin Kim
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Jana Zernant
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Carolyn Cai
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
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Sengillo JD, Cho GY, Paavo M, Lee W, White E, Jauregui R, Sparrow JR, Allikmets R, Tsang SH. Hyperautofluorescent Dots are Characteristic in Ceramide Kinase Like-associated Retinal Degeneration. Sci Rep 2019; 9:876. [PMID: 30696906 PMCID: PMC6351646 DOI: 10.1038/s41598-018-37578-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/27/2018] [Indexed: 11/17/2022] Open
Abstract
There is a lack of studies which seek to discern disease expression in patients with mutations that alter retinal ceramide metabolism, specifically in the ceramide kinase like (CERKL) gene. This cross-sectional case series reports a novel phenotypic manifestation of CERKL-associated retinopathy. Four unrelated patients with homozygous CERKL mutations underwent a complete ocular exam, spectral-domain optical coherence tomography, short-wavelength fundus autofluorescence (SW-AF), quantitative autofluorescence (qAF), and full-field electroretinogram (ffERG). Decreased visual acuity and early-onset maculopathy were present in all patients. All four patients had extensive hyperautofluorescent foci surrounding an area of central atrophy on SW-AF imaging, which has not been previously characterized. An abnormal spatial distribution of qAF signal was seen in one patient, and abnormally elevated qAF8 signal in another patient. FfERG recordings showed markedly attenuated rod and cone response in all patients. We conclude that these patients exhibit several features that, collectively, may warrant screening of CERKL as a first candidate: early-onset maculopathy, severe generalized retinal dysfunction, peripheral lacunae, intraretinal pigment migration, and hyperautofluorescent foci on SW-AF.
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Affiliation(s)
- Jesse D Sengillo
- Department of Internal Medicine, Reading Hospital, West Reading, PA, USA
| | - Galaxy Y Cho
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Maarjaliis Paavo
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Eugenia White
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | | | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Stephen H Tsang
- Jonas Children's Vision Care, and Bernard & Shirlee Brown Glaucoma Laboratory, New York, USA. .,Department of Ophthalmology, Columbia University, New York, NY, USA. .,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA. .,Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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83
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Hashimoto Y, Inoue T, Ono T, Lee J, Tsuneyoshi S, Fujita A, Inoue Y, Ogawa S, Asaoka R, Obata R. A Novel Method for the Objective Identification of Hyperautofluorescent Ring in Retinitis Pigmentosa Using Binarization Processing. Transl Vis Sci Technol 2019; 8:20. [PMID: 30775157 PMCID: PMC6371951 DOI: 10.1167/tvst.8.1.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess precision and accuracy of a new objective algorithm using binarization in a software for identifying the hyperautofluorescent ring (AF ring) in retinitis pigmentosa (RP) compared with subjective visual inspection. METHODS Ultra-widefield AF images were obtained from 23 eyes of 13 patients with retinitis pigmentosa (RP). We defined the borders of the AF rings using semiautomatic binarization algorithm in Fiji software. We compared the degree of precision (intra- and interrater agreements) of this algorithm and that of subjective visual inspection (freehand method) using Jaccard indices (JIs). To compare the classification performance (whether 68 points of Humphrey Field Analyzer is classified as inside, on, or outside AF rings), we calculated percent agreement and weighted kappa statistic between the two methods. The relationship between the distance from the AF ring and retinal sensitivities was also investigated. RESULTS The binarization method showed significantly higher JIs than the freehand method (for interrater: 0.94-0.95 vs. 0.73-0.78, respectively, P = 0.002; for intrarater: 0.95 vs. 0.68-0.71, respectively, P = 0.005). Percent agreement for classification between the two methods were 0.94 and weighted kappa statistic was 0.94 (P < 0.001). The retinal sensitivities decreased significantly and eccentrically from 2° inside to 3° outside the AF ring. CONCLUSIONS Defining the AF ring in RP using the binarization algorithm showed significantly higher precision and the same degree of accuracy compared with visual inspection. TRANSLATION RELEVANCE This novel method may enable quantitative analysis of the AF ring, an indicator of retinal function in RP.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Ono
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Jinhee Lee
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Saori Tsuneyoshi
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Asahi Fujita
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuji Inoue
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shun Ogawa
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Obata
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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84
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Lapierre-Landry M, Carroll J, Skala MC. Imaging retinal melanin: a review of current technologies. J Biol Eng 2018; 12:29. [PMID: 30534199 PMCID: PMC6280494 DOI: 10.1186/s13036-018-0124-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/22/2018] [Indexed: 11/10/2022] Open
Abstract
The retinal pigment epithelium (RPE) is essential to the health of the retina and the proper functioning of the photoreceptors. The RPE is rich in melanosomes, which contain the pigment melanin. Changes in RPE pigmentation are seen with normal aging and in diseases such as albinism and age-related macular degeneration. However, most techniques used to this day to detect and quantify ocular melanin are performed ex vivo and are destructive to the tissue. There is a need for in vivo imaging of melanin both at the clinical and pre-clinical level to study how pigmentation changes can inform disease progression. In this manuscript, we review in vivo imaging techniques such as fundus photography, fundus reflectometry, near-infrared autofluorescence imaging, photoacoustic imaging, and functional optical coherence tomography that specifically detect melanin in the retina. These methods use different contrast mechanisms to detect melanin and provide images with different resolutions and field-of-views, making them complementary to each other.
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Affiliation(s)
- Maryse Lapierre-Landry
- 1Morgridge Institute for Research, Madison, WI USA.,2Department of Biomedical Engineering, Vanderbilt University, Nashville, TN USA.,6Department of Pediatrics, Case Western Reserve University, Cleveland, OH USA
| | - Joseph Carroll
- 3Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI USA.,4Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI USA
| | - Melissa C Skala
- 1Morgridge Institute for Research, Madison, WI USA.,5Department of Biomedical Engineering, University of Wisconsin Madison, Madison, WI USA
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85
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Nafar Z, Wen R, Jiao S. Visible-light optical coherence tomography-based multimodal system for quantitative fundus autofluorescence imaging. Exp Biol Med (Maywood) 2018; 243:1265-1274. [PMID: 30472882 PMCID: PMC6348593 DOI: 10.1177/1535370218813529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPACT STATEMENT Quantitative fundus autofluorescence imaging with simultaneous visible-light optical coherence tomography-based multimodal technology has potential significant impact on the diagnosis and monitoring the progression of retinal diseases.
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Affiliation(s)
- Zahra Nafar
- Department of Biomedical Engineering, Florida International
University, Miami, FL 33174, USA
| | - Rong Wen
- Bascom Palmer Eye Institute, University of Miami Miller School
of Medicine, Miami, FL 33136, USA
| | - Shuliang Jiao
- Department of Biomedical Engineering, Florida International
University, Miami, FL 33174, USA
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86
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Ctori I, Mahroo OA, Williams KM, Hammond CJ, Huntjens B. Repeatability of the macular pigment spatial profile: A comparison of objective versus subjective classification. Acta Ophthalmol 2018; 96:e797-e803. [PMID: 30156017 PMCID: PMC6282784 DOI: 10.1111/aos.13725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 01/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Classification of macular pigment (MP) spatial profile phenotypes varies and is often based on subjective visualisation. We investigated repeatability of MP optical density (MPOD) comparing an objective versus subjective profiling system. METHODS The coefficient of repeatability (CoR) was calculated for point MPOD values (0-3.8°) obtained by dual-wavelength fundus autofluorescence (FAF) from two scans obtained in a single visit of 40 healthy individuals (39 ± 9 years). For each individual's dataset, the MP profile was classified as exponential, ring-like or central dip using an objective method (based on deviations away from an exponential fit), as well as by subjective visual profiling. Existing FAF images of 88 monozygotic (MZ) and 69 dizygotic (DZ) twin pairs were reanalysed using the objective profiling method and concordance and heritability of ring-like profiles determined. RESULTS The CoR was 0.23 at 0° and 0.06 at 0.8°. Agreement of objective profiling between scans was excellent (κ = 0.85, 95% CI 0.69 to 1.00; p < 0.0005). Subjective profiling showed moderate agreement between scans (κ = 0.48, 95% CI 0.23 to 0.73; p < 0.0005). Agreement between objective and subjective classification was low (κ = 0.23, 95% CI 0.04 to 0.42; p = 0.02). Concordance for the ring-like profile using objective profiling was 0.74 for MZ compared to 0.36 for DZ twins. Heritability was calculated as 81.5% (95% confidence interval 61.1-93.1%). CONCLUSION Compared to visual assessment, objective MP profiling is a more reliable method and should be considered in future observational and interventional studies. In addition, MP profile phenotypes showed high heritability.
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Affiliation(s)
- Irene Ctori
- Applied Vision Research CentreCity, University of LondonNorthampton SquareLondonUK
| | - Omar A. Mahroo
- Department of Twin Research and Genetic EpidemiologyKing's College LondonSt Thomas’ Hospital CampusLondonUK
- Department of OphthalmologyKing's College LondonSt Thomas’ Hospital CampusLondonUK
- Retinal ServiceMoorfields Eye HospitalLondonUK
- UCL Institute of OphthalmologyLondonUK
| | - Katie M. Williams
- Department of Twin Research and Genetic EpidemiologyKing's College LondonSt Thomas’ Hospital CampusLondonUK
- Department of OphthalmologyKing's College LondonSt Thomas’ Hospital CampusLondonUK
| | - Christopher J. Hammond
- Department of Twin Research and Genetic EpidemiologyKing's College LondonSt Thomas’ Hospital CampusLondonUK
- Department of OphthalmologyKing's College LondonSt Thomas’ Hospital CampusLondonUK
| | - Byki Huntjens
- Applied Vision Research CentreCity, University of LondonNorthampton SquareLondonUK
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87
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Garrity ST, Sarraf D, Freund KB, Sadda SR. Multimodal Imaging of Nonneovascular Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2018; 59:AMD48-AMD64. [PMID: 30025107 DOI: 10.1167/iovs.18-24158] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Nonneovascular (dry) AMD is a retinal disease with potential for significant central visual impairment. The hallmarks of this disease are macular drusen, RPE alterations, and geographic atrophy (GA). Classification schemes for nonneovascular AMD have evolved over the years as major advances in retinal imaging have enabled a greater understanding of disease pathophysiology. The original classifications of nonneovascular AMD were based on color fundus photography (CFP), while more modern schemes rely on a multimodal imaging approach. Effective diagnosis and management of nonneovascular AMD requires a thorough understanding of its multimodal imaging features as detailed in this review. Future imaging modalities and imaging biomarkers that may aid in diagnosis and management are also discussed.
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Affiliation(s)
- Sean T Garrity
- Stein Eye Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
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88
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Müller PL, Pfau M, Möller PT, Nadal J, Schmid M, Lindner M, de Sisternes L, Stöhr H, Weber BHF, Neuhaus C, Herrmann P, Schmitz-Valckenberg S, Holz FG, Fleckenstein M. Choroidal Flow Signal in Late-Onset Stargardt Disease and Age-Related Macular Degeneration: An OCT-Angiography Study. ACTA ACUST UNITED AC 2018; 59:AMD122-AMD131. [DOI: 10.1167/iovs.18-23819] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Philipp L. Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | - Philipp T. Möller
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | - Jennifer Nadal
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Moritz Lindner
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- The Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Luis de Sisternes
- Department of Radiology, Stanford University, Stanford, California, United States
- Carl Zeiss Meditec, Inc., Dublin, California, United States
| | - Heidi Stöhr
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | | | | | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases, University of Bonn, Bonn, Germany
| | | | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
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89
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Nafar Z, Wen R, Jiao S. Visible light OCT-based quantitative imaging of lipofuscin in the retinal pigment epithelium with standard reference targets. BIOMEDICAL OPTICS EXPRESS 2018; 9:3768-3782. [PMID: 30338154 PMCID: PMC6191616 DOI: 10.1364/boe.9.003768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 05/24/2023]
Abstract
We developed a technology for quantitative retinal autofluorescence (AF, or FAF for fundus AF) imaging for quantifying lipofuscin in the retinal pigment epithelium (RPE). The technology is based on simultaneous visible light optical coherence tomography (VIS-OCT) and AF imaging of the retina and a pair of reference standard targets at the intermediate retinal imaging plane with known reflectivity for the OCT and fluorescence efficiency for the FAF. The technology is able to eliminate the pre-RPE attenuation in FAF imaging by using the simultaneously acquired VIS-OCT image. With the OCT and fluorescence images of the reference targets, the effects of illumination power and detector sensitivity can be eliminated.
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Affiliation(s)
- Zahra Nafar
- Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL 33174, USA
| | - Rong Wen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10 Ave, Miami, FL 33136, USA
| | - Shuliang Jiao
- Department of Biomedical Engineering, Florida International University, 10555 W Flagler St, Miami, FL 33174, USA
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90
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Peripapillary fluorescence lifetime reveals age-dependent changes using fluorescence lifetime imaging ophthalmoscopy in rats. Exp Eye Res 2018; 176:110-120. [PMID: 29990482 DOI: 10.1016/j.exer.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/28/2018] [Accepted: 07/06/2018] [Indexed: 11/24/2022]
Abstract
Many fundus diseases accompany fundus autofluorescence change. Fluorescence lifetime imaging ophthalmoscope (FLIO) is a latest technique in imaging fundus autofluorescence. With FLIO, the fundus fluorescence lifetime (FLT) is recorded topographically, assisting to diagnose and monitor multiple fundus diseases. The purpose of this study was to evaluate the repeatability of FLT using FLIO on adult rats and to analyze the age-dependency of the peripapillary FLT of the fundus in a short spectral channel (498-560 nm) and a long spectral channel (560-720 nm). Sprague Dawley rats (n of eyes = 10) were used for repeatability experiments. Age-dependent changes were investigated in young (two months old, n of eyes = 20) and old (eight months old, n of eyes = 10) rats. Repeatability experiments showed highly corresponding data for all segments in both spectral channel, with higher repeatability in the short spectral channel. FLT decreased significantly in all areas in the short (young: 991 ± 29 ps; old: 547 ± 42 ps) and long (young: 382 ± 28 ps; old: 261 ± 16 ps) spectral channels, indicating an overall metabolic change of the fundus in old animals. FLT of veins increased in the short spectral channel (young: 385 ± 43 ps; old: 424 ± 25 ps) and no change was observed in the long spectral channel (young: 274 ± 9 ps; old: 269 ± 24 ps). FLIO represents a highly repeatable and sensitive method to detect changes of the FLT in aged eyes for monitoring the degeneration of the rodent retinae.
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91
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Paavo M, Lee W, Allikmets R, Tsang S, Sparrow JR. Photoreceptor cells as a source of fundus autofluorescence in recessive Stargardt disease. J Neurosci Res 2018; 97:98-106. [PMID: 29701254 DOI: 10.1002/jnr.24252] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/12/2018] [Accepted: 04/10/2018] [Indexed: 11/08/2022]
Abstract
Bisretinoid fluorophores form in photoreceptor outer segments from nonenzymatic reactions of vitamin A aldehyde. The short-wavelength autofluorescence (SW-AF) of fundus flecks in recessive Stargardt disease (STGD1) suggests a connection to these fluorophores. Through multimodal imaging, we sought to elucidate this link. Flecks observed in SW-AF images often colocalized with foci exhibiting reduced or absent near-infrared autofluorescence signal, the source of which is melanin in retinal pigment epithelial (RPE) cells. With serial imaging, changes in near-infrared autofluorescence (NIR-AF) preceded the onset of fleck hyperautofluorescence in SW-AF images and fleck profiles in NIR-AF images tended to be larger. Flecks in SW-AF and NIR-AF images also corresponded to hyperreflective lesions traversing photoreceptor-attributable bands in horizontal SD-OCT scans. The hyperreflective lesions interrupted adjacent OCT reflectivity bands and were associated with thinning of the outer nuclear layer. These SD-OCT findings are attributable to photoreceptor cell degeneration. Progressive increases and decreases in the SW-AF intensity of flecks were evident in color-coded quantitative fundus autofluorescence maps. In some cases, flecks appeared to spread radially from the fovea to approximately 8° of eccentricity, beyond which a circumferential spread characterized the distribution. Since the NIR-AF signal is derived from melanin and loss of this autofluorescence is indicative of RPE atrophy, the SW-AF of flecks cannot be accounted for by bisretinoid lipofuscin in RPE. Instead, we suggest that the bisretinoid serving as the source of the SW-AF signal, resides in photoreceptors, the cell that is also the site of bisretinoid synthesis.
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Affiliation(s)
- Maarjaliis Paavo
- Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Winston Lee
- Department of Ophthalmology, Columbia University Medical Center, New York, New York
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University Medical Center, New York, New York.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Stephen Tsang
- Department of Ophthalmology, Columbia University Medical Center, New York, New York.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University Medical Center, New York, New York.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
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92
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Matet A, Kohl S, Baumann B, Antonio A, Mohand-Said S, Sahel JA, Audo I. Multimodal imaging including semiquantitative short-wavelength and near-infrared autofluorescence in achromatopsia. Sci Rep 2018; 8:5665. [PMID: 29618791 PMCID: PMC5884771 DOI: 10.1038/s41598-018-23919-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/20/2018] [Indexed: 11/11/2022] Open
Abstract
Multimodal imaging provides insights into phenotype and disease progression in inherited retinal disorders. Congenital achromatopsia (ACHM), a cone dysfunction syndrome, has been long considered a stable condition, but recent evidence suggests structural progression. With gene replacement strategies under development for ACHM, there is a critical need for imaging biomarkers to define progression patterns and follow therapy. Using semiquantitative plots, near-infrared (NIR-AF) and short-wavelength autofluorescence (SW-AF) were explored and correlated with clinical characteristics and retinal structure on optical coherence tomography (OCT). In sixteen ACHM patients with genetic confirmation (CNGA3, n = 8; CNGB3, n = 7; PDE6C, n = 1), semiquantitative plots allowed the detailed analysis of autofluorescence patterns, even in poorly fixating eyes. Twelve eyes showed perifoveal hyperautofluorescent rings on SW-AF, and 7 eyes had central hypoautofluorescent areas on NIR-AF, without association between these alterations (P = 0.57). Patients with central NIR-AF hypoautofluorescence were older (P = 0.004) and showed more advanced retinal alterations on OCT than those with normal NIR-AF (P = 0.051). NIR-AF hypoautofluorescence diameter was correlated to patient age (r = 0.63, P = 0.009), size of ellipsoid zone defect on OCT (r = 0.67, P = 0.005), but not to the size of SW-AF hyperautofluorescence (P = 0.27). These results demonstrate the interest of NIR-AF as imaging biomarker in ACHM, suggesting a relationship with age and disease progression.
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Affiliation(s)
- Alexandre Matet
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France
- INSERM-DHOS, CIC1423, DHU ViewMaintain, CHNO des Quinze-Vingts, Paris, 75012, France
| | - Susanne Kohl
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Britta Baumann
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Aline Antonio
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France
| | - Saddek Mohand-Said
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France
- INSERM-DHOS, CIC1423, DHU ViewMaintain, CHNO des Quinze-Vingts, Paris, 75012, France
| | - José-Alain Sahel
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France
- INSERM-DHOS, CIC1423, DHU ViewMaintain, CHNO des Quinze-Vingts, Paris, 75012, France
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, F-75019, France
- Académie des Sciences, Institut de France, Paris, F-75006, France
- Department of Ophthalmology, The University of Pittsburgh School of Medicine, Pittsburg, PA, United States
- University College London, Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Isabelle Audo
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France.
- INSERM-DHOS, CIC1423, DHU ViewMaintain, CHNO des Quinze-Vingts, Paris, 75012, France.
- University College London, Institute of Ophthalmology, London, EC1V 9EL, UK.
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93
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BEST1 gene therapy corrects a diffuse retina-wide microdetachment modulated by light exposure. Proc Natl Acad Sci U S A 2018; 115:E2839-E2848. [PMID: 29507198 PMCID: PMC5866594 DOI: 10.1073/pnas.1720662115] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
One of the most common forms of monogenic macular degeneration worldwide is caused by dominant or recessive bestrophinopathies associated with mutations in the BEST1 gene. Disease expression is known to start with a retina-wide electrophysiological defect leading to localized vitelliform and atrophic lesions and vision loss. To develop lasting therapies for this incurable disease, there is a need for greater understanding of the early pathophysiology before lesion formation. Here we find that the loss of retinal pigment epithelium apical microvilli and resulting microdetachment of the retina represent the earliest features of canine bestrophinopathies. We show that retinal light exposure expands, and dark adaptation contracts, the microdetachments. Subretinal adeno-associated virus-based gene therapy corrects both the vitelliform lesions and the light-modulated microdetachments. Mutations in the BEST1 gene cause detachment of the retina and degeneration of photoreceptor (PR) cells due to a primary channelopathy in the neighboring retinal pigment epithelium (RPE) cells. The pathophysiology of the interaction between RPE and PR cells preceding the formation of retinal detachment remains not well-understood. Our studies of molecular pathology in the canine BEST1 disease model revealed retina-wide abnormalities at the RPE-PR interface associated with defects in the RPE microvillar ensheathment and a cone PR-associated insoluble interphotoreceptor matrix. In vivo imaging demonstrated a retina-wide RPE–PR microdetachment, which contracted with dark adaptation and expanded upon exposure to a moderate intensity of light. Subretinal BEST1 gene augmentation therapy using adeno-associated virus 2 reversed not only clinically detectable subretinal lesions but also the diffuse microdetachments. Immunohistochemical analyses showed correction of the structural alterations at the RPE–PR interface in areas with BEST1 transgene expression. Successful treatment effects were demonstrated in three different canine BEST1 genotypes with vector titers in the 0.1-to-5E11 vector genomes per mL range. Patients with biallelic BEST1 mutations exhibited large regions of retinal lamination defects, severe PR sensitivity loss, and slowing of the retinoid cycle. Human translation of canine BEST1 gene therapy success in reversal of macro- and microdetachments through restoration of cytoarchitecture at the RPE–PR interface has promise to result in improved visual function and prevent disease progression in patients affected with bestrophinopathies.
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94
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Romano V, Steger B, Brunner M, Kaye A, Zheng Y, Willoughby CE, Kaye SB. Detecting Change in Conjunctival Hyperemia Using a Pixel Densitometry Index. Ocul Immunol Inflamm 2017; 27:276-281. [DOI: 10.1080/09273948.2017.1387276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Vito Romano
- Department of Corneal and External Eye Diseases, St. Paul’s Eye Unit, The Royal Liverpool University Hospital, Liverpool, UK
| | - Bernhard Steger
- Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Brunner
- Department of Corneal and External Eye Diseases, St. Paul’s Eye Unit, The Royal Liverpool University Hospital, Liverpool, UK
| | - Abigail Kaye
- Department of Ophthalmology, Worthing Hospital, Worthing, UK
| | - Yalin Zheng
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Colin E. Willoughby
- Department of Corneal and External Eye Diseases, St. Paul’s Eye Unit, The Royal Liverpool University Hospital, Liverpool, UK
| | - Stephen B. Kaye
- Department of Corneal and External Eye Diseases, St. Paul’s Eye Unit, The Royal Liverpool University Hospital, Liverpool, UK
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95
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Greenstein VC, Nunez J, Lee W, Schuerch K, Fortune B, Tsang SH, Allikmets R, Sparrow JR, Hood DC. A Comparison of En Face Optical Coherence Tomography and Fundus Autofluorescence in Stargardt Disease. Invest Ophthalmol Vis Sci 2017; 58:5227-5236. [PMID: 29049723 PMCID: PMC5642378 DOI: 10.1167/iovs.17-22532] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose To compare morphologic changes on en face images derived from wide-field swept-source optical coherence tomography (ssOCT) to hypo- and hyperautofluorescent (hypoAF, hyperAF) areas on short-wavelength autofluorescence (SW-AF), and near-infrared (NIR)-AF in recessive Stargardt disease (STGD1). Methods Wide-field ssOCT cube scans were obtained from 16 patients (16 eyes). Averaged B-scans and SW-AF images were obtained using Spectralis HRA+OCT. NIR-AF images were obtained from 6 eyes. The inner/outer segment (IS/OS), OS/RPE, and RPE/Bruch's membrane boundaries were segmented, and en face slab images generated. A subRPE slab image was used to measure the abnormal RPE area, and an IS/OS slab image, the IS/OS junction loss area. These were compared to hypo- and abnormal SW-AF areas, and hypoNIR-AF areas. A preRPE(OS) slab image was used to evaluate the spatial and intraretinal locations of flecks. Results For all eyes, RPE atrophy was visualized as a central hyperreflective area on the subRPE slab, and IS/OS junction loss as an abnormal reflective area on the IS/OS slab; the latter was significantly larger (P = 0.04). There was good agreement between the hyperreflective area on the subRPE slab image and hypoSW-AF area, and between the abnormal reflective area on the IS/OS slab and hypo-hyperSW-AF area; the hypoNIR-AF area indicated that the hyperreflective area on the subRPE slab underestimated RPE atrophy. The spatial locations of hyperreflective flecks on the en face preRPE(OS) slab image corresponded to those on the SW-AF images. Conclusions Wide-field en face OCT imaging has the potential to be a clinically useful tool for the management of STGD1.
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Affiliation(s)
| | - Jason Nunez
- Department of Psychology, Columbia University, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Kaspar Schuerch
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Brad Fortune
- Devers Eye Institute, Portland, Oregon, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States.,Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States.,Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States.,Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Donald C Hood
- Department of Ophthalmology, Columbia University, New York, New York, United States.,Department of Psychology, Columbia University, New York, New York, United States
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96
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Pollreisz A, Messinger JD, Sloan KR, Mittermueller TJ, Weinhandl AS, Benson EK, Kidd GJ, Schmidt-Erfurth U, Curcio CA. Visualizing melanosomes, lipofuscin, and melanolipofuscin in human retinal pigment epithelium using serial block face scanning electron microscopy. Exp Eye Res 2017; 166:131-139. [PMID: 29066281 DOI: 10.1016/j.exer.2017.10.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
To assess serial section block-face scanning electron microscopy (SBFSEM) for retinal pigment epithelium (RPE) ultrastructure, we determined the number and distribution within RPE cell bodies of melanosomes (M), lipofuscin (L), and melanolipofuscin (ML). Eyes of 4 Caucasian donors (16M, 32F, 76F, 84M) with unremarkable maculas were sectioned and imaged using an SEM fitted with an in-chamber automated ultramicrotome. Aligned image stacks were generated by alternately imaging an epoxy resin block face using backscattered electrons, then removing a 125 nm-thick layer. Series of 249-499 sections containing 5-24 nuclei were examined per eye. Trained readers manually assigned boundaries of individual cells and x,y,z locations of M, L, and ML. A Density Recovery Profile was computed in three dimensions for M, L, and ML. The number of granules per RPE cell body in 16M, 32F, 76F, and 84M eyes, respectively, was 465 ± 127 (mean ± SD), 305 ± 92, 79 ± 40, and 333 ± 134 for L; 13 ± 9; 6 ± 7, 131 ± 55, and 184 ± 66 for ML; and 29 ± 19, 24 ± 12, 12 ± 7, and 7 ± 3 for M. Granule types were spatially organized, with M near apical processes. The effective radius, a sphere of decreased probability for granule occurrence, was 1 μm for L, ML, and M combined. In conclusion, SBFEM reveals that adult human RPE has hundreds of L, LF, and M and that granule spacing is regulated by granule size alone. When obtained for a larger sample, this information will enable hypothesis testing about organelle turnover and regulation in health, aging, and disease, and elucidate how RPE-specific signals are generated in clinical optical coherence tomography and autofluorescence imaging.
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Affiliation(s)
| | - Jeffrey D Messinger
- Ophthalmology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kenneth R Sloan
- Ophthalmology, University of Alabama at Birmingham, Birmingham, AL, United States; Computer Science, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | | | | | - Grahame J Kidd
- Renovo Neural Inc., Cleveland, OH, United States; Neurosciences, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, United States
| | | | - Christine A Curcio
- Ophthalmology, University of Alabama at Birmingham, Birmingham, AL, United States.
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97
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Charng J, Tan R, Luu CD, Sadigh S, Stambolian D, Guymer RH, Jacobson SG, Cideciyan AV. Imaging Lenticular Autofluorescence in Older Subjects. Invest Ophthalmol Vis Sci 2017; 58:4940-4947. [PMID: 28973367 PMCID: PMC5627676 DOI: 10.1167/iovs.17-22540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose To evaluate whether a practical method of imaging lenticular autofluorescence (AF) can provide an individualized measure correlated with age-related lens yellowing in older subjects undergoing tests involving shorter wavelength lights. Methods Lenticular AF was imaged with 488-nm excitation using a confocal scanning laser ophthalmoscope (cSLO) routinely used for retinal AF imaging. There were 75 older subjects (ages 47–87) at two sites; a small cohort of younger subjects served as controls. At one site, the cSLO was equipped with an internal reference to allow quantitative AF measurements; at the other site, reduced-illuminance AF imaging (RAFI) was used. In a subset of subjects, lens density index was independently estimated from dark-adapted spectral sensitivities performed psychophysically. Results Lenticular AF intensity was significantly higher in the older eyes than the younger cohort when measured with the internal reference (59.2 ± 15.4 vs. 134.4 ± 31.7 gray levels; P < 0.05) as well as when recorded with RAFI without the internal reference (10.9 ± 1.5 vs. 26.1 ± 5.7 gray levels; P < 0.05). Lenticular AF was positively correlated with age; however, there could also be large differences between individuals of similar age. Lenticular AF intensity correlated well with lens density indices estimated from psychophysical measures. Conclusions Lenticular AF measured with a retinal cSLO can provide a practical and individualized measure of lens yellowing, and may be a good candidate to distinguish between preretinal and retinal deficits involving short-wavelength lights in older eyes.
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Affiliation(s)
- Jason Charng
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Rose Tan
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Victoria, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Victoria, Australia
| | - Sam Sadigh
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Dwight Stambolian
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Victoria, Australia
| | - Samuel G Jacobson
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Artur V Cideciyan
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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98
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The Rapid-Onset Chorioretinopathy Phenotype of ABCA4 Disease. Ophthalmology 2017; 125:89-99. [PMID: 28947085 DOI: 10.1016/j.ophtha.2017.07.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To characterize patients affected by a uniquely severe, rapid-onset chorioretinopathy (ROC) phenotype of ABCA4 disease. DESIGN Comparative cohort study. PARTICIPANTS Sixteen patients were selected from a large clinically diagnosed and genetically confirmed cohort (n = 300) of patients diagnosed with ABCA4 disease. MAIN OUTCOME MEASURES Phenotypic characteristics were assessed on color fundus photographs, short-wavelength autofluorescence (488-nm), and near-infrared autofluorescence (NIR-AF, 787-nm) images. Subfoveal thickness measurements were obtained from enhanced-depth imaging OCT. Generalized retinal function was determined with full-field electroretinogram (ffERG) testing, and lipofuscin accumulation was assessed by quantitative autofluorescence (qAF). RESULTS All patients exhibited advanced disease features, including pigment migration in the macula and retinal vessel attenuation at an early age, and reported a symptomatic onset, on average, at 7.4 years (average for ABCA4 disease is 21.9 years, P < 0.0001). Deterioration of the macula was observed to begin with an intense, homogeneous signal on short-wavelength autofluorescence, which corresponds to an attenuated NIR-AF signal and progresses to a patchy, coalescing pattern of chorioretinal atrophy within the subsequent decade. Measurement of choroidal thickness revealed a more rapid thinning of choriocapillaris with age of Sattler's layer compared with the rate in most other patients with ABCA4 disease (P < 0.001). Levels of qAF in the macula before atrophy were above both the 95% confidence intervals for healthy individuals and patients with Stargardt disease (STGD1) (>1000 qAF units). Severe attenuation of cone responses and notable decreases in rod responses were detected by ffERG. Sequencing of the ABCA4 gene revealed exclusively deleterious, null mutations, including stop codons; frameshift deletions; variants in canonical splice sites, which completely abolish splicing; and known deleterious missense alleles. CONCLUSIONS The ROC phenotype is a unique classification of ABCA4 disease, which is caused by deleterious null biallelic ABCA4 mutations and is characterized by the rapid deterioration of retinal pigment epithelium and photoreceptor layers in the macula and significant choroidal thinning within the first 2 decades of life.
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99
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THE EFFECT OF PHOTOPIGMENT BLEACHING ON FUNDUS AUTOFLUORESCENCE IN ACUTE CENTRAL SEROUS CHORIORETINOPATHY. Retina 2017; 37:568-577. [PMID: 27429375 DOI: 10.1097/iae.0000000000001170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of photobleaching on fundus autofluorescence (FAF) images in acute central serous chorioretinopathy. METHODS We obtained prephotobleaching and postphotobleaching images using an Optomap 200Tx, and photobleaching was induced with a Heidelberg Retina Angiograph 2. Degrees of photobleaching were assessed as grayscale values in Optomap images. Concordances among the three kinds of images were analyzed. Hyper-AF lesions in prephotobleaching images were classified as Type 1 (changed to normal-AF after photobleaching) and Type 2 (unchanged after photobleaching). The FAF composite patterns of central serous chorioretinopathy lesions were classified as diffuse or mottled. Initial and final best-corrected visual acuity, central retinal thickness, and disease duration were compared according to fovea FAF type. RESULTS Forty-one eyes of 41 patients were analyzed. The lesion brightness of postphotobleaching Optomap FAF showed greater concordance with Heidelberg Retina Angiograph 2 FAF (94.74%) than the prephotobleaching Optomap FAF (80.49%). Eyes with Type 1 fovea had greater initial and final best-corrected visual acuity (20/23 vs. 20/41, 20/21 vs. 20/32, P < 0.0001, P = 0.001, respectively) and shorter disease duration (19.68 ± 12.98 vs. 51.55 ± 44.98 days, P = 0.043) than those with Type 2 fovea. However, eyes with diffuse Type 2 fovea had only lower initial and final best-corrected visual acuity (20/23 vs. 20/45, 20/21 vs. 20/36, P < 0.0001, P < 0.0001, respectively) than those with Type 1 fovea. CONCLUSION Understanding the photobleaching effect is necessary for the accurate interpretation of FAF images. Furthermore, comparing prephotobleaching and postphotobleaching FAF images may be helpful for estimation of lesion status in central serous chorioretinopathy.
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100
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Laíns I, Miller JB, Park DH, Tsikata E, Davoudi S, Rahmani S, Pierce J, Silva R, Chen TC, Kim IK, Vavvas D, Miller JW, Husain D. Structural Changes Associated with Delayed Dark Adaptation in Age-Related Macular Degeneration. Ophthalmology 2017; 124:1340-1352. [PMID: 28501377 DOI: 10.1016/j.ophtha.2017.03.061] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To examine the relationship between dark adaptation (DA) and optical coherence tomography (OCT)-based macular morphology in age-related macular degeneration (AMD). DESIGN Prospective, cross-sectional study. PARTICIPANTS Patients with AMD and a comparison group (>50 years) without any vitreoretinal disease. METHODS All participants were imaged with spectral-domain OCT and color fundus photographs, and then staged for AMD (Age-related Eye Disease Study system). Both eyes were tested with the AdaptDx (MacuLogix, Middletown, PA) DA extended protocol (20 minutes). A software program was developed to map the DA testing spot (2° circle, 5° superior to the fovea) to the OCT B-scans. Two independent graders evaluated the B-scans within this testing spot, as well as the entire macula, recording the presence of several AMD-associated abnormalities. Multilevel mixed-effects models (accounting for correlated outcomes between 2 eyes) were used for analyses. MAIN OUTCOME MEASURES The primary outcome was rod-intercept time (RIT), defined in minutes, as a continuous variable. For subjects unable to reach RIT within the 20 minutes of testing, the value of 20 was assigned. RESULTS We included 137 eyes (n = 77 subjects), 72.3% (n = 99 eyes) with AMD and the remainder belonging to the comparison group. Multivariable analysis revealed that even after adjusting for age and AMD stage, the presence of any abnormalities within the DA testing spot (ß = 4.8, P < 0.001), as well as any abnormalities in the macula (ß = 2.4, P = 0.047), were significantly associated with delayed RITs and therefore impaired DA. In eyes with no structural changes within the DA testing spot (n = 76, 55.5%), the presence of any abnormalities in the remaining macula was still associated with delayed RITs (ß = 2.00, P = 0.046). Presence of subretinal drusenoid deposits and ellipsoid zone disruption were a consistent predictor of RIT, whether located within the DA testing spot (P = 0.001 for both) or anywhere in the macula (P < 0.001 for both). Within the testing spot, the presence of classic drusen or serous pigment epithelium detachment was also significantly associated with impairments in DA (P ≤ 0.018). CONCLUSIONS Our results suggest a significant association between macular morphology evaluated by OCT and time to dark-adapt. Subretinal drusenoid deposits and ellipsoid zone changes seem to be strongly associated with impaired dark adaptation.
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Affiliation(s)
- Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light, AIBILI, Coimbra, Portugal; Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Dong H Park
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, School of Medicine, Kyungpook National University, South Korea
| | - Edem Tsikata
- Glaucoma Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Samaneh Davoudi
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Safa Rahmani
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Pierce
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Rufino Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light, AIBILI, Coimbra, Portugal; Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa C Chen
- Glaucoma Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ivana K Kim
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Demetrios Vavvas
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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