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Sheth JU, Stewart MW, Narayanan R, Anantharaman G, Chandran K, Lai TYY, Chakravarthy U, Das T. Macular neovascularization. Surv Ophthalmol 2024:S0039-6257(24)00095-X. [PMID: 39222802 DOI: 10.1016/j.survophthal.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
Neovascularization of the macula, a common complication of many chorioretinal diseases such as neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, and pathologic myopia results from increased synthesis of vascular endothelial growth factor (VEGF) by the retinal pigment epithelium and/or Müller cells because of localized ischemia and inflammation. The Consensus on Neovascular AMD Nomenclature (CONAN) study group acknowledged that these vessels may originate from either the choriocapillaris or the retinal microvasculature, prompting them to propose the term 'macular neovascularization' (MNV) to include intraretinal, subretinal, and sub-pigment epithelial neovascularization localized to the macula. MNV frequently appears as a grey-green macular lesion with overlying intraretinal thickening and/or subretinal exudation, causing metamorphopsia, reduced central vision, relative central scotoma, decreased reading speed, and problems with color recognition. Multimodal imaging with optical coherence tomography (OCT), OCT angiography, dye-based angiographies, fundus autofluorescence, and multiwavelength photography help establish the diagnosis and aid in selecting an appropriate treatment. The standard of care for MNV is usually intravitreal anti-VEGF injections, though thermal laser photocoagulation, verteporfin photodynamic therapy, and vitreoretinal surgery are occasionally used. This current review discusses the etiology and clinical features of MNV, the role of multimodal imaging in establishing the diagnosis, and the available therapeutic options.
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Affiliation(s)
- Jay U Sheth
- Department of Vitreoretinal Services, Shantilal Shanghvi Eye Institute, Mumbai, India
| | - Michael W Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | - Raja Narayanan
- Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | | | - Kiran Chandran
- Department of Vitreoretinal Services, Giridhar Eye Institute, Cochin, India
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong, Hong Kong
| | - Usha Chakravarthy
- Department of Ophthalmology and Vision Science, Queen's University of Belfast, Belfast, United Kingdom
| | - Taraprasad Das
- Department of Vitreoretinal Services, Shantilal Shanghvi Eye Institute, Mumbai, India; Anant Bajaj Retina Institute, Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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Cheng AMS, Chalam KV, Brar VS, Yang DTY, Bhatt J, Banoub RG, Gupta SK. Recent Advances in Imaging Macular Atrophy for Late-Stage Age-Related Macular Degeneration. Diagnostics (Basel) 2023; 13:3635. [PMID: 38132220 PMCID: PMC10742961 DOI: 10.3390/diagnostics13243635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. In late-stage AMD, geographic atrophy (GA) of dry AMD or choroidal neovascularization (CNV) of neovascular AMD eventually results in macular atrophy (MA), leading to significant visual loss. Despite the development of innovative therapies, there are currently no established effective treatments for MA. As a result, early detection of MA is critical in identifying later central macular involvement throughout time. Accurate and early diagnosis is achieved through a combination of clinical examination and imaging techniques. Our review of the literature depicts advances in retinal imaging to identify biomarkers of progression and risk factors for late AMD. Imaging methods like fundus photography; dye-based angiography; fundus autofluorescence (FAF); near-infrared reflectance (NIR); optical coherence tomography (OCT); and optical coherence tomography angiography (OCTA) can be used to detect and monitor the progression of retinal atrophy. These evolving diverse imaging modalities optimize detection of pathologic anatomy and measurement of visual function; they may also contribute to the understanding of underlying mechanistic pathways, particularly the underlying MA changes in late AMD.
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Affiliation(s)
- Anny M. S. Cheng
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
- Department of Ophthalmology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Kakarla V. Chalam
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA 92350, USA;
| | - Vikram S. Brar
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - David T. Y. Yang
- College of Biological Science, University of California, Davis, Sacramento, CA 95616, USA;
| | - Jineel Bhatt
- Specialty Retina Center, Coral Springs, FL 33067, USA;
| | - Raphael G. Banoub
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
| | - Shailesh K. Gupta
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
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Song JE, Lee EJ, Kim TW, Kim H. Multicolor imaging compared with red-free fundus photography in the detection of glaucomatous retinal nerve fiber layer thinning. Photodiagnosis Photodyn Ther 2023; 42:103352. [PMID: 36806827 DOI: 10.1016/j.pdpdt.2023.103352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/25/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND To compare the ability of multicolor imaging (MCI) with red-free fundus photography (RFP) to detect glaucomatous retinal nerve fiber layer (RNFL) thinning. METHODS A total of 127 eyes of 79 patients with glaucoma underwent MCI using blue light, RFP, and circumpapillary optical coherence tomography (OCT) scanning on the same day. Angular location and width of the RNFL defects (RNFLDs) identified on the MCI and RFP were independently measured, and compared with those of RNFL thinning indicated by abnormal color codes on OCT. RESULTS The angular location and width of the RNFLDs determined by both MCI and RFP were well correlated with those of RNFL thinning determined by OCT (all P ≤ 0.013). The correlation of angular width with OCT was significantly stronger for MCI than for RFP (R = 0.708 vs. R = 0.616, P = 0.009). The superiority of MCI to RFP in the detection of OCT-determined RNFL thinning was significant in the inferior (P = 0.025) and marginally significant in the superior (P = 0.084) hemisectors. Thinner RNFL and longer axial length were significantly associated with better visualization of RNFLD by MCI than by RFP, respectively in the superior (OR = 0.948, P = 0.048) and inferior (OR = 1.490, P = 0.012) hemisectors. CONCLUSIONS RNFLD on MCI correlated well with OCT measurement of RNFL thinning in eyes with glaucoma. MCI performed better than conventional RFP in the detection of OCT-determined RNFL thinning, specifically in eyes with thinner RNFL and those with myopia. MCI may be more useful than conventional RFP in evaluating glaucomatous RNFL thinning.
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Affiliation(s)
- Ji Eun Song
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Tea-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyunjoong Kim
- Department of Applied Statistics, Yonsei University, Seoul, Republic of Korea
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Crincoli E, De Rosa I, Miere A, Colantuono D, Mehanna CJ, Souied EH. Comparison of Multimodal Imaging for the Characterization of Geographic Atrophy. Transl Vis Sci Technol 2022; 11:21. [DOI: 10.1167/tvst.11.11.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Emanuele Crincoli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil Cedex, France
- Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli IRCCS,” Rome, Italy
- Catholic University of “Sacro Cuore,” Rome, Italy
| | - Irene De Rosa
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil Cedex, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil Cedex, France
| | - Donato Colantuono
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil Cedex, France
| | - Carl Joe Mehanna
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil Cedex, France
| | - Eric H. Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil Cedex, France
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Agrón E, Domalpally A, Cukras CA, Clemons TE, Chen Q, Lu Z, Chew EY, Keenan TDL. Reticular Pseudodrusen: The Third Macular Risk Feature for Progression to Late Age-Related Macular Degeneration: Age-Related Eye Disease Study 2 Report 30. Ophthalmology 2022; 129:1107-1119. [PMID: 35660417 PMCID: PMC9509418 DOI: 10.1016/j.ophtha.2022.05.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To analyze reticular pseudodrusen (RPD) as an independent risk factor for progression to late age-related macular degeneration (AMD), alongside traditional macular risk factors (soft drusen and pigmentary abnormalities) considered simultaneously. DESIGN Post hoc analysis of 2 clinical trial cohorts: Age-Related Eye Disease Study (AREDS) and AREDS2. PARTICIPANTS Eyes with no late AMD at baseline in AREDS (6959 eyes, 3780 participants) and AREDS2 (3355 eyes, 2056 participants). METHODS Color fundus photographs (CFPs) from annual visits were graded for soft drusen, pigmentary abnormalities, and late AMD. Presence of RPD was from grading of fundus autofluorescence images (AREDS2) and deep learning grading of CFPs (AREDS). Proportional hazards regression analyses were performed, considering AREDS AMD severity scales (modified simplified severity scale [person] and 9-step scale [eye]) and RPD presence simultaneously. MAIN OUTCOME MEASURES Progression to late AMD, geographic atrophy (GA), and neovascular AMD. RESULTS In AREDS, for late AMD analyses by person, in a model considering the simplified severity scale simultaneously, RPD presence was associated with a higher risk of progression: hazard ratio (HR), 2.15 (95% confidence interval [CI], 1.75-2.64). However, the risk associated with RPD presence differed at different severity scale levels: HR, 3.23 (95% CI, 1.60-6.51), HR, 3.81 (95% CI, 2.38-6.10), HR, 2.28 (95% CI, 1.59-3.27), and HR, 1.64 (95% CI, 1.20-2.24), at levels 0-1, 2, 3, and 4, respectively. Considering the 9-step scale (by eye), RPD presence was associated with higher risk: HR, 2.54 (95% CI, 2.07-3.13). The HRs were 5.11 (95% CI, 3.93-6.66) at levels 1-6 and 1.78 (95% CI, 1.43-2.22) at levels 7 and 8. In AREDS2, by person, RPD presence was not associated with higher risk: HR, 1.18 (95% CI, 0.90-1.56); by eye, it was HR, 1.57 (95% CI, 1.31-1.89). In both cohorts, RPD presence carried a higher risk for GA than neovascular AMD. CONCLUSIONS Reticular pseudodrusen represent an important risk factor for progression to late AMD, particularly GA. However, the added risk varies markedly by severity level, with highly increased risk at lower/moderate levels and less increased risk at higher levels. Reticular pseudodrusen status should be included in updated AMD classification systems, risk calculators, and clinical trials.
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Affiliation(s)
- Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health (NIH), Bethesda, Maryland
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health (NIH), Bethesda, Maryland
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| | - Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Saßmannshausen M, Thiele S, Behning C, Pfau M, Schmid M, Leal S, Luhmann UFO, Finger RP, Holz FG, Schmitz-Valckenberg S. Intersession Repeatability of Structural Biomarkers in Early and Intermediate Age-Related Macular Degeneration: A MACUSTAR Study Report. Transl Vis Sci Technol 2022; 11:27. [PMID: 35333287 PMCID: PMC8963672 DOI: 10.1167/tvst.11.3.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To analyze the intersession repeatability of structural biomarkers in eyes with early and intermediate age-related macular degeneration (iAMD) within the cross-sectional part of the observational multicenter MACUSTAR study. Methods Certified site personnel obtained multimodal imaging data at two visits (38 ± 20 [mean ± standard deviation] days apart), including spectral-domain optical coherence tomography (SD-OCT). One junior reader performed systematic and blinded grading at the central reading center, followed by senior reader review. Structural biomarkers included maximum drusen size classification (>63 to ≤125 µm vs. >125 µm), presence of large pigment epithelium detachments (PEDs), reticular pseudodrusen (RPD), vitelliform lesions, and refractile deposits. Intrasession variability was assessed using Cohen's κ statistics. Results At the first visit, 202 study eyes of 202 participants were graded as manifesting with either early (n = 34) or intermediate (n = 168) AMD. Grading of imaging data between visits revealed perfect agreement for the maximum drusen size classification (κ = 0.817; 95% confidence interval, 0.70–0.94). In iAMD eyes, perfect to substantial agreement was determined for the presence of large PEDs (0.87; 0.69–1.00) and RPD (0.752; 0.63–0.87), while intersession agreement was lower for the presence of vitelliform lesions (0.649; 0.39–0.65) and refractile deposits (0.342; −0.029–0.713), respectively. Conclusions Multimodal retinal imaging analysis between sessions showed a higher repeatability for structural biomarkers with predefined cutoff values than purely qualitative defined parameters. Translational Relevance A high repeatability of retinal imaging biomarkers will be important to implement automatic grading approaches and to establish robust and meaningful structural clinical endpoints for future interventional clinical trials in patients with iAMD.
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Affiliation(s)
- Marlene Saßmannshausen
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany.,Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Bethesda, MD, USA
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, Bonn, Germany
| | | | - Ulrich F O Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center Basel, Basel, Switzerland
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,GRADE Reading Center, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT, USA
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Chen Q, Keenan TD, Allot A, Peng Y, Agrón E, Domalpally A, Klaver CCW, Luttikhuizen DT, Colyer MH, Cukras CA, Wiley HE, Teresa Magone M, Cousineau-Krieger C, Wong WT, Zhu Y, Chew EY, Lu Z. Multimodal, multitask, multiattention (M3) deep learning detection of reticular pseudodrusen: Toward automated and accessible classification of age-related macular degeneration. J Am Med Inform Assoc 2021; 28:1135-1148. [PMID: 33792724 PMCID: PMC8200273 DOI: 10.1093/jamia/ocaa302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Reticular pseudodrusen (RPD), a key feature of age-related macular degeneration (AMD), are poorly detected by human experts on standard color fundus photography (CFP) and typically require advanced imaging modalities such as fundus autofluorescence (FAF). The objective was to develop and evaluate the performance of a novel multimodal, multitask, multiattention (M3) deep learning framework on RPD detection. MATERIALS AND METHODS A deep learning framework (M3) was developed to detect RPD presence accurately using CFP alone, FAF alone, or both, employing >8000 CFP-FAF image pairs obtained prospectively (Age-Related Eye Disease Study 2). The M3 framework includes multimodal (detection from single or multiple image modalities), multitask (training different tasks simultaneously to improve generalizability), and multiattention (improving ensembled feature representation) operation. Performance on RPD detection was compared with state-of-the-art deep learning models and 13 ophthalmologists; performance on detection of 2 other AMD features (geographic atrophy and pigmentary abnormalities) was also evaluated. RESULTS For RPD detection, M3 achieved an area under the receiver-operating characteristic curve (AUROC) of 0.832, 0.931, and 0.933 for CFP alone, FAF alone, and both, respectively. M3 performance on CFP was very substantially superior to human retinal specialists (median F1 score = 0.644 vs 0.350). External validation (the Rotterdam Study) demonstrated high accuracy on CFP alone (AUROC, 0.965). The M3 framework also accurately detected geographic atrophy and pigmentary abnormalities (AUROC, 0.909 and 0.912, respectively), demonstrating its generalizability. CONCLUSIONS This study demonstrates the successful development, robust evaluation, and external validation of a novel deep learning framework that enables accessible, accurate, and automated AMD diagnosis and prognosis.
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Affiliation(s)
- Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiarnan D.L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexis Allot
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Yifan Peng
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amitha Domalpally
- Fundus Photograph Reading Center, University of Wisconsin, Madison, Wisconsin, USA
| | | | | | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - M Teresa Magone
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chantal Cousineau-Krieger
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wai T Wong
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Section on Neuron-Glia Interactions in Retinal Disease, Laboratory of Retinal Cell and Molecular Biology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yingying Zhu
- Department of Computer Science and Engineering, University of Texas at Arlington, Arlington, Texas, USA
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
PURPOSE To characterize features of central serous chorioretinopathy (CSC) using multicolor (MC) imaging and to compare the efficacy of using MC imaging and traditional color fundus photography (CFP) for detecting features of CSC. METHODS A retrospective review of 75 eyes of 69 participants with CSC from the Eye Center of the Renmin Hospital of Wuhan University. The patients underwent same-day CFP, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT), and MC imaging (including infrared reflectance (IR), green reflectance (GR), blue reflectance (BR), combined standard MC image, and green-blue-enhanced image). Positive CSC lesions were evaluated using FFA and SD-OCT. Features in images of CFP, standard MC, green-blue-enhanced, IR, GR, and BR were analyzed and calculated. RESULTS Among the 75 eyes of 69 patients, 75 eyes with subretinal fluid (SRF) and retinal pigment epithelial (RPE) leakage point, and 43 eyes with RPE damage were observed by FFA and SD-OCT. The detection rate of SRF was significantly higher with the standard MC image (92.0%), green-blue-enhanced image (92.0%), IR (88.0%), and GR (88.0%) than that with CFP (66.7%) (P < 0.05). Blue reflectance (45.3%) was associated with lower rate of SRF detection compared to CFP (P < 0.05). The standard MC image (84.0%), green-blue-enhanced image (84.0%), IR (78.7%), and GR (80%) delineated the boundaries of SRF more effectively than CFP (44%). The abnormal areas corresponding to RPE leakage points on FFA were observed with the standard MC image, green-blue-enhanced image, and IR at detection rates of 90.7, 82.7, and 90.7%, respectively, which were significantly higher than with CFP (29.3%) (P < 0.05). However, the detection rates of the abnormalities corresponding to leakage on FFA were lower with GR (5.3%) and BR (1.3%) than those with CFP (P < 0.05). Areas of RPE damage on FFA were observed at the same locations with the standard MC image, green-blue-enhanced image, and IR at detection rates of 97.7, 93.0, and 95.3%, respectively, which were significantly higher than with CFP (41.9%) (P < 0.05). Compared with CFP, the detectable rates of RPE damage on GR (14.0%) and BR (9.3%) were lower (P < 0.05). CONCLUSION As an adjunct to SD-OCT, the MC image can delineate the extent or boundaries of SRF more effectively than CFP. As an adjunct to FFA, the MC image can identify foci of leakage more effectively than CFP. The MC image, particularly the IR channel, can identify areas of RPE damage more effectively than CFP. Therefore, the MC image may be a useful adjunct to FFA and OCT for detecting or monitoring CSC.
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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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Keenan TDL, Chen Q, Peng Y, Domalpally A, Agrón E, Hwang CK, Thavikulwat AT, Lee DH, Li D, Wong WT, Lu Z, Chew EY. Deep Learning Automated Detection of Reticular Pseudodrusen from Fundus Autofluorescence Images or Color Fundus Photographs in AREDS2. Ophthalmology 2020; 127:1674-1687. [PMID: 32447042 PMCID: PMC11079794 DOI: 10.1016/j.ophtha.2020.05.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To develop deep learning models for detecting reticular pseudodrusen (RPD) using fundus autofluorescence (FAF) images or, alternatively, color fundus photographs (CFP) in the context of age-related macular degeneration (AMD). DESIGN Application of deep learning models to the Age-Related Eye Disease Study 2 (AREDS2) dataset. PARTICIPANTS FAF and CFP images (n = 11 535) from 2450 AREDS2 participants. Gold standard labels from reading center grading of the FAF images were transferred to the corresponding CFP images. METHODS A deep learning model was trained to detect RPD in eyes with intermediate to late AMD using FAF images (FAF model). Using label transfer from FAF to CFP images, a deep learning model was trained to detect RPD from CFP (CFP model). Performance was compared with 4 ophthalmologists using a random subset from the full test set. MAIN OUTCOME MEASURES Area under the receiver operating characteristic curve (AUC), κ value, accuracy, and F1 score. RESULTS The FAF model had an AUC of 0.939 (95% confidence interval [CI], 0.927-0.950), a κ value of 0.718 (95% CI, 0.685-0.751), and accuracy of 0.899 (95% CI, 0.887-0.911). The CFP model showed equivalent values of 0.832 (95% CI, 0.812-0.851), 0.470 (95% CI, 0.426-0.511), and 0.809 (95% CI, 0.793-0.825), respectively. The FAF model demonstrated superior performance to 4 ophthalmologists, showing a higher κ value of 0.789 (95% CI, 0.675-0.875) versus a range of 0.367 to 0.756 and higher accuracy of 0.937 (95% CI, 0.907-0.963) versus a range of 0.696 to 0.933. The CFP model demonstrated substantially superior performance to 4 ophthalmologists, showing a higher κ value of 0.471 (95% CI, 0.330-0.606) versus a range of 0.105 to 0.180 and higher accuracy of 0.844 (95% CI, 0.798-0.886) versus a range of 0.717 to 0.814. CONCLUSIONS Deep learning-enabled automated detection of RPD presence from FAF images achieved a high level of accuracy, equal or superior to that of ophthalmologists. Automated RPD detection using CFP achieved a lower accuracy that still surpassed that of ophthalmologists. Deep learning models can assist, and even augment, the detection of this clinically important AMD-associated lesion.
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Affiliation(s)
- Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Yifan Peng
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Amitha Domalpally
- Fundus Photograph Reading Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Christopher K Hwang
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Alisa T Thavikulwat
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Debora H Lee
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel Li
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Wai T Wong
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland; Section on Neuron-Glia Interactions in Retinal Disease, Laboratory of Retinal Cell and Molecular Biology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland.
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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Abstract
PURPOSE To compare retinal pathology visualization in multispectral scanning laser ophthalmoscope imaging between the Spectralis and Optos devices. METHODS This retrospective cross-sectional study included 42 eyes from 30 patients with age-related macular degeneration (19 eyes), diabetic retinopathy (10 eyes), and epiretinal membrane (13 eyes). All patients underwent retinal imaging with a color fundus camera (broad-spectrum white light), the Spectralis HRA-2 system (3-color monochromatic lasers), and the Optos P200 system (2-color monochromatic lasers). The Optos image was cropped to a similar size as the Spectralis image. Seven masked graders marked retinal pathologies in each image within a 5 × 5 grid that included the macula. RESULTS The average area with detected retinal pathology in all eyes was larger in the Spectralis images compared with Optos images (32.4% larger, P < 0.0001), mainly because of better visualization of epiretinal membrane and retinal hemorrhage. The average detection rate of age-related macular degeneration and diabetic retinopathy pathologies was similar across the three modalities, whereas epiretinal membrane detection rate was significantly higher in the Spectralis images. CONCLUSION Spectralis tricolor multispectral scanning laser ophthalmoscope imaging had higher rate of pathology detection primarily because of better epiretinal membrane and retinal hemorrhage visualization compared with Optos bicolor multispectral scanning laser ophthalmoscope imaging.
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Govindahari V, Fraser-Bell S, Ayachit AG, Invernizzi A, Nair U, Nair DV, Lupidi M, Singh SR, Rajendran A, Zur D, Gallego-Pinazo R, Marco RD, Cagini C, Cozzi M, Chhablani J. Multicolor imaging in macular telangiectasia-a comparison with fundus autofluorescence. Graefes Arch Clin Exp Ophthalmol 2020; 258:2379-2387. [PMID: 32803329 DOI: 10.1007/s00417-020-04878-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To describe various clinical features of idiopathic juxtafoveal retinal telangiectasis group 2A or idiopathic macular telangiectasia type 2 (MacTel) on multicolor imaging (MCI) and compare imaging findings of MacTel on MCI with fundus autofluorescence (FAF). METHODS Patients with a clinical diagnosis of MacTel based on Gass and Blodi's classification were included. FAF and MCI images were graded qualitatively for stage of disease, margins of involvement, hyperautofluorescence on FAF (corresponding retinal atrophy on MCI), and detection of crystals. FAF and MCI were graded quantitatively for the area and number of quadrants involved, hypoautofluorescene on FAF (corresponding intraretinal pigment hyperplasia or retinal pigment epithelium [RPE] atrophy on MCI), and foci of right-angled venules. RESULTS Seventy-eight eyes of forty five patients were included with both imaging modalities showing no difference with respect to staging of non-proliferative MacTel. Retinal crystals were recognized on MCI but not on FAF. Neurosensory retinal atrophy and subretinal neovascular membranes were detected using MCI with 92.3 and 83.3% sensitivity, respectively. Intraretinal pigmented hyperplasia was more accurately detected (70.1 vs 58.4%) compared with RPE atrophy on MCI. MCI showed larger area of involvement, higher number of quadrants involved (p < 0.001), and better delineation of margins (p = 0.002) compared with FAF. A higher mean number of vessel dipping foci was noted on MCI in comparison with FAF (3.34 vs 3.1). CONCLUSION Various parameters were more easily defined using MCI compared with FAF which qualifies MCI as an enface depth-resolved imaging adjunct to conventional multimodal imaging in MacTel. The ability to detect enface as well as cross-sectional imaging features makes MCI a valuable tool in MacTel.
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Affiliation(s)
- Vishal Govindahari
- Department of Retina, Pushpagiri Vitreo-Retina Institute, Hyderabad, India
| | - Samantha Fraser-Bell
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Apoorva G Ayachit
- Department of Vitreoretina, M. M. Joshi Eye Institute, Hubballi, Karnataka, India
| | - Alessandro Invernizzi
- Eye Clinic - Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Unnikrishnan Nair
- Department of Retina, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India
| | - Dhanya V Nair
- Department of Retina, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India
| | - Marco Lupidi
- Department of Ophthalmology, University of Perugia, Perugia, Italy
| | - Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Institute, Hyderabad, India
| | | | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Carlo Cagini
- Department of Biomedical and Surgical Sciences, Section of Ophtalmology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Mariano Cozzi
- Eye Clinic - Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jay Chhablani
- UPMC eye center, University of Pittsburg, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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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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14
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Govindahari V, Singh SR, Rajesh B, Gallego-Pinazo R, Marco RD, Nair DV, Nair U, Chhablani J. Multicolor imaging in central serous chorioretinopathy - a quantitative and qualitative comparison with fundus autofluorescence. Sci Rep 2019; 9:11728. [PMID: 31409843 PMCID: PMC6692404 DOI: 10.1038/s41598-019-48040-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/23/2019] [Indexed: 11/08/2022] Open
Abstract
Central serous chorioretinopathy (CSCR) is characterised by choroidal hyperpermeability which results in neurosensory detachments (NSD) along with numerous retinal pigment epithelium (RPE) alterations such as RPE atrophy. Fundus autofluorescence (FAF) demonstrates the functionality of the RPE while multicolor imaging(MCI), by means of its three incident wavelengths, provides insight into clinical changes at various levels of the retina and choroid in CSCR. This study compares various clinical findings in CSCR (NSD, subretinal deposits, RPE atrophy, pigment epithelial detachments (PED) and pachyvessels) on the above mentioned imaging modalities both qualitatively and quantitatively. MCI showed higher mean cumulative area of RPE atrophic patches (6.3 ± 6.02 vs 5.7 ± 5.7 mm2, p = 0.046), PED (1.3 ± 1.4 vs 1.1 ± 1.2 mm2, p = 0.068) and NSD (17.2 ± 11.4 vs 15.7 ± 10.7 mm2, p = 0.033). MCI demonstrated better defined lesions (NSD, PED, RPE atrophy) and more number of eyes with PED and pachyvessels in comparison to FAF.Both investigations had a 100% sensitivity in detecting NSD and 100% specificity for sub retinal deposits. This study demonstrates the ability of MCI to quantitatively and qualitatively define various clinical features in CSCR and the advantages it holds over FAF. MCI can hence be considered as a useful imaging modality in documenting and monitoring various structural changes in eyes with CSCR.
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Affiliation(s)
- Vishal Govindahari
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Bindu Rajesh
- Ophthalmology and Visual Sciences department, Khoo Teck Puat Hospital(KTPH), 90 Yishun Central, Singapore, Singapore
| | | | | | - Dhanya V Nair
- Department of Retina, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India
| | - Unni Nair
- Department of Retina, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.
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15
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Neroev VV, Zaytseva OV, Okhotsimskaya TD, Fadeeva VA, Verbitskaya VA. [Possibilities of multicolor confocal scanning laser ophthalmoscopy in complex diagnostics of severe proliferative diabetic retinopathy]. Vestn Oftalmol 2019; 135:22-31. [PMID: 31215531 DOI: 10.17116/oftalma201913502122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multicolor scanning laser ophthalmoscopy (multicolor SLO) is a new informative method of eye fundus visualization. The method is based on synchronously obtaining three separate confocal images with monochromatic laser sources - blue (488 nm), green (515 nm) and infrared (820 nm), which are then combined into one in the Multicolor mode. PURPOSE To evaluate the informative value of multicolor SLO in a complex examination of patients with severe proliferative diabetic retinopathy (PDR). MATERIAL AND METHODS A total of 46 patients (62 eyes) aged 19 to 75 years with severe PDR was examined. All patients had massive growth of proliferative tissue on the eye fundus, which caused traction deformation and/or retinal detachment in the posterior pole. Optical mediums of the eyes were sufficiently transparent to obtain high quality images. All patients underwent color photo-registration of the fundus, fluorescein angiography (FA), optical coherence tomography (OCT) and multicolor SLO under drug-induced mydriasis. RESULTS Pseudo-volumetric images obtained with multicolor SLO allow visualization of of preretinal proliferative membranes and their structure, the degree of their vascularization, the anatomical features of their attachment to retina, and the occluded vessels on fundus periphery. Being an additional option on scanning laser ophthalmoscope, the technique does not require special equipment, which enables several separate examinations, including OCT and FA, to be performed on a single device. CONCLUSION Multicolor SLO is a promising new method of visualizing structures of the eye fundus and can be successfully used in complex diagnostics, monitoring and preoperative preparation of patients with severe PDR.
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Affiliation(s)
- V V Neroev
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - O V Zaytseva
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - T D Okhotsimskaya
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - V A Fadeeva
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - V A Verbitskaya
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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Electrophysiological function in eyes with reticular pseudodrusen according to fundus distribution. PLoS One 2018; 13:e0203146. [PMID: 30157256 PMCID: PMC6114915 DOI: 10.1371/journal.pone.0203146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 08/15/2018] [Indexed: 11/19/2022] Open
Abstract
Reticular pseudodrusen (RPD) could be present not only in the posterior pole but extramacular area also as a confluent morphological pattern. Thus RPD can be classified by the fundus distribution for the assessment of visual prognosis. The electrophysiological function in eyes with reticular pseudodrusen (RPD), showing various fundus distribution were evaluated using full-field electroretinogram (ERG). Retinal distribution of RPD was divided into three types (localized, intermediate, and diffuse) according to the extent of involvement of retinal areas by fundus photograph montages. RPD were present with the diffuse type in 21 eyes (25.6%), with the intermediate type in 30 eyes (36.6%), and with the localized type in 31 eyes (37.8%). The average age was 74.76 ± 4.52 (range, 65-81) years in the diffuse type, 72.47 ± 9.13 (range, 55-91) years in the intermediate type, and 70.26 ± 7.77 (range, 61-89) years in the localized type. The mean amplitudes of the scotopic rod response, scotopic maximal combined response, oscillatory potentials (OP), photopic cone response, and 30Hz cone flicker response were more decreased in the diffuse, intermediate, and localized types in order, except for the photopic cone a-wave response. The diffuse type showed reduced amplitudes of ERG responses than the normal control group under all testing conditions except for the photopic a-wave response, and differences were statistically significant with the age restriction and adjustment methods (Bonferroni-corrected P < 0.05). The mean implicit times of ERG responses were significantly delayed in the diffuse type in the photopic b-wave. (Bonferroni-corrected P < 0.05). Extensive retinal involvement of RPD correlates with severely reduced electrophysiological retinal function. This acquired form of decreased electrophysiological function should be regarded as different from those of hereditary retinal degeneration.
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17
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Huang G, Peng J, Ye Z, Kijlstra A, Zhang D, Yang P. Multispectral image analysis in Vogt-Koyanagi-Harada disease. Acta Ophthalmol 2018; 96:411-419. [PMID: 29220112 DOI: 10.1111/aos.13606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate fundus abnormalities in Vogt-Koyanagi-Harada (VKH) disease by a noninvasive tool, multispectral imaging (MSI). METHODS A total of 77 patients with VKH and 163 healthy controls were enrolled between January and April 2015. The MSI findings were evaluated in combination with fundus fluorescein angiography (FFA), optical coherent tomography (OCT) and fundus photography (FP). Additionally, we compared extent of exposure of choroidal blood vessels between patients with VKH and healthy controls to evaluate retinal transmission function. RESULTS A number of features could be recognized by MSI which included (i) general depigmentation, (ii) clumping of pigment and (iii) macular depigmentation and/or hyperpigmentation. The percentages of these three abnormalities discovered by MSI in 52 inactive VKH patients with a duration of more than 2 months in VKH were 67.3%, 75% and 84.6% respectively, which were all significantly higher than those detected by FFA, OCT or FP (p = 0.0398, p < 0.0001). Our study showed that MSI detected a higher percentages of these four abnormalities in patients with sunset glow fundus than in patients without this phenomenon (p = 0.0492, p < 0.0001). Additionally, at the same wavelength (590 nm), exposure of choroidal blood vessels in inactive patients was stronger than in healthy controls and active patients (p < 0.01, p < 0.001). CONCLUSION Our results show that MSI is a sensitive noninvasive method to investigate the retinal pigment epithelium (RPE) in VKH disease. It is more likely to detect RPE abnormalities with MSI than when using FFA, OCT or FP. Retinal transmission function in inactive patients is stronger than that observed in active patients or healthy controls.
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Affiliation(s)
- Guo Huang
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
| | - Junchao Peng
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
| | - Zi Ye
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
| | - Aize Kijlstra
- University Eye Clinic Maastricht; Maastricht the Netherlands
| | - Donglei Zhang
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University; Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute; Chongqing China
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Spaide RF, Ooto S, Curcio CA. Subretinal drusenoid deposits AKA pseudodrusen. Surv Ophthalmol 2018; 63:782-815. [PMID: 29859199 DOI: 10.1016/j.survophthal.2018.05.005] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 01/30/2023]
Abstract
A distinction between conventional drusen and pseudodrusen was first made in 1990, and more recently knowledge of pseudodrusen, more accurately called subretinal drusenoid deposits (SDDs), has expanded. Pseudodrusen have a bluish-white appearance by biomicroscopy and color fundus photography. Using optical coherence tomography, pseudodrusen were found to be accumulations of material internal to the retinal pigment epithelium that could extend internally through the ellipsoid zone. These deposits are more commonly seen in older eyes with thinner choroids. Histologic evaluation of these deposits revealed aggregations of material in the subretinal space between photoreceptors and retinal pigment epithelium. SDDs contain some proteins in common with soft drusen but differ in lipid composition. Many studies reported that SDDs are strong independent risk factors for late age-related macular degeneration. Geographic atrophy and type 3 neovascularization are particularly associated with SDD. Unlike conventional drusen, eyes with SDD show slow dark adaptation and poor contrast sensitivity. Outer retinal atrophy develops in eyes with regression of SDD, a newly recognized form of late age-related macular degeneration. Advances in imaging technology have enabled many insights into this condition, including associated photoreceptor, retinal pigment epithelium, and underlying choroidal changes.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.
| | - Sotaro Ooto
- Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA; Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Christine A Curcio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabamas, USA
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Rabiolo A, Sacconi R, Cicinelli MV, Querques L, Bandello F, Querques G. Spotlight on reticular pseudodrusen. Clin Ophthalmol 2017; 11:1707-1718. [PMID: 29033536 PMCID: PMC5614782 DOI: 10.2147/opth.s130165] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of vision loss in patients >50 years old. The hallmark of the disease is represented by the accumulation of extracellular material between retinal pigment epithelium and the inner collagenous layer of Bruch's membrane, called drusen. Although identified almost 30 years ago, reticular pseudodrusen (RPD) have been recently recognized as a distinctive phenotype. Unlike drusen, they are located in the subretinal space. RPD are strongly associated with late AMD, especially geographic atrophy, type 2 and 3 choroidal neovascularization, which, in turn, are less common in typical AMD. RPD identification is not straightforward at fundus examination, and their identification should employ at least 2 different imaging modalities. In this narrative review, we embrace all aspects of RPD, including history, epidemiology, histology, imaging, functional test, natural history and therapy.
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Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
- Eye Clinic, Department of Neurological and Movement Sciences, University of Verona, Verona
| | | | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
- G. B. Bietti Foundation-IRCCS, Rome, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan
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Abstract
PURPOSE To characterize longitudinal structural changes in early stages of late-onset retinal degeneration to investigate pathogenic mechanisms. METHODS Two affected siblings, both with a S163R missense mutation in the causative gene C1QTNF5, were followed for 8+ years. Color fundus photos, fundus autofluorescence images, near-infrared reflectance fundus images, and spectral domain optical coherence tomography scans were acquired during follow-up. RESULTS Both patients, aged 45 and 50 years, had good visual acuities (>20/20) in the context of prolonged dark adaptation. Baseline color fundus photography demonstrated yellow-white, punctate lesions in the temporal macula that correlated with a reticular pattern on fundus autofluorescence and near-infrared reflectance imaging. Baseline spectral domain optical coherence tomography imaging revealed subretinal deposits that resemble reticular pseudodrusen described in age-related macular degeneration. During follow-up, these affected areas developed confluent thickening of the retinal pigment epithelial layer and disruption of the ellipsoid zone of photoreceptors before progressing to overt retinal pigment epithelium and outer retinal atrophy. CONCLUSION Structural changes in early stages of late-onset retinal degeneration, revealed by multimodal imaging, resemble those of reticular pseudodrusen observed in age-related macular degeneration and other retinal diseases. Longitudinal follow-up of these lesions helps elucidate their progression to frank atrophy and may lend insight into the pathogenic mechanisms underlying diverse retinal degenerations.
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Imaging Protocols in Clinical Studies in Advanced Age-Related Macular Degeneration. Ophthalmology 2017; 124:464-478. [DOI: 10.1016/j.ophtha.2016.12.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 02/07/2023] Open
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Perspectives on reticular pseudodrusen in age-related macular degeneration. Surv Ophthalmol 2016; 61:521-37. [DOI: 10.1016/j.survophthal.2016.02.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 11/20/2022]
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PREVALENCE OF RETICULAR PSEUDODRUSEN IN AGE-RELATED MACULAR DEGENERATION USING MULTIMODAL IMAGING. Retina 2016; 36:46-52. [PMID: 26090899 DOI: 10.1097/iae.0000000000000648] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the rate of reticular pseudodrusen (RPD) in age-related macular degeneration using multimodal imaging, including color fundus photography, the blue channel image of fundus photography, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography, as well as to compare the sensitivities and specificities of these modalities for detecting RPD. METHODS This prospective study included 243 eyes from 125 consecutive patients with age-related macular degeneration. They underwent fundus examination including color fundus photography, blue channel, infrared reflectance, fundus autofluorescence, multicolor imaging, and spectral domain optical coherence tomography in both eyes. To be considered as having RPD, eyes had to have reticular patterns on spectral domain optical coherence tomography in a large studied cube of 30° × 25° or on infrared reflectance with at least one other examination. RESULTS The mean age of the 125 patients was 81.1 years (± 8.1). Eighty-six patients (68.8%) were diagnosed with RPD. Spectral domain optical coherence tomography, infrared reflectance, and multicolor imaging had the highest sensitivity (99.3, 84.6, and 87.1%, respectively) and specificity (100%). The color fundus photography, blue channel, and fundus autofluorescence had lower sensitivity to detect RPD. CONCLUSION Reticular pseudodrusen is frequently associated with soft drusen in patients with age-related macular degeneration. As RPD may be rarely located only in the perifoveal area, spectral domain optical coherence tomography with a larger cube (30 × 25°) than that usually used (20 × 20°) had the highest sensitivity and specificity to detect RPD and is recommended to optimize the rate of detection.
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Tan ACS, Fleckenstein M, Schmitz-Valckenberg S, Holz FG. Clinical Application of Multicolor Imaging Technology. Ophthalmologica 2016; 236:8-18. [PMID: 27404384 DOI: 10.1159/000446857] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/12/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the clinical application of multicolor imaging by confocal scanning laser ophthalmoscopy (cSLO). METHODS Retinal imaging was performed in 76 patients including cSLO multicolor imaging (SPECTRALIS SD-OCT, Heidelberg Engineering, Heidelberg, Germany) and color fundus photography (CFP). RESULTS The use of confocal optics, reduced light scatter and automated eye tracking enable high-resolution cSLO reflectance images. Compared to CFP, the appearance of pigment alterations and hemorrhages were some of the differences observed. Various artifacts including those derived from optical media alterations need to be considered when interpreting images. Specific pathological findings including epiretinal membranes, fibrovascular proliferations, and reticular pseudodrusen may be better visualized on multicolor images. CONCLUSIONS When using multicolor imaging, ophthalmologists need to be mindful about differences in the appearance of pathological changes and artifacts. Multicolor imaging may offer information over and above conventional CFP; it can be performed through undilated pupils and is less affected by media opacities.
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Affiliation(s)
- Anna C S Tan
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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Khan KN, Mahroo OA, Khan RS, Mohamed MD, McKibbin M, Bird A, Michaelides M, Tufail A, Moore AT. Differentiating drusen: Drusen and drusen-like appearances associated with ageing, age-related macular degeneration, inherited eye disease and other pathological processes. Prog Retin Eye Res 2016; 53:70-106. [DOI: 10.1016/j.preteyeres.2016.04.008] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 04/24/2016] [Accepted: 04/27/2016] [Indexed: 12/11/2022]
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Zarubina AV, Neely DC, Clark ME, Huisingh CE, Samuels BC, Zhang Y, McGwin G, Owsley C, Curcio CA. Prevalence of Subretinal Drusenoid Deposits in Older Persons with and without Age-Related Macular Degeneration, by Multimodal Imaging. Ophthalmology 2016; 123:1090-100. [PMID: 26875000 DOI: 10.1016/j.ophtha.2015.12.034] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the prevalence of subretinal drusenoid deposits (SDD) in older adults with healthy maculas and early and intermediate age-related macular degeneration (AMD) using multimodal imaging. DESIGN Cross-sectional study. PARTICIPANTS A total of 651 subjects aged ≥60 years enrolled in the Alabama Study of Early Age-Related Macular Degeneration from primary care ophthalmology clinics. METHODS Subjects were imaged using spectral domain optical coherence tomography (SD OCT) of the macula and optic nerve head (ONH), infrared reflectance, fundus autofluorescence, and color fundus photographs (CFP). Eyes were assessed for AMD presence and severity using the Age-Related Eye Disease Study (AREDS) 9-step scale. Criteria for SDD presence were identification on ≥1 en face modality plus SD OCT or on ≥2 en face modalities if absent on SD OCT. Subretinal drusenoid deposits were considered present at the person level if present in 1 or both eyes. MAIN OUTCOME MEASURES Prevalence of SDD in participants with and without AMD. RESULTS Overall prevalence of SDD was 32% (197/611), with 62% (122/197) affected in both eyes. Persons with SDD were older than those without SDD (70.6 vs. 68.7 years, P = 0.0002). Prevalence of SDD was 23% in subjects without AMD and 52% in subjects with AMD (P < 0.0001). Among those with early and intermediate AMD, SDD prevalence was 49% and 79%, respectively. After age adjustment, those with SDD were 3.4 times more likely to have AMD than those without SDD (95% confidence interval, 2.3-4.9). By using CFP only for SDD detection per the AREDS protocol, prevalence of SDD was 2% (12/610). Of persons with SDD detected by SD OCT and confirmed by at least 1 en face modality, 47% (89/190) were detected exclusively on the ONH SD OCT volume. CONCLUSIONS Subretinal drusenoid deposits are present in approximately one quarter of older adults with healthy maculae and in more than half of persons with early to intermediate AMD, even by stringent criteria. The prevalence of SDD is strongly associated with AMD presence and severity and increases with age, and its retinal topography including peripapillary involvement resembles that of rod photoreceptors. Consensus on SDD detection methods is recommended to advance our knowledge of this lesion and its clinical and biologic significance.
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Affiliation(s)
- Anna V Zarubina
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David C Neely
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark E Clark
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carrie E Huisingh
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian C Samuels
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Yuhua Zhang
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald McGwin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine A Curcio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
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Schaal KB, Legarreta AD, Gregori G, Legarreta JE, Cheng Q, Stetson PF, Cai M, Laron M, Durbin M, Rosenfeld PJ. Widefield En Face Optical Coherence Tomography Imaging of Subretinal Drusenoid Deposits. Ophthalmic Surg Lasers Imaging Retina 2015; 46:550-9. [PMID: 26057758 DOI: 10.3928/23258160-20150521-06] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/13/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine whether subretinal drusenoid deposits (SDD) can be detected on widefield en face slab images derived from spectral-domain (SD) and swept-source (SS) optical coherence tomography (OCT) volume scans. PATIENTS AND METHODS Retrospective study of patients with dry age-related macular degeneration (AMD) enrolled prospectively in an OCT imaging study using SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA) with a central wavelength of 840 nm, and a prototype 100-kHz SS-OCT instrument (Carl Zeiss Meditec) with a central wavelength of 1,050 nm. Seven en face slabs were evaluated with thicknesses from 20 to 55 µm and positioned at distances up to 55 µm above the retinal pigment epithelium (RPE). A montage of 6 × 6 mm SD-OCT en face images of the posterior pole from each patient was compared with a 9 × 12 mm SS-OCT single en face slab image and with color, autofluorescence, and infrared reflectance images. RESULTS A total of 160 patients (256 eyes) underwent scanning with both OCT instruments; 57 patients (95 eyes) also underwent multimodal fundus imaging. Of 95 eyes, 32 (34%) were diagnosed with reticular pseudodrusen (RPD) using multimodal imaging. All eyes with RPD demonstrated a pattern of SDD on widefield en face OCT similar to that observed for RPD. The en face slab image that consistently identified SDD was the 20-µm thick slab with boundaries from 35 to 55 µm above the RPE. CONCLUSION Widefield en face slab imaging with SD-OCT and SS-OCT can detect SDD and could replace multimodal imaging for the diagnosis of RPD in the future.
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Steinberg JS, Göbel AP, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Reticular drusen in eyes with high-risk characteristics for progression to late-stage age-related macular degeneration. Br J Ophthalmol 2015; 99:1289-94. [DOI: 10.1136/bjophthalmol-2014-306535] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/04/2015] [Indexed: 11/04/2022]
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Alten F, Eter N. Current knowledge on reticular pseudodrusen in age-related macular degeneration. Br J Ophthalmol 2014; 99:717-22. [DOI: 10.1136/bjophthalmol-2014-305339] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/28/2014] [Indexed: 11/03/2022]
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