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Sabharwal J, Liu TYA, Antonio-Aguirre B, Abousy M, Patel T, Cai CX, Jones CK, Singh MS. Automated identification of fleck lesions in Stargardt disease using deep learning enhances lesion detection sensitivity and enables morphometric analysis of flecks. Br J Ophthalmol 2024; 108:1226-1233. [PMID: 38408857 DOI: 10.1136/bjo-2023-323592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To classify fleck lesions and assess artificial intelligence (AI) in identifying flecks in Stargardt disease (STGD). METHODS A retrospective study of 170 eyes from 85 consecutive patients with confirmed STGD. Fundus autofluorescence images were extracted, and flecks were manually outlined. A deep learning model was trained, and a hold-out testing subset was used to compare with manually identified flecks and for graders to assess. Flecks were clustered using K-means clustering. RESULTS Of the 85 subjects, 45 were female, and the median age was 37 years (IQR 25-59). A subset of subjects (n=41) had clearly identifiable fleck lesions, and an AI was successfully trained to identify these lesions (average Dice score of 0.53, n=18). The AI segmentation had smaller (0.018 compared with 0.034 mm2, p<0.001) but more numerous flecks (75.5 per retina compared with 40.0, p<0.001), but the total size of flecks was not different. The AI model had higher sensitivity to detect flecks but resulted in more false positives. There were two clusters of flecks based on morphology: broadly, one cluster of small round flecks and another of large amorphous flecks. The per cent frequency of small round flecks negatively correlated with subject age (r=-0.31, p<0.005). CONCLUSIONS AI-based detection of flecks shows greater sensitivity than human graders but with a higher false-positive rate. With further optimisation to address current shortcomings, this approach could be used to prescreen subjects for clinical research. The feasibility and utility of quantifying fleck morphology in conjunction with AI-based segmentation as a biomarker of progression require further study.
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Affiliation(s)
| | | | | | - Mya Abousy
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tapan Patel
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Cindy X Cai
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Craig K Jones
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mandeep S Singh
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Horie S, Corradetti G, Esmaeilkhanian H, Sadda SR, Cheung CMG, Ham Y, Chang A, Takahashi T, Ohno-Matsui K. Microperimetry in Retinal Diseases. Asia Pac J Ophthalmol (Phila) 2023; 12:211-227. [PMID: 36971707 DOI: 10.1097/apo.0000000000000597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/06/2022] [Indexed: 03/29/2023] Open
Abstract
Retinal microperimetry (MP) is a procedure that assesses the retinal sensitivity while the fundus is directly observed, and an eye tracker system is active to compensate for involuntary eye movements during testing. With this system, the sensitivity of a small locus can be accurately determined, and it has become an established ophthalmic test for retinal specialists. Macular diseases are characterized by chorioretinal changes; therefore, the condition of the retina and choroid requires careful and detailed evaluations to perform effective therapy. Age-related macular degeneration is a representative retinal disease in which the macular function has been evaluated by the visual acuity throughout the course of the disease process. However, the visual acuity represents the physiological function of only the central fovea, and the function of the surrounding macular area has not been sufficiently evaluated throughout the different stages of the macula disease process. The new technique of MP can compensate for such limitations by being able to test the same sites of the macular area repeatedly. This is especially useful in the recent management of age-related macular degeneration or diabetic macular edema during anti-vascular endothelial growth factor treatments because MP can assess the effectiveness of the treatment. MP examinations are also valuable in diagnosing Stargardt disease as they can detect visual impairments before any abnormalities are found in the retinal images. The visual function needs to be carefully assessed along with morphologic observations by optical coherence tomography. In addition, the assessment of retinal sensitivity is useful in the presurgical or postsurgical evaluations.
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Affiliation(s)
- Shintaro Horie
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Giulia Corradetti
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | - Houri Esmaeilkhanian
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | - SriniVas R Sadda
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | | | - Yeji Ham
- Sydney Retina Clinic and Day Surgery, Sydney, Australia
| | - Andrew Chang
- Sydney Eye Hospital, The University of Sydney, Sydney Retina Clinic and Day Surgery, Sydney, Australia
| | - Tomonari Takahashi
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
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Bowers NR, Gautier J, Lin S, Roorda A. Fixational eye movements in passive versus active sustained fixation tasks. J Vis 2021; 21:16. [PMID: 34677574 PMCID: PMC8556553 DOI: 10.1167/jov.21.11.16] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Human fixational eye movements are so small and precise that high-speed, accurate tools are needed to fully reveal their properties and functional roles. Where the fixated image lands on the retina and how it moves for different levels of visually demanding tasks is the subject of the current study. An Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO) was used to image, track and present a variety of fixation targets (Maltese cross, disk, concentric circles, Vernier and tumbling-E letter) to healthy subjects. During these different passive (static) or active (discriminating) tasks under natural eye motion, the landing position of the target on the retina was tracked in space and time over the retinal image directly with high spatial (<1 arcmin) and temporal (960 Hz) resolution. We computed both the eye motion and the exact trajectory of the fixated target's motion over the retina. We confirmed that compared to passive tasks, active tasks elicited a partial inhibition of microsaccades, leading to longer drift periods compensated by larger corrective saccades. Consequently, the overall fixation stability during active tasks was on average 57% larger than during passive tasks. The preferred retinal locus of fixation was the same for each task and did not coincide with the location of the peak cone density.
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Affiliation(s)
- Norick R Bowers
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, CA, USA.,
| | - Josselin Gautier
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, CA, USA.,
| | - Samantha Lin
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, CA, USA.,
| | - Austin Roorda
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, CA, USA.,
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Li S, Deng X, Zhang J. An Overview of Preferred Retinal Locus and Its Application in Biofeedback Training for Low-Vision Rehabilitation. Semin Ophthalmol 2021; 37:142-152. [PMID: 34436959 DOI: 10.1080/08820538.2021.1931355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Central vision loss (CVL) caused by macular damage generally disables common daily tasks, which cannot be reversed by present treatments. Fortunately, it has been found that biofeedback training by inducing or reinforcing preferred retinal locus (PRL) as an eccentric fixation reference contributes to the improvement of visual performance in patients with CVL. However, the clinical application is still under controversy due to poor knowledge of its fundamental and inconsistent practical standards. This article aims to summarize the possible rationale for the development, location, re-location and evaluating indicators of PRL, and the general apparatus, protocol, and outcome of biofeedback PRL training.
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Affiliation(s)
- Shengnan Li
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Xuan Deng
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Jinglin Zhang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China.,Guangzhou Aier Eye Hospital, Guangzhou, Guangdong China
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Li S, Deng X, Chen Q, Lin H, Zhang J. Characteristics of Preferred Retinal Locus in Eyes with Central Vision Loss Secondary to Different Macular Lesions. Semin Ophthalmol 2021; 36:734-741. [PMID: 33764273 DOI: 10.1080/08820538.2021.1900289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Preferred retinal locus (PRL) training has been applied to low-vision rehabilitation for patients with central vision loss (CVL). This study aimed to explore the characteristics of a natural PRL in eyes with different macular lesions. The data may be useful in customizing training programs. METHODS A total of 72 eyes with CVL were included and assigned into two groups. In group A, 29 eyes diagnosed with macular holes featured relatively sharp borders and small areas of lesions. In group B, 44 eyes showed lesions characterized by irregular borders and large areas. The PRL location relative to a scotoma in the retina, fixation stability, and the average threshold surrounding the PRL were determined and compared between the two groups. RESULTS In group A, the PRL was located above in 48.28%, below in 27.59%, left in 62.07%, right in 31.03%, and inside in 3.45% of the eyes. In group B, the PRL was located above in 39.53%, below in 4.65%, left in 44.19%, right in 6.98%, and inside in 27.91% of eyes. The amount of retinal displacement occurring within 1° from an initial reference point (P< .05) and the 95% bivariate contour ellipse area (P< .05) in group A were respectively higher and lower than those in group B. However, the average thresholds around the PRLs in the two groups showed no significant difference (P > .05). CONCLUSIONS A PRL to the left of or above a scotoma tends to develop to avoid the right and inferior field defect, regardless of the scale and boundary of lesions. Although light sensitivity around a PRL shows no relation to lesion features, fixation stability is worse in irregular and large lesions.
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Affiliation(s)
- Shengnan Li
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Xuan Deng
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Qianyin Chen
- Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
| | - Huimin Lin
- Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
| | - Jinglin Zhang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China.,Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
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Efficacy of biofeedback rehabilitation based on visual evoked potentials analysis in patients with advanced age-related macular degeneration. Sci Rep 2020; 10:20886. [PMID: 33257759 PMCID: PMC7704611 DOI: 10.1038/s41598-020-78076-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
Age-related macular degeneration (AMD) is a progressive and degenerative disorder of the macula. In advanced stages, it is characterized by the formation of areas of geographic atrophy or fibrous scars in the central macula, which determines irreversible loss of central vision. These patients can benefit from visual rehabilitation programmes with acoustic “biofeedback” mechanisms that can instruct the patient to move fixation from the central degenerated macular area to an adjacent healthy area, with a reorganization of the primary visual cortex. In this prospective, comparative, non-randomized study we evaluated the efficacy of visual rehabilitation with an innovative acoustic biofeedback training system based on visual evoked potentials (VEP) real-time examination (Retimax Vision Trainer, CSO, Florence), in a series of patients with advanced AMD compared to a control group. Patients undergoing training were subjected to ten consecutive visual training sessions of 10 min each, performed twice a week. Patients in the control group did not receive any training. VEP biofeedback rehabilitation seems to improve visual acuity, reading performances, contrast sensitivity, retinal fixation and sensitivity and quality of life in AMD patients.
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Analysis of retinal sublayer thicknesses and rates of change in ABCA4-associated Stargardt disease. Sci Rep 2020; 10:16576. [PMID: 33024232 PMCID: PMC7538899 DOI: 10.1038/s41598-020-73645-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
Stargardt disease, the most common inherited macular dystrophy, is characterized by vision loss due to central retinal atrophy. Although clinical trials for Stargardt are currently underway, the disease is typically slowly progressive, and objective, imaging-based biomarkers are critically needed. In this retrospective, observational study, we characterize the thicknesses of individual retinal sublayers by macular optical coherence tomography (OCT) in a large cohort of patients with molecularly-confirmed, ABCA4-associated Stargardt disease (STGD1) relative to normal controls. Automated segmentation of retinal sublayers was performed with manual correction as needed, and thicknesses in various macular regions were compared using mixed effects models. Relative to controls (42 eyes, 40 patients), STGD1 patients (107 eyes, 63 patients) had slight thickening of the nerve fiber layer and retinal pigment epithelium-Bruch’s membrane, with thinning in other sublayers, especially the outer nuclear layer (ONL) (p < 0.0015). When comparing the rate of retinal sublayer thickness change over time (mean follow-up 3.9 years for STGD1, 2.5 years for controls), STGD1 retinas thinned faster than controls in the outer retina (ONL to photoreceptor outer segments). OCT-based retinal sublayer thickness measurements are feasible in STGD1 patients and may provide objective measures of disease progression or treatment response.
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Verdina T, Piaggi S, Peschiera R, Russolillo V, Ferraro V, Chester J, Mastropasqua R, Cavallini GM. Biofeedback Low Vision Rehabilitation with Retimax Vision Trainer in Patients with Advanced Age-related Macular Degeneration: A Pilot Study. Semin Ophthalmol 2020; 35:164-169. [PMID: 32476579 DOI: 10.1080/08820538.2020.1774624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the effectiveness of Visual Evoked Potential (VEP) biofeedback rehabilitation in selected low vision patients with advanced age-related macular degeneration (AMD). DESIGN Retrospective observational cohort study. METHODS Patients affected by advanced AMD, central macular atrophy with unstable fixation and best corrected visual acuity (BCVA) between 20/100 and 20/320 were considered. Selected patients underwent fundus photography and microperimetry with fixation analysis for the selected eye (highest BCVA). Ten consecutive training sessions of 10 min each were performed twice a week in the selected eye with Retimax Vision Trainer (CSO, Florence). BCVA, reading acuity and reading speed, contrast sensitivity, fixation, retinal sensitivity and quality of life questionnaire (VFQ-25) were evaluated at baseline and 7 days following the final session. RESULTS Significant improvements in terms of BCVA [p = .011], reading speed [p = .007], VFQ-25 score [p = .007], retinal sensitivity [p = .021] and fixation stability in the central 2° and 4° [p = .048; p = .037] post-treatment were observed for the 9 patients enrolled, with insignificant improvements observed in reading acuity and contrast sensitivity [p = .335; p = .291]. CONCLUSIONS Preliminary results support VEP biofeedback rehabilitation improvements for visual function and quality of life in advanced AMD patients with low vision.
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Affiliation(s)
- Tommaso Verdina
- Institute of Ophthalmology, University of Modena and Reggio Emilia , Modena, Italy
| | - Stefania Piaggi
- Institute of Ophthalmology, University of Modena and Reggio Emilia , Modena, Italy
| | - Riccardo Peschiera
- Institute of Ophthalmology, University of Modena and Reggio Emilia , Modena, Italy
| | - Valeria Russolillo
- Institute of Ophthalmology, University of Modena and Reggio Emilia , Modena, Italy
| | - Vanessa Ferraro
- Institute of Ophthalmology, University of Modena and Reggio Emilia , Modena, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia , Modena, Italy
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia , Modena, Italy
| | - Gian Maria Cavallini
- Institute of Ophthalmology, University of Modena and Reggio Emilia , Modena, Italy
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Sunness JS, Ifrah A, Wolf R, Applegate CA, Sparrow JR. Abnormal Visual Function Outside the Area of Atrophy Defined by Short-Wavelength Fundus Autofluorescence in Stargardt Disease. Invest Ophthalmol Vis Sci 2020; 61:36. [PMID: 32334431 PMCID: PMC7401975 DOI: 10.1167/iovs.61.4.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/03/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To examine the extent of visual function abnormality outside the dark lesion on short-wavelength fundus autofluorescence (SW-AF), and its correlation with background SW-AF features and optical coherence tomography (OCT) in recessive Stargardt disease (STGD1). Methods Forty-nine eyes of 25 participants in the ProgStar (the Natural History of the Progression of Atrophy Secondary to Stargardt Disease) study at our center were included. Patients underwent microperimetry (both threshold and dense scotoma mapping), OCT, SW-AF, and visual acuity testing. The Fisher's exact test, the χ2 test, and unpaired t-tests were used to analyze the data. Results Of 40 eyes without central fixation, 33 (82%) placed fixation remote (most ≥5°) from the dense scotoma edge, despite good intervening retinal sensitivity. OCT findings accounted for the remote fixation in 75%. Eighteen (37%) of all 49 eyes had dense scotoma extending past the dark lesion border. OCT was not adequate to define the edge of the scotoma. Of the 49 eyes, 28 (57%) had the mottled background pattern, 10 (20%) had the uniform pattern, and 11 (22%) had the other pattern, with >75% of eyes in each pattern having remote fixation. The dense scotoma exceeded the dark lesion primarily in the mottled pattern. The two eyes of each patient were concordant in all features. Conclusions Functional abnormalities in STGD1 extend past the SW-AF dark lesion. The disruption of the ellipsoid zone shows that photoreceptor abnormality extends peripheral to the dark lesion, and it explains in part the remote fixation pattern and the dense scotoma exceeding the dark lesion. This has implications for clinical trials for STGD1.
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Affiliation(s)
- Janet S. Sunness
- Richard E. Hoover Low Vision Rehabilitation Services and Department of Ophthalmology, GreaterBaltimore Medical Center, Baltimore, Maryland, United States
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Abraham Ifrah
- Richard E. Hoover Low Vision Rehabilitation Services and Department of Ophthalmology, GreaterBaltimore Medical Center, Baltimore, Maryland, United States
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Robert Wolf
- Richard E. Hoover Low Vision Rehabilitation Services and Department of Ophthalmology, GreaterBaltimore Medical Center, Baltimore, Maryland, United States
- Boston University School of Medicine, Boston, Massachusetts, United States
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Carol A. Applegate
- Richard E. Hoover Low Vision Rehabilitation Services and Department of Ophthalmology, GreaterBaltimore Medical Center, Baltimore, Maryland, United States
| | - Janet R. Sparrow
- Department of Ophthalmology, Harkness Eye Institute, Columbia University Medical Center, New York,New York,United States
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Krishnan AK, Queener HM, Stevenson SB, Benoit JS, Bedell HE. Impact of simulated micro-scotomas on reading performance in central and peripheral retina. Exp Eye Res 2019; 183:9-19. [PMID: 29959926 PMCID: PMC7298809 DOI: 10.1016/j.exer.2018.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
Observers with central field loss typically fixate within a non-foveal region called the preferred retinal locus, which can include localized sensitivity losses, or micro-scotomas (Krishnan and Bedell, 2018). In this study, we simulated micro-scotomas at the fovea and in the peripheral retina to assess their impact on reading speed. Ten younger (<36 years old) and 8 older (>50 years old) naïve observers with normal vision monocularly read high and/or low contrast sentences, presented at or above the critical print size for young observers at the fovea and at 5 and 10 deg in the inferior visual field. Reading material comprised MNREAD sentences and sentences taken from novels that were presented in rapid serial visual presentation (RSVP) format. Randomly distributed 13 × 13 arc min blocks corresponding to 0-78% of the text area (corresponding to ∼0-17 micro-scotomas/deg2) were set to the background luminance to simulate micro-scotomas. A staircase algorithm estimated maximum reading speed from the threshold exposure duration for each combination of retinal eccentricity, contrast and micro-scotoma density in both age groups. Log10(RSVP reading speed) decreased significantly with simulated micro-scotoma density and eccentricity. Across conditions, reading speed was slower with low-compared to high-contrast text and was faster in younger than older normal observers. For a given eccentricity and contrast, a higher density of random element losses maximally affected older observers with normal vision. These outcomes may explain some of the reading deficits observed in older observers with central field loss.
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Affiliation(s)
- Arun Kumar Krishnan
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA.
| | - Hope M Queener
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA
| | - Scott B Stevenson
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA
| | - Julia S Benoit
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA; Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, 4849 Calhoun Road, Houston, TX, 77204, USA
| | - Harold E Bedell
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX, 77204, USA
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Singh MS, MacLaren RE. Stem Cell Treatment for Age-Related Macular Degeneration: the Challenges. Invest Ophthalmol Vis Sci 2018; 59:AMD78-AMD82. [PMID: 30025109 DOI: 10.1167/iovs.18-24426] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Mandeep S Singh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford and Oxford University Hospitals, NHS Foundation Trust NIHR Biomedical Research Centre, Oxford, United Kingdom
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Cai CX, Light JG, Handa JT. Quantifying the Rate of Ellipsoid Zone Loss in Stargardt Disease. Am J Ophthalmol 2018; 186:1-9. [PMID: 29126757 DOI: 10.1016/j.ajo.2017.10.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine a reliable method of using the ellipsoid zone (EZ) on optical coherence tomography (OCT) to track disease progression in Stardgardt disease (STGD). DESIGN Retrospective reliability study. METHODS STGD patients with genetically confirmed ABCA4 gene mutations seen at the Wilmer Eye Institute with follow-up visits separated by at least 12 months were identified. Spectral-domain optical coherence tomography (SD-OCT) macula volume scans centered at the fovea and fundus autofluorescence (FAF) images were obtained. The area of EZ loss was calculated from the SD-OCT and the area of retinal pigment epithelium (RPE) loss from the FAF. Scans were reanalyzed by the primary grader to assess intragrader reliability, and reanalyzed by a second grader to assess intergrader reliability. RESULTS Sixteen STGD patients (total of 31 eyes) were followed for a mean of 2 years (range 1-4.7 years). The mean rate of EZ loss, 0.31 ± 0.31 mm2/year, was similar to the average rate of RPE loss, 0.33 ± 0.38 mm2/year. The average area of EZ loss at the initial examination, 4.18 ± 1.91 mm2, was larger than the initial area of RPE loss, 2.25 ± 1.66 mm2 (P < .01). The absolute difference of the area of EZ loss on test-retest for the first grader was 0.12 ± 0.10 mm2, and between graders 0.21 ± 0.21 mm2. The intraclass correlation (ICC) of both intragrader and intergrader reliability for EZ loss was excellent at 0.99. CONCLUSIONS Tracking the area of EZ loss on SD-OCT macular volume scans longitudinally is a reliable way of monitoring disease progression in STGD. This could be used as a sensitive anatomic outcome measure in clinical trials related to STGD.
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Abalem MF, Otte B, Andrews C, Joltikov KA, Branham K, Fahim AT, Schlegel D, Qian CX, Heckenlively JR, Jayasundera T. Peripheral Visual Fields in ABCA4 Stargardt Disease and Correlation With Disease Extent on Ultra-widefield Fundus Autofluorescence. Am J Ophthalmol 2017; 184:181-188. [PMID: 29038010 DOI: 10.1016/j.ajo.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the disease extent on ultra-widefield fundus autofluorescence (UWF-FAF) in patients with ABCA4 Stargardt disease (STGD) and correlate these data with functional outcome measures. DESIGN Retrospective cross-sectional study. METHODS Setting: Kellogg Eye Center, University of Michigan. STUDY POPULATION Sixty-five patients with clinical diagnosis and proven pathogenic variants in the ABCA4 gene. Observational Procedures: The UWF-FAF images were obtained using Optos (200 degrees) and classified into 3 types. Functional testing included kinetic widefield perimetry, full-field electroretinogram (ffERG), and visual acuity (VA). All results were evaluated with respect to UWF-FAF classification. MAIN OUTCOME MEASURES Classification of UWF-FAF; area comprising the I4e, III4e, and IV4e isopters; ffERG patterns; and VA. RESULTS For UWF-FAF, 27 subjects (41.5%) were classified as type I, 17 (26.2%) as type II, and 21 (32.4%) as type III. The area of each isopter correlated inversely with the extent of the disease and all isopters were able to detect differences among UWF-FAF types (IV4e, P = .0013; III4e, P = .0003; I4e, P < .0001 = 3.93e-8). ffERG patterns and VA were also different among the 3 UWF-FAF types (P < .001 = 6.61e-6 and P < .001 = 7.3e-5, respectively). CONCLUSION Patients with widespread disease presented with more constriction of peripheral visual fields and had more dysfunction on ffERG and worse VA compared to patients with disease confined to the macula. UWF-FAF images may provide information for estimating peripheral and central visual function in STGD.
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