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Schmidt-Erfurth U, Riedl S. [Complement inhibition treatment for geographic atrophy (GA): functional and morphological efficacy and relevant biomarkers in clinical practice]. DIE OPHTHALMOLOGIE 2024; 121:476-481. [PMID: 38691156 DOI: 10.1007/s00347-024-02039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
The approval of complement inhibitory therapeutic agents for the treatment of geographic atrophy (GA) has highlighted the need for reliable and reproducible measurement of disease progression and therapeutic efficacy. Due to its availability and imaging characteristics optical coherence tomography (OCT) is the method of choice. Using OCT analysis based on artificial intelligence (AI), the therapeutic efficacy of pegcetacoplan was demonstrated at the levels of both the retinal pigment epithelium (RPE) and photoreceptors (PR). Cloud-based solutions that enable monitoring of GA are already available.
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Affiliation(s)
- Ursula Schmidt-Erfurth
- Medizinische Universität Wien, Universitätsklinik für Augenheilkunde und Optometrie, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Sophie Riedl
- Medizinische Universität Wien, Universitätsklinik für Augenheilkunde und Optometrie, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Samanta A, Alsoudi AF, Rahimy E, Chhablani J, Weng CY. Imaging Modalities for Dry Macular Degeneration. Int Ophthalmol Clin 2024; 64:35-55. [PMID: 38146880 DOI: 10.1097/iio.0000000000000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
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Mai J, Lachinov D, Riedl S, Reiter GS, Vogl WD, Bogunovic H, Schmidt-Erfurth U. Clinical validation for automated geographic atrophy monitoring on OCT under complement inhibitory treatment. Sci Rep 2023; 13:7028. [PMID: 37120456 PMCID: PMC10148818 DOI: 10.1038/s41598-023-34139-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/25/2023] [Indexed: 05/01/2023] Open
Abstract
Geographic atrophy (GA) represents a late stage of age-related macular degeneration, which leads to irreversible vision loss. With the first successful therapeutic approach, namely complement inhibition, huge numbers of patients will have to be monitored regularly. Given these perspectives, a strong need for automated GA segmentation has evolved. The main purpose of this study was the clinical validation of an artificial intelligence (AI)-based algorithm to segment a topographic 2D GA area on a 3D optical coherence tomography (OCT) volume, and to evaluate its potential for AI-based monitoring of GA progression under complement-targeted treatment. 100 GA patients from routine clinical care at the Medical University of Vienna for internal validation and 113 patients from the FILLY phase 2 clinical trial for external validation were included. Mean Dice Similarity Coefficient (DSC) was 0.86 ± 0.12 and 0.91 ± 0.05 for total GA area on the internal and external validation, respectively. Mean DSC for the GA growth area at month 12 on the external test set was 0.46 ± 0.16. Importantly, the automated segmentation by the algorithm corresponded to the outcome of the original FILLY trial measured manually on fundus autofluorescence. The proposed AI approach can reliably segment GA area on OCT with high accuracy. The availability of such tools represents an important step towards AI-based monitoring of GA progression under treatment on OCT for clinical management as well as regulatory trials.
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Affiliation(s)
- Julia Mai
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Dmitrii Lachinov
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Artificial Intelligence in Retina, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Sophie Riedl
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gregor S Reiter
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolf-Dieter Vogl
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hrvoje Bogunovic
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Artificial Intelligence in Retina, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Laboratory for Ophthalmic Image Analysis (OPTIMA), Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Cavichini M, Bartsch DUG, Warter A, Singh S, An C, Wang Y, Zhang J, Nguyen T, Freeman WR. Accuracy and Time Comparison Between Side-by-Side and Artificial Intelligence Overlayed Images. Ophthalmic Surg Lasers Imaging Retina 2023; 54:108-113. [PMID: 36780638 DOI: 10.3928/23258160-20230130-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to evaluate the accuracy and the time to find a lesion, taken in different platforms, color fundus photographs and infrared scanning laser ophthalmoscope images, using the traditional side-by-side (SBS) colocalization technique to an artificial intelligence (AI)-assisted technique. PATIENTS AND METHODS Fifty-three pathological lesions were studied in 11 eyes. Images were aligned using SBS and AI overlaid methods. The location of each color fundus lesion on the corresponding infrared scanning laser ophthalmoscope image was analyzed twice, one time for each method, on different days, for two specialists, in random order. The outcomes for each method were measured and recorded by an independent observer. RESULTS The colocalization AI method was superior to the conventional in accuracy and time (P < .001), with a mean time to colocalize 37% faster. The error rate using AI was 0% compared with 18% in SBS measurements. CONCLUSIONS AI permitted a more accurate and faster colocalization of pathologic lesions than the conventional method. [Ophthalmic Surg Lasers Imaging Retina 2023;54:108-113.].
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Mai J, Riedl S, Reiter GS, Lachinov D, Vogl WD, Bogunovic H, Schmidt-Erfurth U. Comparison of Fundus Autofluorescence Versus Optical Coherence Tomography-based Evaluation of the Therapeutic Response to Pegcetacoplan in Geographic Atrophy. Am J Ophthalmol 2022; 244:175-182. [PMID: 35853489 DOI: 10.1016/j.ajo.2022.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To perform an optical coherence tomography (OCT)-based analysis of geographic atrophy (GA) progression in patients treated with pegcetacoplan. DESIGN Post hoc analysis of a phase 2 multicenter, randomized, sham-controlled trial. METHODS Manual annotation of retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) loss was performed on OCT volumes from baseline and month 12 from the phase 2 FILLY trial of intravitreal pegcetacoplan for the treatment of GA secondary to age-related macular degeneration. MAIN OUTCOME MEASURES Correlation of GA areas measured on fundus autofluorescence and OCT. Difference in square root transformed growth rates of RPE, EZ, and ELM loss between treatment groups (monthly injection [AM], injection every other month [AEOM], and sham [SM]). RESULTS OCT volumes from 113 eyes of 113 patients (38 AM, 36 AEOM, and 39 SM) were included, resulting in 11 074 B-scans. The median growth of RPE loss was significantly slower in the AM group (0.158 [0.057-0.296]) than the SM group (0.255 [0.188-0.359], P = .014). Importantly, the growth of EZ loss was also significantly slower in the AM group (0.127 [0.041-0.247]) than the SM group (0.232 [0.130-0.349], P = .017). There was no significant difference in the growth of ELM loss between the treatment groups (P = .114). CONCLUSIONS OCT imaging provided consistent results for GA growth compared with fundus autofluorescence. In addition to slower RPE atrophy progression in patients treated with pegcetacoplan, a significant reduction in EZ impairment was also identified by OCT, suggesting the use of OCT as a potentially more sensitive monitoring tool in GA therapy.
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Affiliation(s)
- Julia Mai
- From the OPTIMA-Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Sophie Riedl
- From the OPTIMA-Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Gregor S Reiter
- From the OPTIMA-Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Dmitrii Lachinov
- From the OPTIMA-Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Vogl
- From the OPTIMA-Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- From the OPTIMA-Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- From the OPTIMA-Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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Bui PTA, Reiter GS, Fabianska M, Waldstein SM, Grechenig C, Bogunovic H, Arikan M, Schmidt-Erfurth U. Fundus autofluorescence and optical coherence tomography biomarkers associated with the progression of geographic atrophy secondary to age-related macular degeneration. Eye (Lond) 2022; 36:2013-2019. [PMID: 34400806 PMCID: PMC9499954 DOI: 10.1038/s41433-021-01747-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate the impact of qualitatively graded and deep learning quantified imaging biomarkers on growth of geographic atrophy (GA) secondary to age-related macular degeneration. METHODS This prospective study included 1062 visits of 181 eyes of 100 patients with GA. Spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) images were acquired at each visit. Hyperreflective foci (HRF) were quantitatively assessed in SD-OCT volumes using a validated deep learning algorithm. FAF images were graded for FAF patterns, subretinal drusenoid deposits (SDD), GA lesion configuration and atrophy enlargement. Linear mixed models were calculated to investigate associations between all parameters and GA progression. RESULTS FAF patterns were significantly associated with GA progression (p < 0.001). SDD was associated with faster GA growth (p = 0.005). Eyes with higher HRF concentrations showed a trend towards faster GA progression (p = 0.072) and revealed a significant impact on GA enlargement in interaction with FAF patterns (p = 0.01). The fellow eye status had no significant effect on lesion enlargement (p > 0.05). The diffuse-trickling FAF pattern exhibited significantly higher HRF concentrations than any other pattern (p < 0.001). CONCLUSION Among a wide range of investigated biomarkers, SDD and FAF patterns, particularly in interaction with HRF, significantly impact GA progression. Fully automated quantification of retinal imaging biomarkers such as HRF is both reliable and merited as HRF are indicators of retinal pigment epithelium dysmorphia, a central pathogenetic mechanism in GA. Identifying disease markers using the combination of FAF and SD-OCT is of high prognostic value and facilitates individualized patient management in a clinical setting.
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Affiliation(s)
- Patricia T A Bui
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Gregor S Reiter
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Maria Fabianska
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Sebastian M Waldstein
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Christoph Grechenig
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Mustafa Arikan
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Christian Doppler Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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Zhang C, Owen LA, Lillvis JH, Zhang SX, Kim IK, DeAngelis MM. AMD Genomics: Non-Coding RNAs as Biomarkers and Therapeutic Targets. J Clin Med 2022; 11:jcm11061484. [PMID: 35329812 PMCID: PMC8954267 DOI: 10.3390/jcm11061484] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 12/04/2022] Open
Abstract
Age-related macular degeneration (AMD) is a progressive neurodegenerative disease that is the world’s leading cause of blindness in the aging population. Although the clinical stages and forms of AMD have been elucidated, more specific prognostic tools are required to determine when patients with early and intermediate AMD will progress into the advanced stages of AMD. Another challenge in the field has been the appropriate development of therapies for intermediate AMD and advanced atrophic AMD. After numerous negative clinical trials, an anti-C5 agent and anti-C3 agent have recently shown promising results in phase 3 clinical trials, in terms of slowing the growth of geographic atrophy, an advanced form of AMD. Interestingly, both drugs appear to be associated with an increased incidence of wet AMD, another advanced form of the disease, and will require frequent intravitreal injections. Certainly, there remains a need for other therapeutic agents with the potential to prevent progression to advanced stages of the disease. Investigation of the role and clinical utility of non-coding RNAs (ncRNAs) is a major advancement in biology that has only been minimally applied to AMD. In the following review, we discuss the clinical relevance of ncRNAs in AMD as both biomarkers and therapeutic targets.
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Affiliation(s)
- Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
| | - Leah A. Owen
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
| | - John H. Lillvis
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
- Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA
| | - Sarah X. Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
| | - Ivana K. Kim
- Retina Service, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (I.K.K.); (M.M.D.)
| | - Margaret M. DeAngelis
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Genetics, Genomics and Bioinformatics Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Correspondence: (I.K.K.); (M.M.D.)
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Shmueli O, Yehuda R, Szeskin A, Joskowicz L, Levy J. Progression of cRORA (Complete RPE and Outer Retinal Atrophy) in Dry Age-Related Macular Degeneration Measured Using SD-OCT. Transl Vis Sci Technol 2022; 11:19. [PMID: 35029632 PMCID: PMC8762698 DOI: 10.1167/tvst.11.1.19] [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: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the long-term rate of progression and baseline predictors of geographic atrophy (GA) using complete retinal pigment epithelium and outer retinal atrophy (cRORA) annotation criteria. Methods This is a retrospective study. Columns of GA were manually annotated by two graders using a self-developed software on optical coherence tomography (OCT) B-scans and projected onto the infrared images. The primary outcomes were: (1) rate of area progression, (2) rate of square root area progression, and (3) rate of radial progression towards the fovea. The effects of 11 additional baseline predictors on the primary outcomes were analyzed: total area, focality (defined as the number of lesions whose area is >0.05 mm2), circularity, total lesion perimeter, minimum diameter, maximum diameter, minimum distance from the center, sex, age, presence/absence of hypertension, and lens status. Results GA was annotated in 33 pairs of baseline and follow-up OCT scans from 33 eyes of 18 patients with dry age-related macular degeneration (AMD) followed for at least 6 months. The mean rate of area progression was 1.49 ± 0.86 mm2/year (P < 0.0001 vs. baseline), and the mean rate of square root area progression was 0.33 ± 0.15 mm/year (P < 0.0001 vs. baseline). The mean rate of radial progression toward the fovea was 0.07 ± 0.11 mm/year. A multiple variable linear regression model (adjusted r2 = 0.522) revealed that baseline focality and female sex were significantly correlated with the rate of GA area progression. Conclusions GA area progression was quantified using OCT as an alternative to conventional measurements performed on fundus autofluorescence images. Baseline focality correlated with GA area progression rate and lesion's minimal distance from the center correlated with GA radial progression rate toward the center. These may be important markers for the assessment of GA activity. Translational Relevance Advanced method linking specific retinal micro-anatomy to GA area progression analysis.
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Affiliation(s)
- Or Shmueli
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Roei Yehuda
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Givat Ram, Jerusalem, Israel
| | - Adi Szeskin
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Givat Ram, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Givat Ram, Jerusalem, Israel
| | - Jaime Levy
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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INVESTIGATING A GROWTH PREDICTION MODEL IN ADVANCED AGE-RELATED MACULAR DEGENERATION WITH SOLITARY GEOGRAPHIC ATROPHY USING QUANTITATIVE AUTOFLUORESCENCE. Retina 2021; 40:1657-1664. [PMID: 31584560 DOI: 10.1097/iae.0000000000002653] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate geographic atrophy (GA) progression using quantitative autofluorescence (qAF) in eyes with solitary GA. METHODS Forty-three eyes of 26 patients (age 79.7 ± 7.2 years; 28 women; 16 pseudophakic) underwent spectral-domain optical coherence tomography and qAF imaging at baseline and after 12 months. The junctional zone (AJZ) and a nonaffected 300-µm-wide control area (AC) were delineated on spectral-domain optical coherence tomography scans and transferred to the qAF image. Linear mixed models were calculated to investigate the association between GA progression and qAF, age, and baseline GA area. Mixed model analyses of variance were used to investigate differences in qAF between areas. RESULTS Quantitative autofluorescence of the three inferior sections of both the AJZ (P = 0.028; P = 0.014 and P = 0.032) and the AC (P = 0.043; P = 0.02 and P = 0.028) were significantly associated with GA progression after 12 months. However, qAF measurements were not associated with GA progression in the overall model (P > 0.05). Mean qAF was significantly lower in the AJZ and growth area (AG12) than in the AC (both P ≤ 0.001). CONCLUSION The authors report a statistically significant association between GA growth area and qAF measurements at specific retinal locations and a significant difference in qAF between the GA border and unaffected areas outside the lesion. Quantitative autofluorescence measurements may be limitedly useful for predicting GA progression.
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Thibaut M, Tran T, Szaffarczyk S, Boucart M. Impact of age‐related macular degeneration on object searches in realistic panoramic scenes. Clin Exp Optom 2021; 101:372-379. [DOI: 10.1111/cxo.12644] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/10/2017] [Accepted: 10/24/2017] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Thi‐ha‐chau Tran
- SCALab, University of Lille, CNRS, Lille, France,
- Department of Ophthalmology, Lille Group Hospitals, Lille Catholic University, Lille, France,
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Reiter GS, Told R, Schranz M, Baumann L, Mylonas G, Sacu S, Pollreisz A, Schmidt-Erfurth U. Subretinal Drusenoid Deposits and Photoreceptor Loss Detecting Global and Local Progression of Geographic Atrophy by SD-OCT Imaging. Invest Ophthalmol Vis Sci 2021; 61:11. [PMID: 32503052 PMCID: PMC7415285 DOI: 10.1167/iovs.61.6.11] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose To investigate the impact of subretinal drusenoid deposits (SDD) and photoreceptor integrity on global and local geographic atrophy (GA) progression. Methods Eighty-three eyes of 49 patients, aged 50 years and older with GA secondary to age-related macular degeneration (AMD), were prospectively included in this study. Participants underwent spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) imaging at baseline and after 12 months. The junctional zone and presence of SDD were delineated on SD-OCT and FAF images. Linear mixed models were calculated to investigate the association between GA progression and the junctional zone area, baseline GA area, age, global and local presence of SDD and unifocal versus multifocal lesions. Results The area of the junctional zone was significantly associated with the progression of GA, both globally and locally (all P < 0.001). SDD were associated with faster growth in the overall model (P = 0.039), as well as in the superior-temporal (P = 0.005) and temporal (P = 0.002) sections. Faster progression was associated with GA baseline area (P < 0.001). No difference was found between unifocal and multifocal lesions (P > 0.05). Age did not have an effect on GA progression (P > 0.05). Conclusions Photoreceptor integrity and SDD are useful for predicting global and local growth in GA. Investigation of the junctional zone is merited because this area is destined to become atrophic. Photoreceptor loss visible on SD-OCT might lead to new structural outcome measurements visible before irreversible loss of retinal pigment epithelium occurs.
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Schmidt-Erfurth U, Bogunovic H, Grechenig C, Bui P, Fabianska M, Waldstein S, Reiter GS. Role of Deep Learning-Quantified Hyperreflective Foci for the Prediction of Geographic Atrophy Progression. Am J Ophthalmol 2020; 216:257-270. [PMID: 32277942 DOI: 10.1016/j.ajo.2020.03.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To quantitatively measure hyperreflective foci (HRF) during the progression of geographic atrophy (GA) secondary to age-related macular degeneration (AMD) using deep learning (DL) and investigate the association with local and global growth of GA. METHODS Eyes with GA were prospectively included. Spectral-domain optical coherence tomography (SDOCT) and fundus autofluorescence images were acquired every 6 months. A 500-μm-wide junctional zone adjacent to the GA border was delineated and HRF were quantified using a validated DL algorithm. HRF concentrations in progressing and nonprogressing areas, as well as correlations between HRF quantifications and global and local GA progression, were assessed. RESULTS A total of 491 SDOCT volumes from 87 eyes of 54 patients were assessed with a median follow-up of 28 months. Two-thirds of HRF were localized within a millimeter adjacent to the GA border. HRF concentration was positively correlated with GA progression in unifocal and multifocal GA (all P < .001) and de novo GA development (P = .037). Local progression speed correlated positively with local increase of HRF (P value range <.001-.004). Global progression speed, however, did not correlate with HRF concentrations (P > .05). Changes in HRF over time did not have an impact on the growth in GA (P > .05). CONCLUSION Advanced artificial intelligence (AI) methods in high-resolution retinal imaging allows to identify, localize, and quantify biomarkers such as HRF. Increased HRF concentrations in the junctional zone and future macular atrophy may represent progressive migration and loss of retinal pigment epithelium. AI-based biomarker monitoring may pave the way into the era of individualized risk assessment and objective decision-making processes. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Wang J, Ying GS. Growth Rate of Geographic Atrophy Secondary to Age-Related Macular Degeneration: A Meta-Analysis of Natural History Studies and Implications for Designing Future Trials. Ophthalmic Res 2020; 64:205-215. [PMID: 32721951 DOI: 10.1159/000510507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is no effective treatment for geographic atrophy (GA). To help design future GA treatment trials, we conducted a meta-analysis for GA growth rate and its variability in natural history studies. METHODS Literatures were searched up to April 30, 2020. Data were extracted independently by 2 authors and analyzed using random-effects models. RESULTS The pooled mean GA growth rate was 1.66 mm2/year (SD = 1.27 mm2/year, I2 = 97.0%, p < 0.001) from 23 studies (3,078 patients) reported with growth rate in mm2/year and 0.33 mm/year (SD = 0.17 mm/year, I2 = 83.0%, p < 0.001) from 12 studies (1,808 patients) reported with growth rate in mm/year. Larger mean baseline GA area in mm2 was associated with larger mean growth rate in both mm2/year and mm/year (p < 0.001). The sample size at 85% power for detecting 15% reduction in growth rate in a 2-arm GA trial is 464 and 209 patients per arm, respectively, for using mm2/year and mm/year as the primary outcome. DISCUSSION/CONCLUSION GA natural history studies had a pooled mean (SD) GA growth rate of 1.66 (1.27) mm2/year or 0.33 (0.17) mm/year. Because GA growth rate using mm/year requires smaller sample size than using mm2/year, GA growth rate in mm/year is recommended as the primary outcome measure for future GA trials.
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Affiliation(s)
- Jianyong Wang
- Department of Ophthalmology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
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Wang DL, Agee J, Mazzola M, Sacconi R, Querques G, Weinberg AD, Smith RT. Outer Retinal Thickness and Fundus Autofluorescence in Geographic Atrophy. Ophthalmol Retina 2019; 3:1035-1044. [PMID: 31810572 DOI: 10.1016/j.oret.2019.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/16/2019] [Accepted: 07/25/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Most studies of fundus autofluorescence (FAF) in geographic atrophy (GA) have been nonquantitative, with inadequate registration of image modalities. Furthermore, as pointed out in the recent Consensus Definition for Atrophy Associated with Age-Related Macular Degeneration on OCT, it is unclear whether decreased FAF would be correlated exclusively with a single category of OCT-defined atrophy. We sought to determine how FAF intensity in eyes with GA correlates with structural changes of the outer retina and choroid as seen on co-registered spectral domain OCT (SD-OCT) images. DESIGN Retrospective cross-sectional. PARTICIPANTS Twenty eyes of 11 patients with GA secondary to non-neovascular age-related macular degeneration (AMD). METHODS Spectral domain OCT and FAF images for each eye were co-registered using MATLAB (MathWorks Inc, Natick, MA). On B-scans, the choroid, retinal pigment epithelium (RPE), photoreceptor (PR) layer, and outer nuclear layer (ONL) were segmented. Regions of interest (ROIs) including all atrophic and border regions were selected manually on the FAF scans. Regions of interest were subdivided into quartiles of FAF level to correlate with retinal thickness measurements taken along the B-scans. Mean choroid, RPE, PR, and ONL thicknesses were compared across quartiles using an analysis of variance factorial design testing for interaction effects, adjusted for repeated measures (on both eyes) with a within-subjects factor. RESULTS Seventeen eyes of 10 patients were selected for analysis. The mean choroidal thicknesses were not significantly different across FAF quartiles, but the overall differences in mean RPE, PR layer, and ONL thicknesses across quartiles were statistically significant (analysis of variance, P < 0.001, P < 0.001, and P = 0.015, respectively). Post hoc analysis demonstrated significant differences in thickness among quartiles 1, 2, and 3 for the RPE and PR layers (Tukey, P < 0.01 in each case). The FAF quartiles within GA did not correlate exclusively with single categories of Consensus Definition for Atrophy Associated with Age-Related Macular Degeneration-defined atrophy. CONCLUSIONS Not only RPE but also PR layer thickness on SD-OCT varies significantly with FAF levels in GA. This suggests that although the RPE cells are losing thickness and function, evidenced by decreased FAF from fluorophores, delicate PR cells also succumb early in the disease process. These relationships should be pursued as a possibly better-detailed mechanism in GA.
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Affiliation(s)
- Diane L Wang
- Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - Julia Agee
- Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - Marco Mazzola
- Ophthalmology Clinic, Department of Medicine and Surgery, University of Insubria Varese-Como, Varese, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, Milan, Italy
| | | | - Alan D Weinberg
- Ophthalmology, Mount Sinai School of Medicine, New York, New York
| | - R Theodore Smith
- Ophthalmology, Mount Sinai School of Medicine, New York, New York.
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Wu M, Cai X, Chen Q, Ji Z, Niu S, Leng T, Rubin DL, Park H. Geographic atrophy segmentation in SD-OCT images using synthesized fundus autofluorescence imaging. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 182:105101. [PMID: 31600644 DOI: 10.1016/j.cmpb.2019.105101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/04/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Accurate assessment of geographic atrophy (GA) is critical for diagnosis and therapy of non-exudative age-related macular degeneration (AMD). Herein, we propose a novel GA segmentation framework for spectral-domain optical coherence tomography (SD-OCT) images that employs synthesized fundus autofluorescence (FAF) images. METHODS An en-face OCT image is created via the restricted sub-volume projection of three-dimensional OCT data. A GA region-aware conditional generative adversarial network is employed to generate a plausible FAF image from the en-face OCT image. The network balances the consistency between the entire synthesize FAF image and the lesion. We use a fully convolutional deep network architecture to segment the GA region using the multimodal images, where the features of the en-face OCT and synthesized FAF images are fused on the front-end of the network. RESULTS Experimental results for 56 SD-OCT scans with GA indicate that our synthesis algorithm can generate high-quality synthesized FAF images and that the proposed segmentation network achieves a dice similarity coefficient, an overlap ratio, and an absolute area difference of 87.2%, 77.9%, and 11.0%, respectively. CONCLUSION We report an automatic GA segmentation method utilizing synthesized FAF images. SIGNIFICANCE Our method is effective for multimodal segmentation of the GA region and can improve AMD treatment.
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Affiliation(s)
- Menglin Wu
- School of Computer Science and Technology, Nanjing Tech University, Nanjing, China
| | - Xinxin Cai
- School of Computer Science and Technology, Nanjing Tech University, Nanjing, China
| | - Qiang Chen
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China
| | - Zexuan Ji
- School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China
| | - Sijie Niu
- School of Information Science and Engineering, University of Jinan, Jinan, China
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Daniel L Rubin
- Department of Radiology and Medicine (Biomedical Informatics Research) and Ophthalmology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Hyunjin Park
- School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, South Korea; Center for Neuroscience Imaging Research, Institute of Basic Science, Suwon, South Korea.
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Quellec G, Kowal J, Hasler PW, Scholl HPN, Zweifel S, Konstantinos B, Carvalho JER, Heeren T, Egan C, Tufail A, Maloca PM. Feasibility of support vector machine learning in age-related macular degeneration using small sample yielding sparse optical coherence tomography data. Acta Ophthalmol 2019; 97:e719-e728. [PMID: 30839157 DOI: 10.1111/aos.14055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/19/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE A retrospective pilot study is conducted to demonstrate the utility of a novel support vector machine learning (SVML) algorithm in a small three-dimensional (3D) sample yielding sparse optical coherence tomography (spOCT) data for the automatic monitoring of neovascular (wet) age-related macular degeneration (wAMD). METHODS From the anti-vascular endothelial growth factor injection database, 588 consecutive pairs of OCT volumes (57.624 B-scans) were selected in 70 randomly chosen wAMD patients treated with ranibizumab. The SVML algorithm was applied to 183 OCT volume pairs (17.934 B-scans) in 30 patients. Four independent, diagnosis-blinded retina specialists indicated whether wAMD activity was present between 100 pairs of consecutive OCT volumes (9800 B-scans) in the remaining 40 patients for comparison with the SVML algorithm and a non-complex baseline algorithm using only retinal thickness. The SVML algorithm was assessed using inter-observer variability and receiver operating characteristic (ROC) analyses. RESULTS The retina specialists showed an average Cohen's κ of 0.57 ± 0.13 (minimum: 0.41, maximum: 0.83). The average κ between the proposed algorithm and the retina specialists was 0.62 ± 0.05 and 0.43 ± 0.14 between the baseline algorithm and the retina specialists. Using each of the four retina specialists as the reference, the proposed method showed a superior area under the ROC curve of 0.91 ± 0.03 compared to the ROC 0.81 ± 0.05 shown by the baseline algorithm. CONCLUSION The SVML algorithm was as effective as the retina specialists were in detecting activity in wAMD. Support vector machine learning (SVML) may be a useful monitoring tool in wAMD suited for small samples that yield sparse OCT data possibly derived from self-measuring OCT-robots.
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Affiliation(s)
- Gwenolé Quellec
- ARTORG Centre for Biomedical Engineering Research University of Bern Bern Switzerland
- Inserm, UMR 1101 Brest France
| | - Jens Kowal
- ARTORG Centre for Biomedical Engineering Research University of Bern Bern Switzerland
| | - Pascal W. Hasler
- OCTlab Department of Ophthalmology University of Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
| | - Hendrik P. N. Scholl
- Department of Ophthalmology University of Basel Basel Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- Wilmer Eye Institute Johns Hopkins University Baltimore Maryland USA
| | - Sandrine Zweifel
- Department of Ophthalmology University Hospital Zurich Zurich Switzerland
| | | | | | | | - Catherine Egan
- Moorfields Eye Hospital NHS Trust Institute of Ophthalmology UCL London UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Trust Institute of Ophthalmology UCL London UK
| | - Peter M. Maloca
- OCTlab Department of Ophthalmology University of Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- Moorfields Eye Hospital NHS Trust Institute of Ophthalmology UCL London UK
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Wu J, Sun X. Complement system and age-related macular degeneration: drugs and challenges. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:2413-2425. [PMID: 31409975 PMCID: PMC6650090 DOI: 10.2147/dddt.s206355] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023]
Abstract
Age-related macular degeneration (AMD) is directly attributable to vision loss, posing significant pressure on public health. AMD is recognized to be a multi-factorial disease and among them, complement system is under heated discussion in recent years. In this review, we start with an overview of complement pathways involved in AMD and their therapies correspondingly. Finally, we discuss the development of the therapeutics existed now. Also, we enclose a list of drugs undergoing clinical trials.
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Affiliation(s)
- Jiali Wu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, People's Republic of China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People's Republic of China
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Orellana-Rios J, Yokoyama S, Agee JM, Challa N, Freund KB, Yannuzzi LA, Smith RT. Quantitative Fundus Autofluorescence in Non-Neovascular Age-Related Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina 2019; 49:S34-S42. [PMID: 30339266 DOI: 10.3928/23258160-20180814-06] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/03/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE To use quantitative fundus autofluorescence (qAF) to analyze different stages of non-neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS In this cohort study, 38 pseudophakic patients and 36 age-matched controls participated. We performed near-infrared, spectral-domain optical coherence tomography and qAF imaging on 31 pseudophakic eyes and controls of participants older than 60 years with non-neovascular AMD phenotypes using the Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany). RESULTS The patients included in this study had a mean age of 83.9 years, and 35.7% patients were men. Mean qAF was higher in control participants than in all patients with AMD (P < .001). According to non-neovascular AMD phenotype, mean qAF levels were significantly lower in eyes with subretinal drusenoid deposits than in control eyes (P < .05). The lowest mean qAF was in patients with geographic atrophy. CONCLUSION Quantitative fundus autofluorescence of non-neovascular AMD decreases from normal to early to late AMD, suggesting that loss of lipofuscin fluorophores, not increase, signifies AMD progression. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S34-S42.].
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Dolz-Marco R, Balaratnasingam C, Messinger JD, Li M, Ferrara D, Freund KB, Curcio CA. The Border of Macular Atrophy in Age-Related Macular Degeneration: A Clinicopathologic Correlation. Am J Ophthalmol 2018; 193:166-177. [PMID: 29981740 DOI: 10.1016/j.ajo.2018.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/23/2018] [Accepted: 06/27/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To correlate in vivo imaging to histology in an eye with macular atrophy owing to age-related macular degeneration (AMD; complete retinal pigment epithelium [RPE] and outer retinal atrophy [cRORA]) to evaluate the utility of new optical coherence tomography (OCT) suggested by previous histology. DESIGN Case study with clinicopathologic correlation. METHODS In vivo eye-tracked cross-sectional OCT scans at 13 and 8 months before death were compared to postmortem histopathology. On OCT, the atrophy border was identified as either the descent of the external limiting membrane (ELM) toward the Bruch membrane (BrM) (representing gliosis) or the presence of choroidal hypertransmission (representing lack of shadowing by RPE). Thicknesses of RPE, basal laminar deposit (BLamD), and BrM were measured at 500 and 100 μm on the nonatrophic and atrophic sides of these borders, on in vivo eye-tracked OCT and histology matched to the same location. RESULTS In all OCT scans, the ELM descent was visible. The RPE-BLamD band significantly thickened toward it (P < .005), over time (P = .015 and P = .043, at 500 and 100 μm, respectively). On OCT, the ELM descent delineated a smaller atrophic area than did hypertransmission. RPE-BLamD thicknesses manually measured on OCT overestimated histologic thicknesses. BrM visibility varied with RPE status. CONCLUSION Visible on OCT, the ELM descent is a histopathologic atrophy border supporting new terminology of cRORA, whereas hypertransmission reveals RPE degeneration. RPE-BLamD thickening across the macula, toward the atrophy and over time is confirmed. The presence of gliosis and thick RPE-BLamD suggests that macular atrophy is a late stage in disease progression, encouraging anatomic endpoints at earlier AMD stages than atrophy enlargement.
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Affiliation(s)
- Rosa Dolz-Marco
- Vitreous Retina Macula Consultants of New York, New York, New York, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA; Unit of Macula, Oftalvist Clinic, Valencia, Spain
| | - Chandrakumar Balaratnasingam
- Vitreous Retina Macula Consultants of New York, New York, New York, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA; Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia; Sir Charles Gairdner Hospital, Perth, Australia
| | - Jeffrey D Messinger
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Miaoling Li
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA; Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York, USA; Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Sauer L, Klemm M, Peters S, Schweitzer D, Schmidt J, Kreilkamp L, Ramm L, Meller D, Hammer M. Monitoring foveal sparing in geographic atrophy with fluorescence lifetime imaging ophthalmoscopy - a novel approach. Acta Ophthalmol 2018; 96:257-266. [PMID: 29105362 DOI: 10.1111/aos.13587] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/09/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE To investigate fundus autofluorescence (FAF) lifetimes in geographic atrophy (GA) with a focus on macular pigment (MP) and foveal sparing. METHODS The study included 35 eyes from 28 patients (mean age 79.2 ± 8.0 years) with GA. A 30° retinal field, centred at the macula, was investigated using fluorescence lifetime imaging ophthalmoscopy (FLIO). The FLIO technology is based on a Heidelberg Engineering Spectralis system. Decays of FAF were detected in a short (498-560 nm, SSC) and long (560-720 nm, LSC) spectral channel. The mean fluorescence lifetime, τm , was calculated from a three-exponential approximation of the FAF decays. Macular optical coherence tomography (OCT) scans as well as fundus photography were recorded. RESULTS Review of FLIO data reveals specific patterns of significantly prolonged τm in regions of GA (SSC 616 ± 343 ps, LSC 615 ± 154 ps) as compared to non-atrophic regions. Large τm differences between the fovea and atrophic areas correlate with better visual acuity (VA). Shorter τm at the fovea than within other non-atrophic regions indicates sparing, which was identified in 16 eyes. Seventy per cent of patients treated with lutein supplementation showed foveal sparing, whereas the rate among non-supplemented patients was 22%. CONCLUSION Using FLIO, we present a novel way to detect foveal sparing, investigate MP, and analyse variability of τm in different foveal regions (including the prognostic valuable border region) in GA. These findings support the potential utility of FLIO in monitoring disease progression. The findings also highlight the possibly protective effect of lutein supplementation, with implication in recording the presence and distributional pattern of MP.
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Affiliation(s)
| | - Matthias Klemm
- Institute of Biomedical Engineering and Informatics; Technical University Ilmenau; Ilmenau Germany
| | | | - Dietrich Schweitzer
- University Hospital Jena; Jena Germany
- Center for Medical Optics and Photonics; University of Jena; Jena Germany
| | | | | | - Lisa Ramm
- Department of Ophthalmology; University Hospital Carl-Gustav Carus; TU Dresden; Dresden Germany
| | | | - Martin Hammer
- University Hospital Jena; Jena Germany
- Center for Medical Optics and Photonics; University of Jena; Jena Germany
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Frampton GK, Kalita N, Payne L, Colquitt J, Loveman E. Accuracy of fundus autofluorescence imaging for the diagnosis and monitoring of retinal conditions: a systematic review. Health Technol Assess 2018; 20:1-108. [PMID: 27115052 DOI: 10.3310/hta20310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Natural fluorescence in the eye may be increased or decreased by diseases that affect the retina. Imaging methods based on confocal scanning laser ophthalmoscopy (cSLO) can detect this 'fundus autofluorescence' (FAF) by illuminating the retina using a specific light 'excitation wavelength'. FAF imaging could assist the diagnosis or monitoring of retinal conditions. However, the accuracy of the method for diagnosis or monitoring is unclear. OBJECTIVE To conduct a systematic review to determine the accuracy of FAF imaging using cSLO for the diagnosis or monitoring of retinal conditions, including monitoring of response to therapy. DATA SOURCES Electronic bibliographic databases; scrutiny of reference lists of included studies and relevant systematic reviews; and searches of internet pages of relevant organisations, meetings and trial registries. Databases included MEDLINE, EMBASE, The Cochrane Library, Web of Science and the Medion database of diagnostic accuracy studies. Searches covered 1990 to November 2014 and were limited to the English language. REVIEW METHODS References were screened for relevance using prespecified inclusion criteria to capture a broad range of retinal conditions. Two reviewers assessed titles and abstracts independently. Full-text versions of relevant records were retrieved and screened by one reviewer and checked by a second. Data were extracted and critically appraised using the Quality Assessment of Diagnostic Accuracy Studies criteria (QUADAS) for assessing risk of bias in test accuracy studies by one reviewer and checked by a second. At all stages any reviewer disagreement was resolved through discussion or arbitration by a third reviewer. RESULTS Eight primary research studies have investigated the diagnostic accuracy of FAF imaging in retinal conditions: choroidal neovascularisation (one study), reticular pseudodrusen (three studies), cystoid macular oedema (two studies) and diabetic macular oedema (two studies). Sensitivity of FAF imaging using an excitation wavelength of 488 nm was generally high (range 81-100%), but was lower (55% and 32%) in two studies using longer excitation wavelengths (514 nm and 790 nm, respectively). Specificity ranged from 34% to 100%. However, owing to limitations of the data, none of the studies provide conclusive evidence of the diagnostic accuracy of FAF imaging. LIMITATIONS No studies on the accuracy of FAF imaging for monitoring the progression of retinal conditions or response to therapy were identified. Owing to study heterogeneity, pooling of diagnostic outcomes in meta-analysis was not conducted. All included studies had high risk of bias. In most studies the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported how FAF images were interpreted. CONCLUSIONS Although already in use in clinical practice, it is unclear whether or not FAF imaging is accurate, and whether or not it is applied and interpreted consistently for the diagnosis and/or monitoring of retinal conditions. Well-designed prospective primary research studies, which conform to the paradigm of diagnostic test accuracy assessment, are required to investigate the accuracy of FAF imaging in diagnosis and monitoring of inherited retinal dystrophies, early age-related macular degeneration, geographic atrophy and central serous chorioretinopathy. STUDY REGISTRATION This study is registered as PROSPERO CRD42014014997. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geoff K Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Liz Payne
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Fleckenstein M, Mitchell P, Freund KB, Sadda S, Holz FG, Brittain C, Henry EC, Ferrara D. The Progression of Geographic Atrophy Secondary to Age-Related Macular Degeneration. Ophthalmology 2017; 125:369-390. [PMID: 29110945 DOI: 10.1016/j.ophtha.2017.08.038] [Citation(s) in RCA: 295] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/21/2017] [Accepted: 08/30/2017] [Indexed: 01/03/2023] Open
Abstract
Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) that leads to progressive and irreversible loss of visual function. Geographic atrophy is defined by the presence of sharply demarcated atrophic lesions of the outer retina, resulting from loss of photoreceptors, retinal pigment epithelium (RPE), and underlying choriocapillaris. These lesions typically appear first in the perifoveal macula, initially sparing the foveal center, and over time often expand and coalesce to include the fovea. Although the kinetics of GA progression are highly variable among individual patients, a growing body of evidence suggests that specific characteristics may be important in predicting disease progression and outcomes. This review synthesizes current understanding of GA progression in AMD and the factors known or postulated to be relevant to GA lesion enlargement, including both affected and fellow eye characteristics. In addition, the roles of genetic, environmental, and demographic factors in GA lesion enlargement are discussed. Overall, GA progression rates reported in the literature for total study populations range from 0.53 to 2.6 mm2/year (median, ∼1.78 mm2/year), assessed primarily by color fundus photography or fundus autofluorescence (FAF) imaging. Several factors that could inform an individual's disease prognosis have been replicated in multiple cohorts: baseline lesion size, lesion location, multifocality, FAF patterns, and fellow eye status. Because best-corrected visual acuity does not correspond directly to GA lesion enlargement due to possible foveal sparing, alternative assessments are being explored to capture the relationship between anatomic progression and visual function decline, including microperimetry, low-luminance visual acuity, reading speed assessments, and patient-reported outcomes. Understanding GA progression and its individual variability is critical in the design of clinical studies, in the interpretation and application of clinical trial results, and for counseling patients on how disease progression may affect their individual prognosis.
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Affiliation(s)
| | - Paul Mitchell
- Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - SriniVas Sadda
- Doheny Eye Institute, Los Angeles, California; University of California at Los Angeles, Los Angeles, California
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Erin C Henry
- Genentech, Inc., South San Francisco, California
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THE PATHOPHYSIOLOGY OF GEOGRAPHIC ATROPHY SECONDARY TO AGE-RELATED MACULAR DEGENERATION AND THE COMPLEMENT PATHWAY AS A THERAPEUTIC TARGET. Retina 2017; 37:819-835. [PMID: 27902638 PMCID: PMC5424580 DOI: 10.1097/iae.0000000000001392] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Geographic atrophy is an advanced form of age-related macular degeneration that can significantly impact visual function, but has no approved treatment. This review focuses on the pathophysiology of geographic atrophy, particularly the role of complement cascade dysregulation and emerging therapies targeting the complement cascade. Purpose: Geographic atrophy (GA) is an advanced, vision-threatening form of age-related macular degeneration (AMD) affecting approximately five million individuals worldwide. To date, there are no approved therapeutics for GA treatment; however, several are in clinical trials. This review focuses on the pathophysiology of GA, particularly the role of complement cascade dysregulation and emerging therapies targeting the complement cascade. Methods: Primary literature search on PubMed for GA, complement cascade in age-related macular degeneration. ClinicalTrials.gov was searched for natural history studies in GA and clinical trials of drugs targeting the complement cascade for GA. Results: Cumulative damage to the retina by aging, environmental stress, and other factors triggers inflammation via multiple pathways, including the complement cascade. When regulatory components in these pathways are compromised, as with several GA-linked genetic risk factors in the complement cascade, chronic inflammation can ultimately lead to the retinal cell death characteristic of GA. Complement inhibition has been identified as a key candidate for therapeutic intervention, and drugs targeting the complement pathway are currently in clinical trials. Conclusion: The complement cascade is a strategic target for GA therapy. Further research, including on natural history and genetics, is crucial to expand the understanding of GA pathophysiology and identify effective therapeutic targets.
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Curcio CA, Zanzottera EC, Ach T, Balaratnasingam C, Freund KB. Activated Retinal Pigment Epithelium, an Optical Coherence Tomography Biomarker for Progression in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2017; 58:BIO211-BIO226. [PMID: 28785769 PMCID: PMC5557213 DOI: 10.1167/iovs.17-21872] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose To summarize and contextualize recent histology and clinical imaging publications on retinal pigment epithelium (RPE) fate in advanced age-related macular degeneration (AMD); to support RPE activation and migration as important precursors to atrophy, manifest as intraretinal hyperreflective foci in spectral-domain optical coherence tomography (SDOCT). Methods The Project MACULA online resource for AMD histopathology was surveyed systematically to form a catalog of 15 phenotypes of RPE and RPE-derived cells and layer thicknesses in advanced disease. Phenotypes were also sought in correlations with clinical longitudinal eye-tracked SDOCT and with ex vivo imaging–histopathology correlations in geographic atrophy (GA) and pigment epithelium detachments (PED). Results The morphology catalog suggested two main pathways of RPE fate: basolateral shedding of intracellular organelles (apparent apoptosis in situ) and activation with anterior migration. Acquired vitelliform lesions may represent a third pathway. Migrated cells are packed with RPE organelles and confirmed as hyperreflective on SDOCT. RPE layer thickening due to cellular dysmorphia and thick basal laminar deposit is observed near the border of GA. Drusenoid PED show a life cycle of slow growth and rapid collapse preceded by RPE layer disruption and anterior migration. Conclusions RPE activation and migration comprise an important precursor to atrophy that can be observed at the cellular level in vivo via validated SDOCT. Collapse of large drusen and drusenoid PED appears to occur when RPE death and migration prevent continued production of druse components. Data implicate excessive diffusion distance from choriocapillaris in RPE death as well as support a potential benefit in targeting drusen in GA.
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Affiliation(s)
- Christine A Curcio
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, United States
| | - Emma C Zanzottera
- Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Thomas Ach
- University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Chandrakumar Balaratnasingam
- Center for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - K Bailey Freund
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, United States.,Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy.,University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany.,Center for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia.,Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Institute, New York, New York, United States.,Department of Ophthalmology, New York University Langone School of Medicine, New York, New York, United States
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Sayegh RG, Sacu S, Dunavölgyi R, Kroh ME, Roberts P, Mitsch C, Montuoro A, Ehrenmüller M, Schmidt-Erfurth U. Geographic Atrophy and Foveal-Sparing Changes Related to Visual Acuity in Patients With Dry Age-Related Macular Degeneration Over Time. Am J Ophthalmol 2017; 179:118-128. [PMID: 28385474 DOI: 10.1016/j.ajo.2017.03.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE To correlate the area of geographic atrophy (GA) and residual foveal sparing (FS), and to identify the minimum FS and maximum GA area allowing sufficient visual acuity (VA) for daily tasks. DESIGN Prospective cohort study. METHODS Thirty-six eyes of 25 patients with GA and FS were followed for 18 months using spectral-domain optical coherence tomography and VA tests. Volume scans were imported into software enabling grading of areas in B-scans and computing of planimetric measurements in complete volume scans. Correlation of areas 1 (complete atrophy), 2 (FS in the central millimeter), and 3 (FS in the central 3 mm) with each other and with best-corrected VA (BCVA) were evaluated. RESULTS Baseline means of areas 1, 2, and 3 were 6.15 mm2, 0.49 mm2, and 3.08 mm2, respectively. At 1 year, area 1 increased by a mean of 1.33 mm2, while areas 2 and 3 were decreased by 0.12 mm2 and 0.65 mm2, respectively. From baseline to 18 months and from visit to visit, all areas and BCVA changed progressively (P < .001). Significant thresholds in GA size and FS for achieving a BCVA ≥ 70 ETDRS letters were detected (area 1: ≤6 mm2; area 2: ≥0.48 mm2; and area 3: ≥3.28 mm2). CONCLUSION GA and FS changed inversely over time. In general, FS highly correlated with BCVA, while GA progression correlated with the central 3-mm FS regression, but not with BCVA. A threshold in GA and FS area could be determined for BCVA necessary for daily activity.
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VISUALIZING RETINAL PIGMENT EPITHELIUM PHENOTYPES IN THE TRANSITION TO GEOGRAPHIC ATROPHY IN AGE-RELATED MACULAR DEGENERATION. Retina 2017; 36 Suppl 1:S12-S25. [PMID: 28005660 DOI: 10.1097/iae.0000000000001276] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To inform the interpretation of clinical optical coherence tomography and fundus autofluorescence imaging in geographic atrophy (GA) of age-related macular degeneration by determining the distribution of retinal pigment epithelium (RPE) phenotypes in the transition from health to atrophy in donor eyes. METHODS In RPE-Bruch membrane flat mounts of two GA eyes, the terminations of organized RPE cytoskeleton and autofluorescent material were compared. In high-resolution histological sections of 13 GA eyes, RPE phenotypes were assessed at ±500 and ±100 μm from the descent of the external limiting membrane (ELM) toward Bruch membrane. The ELM descent was defined as curved, reflected, or oblique in shape. Thicknesses of RPE, basal laminar deposit (BLamD), and RPE plus BLamD were measured. RESULTS A border of atrophy that can be precisely delimited is the ELM descent, as opposed to the termination of the RPE layer itself, because of dissociated RPE in the atrophic area. Approaching the ELM descent, the percentage of abnormal RPE morphologies increases, the percentage of age-normal cells decreases, overall RPE thickens, and BLamD does not thin. The combination of RPE plus BLamD is 19.7% thicker at -100 μm from the ELM descent than that at -500 μm (23.1 ± 10.7 μm vs. 19.3 ± 8.2 μm; P = 0.05). CONCLUSION The distribution of RPE phenotypes at the GA transition supports the idea that these morphologies represent defined stages of a degeneration sequence. The idea that RPE dysmorphia including rounding and stacking helps explain variable autofluorescence patterns in GA is supported. The ELM descent and RPE plus BLamD thickness profile may have utility as spectral domain optical coherence tomography metrics in clinical trials.
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Fundus autofluorescence imaging: systematic review of test accuracy for the diagnosis and monitoring of retinal conditions. Eye (Lond) 2017; 31:995-1007. [PMID: 28282065 DOI: 10.1038/eye.2017.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/02/2016] [Indexed: 12/17/2022] Open
Abstract
We conducted a systematic review of the accuracy of fundus autofluorescence (FAF) imaging for diagnosing and monitoring retinal conditions. Searches in November 2014 identified English language references. Sources included MEDLINE, EMBASE, the Cochrane Library, Web of Science, and MEDION databases; reference lists of retrieved studies; and internet pages of relevant organisations, meetings, and trial registries. For inclusion, studies had to report FAF imaging accuracy quantitatively. Studies were critically appraised using QUADAS risk of bias criteria. Two reviewers conducted all review steps. From 2240 unique references identified, eight primary research studies met the inclusion criteria. These investigated diagnostic accuracy of FAF imaging for choroidal neovascularisation (one study), reticular pseudodrusen (three studies), cystoid macular oedema (two studies), and diabetic macular oedema (two studies). Diagnostic sensitivity of FAF imaging ranged from 32 to 100% and specificity from 34 to 100%. However, owing to methodological limitations, including high and/or unclear risks of bias, none of these studies provides conclusive evidence of the diagnostic accuracy of FAF imaging. Study heterogeneity precluded meta-analysis. In most studies, the patient spectrum was not reflective of those who would present in clinical practice and no studies adequately reported whether FAF images were interpreted consistently. No studies of monitoring accuracy were identified. An update in October 2016, based on MEDLINE and internet searches, identified four new studies but did not alter our conclusions. Robust quantitative evidence on the accuracy of FAF imaging and how FAF images are interpreted is lacking. We provide recommendations to address this.
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Schaal KB, Gregori G, Rosenfeld PJ. En Face Optical Coherence Tomography Imaging for the Detection of Nascent Geographic Atrophy. Am J Ophthalmol 2017; 174:145-154. [PMID: 27864062 DOI: 10.1016/j.ajo.2016.11.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/02/2016] [Accepted: 11/06/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine if en face optical coherence tomography (OCT) imaging can identify nascent geographic atrophy (nGA) in eyes with intermediate age-related macular degeneration (iAMD). DESIGN Retrospective observational case series. METHODS Patients with iAMD from the COMPLETE study at the Bascom Palmer Eye Institute were evaluated to determine if nGA was present at baseline and at follow-up using high-density Spectralis OCT B-scans and en face OCT images from the Cirrus OCT instrument. If available, additional en face OCT images and B-scans were analyzed at follow-up times beyond the 52-week period. RESULTS A total of 37 eyes (27 patients) were evaluated for at least 1 year using both B-scans and en face images. Two drusen suspicious for nGA at baseline were identified, but neither druse developed GA after 24 and 62 months of follow-up, respectively. Another druse displayed hypertransmission into the choroid at week 52 on B-scan imaging and was classified as nGA. En face OCT imaging identified this druse as a focal bright area. Drusen breakdown occurred during a follow-up of 39 months. CONCLUSIONS En face OCT imaging appeared to be as useful as routine B-scan imaging for identifying areas suspicious for nGA in this population from the COMPLETE Study. Additional longitudinal follow-up of eyes with drusen is needed to determine if en face OCT imaging can replace the evaluation of individual B-scans for the detection of nGA.
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Affiliation(s)
- Karen B Schaal
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Giovanni Gregori
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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A view of the current and future role of optical coherence tomography in the management of age-related macular degeneration. Eye (Lond) 2016; 31:26-44. [PMID: 27886184 DOI: 10.1038/eye.2016.227] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/20/2016] [Indexed: 01/23/2023] Open
Abstract
Optical coherence tomography (OCT) has become an established diagnostic technology in the clinical management of age-related macular degeneration (AMD). OCT is being used for primary diagnosis, evaluation of therapeutic efficacy, and long-term monitoring. Computer-based advances in image analysis provide complementary imaging tools such as OCT angiography, further novel automated analysis methods as well as feature detection and prediction of prognosis in disease and therapy by machine learning. In early AMD, pathognomonic features such as drusen, pseudodrusen, and abnormalities of the retinal pigment epithelium (RPE) can be imaged in a qualitative and quantitative way to identify early signs of disease activity and define the risk of progression. In advanced AMD, disease activity can be monitored clearly by qualitative and quantified analyses of fluid pooling, such as intraretinal cystoid fluid, subretinal fluid, and pigment epithelial detachment (PED). Moreover, machine learning methods detect a large spectrum of new biomarkers. Evaluation of treatment efficacy and definition of optimal therapeutic regimens are an important aim in managing neovascular AMD. In atrophic AMD hallmarked by geographic atrophy (GA), advanced spectral domain (SD)-OCT imaging largely replaces conventional fundus autofluorescence (FAF) as it adds insight into the condition of the neurosensory layers and associated alterations at the level of the RPE and choroid. Exploration of imaging features by computerized methods has just begun but has already opened relevant and reliable horizons for the optimal use of OCT imaging for individualized and population-based management of AMD-the leading retinal epidemic of modern times.
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Schaal KB, Rosenfeld PJ, Gregori G, Yehoshua Z, Feuer WJ. Anatomic Clinical Trial Endpoints for Nonexudative Age-Related Macular Degeneration. Ophthalmology 2016; 123:1060-79. [DOI: 10.1016/j.ophtha.2016.01.034] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/11/2016] [Accepted: 01/21/2016] [Indexed: 11/24/2022] Open
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Jaffe GJ, Schmitz-Valckenberg S, Boyer D, Heier J, Wolf-Schnurrbusch U, Staurenghi G, Schmidt-Erfurth U, Holz FG. Randomized Trial to Evaluate Tandospirone in Geographic Atrophy Secondary to Age-Related Macular Degeneration: The GATE Study. Am J Ophthalmol 2015; 160:1226-34. [PMID: 26310670 DOI: 10.1016/j.ajo.2015.08.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/15/2015] [Accepted: 08/18/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine the safety and efficacy of AL-8309B (tandospirone) in the management of patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) and obtain standardized data on GA lesion growth progression. DESIGN Prospective, controlled, double-masked, randomized, multicenter phase 3 clinical trial. METHODS setting: Forty-eight clinical sites. PATIENTS Patients with GA associated with AMD were enrolled. All patients were followed for a minimum of 30 months, and up to 36 months. intervention procedures: Patients were randomized (1:1:1) to receive AL-8309B ophthalmic solution 1.0%, 1.75%, or vehicle, administered as a twice-daily topical ocular drop. MAIN OUTCOME MEASURES The primary efficacy endpoint was mean annualized lesion enlargement from baseline as assessed with fundus autofluorescence (FAF) imaging. RESULTS A total of 768 eyes of 768 patients were enrolled and treated with AL-8309B 1.0% (n = 250), AL-8309B 1.75% (n = 258), or vehicle (n = 260). An increase in mean lesion size was observed in both the AL-8309B and vehicle treatment groups, and growth rates were similar in all treatment groups. Annualized lesion growth rates were 1.73, 1.76, and 1.71 mm(2) for AL-8309B 1.0%, AL-8309B 1.75%, and vehicle, respectively. CONCLUSIONS AL-8309B 1.0% and 1.75% did not affect lesion growth in eyes with GA secondary to AMD. There were no clinically relevant safety issues identified for AL-8309B. The large natural history dataset from this study is a valuable repository for future comparisons.
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Affiliation(s)
- Glenn J Jaffe
- Department of Ophthalmology, Duke Reading Center, Duke University, Durham, North Carolina
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany
| | - David Boyer
- Retina-Vitreous Associates Medical Group, Beverly Hills, California; University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Jeffrey Heier
- Ophthalmic Consultants of Boston, Boston, Massachusetts
| | - Ute Wolf-Schnurrbusch
- Bern Photographic Reading Center, Department of Ophthalmology, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco" Sacco Hospital, University of Milan, Milan, Italy
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, University of Bonn, Bonn, Germany.
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Danis RP, Lavine JA, Domalpally A. Geographic atrophy in patients with advanced dry age-related macular degeneration: current challenges and future prospects. Clin Ophthalmol 2015; 9:2159-74. [PMID: 26640366 PMCID: PMC4662367 DOI: 10.2147/opth.s92359] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Geographic atrophy (GA) of the retinal pigment epithelium (RPE) is a devastating complication of age-related macular degeneration (AMD). GA may be classified as drusen-related (drusen-associated GA) or neovascularization-related (neovascular-associated GA). Drusen-related GA remains a large public health concern due to the burden of blindness it produces, but pathophysiology of the condition is obscure and there are no proven treatment options. Genotyping, cell biology, and clinical imaging point to upregulation of parainflammatory pathways, oxidative stress, and choroidal sclerosis as contributors, among other factors. Onset and monitoring of progression is accomplished through clinical imaging instrumentation such as optical coherence tomography, photography, and autofluorescence, which are the tools most helpful in determining end points for clinical trials at present. A number of treatment approaches with diverse targets are in development at this time, some of which are in human clinical trials. Neovascular-associated GA is a consequence of RPE loss after development of neovascular AMD. The neovascular process leads to a plethora of cellular stresses such as ischemia, inflammation, and dramatic changes in cell environment that further taxes RPE cells already dysfunctional from drusen-associated changes. GA may therefore develop secondary to the neovascular process de novo or preexisting drusen-associated GA may continue to worsen with the development of neovascular AMD. Neovascular-associated GA is a prominent cause of continued vision loss in patients with otherwise successfully treated neovascular AMD. Clearly, treatment with vascular endothelial growth factor (VEGF) inhibitors early in the course of the neovascular disease is of great clinical benefit. However, there is a rationale and some suggestive evidence that anti-VEGF agents themselves could be toxic to RPE and enhance neovascular-associated GA. The increasing prevalence of legal blindness from this condition due to the aging of the general population lends urgency to the search for a therapy to ameliorate GA.
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Affiliation(s)
- Ronald P Danis
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Jeremy A Lavine
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Hanus J, Zhao F, Wang S. Current therapeutic developments in atrophic age-related macular degeneration. Br J Ophthalmol 2015; 100:122-7. [PMID: 26553922 DOI: 10.1136/bjophthalmol-2015-306972] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 10/16/2015] [Indexed: 12/14/2022]
Abstract
Age-related macular degeneration (AMD), a degenerative disorder of the central retina, is the leading cause of irreversible blindness in the elderly. The underlying mechanism of the advanced form of dry AMD, also named geographic atrophy (GA) or atrophic AMD, remains unclear. Consequently, no cure is available for dry AMD or GA. The only prevention option currently available is the Age-Related Eye Disease Study (AREDS) formulation, which has been demonstrated to slow down the progression of dry AMD. This review summarises recent advances in therapy for dry AMD and GA. Building on the new understanding of the disease and recent technological breakthroughs, numerous ongoing clinical trials have the goal of meeting the need to cure AMD. Therapeutic agents are being developed to target the key features of the disease, including inhibiting the complement pathway and other inflammatory pathways, reducing oxidative stress and protecting retinal pigment epithelial (RPE) cells, inhibiting lipofuscin and visual cycle, regenerating RPE cells from stem cells and restoring choroidal blood flow. Some of these therapeutic options, especially the stem cell-based therapy, hold great promise, which brings great hope for this devastating blinding disease.
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Affiliation(s)
- Jakub Hanus
- Department of Cell and Molecular Biology, Tulane University, New Orleans, Louisiana, USA
| | - Fangkun Zhao
- Department of Cell and Molecular Biology, Tulane University, New Orleans, Louisiana, USA Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Shusheng Wang
- Department of Cell and Molecular Biology, Tulane University, New Orleans, Louisiana, USA Department of Ophthalmology, Tulane University, New Orleans, Louisiana, USA
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Zanzottera EC, Messinger JD, Ach T, Smith RT, Freund KB, Curcio CA. The Project MACULA Retinal Pigment Epithelium Grading System for Histology and Optical Coherence Tomography in Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2015; 56:3253-68. [PMID: 25813989 DOI: 10.1167/iovs.15-16431] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To seek pathways of retinal pigment epithelium (RPE) fate in age-related macular degeneration via a morphology grading system; provide nomenclature, visualization targets, and metrics for clinical imaging and model systems. METHODS Donor eyes with geographic atrophy (GA) or choroidal neovascularization (CNV) and one GA eye with previous clinical spectral-domain optical coherence tomography (SDOCT) imaging were processed for histology, photodocumented, and annotated at predefined locations. Retinal pigment epithelial cells contained spindle-shaped melanosomes, apposed a basal lamina or basal laminar deposit (BLamD), and exhibited recognizable morphologies. Thicknesses and unbiased estimates of frequencies were obtained. RESULTS In 13 GA eyes (449 locations), 'Shedding,' 'Sloughed,' and 'Dissociated' morphologies were abundant; 22.2% of atrophic locations had 'Dissociated' RPE. In 39 CNV eyes (1363 locations), 37.3% of locations with fibrovascular/fibrocellular scar had 'Entombed' RPE; 'Sloughed,' 'Dissociated,' and 'Bilaminar' morphologies were abundant. Of abnormal RPE, CNV and GA both had ~35% 'Sloughed'/'Intraretinal,' with more Intraretinal in CNV (9.5% vs. 1.8%). 'Shedding' cells associated with granule aggregations in BLamD. The RPE layer did not thin, and BLamD remained thick, with progression. Granule-containing material consistent with three morphologies correlated to SDOCT hyperreflective foci in the previously examined GA patient. CONCLUSIONS Retinal pigment epithelium morphology indicates multiple pathways in GA and CNV. Atrophic/scarred areas have numerous cells capable of transcribing genes and generating imaging signals. Shed granule aggregates, possibly apoptotic, are visible in SDOCT, as are 'Dissociated' and 'Sloughed' cells. The significance of RPE phenotypes is addressable in longitudinal, high-resolution imaging in clinic populations. Data can motivate future molecular phenotyping studies.
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Affiliation(s)
- Emma C Zanzottera
- Department of Ophthalmology University of Alabama School of Medicine, Birmingham, Alabama, United States 2Eye Clinic, Department of Clinical Science "Luigi Sacco," Sacco Hospital, University of Milan, Milan, Italy
| | - Jeffrey D Messinger
- Department of Ophthalmology University of Alabama School of Medicine, Birmingham, Alabama, United States
| | - Thomas Ach
- Department of Ophthalmology University of Alabama School of Medicine, Birmingham, Alabama, United States 3University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - R Theodore Smith
- Department of Ophthalmology, New York University School of Medicine, New York City, New York, United States
| | - K Bailey Freund
- Department of Ophthalmology, New York University School of Medicine, New York City, New York, United States 5Vitreous Retina Macula Consultants of New York, New York, New York, United States 6LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear
| | - Christine A Curcio
- Department of Ophthalmology University of Alabama School of Medicine, Birmingham, Alabama, United States
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Schütze C, Teleky K, Baumann B, Pircher M, Götzinger E, Hitzenberger CK, Schmidt-Erfurth U. Polarisation-sensitive OCT is useful for evaluating retinal pigment epithelial lesions in patients with neovascular AMD. Br J Ophthalmol 2015; 100:371-7. [PMID: 26183936 PMCID: PMC4789720 DOI: 10.1136/bjophthalmol-2015-306607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/19/2015] [Indexed: 11/23/2022]
Abstract
Background/aims To examine the reproducibility of lesion dimensions of the retinal pigment epithelium (RPE) in neovascular age-related macular degeneration (AMD) with polarisation-sensitive optical coherence tomography (PS-OCT), specifically imaging the RPE. Methods Twenty-six patients (28 eyes) with neovascular AMD were included in this study, and examined by a PS-OCT prototype. Each patient was scanned five times at a 1-day visit. The PS-OCT B-scan located closest to the macular centre presenting with RPE atrophy was identified, and the longitudinal diameter of the lesion was quantified manually using AutoCAD 2008. This procedure was followed for the identical B-scan position in all five scans per eye and patient. Reproducibility of qualitative changes in PS-OCT was evaluated. Interobserver variability was assessed. Results were compared with intensity-based spectral-domain OCT (SD-OCT) imaging. Results Mean variability of all atrophy lesion dimensions was 0.10 mm (SD±=0.06 mm). Coefficient of variation (SD±/mean) was 0.06 on average (SD±=0.03). Interobserver variability assessment showed a mean difference of 0.02 mm across all patients regarding RPE lesion size evaluation (paired t test: p=0.38). Spearman correlation coefficient was r=0.98, p<0.001. Results revealed a good overall reproducibility of ∼90%. PS-OCT specifically detected the RPE in all eyes compared with conventional intensity-based SD-OCT that was not capable to clearly identify RPE atrophy in 25 eyes (89.3%, p<0.01). Conclusions PS-OCT offers good reproducibility of RPE atrophy assessment in neovascular AMD, and may be suitable for precise RPE evaluation in clinical practice. PS-OCT unambiguously identifies RPE changes in choroidal neovascularisation compared with intensity-based SD-OCT that does not identify the RPE status reliably.
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Affiliation(s)
| | - Katharina Teleky
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Bernhard Baumann
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Erich Götzinger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Christoph K Hitzenberger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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