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Thomsen AK, Gøttsche LF, Hinnerskov JMV, Falk MK, Sørensen TL. Microperimetry and Structural Risk Factors on OCT in Intermediate Age-Related Macular Degeneration. Ophthalmol Retina 2024; 8:786-793. [PMID: 38442827 DOI: 10.1016/j.oret.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To determine the relationship between structural biomarkers on OCT that increase the risk of disease progression and microperimetric retinal sensitivity in patients with intermediate age-related macular degeneration (iAMD). DESIGN Prospective cross-sectional, observational study. PARTICIPANTS Forty-five eyes of 23 patients with iAMD. METHODS Patients underwent OCT and microperimetry. OCT scans were evaluated for the risk factors intraretinal hyperreflective foci (HRF), hyporeflectivity within drusenoid lesions (HRDL), subretinal drusenoid deposits, double-layer sign (DLS), and drusen volume. Microperimetric retinal sensitivity was analyzed with a 33-point grid covering the macula. With a novel method of determining what part of the retina corresponded to each microperimetry point, a Voronoi diagram was constructed, dividing the macula in cells consisting of the region nearer to each point than any other. The Voronoi diagram was superimposed on the OCT, making it possible to determine the point-to-point location of the OCT risk factors. Univariable and multivariable linear mixed-effect models were used for analysis. MAIN OUTCOME MEASURES Association between microperimetric retinal sensitivity and OCT risk factors at individual measuring points. RESULTS One thousand four hundred seventy-nine points of retinal sensitivity and corresponding structural area on OCT were included in this study. Retinal sensitivity was significantly decreased with presence of the OCT risk factors HRF, HRDL, DLS, and drusen volume (all P < 0.001) when analyzed with the univariable linear mixed-effect model. The multivariable model showed a significant decrease of retinal sensitivity with presence of HRF (P < 0.001), DLS (P = 0.025), and greater drusen volume (P < 0.001). CONCLUSIONS Presence of HRF, DLS, and greater drusen volume, all of which increase the risk of disease progression, is significantly and independently associated with decreased microperimetric retinal sensitivity in patients with iAMD. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alexander Kai Thomsen
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Liselotte Fribo Gøttsche
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Jenni Martinez Villarruel Hinnerskov
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mads Krüger Falk
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark
| | - Torben Lykke Sørensen
- Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Vujosevic S, Loewenstein A, O'Toole L, Schmidt-Erfurth UM, Zur D, Chakravarthy U. Imaging geographic atrophy: integrating structure and function to better understand the effects of new treatments. Br J Ophthalmol 2024; 108:773-778. [PMID: 38290804 DOI: 10.1136/bjo-2023-324246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024]
Abstract
Geographic atrophy (GA) is an advanced and irreversible form of age-related macular degeneration (AMD). Chronic low grade inflammation is thought to act as an initiator of this degenerative process, resulting in loss of photoreceptors (PRs), retinal pigment epithelium (RPE) and the underlying choriocapillaris. This review examined the challenges of clinical trials to date which have sought to treat GA, with particular reference to the successful outcome of C3 complement inhibition. Currently, optical coherence tomography (OCT) seems to be the most suitable method to detect GA and monitor the effect of treatment. In addition, the merits of using novel anatomical endpoints in detecting GA expansion are discussed. Although best-corrected visual acuity is commonly used to monitor disease in GA, other tests to determine visual function are explored. Although not widely available, microperimetry enables quantification of retinal sensitivity (RS) and macular fixation behaviour related to fundus characteristics. There is a spatial correlation between OCT/fundus autofluorescence evaluation of PR damage outside the area of RPE loss and RS on microperimetry, showing important associations with visual function. Standardisation of testing by microperimetry is necessary to enable this modality to detect AMD progression. Artificial intelligence (AI) analysis has shown PR layers integrity precedes and exceeds GA loss. Loss of the ellipsoid zone has been recognised as a primary outcome parameter in therapeutic trials for GA. The integrity of the PR layers imaged by OCT at baseline has been shown to be an important prognostic indicator. AI has the potential to be invaluable in personalising care and justifying treatment intervention.
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Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Anat Loewenstein
- Ophthalmology Division, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | | | - Dinah Zur
- Ophthalmology Division, Tel Aviv University, Tel Aviv, Israel
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Wu Z, Hadoux X, Jannaud M, Glover EK, Gee EE, Hodgson LAB, van Wijngaarden P, Guymer RH. Visual Sensitivity Loss in Geographic Atrophy: Structure-Function Evaluation Using Defect-Mapping Microperimetry. Invest Ophthalmol Vis Sci 2024; 65:36. [PMID: 38241029 PMCID: PMC10807497 DOI: 10.1167/iovs.65.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024] Open
Abstract
Purpose To examine the structure-function relationship in eyes with geographic atrophy (GA) using defect-mapping microperimetry, a testing strategy optimized to quantify the spatial extent of deep visual sensitivity losses. Methods Fifty participants with GA underwent defect-mapping microperimetry testing of the central 8°-radius region (208 locations tested once with a 10-decibel stimuli) and fundus autofluorescence imaging in one eye. The GA extent in the corresponding central 8°-radius was derived by manual annotations and image co-registration to examine the global structure-function relationship. The distance of each test location from the GA margin was also derived, and regions defined, to examine the local structure-function relationship. Results GA extent in the central 8° explained a substantial proportion of variance in the percentage of locations missed (nonresponse) on microperimetry at the global level (R2 = 0.90). At a local level, the probability of missing stimuli at the outer junctional zone (0-500 µm outside the GA margin) and GA margin (probability = 7% and 34%, respectively) was higher than at the outer nonlesional zone (>500 µm outside the GA margin; probability = 2%; P < 0.001 for both). The probability of missing stimuli at the inner junctional zone (0-250 µm inside the GA margin) was also lower than at the inner lesional zone (>250 µm inside the GA margin; probability = 64% and 88%; P < 0.001). Conclusions This study confirms the expected functional relevance of the region with GA on fundus autofluorescence imaging and underscores the potential effectiveness of defect-mapping microperimetry testing for capturing visual function changes when evaluating new GA treatments.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Xavier Hadoux
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Maxime Jannaud
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Emily K. Glover
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Erin E. Gee
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Lauren A. B. Hodgson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Robyn H. Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
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Cheng AMS, Chalam KV, Brar VS, Yang DTY, Bhatt J, Banoub RG, Gupta SK. Recent Advances in Imaging Macular Atrophy for Late-Stage Age-Related Macular Degeneration. Diagnostics (Basel) 2023; 13:3635. [PMID: 38132220 PMCID: PMC10742961 DOI: 10.3390/diagnostics13243635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. In late-stage AMD, geographic atrophy (GA) of dry AMD or choroidal neovascularization (CNV) of neovascular AMD eventually results in macular atrophy (MA), leading to significant visual loss. Despite the development of innovative therapies, there are currently no established effective treatments for MA. As a result, early detection of MA is critical in identifying later central macular involvement throughout time. Accurate and early diagnosis is achieved through a combination of clinical examination and imaging techniques. Our review of the literature depicts advances in retinal imaging to identify biomarkers of progression and risk factors for late AMD. Imaging methods like fundus photography; dye-based angiography; fundus autofluorescence (FAF); near-infrared reflectance (NIR); optical coherence tomography (OCT); and optical coherence tomography angiography (OCTA) can be used to detect and monitor the progression of retinal atrophy. These evolving diverse imaging modalities optimize detection of pathologic anatomy and measurement of visual function; they may also contribute to the understanding of underlying mechanistic pathways, particularly the underlying MA changes in late AMD.
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Affiliation(s)
- Anny M. S. Cheng
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
- Department of Ophthalmology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Kakarla V. Chalam
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA 92350, USA;
| | - Vikram S. Brar
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - David T. Y. Yang
- College of Biological Science, University of California, Davis, Sacramento, CA 95616, USA;
| | - Jineel Bhatt
- Specialty Retina Center, Coral Springs, FL 33067, USA;
| | - Raphael G. Banoub
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
| | - Shailesh K. Gupta
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
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Ktistakis E, Simos P, Tsilimbaris MK, Plainis S. Efficacy οf Wet Age-related Macular Degeneration Treatment οn Reading: A Pilot Study Using Eye-movement Analysis. Optom Vis Sci 2023; 100:670-678. [PMID: 37966366 DOI: 10.1097/opx.0000000000002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
SIGNIFICANCE Functional vision, as evaluated with silent passage reading speed, improves after anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with wet age-related macular antidegeneration (wAMD), reflecting primarily a concomitant reduction in the number of fixations. Implementing eye movement analysis when reading may better characterize the effectiveness of therapeutic approaches in wAMD. PURPOSE This study aimed to evaluate silent reading performance by means of eye fixation analysis before and after anti-VEGF treatment in wAMD patients. METHODS Sixteen wAMD patients who underwent anti-VEGF treatment in one eye and visual acuity (VA) better than 0.5 logMAR served as the AMD group. Twenty adults without ocular pathology served as the control group. Central retinal thickness and near VA were assessed at baseline and 3 to 4 months after their first visit. Reading performance was evaluated using short passages of 0.4-logMAR print size. Eye movements were recorded using EyeLink II video eye tracker. Data analysis included computation of reading speed, fixation duration, number of fixations, and percentage of regressions. Frequency distributions of fixation durations were analyzed with ex-Gaussian fittings. RESULTS In the AMD group, silent reading speed in the treated eye correlated well with central retinal thickness reduction and improved significantly by an average of 15.9 ± 28.5 words per minute (P = .04). This improvement was accompanied by an average reduction of 0.24 ± 0.38 in fixations per word (P = .03). The corresponding improvement in monocular VA was not statistically significant. Other eye fixation parameters did not change significantly after treatment. No statistically significant differences were found in the control group. CONCLUSIONS Visual acuity tests may underestimate the potential therapeutic effects after anti-VEGF treatment in patients with relatively good acuity who are being treated for wAMD. Evaluating silent reading performance and eye fixation parameters may better characterize the effectiveness of therapeutic approaches in wAMD patients.
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Affiliation(s)
- Emmanouil Ktistakis
- Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Heraklion, Greece
| | | | - Miltiadis K Tsilimbaris
- Laboratory of Optics and Vision (LOV), School of Medicine, University of Crete, Heraklion, Greece
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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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Park UC, Yoon CK, Bae K, Lee EK. Association of Retinal Sensitivity With Optical Coherence Tomography Microstructure in Highly Myopic Patients. Invest Ophthalmol Vis Sci 2022; 63:13. [PMID: 36255365 PMCID: PMC9587465 DOI: 10.1167/iovs.63.11.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the association of retinal sensitivity with microstructural features in optical coherence tomography (OCT) of high myopic eyes. Methods This cross-sectional study included 78 eyes (78 patients). Microstructural features on spectral-domain OCT, such as the integrity of the retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) and outer retinoschisis, were evaluated at each retinal location corresponding to microperimetric testing points. Results For all testing points, retinal sensitivity was significantly associated with the integrity of the RPE, EZ, and ELM (all P < 0.001) based on OCT but not with outer retinoschisis (P = 0.183). A higher category of myopic maculopathy according to the Meta-Analysis of Pathologic Myopia classification was associated with lower mean retinal sensitivity (P < 0.001). In eyes with patchy atrophy (PA), mean retinal sensitivity of testing points adjacent to the PA lesion (15.7 ± 6.8 dB) was greater than points within or at the PA border (2.6 ± 5.2 dB; P < 0.001) but lower than distant points (19.6 ± 4.3 dB; P < 0.001). Microstructural features in OCT were well correlated with the differences in retinal sensitivity according to myopic maculopathy severity and proximity to the PA lesion. Conclusions In highly myopic eyes, retinal sensitivity on microperimetry was strongly associated with microstructural features in OCT. Both retinal sensitivity and microstructure were affected by the severity of myopic degeneration and proximity to the PA lesion.
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Affiliation(s)
- Un Chul Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Ki Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Kunho Bae
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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Seeböck P, Vogl WD, Waldstein SM, Orlando JI, Baratsits M, Alten T, Arikan M, Mylonas G, Bogunović H, Schmidt-Erfurth U. Linking Function and Structure with ReSensNet: Predicting Retinal Sensitivity from OCT using Deep Learning. Ophthalmol Retina 2022; 6:501-511. [PMID: 35134543 DOI: 10.1016/j.oret.2022.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE The currently used measures of retinal function are limited by being subjective, nonlocalized, or taxing for patients. To address these limitations, we sought to develop and evaluate a deep learning (DL) method to automatically predict the functional end point (retinal sensitivity) based on structural OCT images. DESIGN Retrospective, cross-sectional study. SUBJECTS In total, 714 volumes of 289 patients were used in this study. METHODS A DL algorithm was developed to automatically predict a comprehensive retinal sensitivity map from an OCT volume. Four hundred sixty-three spectral-domain OCT volumes from 174 patients and their corresponding microperimetry examinations (Nidek MP-1) were used for development and internal validation, with a total of 15 563 retinal sensitivity measurements. The patients presented with a healthy macula, early or intermediate age-related macular degeneration, choroidal neovascularization, or geographic atrophy. In addition, an external validation was performed using 251 volumes of 115 patients, comprising 3 different patient populations: those with diabetic macular edema, retinal vein occlusion, or epiretinal membrane. MAIN OUTCOME MEASURES We evaluated the performance of the algorithm using the mean absolute error (MAE), limits of agreement (LoA), and correlation coefficients of point-wise sensitivity (PWS) and mean sensitivity (MS). RESULTS The algorithm achieved an MAE of 2.34 dB and 1.30 dB, an LoA of 5.70 and 3.07, a Pearson correlation coefficient of 0.66 and 0.84, and a Spearman correlation coefficient of 0.68 and 0.83 for PWS and MS, respectively. In the external test set, the method achieved an MAE of 2.73 dB and 1.66 dB for PWS and MS, respectively. CONCLUSIONS The proposed approach allows the prediction of retinal function at each measured location directly based on an OCT scan, demonstrating how structural imaging can serve as a surrogate of visual function. Prospectively, the approach may help to complement retinal function measures, explore the association between image-based information and retinal functionality, improve disease progression monitoring, and provide objective surrogate measures for future clinical trials.
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Affiliation(s)
- Philipp Seeböck
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Department of Ophthalmology and Optometry, Vienna Reading Center, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Vogl
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Sebastian M Waldstein
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Jose Ignacio Orlando
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Yatiris Group, PLADEMA Institute, UNICEN, CONICET, Tandil, Argentina
| | - Magdalena Baratsits
- Department of Ophthalmology and Optometry, Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Alten
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Mustafa Arikan
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Hrvoje Bogunović
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- OPTIMA - Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria; Department of Ophthalmology and Optometry, Vienna Reading Center, Medical University of Vienna, Vienna, Austria.
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Fukuda S, Narendran S, Varshney A, Nagasaka Y, Wang SB, Ambati K, Apicella I, Pereira F, Fowler BJ, Yasuma T, Hirahara S, Yasuma R, Huang P, Yerramothu P, Makin RD, Wang M, Baker KL, Marion KM, Huang X, Baghdasaryan E, Ambati M, Ambati VL, Banerjee D, Bonilha VL, Tolstonog GV, Held U, Ogura Y, Terasaki H, Oshika T, Bhattarai D, Kim KB, Feldman SH, Aguirre JI, Hinton DR, Kerur N, Sadda SR, Schumann GG, Gelfand BD, Ambati J. Alu complementary DNA is enriched in atrophic macular degeneration and triggers retinal pigmented epithelium toxicity via cytosolic innate immunity. SCIENCE ADVANCES 2021; 7:eabj3658. [PMID: 34586848 PMCID: PMC8480932 DOI: 10.1126/sciadv.abj3658] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/05/2021] [Indexed: 05/08/2023]
Abstract
Long interspersed nuclear element-1 (L1)–mediated reverse transcription (RT) of Alu RNA into cytoplasmic Alu complementary DNA (cDNA) has been implicated in retinal pigmented epithelium (RPE) degeneration. The mechanism of Alu cDNA–induced cytotoxicity and its relevance to human disease are unknown. Here we report that Alu cDNA is highly enriched in the RPE of human eyes with geographic atrophy, an untreatable form of age-related macular degeneration. We demonstrate that the DNA sensor cGAS engages Alu cDNA to induce cytosolic mitochondrial DNA escape, which amplifies cGAS activation, triggering RPE degeneration via the inflammasome. The L1-extinct rice rat was resistant to Alu RNA–induced Alu cDNA synthesis and RPE degeneration, which were enabled upon L1-RT overexpression. Nucleoside RT inhibitors (NRTIs), which inhibit both L1-RT and inflammasome activity, and NRTI derivatives (Kamuvudines) that inhibit inflammasome, but not RT, both block Alu cDNA toxicity, identifying inflammasome activation as the terminal effector of RPE degeneration.
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Affiliation(s)
- Shinichi Fukuda
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Siddharth Narendran
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Aravind Eye Hospital System, Madurai, India
| | - Akhil Varshney
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Yosuke Nagasaka
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shao-bin Wang
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kameshwari Ambati
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ivana Apicella
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Felipe Pereira
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
| | - Benjamin J. Fowler
- Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, KY, USA
| | - Tetsuhiro Yasuma
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
| | - Shuichiro Hirahara
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Reo Yasuma
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Peirong Huang
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Praveen Yerramothu
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ryan D. Makin
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Mo Wang
- Doheny Eye Institute, Los Angeles, CA, USA
| | | | | | | | - Elmira Baghdasaryan
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Meenakshi Ambati
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Center for Digital Image Evaluation, Charlottesville, VA, USA
| | - Vidya L. Ambati
- Center for Digital Image Evaluation, Charlottesville, VA, USA
| | - Daipayan Banerjee
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Genrich V. Tolstonog
- Department of Otolaryngology–Head and Neck Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ulrike Held
- Department of Medical Biotechnology, Paul-Ehrlich-Institute, Langen, Germany
| | - Yuichiro Ogura
- Department of Ophthalmology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Deepak Bhattarai
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, USA
| | - Kyung Bo Kim
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY, USA
| | - Sanford H. Feldman
- Center for Comparative Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - J. Ignacio Aguirre
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - David R. Hinton
- Departments of Pathology and Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nagaraj Kerur
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Srinivas R. Sadda
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Gerald G. Schumann
- Department of Medical Biotechnology, Paul-Ehrlich-Institute, Langen, Germany
| | - Bradley D. Gelfand
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jayakrishna Ambati
- Center for Advanced Vision Science, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, USA
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10
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Fang V, Gomez-Caraballo M, Lad EM. Biomarkers for Nonexudative Age-Related Macular Degeneration and Relevance for Clinical Trials: A Systematic Review. Mol Diagn Ther 2021; 25:691-713. [PMID: 34432254 DOI: 10.1007/s40291-021-00551-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 01/05/2023]
Abstract
TOPIC The purpose of the review was to identify structural, functional, blood-based, and other types of biomarkers for early, intermediate, and late nonexudative stages of age-related macular degeneration (AMD) and summarize the relevant data for proof-of-concept clinical trials. CLINICAL RELEVANCE AMD is a leading cause of blindness in the aging population, yet no treatments exist for its most common nonexudative form. There are limited data on the diagnosis and progression of nonexudative AMD compared to neovascular AMD. Our objective was to provide a comprehensive, systematic review of recently published biomarkers (molecular, structural, and functional) for early AMD, intermediate AMD, and geographic atrophy and to evaluate the relevance of these biomarkers for use in future clinical trials. METHODS A literature search of PubMed, ScienceDirect, EMBASE, and Web of Science from January 1, 1996 to November 30, 2020 and a patent search were conducted. Search terms included "early AMD," "dry AMD," "intermediate AMD," "biomarkers for nonexudative AMD," "fundus autofluorescence patterns," "color fundus photography," "dark adaptation," and "microperimetry." Articles were assessed for bias and quality with the Mixed-Methods Appraisal Tool. A total of 94 articles were included (61,842 individuals). RESULTS Spectral-domain optical coherence tomography was superior at highlighting detailed structural changes in earlier stages of AMD. Fundus autofluorescence patterns were found to be most important in estimating progression of geographic atrophy. Delayed rod intercept time on dark adaptation was the most widely recommended surrogate functional endpoint for early AMD, while retinal sensitivity on microperimetry was most relevant for intermediate AMD. Combinational studies accounting for various patient characteristics and machine/deep-learning approaches were best suited for assessing individualized risk of AMD onset and progression. CONCLUSION This systematic review supports the use of structural and functional biomarkers in early AMD and intermediate AMD, which are more reproducible and less invasive than the other classes of biomarkers described. The use of deep learning and combinational algorithms will gain increasing importance in future clinical trials of nonexudative AMD.
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Affiliation(s)
- Vivienne Fang
- Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611, USA
| | - Maria Gomez-Caraballo
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Rd, DUMC 3802, Durham, NC, 27705, USA
| | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Rd, DUMC 3802, Durham, NC, 27705, USA
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11
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USING MICROPERIMETRY AND LOW-LUMINANCE VISUAL ACUITY TO DETECT THE ONSET OF LATE AGE-RELATED MACULAR DEGENERATION: A LEAD Study Report. Retina 2021; 41:1094-1101. [PMID: 33009222 DOI: 10.1097/iae.0000000000002982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the performance of microperimetry and low-luminance visual acuity for detecting late age-related macular degeneration (AMD) onset. METHODS Two hundred ninety-two individuals with bilateral large drusen in the Laser Intervention in the Early Stages of AMD study underwent best-corrected visual acuity, low-luminance visual acuity, and microperimetry testing as well as multimodal imaging to detect late (neovascular or atrophic) AMD onset. The performance of the change in the measurement from baseline of each of visual function test for detecting late AMD onset was compared. RESULTS The area under the receiver operating characteristic curve for detecting neovascular and atrophic AMD onset was not significantly different for low-luminance visual acuity (area under the receiver operating characteristic curve = 0.71 and 0.56, respectively) and microperimetry (area under the receiver operating characteristic curve = 0.82 and 0.62, respectively) compared with best-corrected visual acuity (area under the receiver operating characteristic curve = 0.57 and 0.56, respectively; P ≥ 0.126 for all). There was also only a fair degree of agreement between the three visual function measures for detecting the onset of neovascular and atrophic AMD (κ ≥ 0.24). CONCLUSION Microperimetry, low-luminance visual acuity, and best-corrected visual acuity demonstrate limited performance for detecting the earliest onset of late AMD. It remains to be established whether they perform better than current methods designed to enable self-detection of neovascular AMD onset, such as Amsler grid testing.
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12
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Corradetti G, Tiosano L, Nassisi M, Alagorie AR, Corvi F, Nittala MG, Sadda S. Scotopic microperimetric sensitivity and inner choroid flow deficits as predictors of progression to nascent geographic atrophy. Br J Ophthalmol 2020; 105:1584-1590. [PMID: 33172861 DOI: 10.1136/bjophthalmol-2020-316893] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/13/2020] [Accepted: 09/19/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIMS To assess the role of microperimetric retinal sensitivity (MPRS) and inner choroid flow deficits (IC FD) in predicting the development of incomplete retinal pigment epithelial and outer retinal atrophy (iRORA) in intermediate AMD (i-AMD). METHODS Thirty eyes with i-AMD evaluated at the Doheny-UCLA Eye Centres were enrolled in this prospective IRB-approved study. Subjects underwent several diagnostic tests: (a) 6×6 mm swept-source optical coherence tomography angiography (SS-OCTA) with the IC slab used to quantify the FDs, (b) 20°×20° spectral-domain optical coherence tomography (SD-OCT) to monitor progression to iRORA and (c) scotopic MPRS within an area of 18° centred on the fovea. All subjects were followed-up for 24 months. The baseline IC FD and MPRS were correlated with the development of iRORA. At 24-month follow-up, the stage of AMD was re-assessed and the eyes were divided into two sub-groups based on the development of iRORA. RESULTS Twenty-eight eyes completed the 2-year follow-up. At baseline, the mean MPRS was 13.40±4.66 dB and the mean IC FD was 27.55±8.67%. The morpho-functional regression showed a significant correlation between baseline MPRS and IC FD and the development of iRORA within 24 months (R2=0.744, p<0.05). A Kaplan-Meier survival curve was fit to determine the cumulative incidence of iRORA over the 24 months. CONCLUSIONS A lower MPRS and greater IC FD at baseline were predictors of progression to iRORA in eyes with i-AMD. These parameters may be useful biomarkers for risk stratification and prognostication.
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Affiliation(s)
- Giulia Corradetti
- Jules Stein Eye Institute, Los Angeles, California, USA.,Doheny Eye Institute, Los Angeles, California, USA
| | | | - Marco Nassisi
- Doheny Eye Institute, Los Angeles, California, USA.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Ophthalmological Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Ahmed Roshdy Alagorie
- Doheny Eye Institute, Los Angeles, California, USA.,Ophthalmology, Tanta University, Tanta, Egypt
| | - Federico Corvi
- Doheny Eye Institute, Los Angeles, California, USA.,Ophthalmology, Sacco Hospital, University of Milan, Milano, Italy
| | | | - SriniVas Sadda
- Doheny Eye Institute, Los Angeles, California, USA .,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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13
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Pfau M, Jolly JK, Wu Z, Denniss J, Lad EM, Guymer RH, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Fundus-controlled perimetry (microperimetry): Application as outcome measure in clinical trials. Prog Retin Eye Res 2020; 82:100907. [PMID: 33022378 DOI: 10.1016/j.preteyeres.2020.100907] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Fundus-controlled perimetry (FCP, also called 'microperimetry') allows for spatially-resolved mapping of visual sensitivity and measurement of fixation stability, both in clinical practice as well as research. The accurate spatial characterization of visual function enabled by FCP can provide insightful information about disease severity and progression not reflected by best-corrected visual acuity in a large range of disorders. This is especially important for monitoring of retinal diseases that initially spare the central retina in earlier disease stages. Improved intra- and inter-session retest-variability through fundus-tracking and precise point-wise follow-up examinations even in patients with unstable fixation represent key advantages of these technique. The design of disease-specific test patterns and protocols reduces the burden of extensive and time-consuming FCP testing, permitting a more meaningful and focused application. Recent developments also allow for photoreceptor-specific testing through implementation of dark-adapted chromatic and photopic testing. A detailed understanding of the variety of available devices and test settings is a key prerequisite for the design and optimization of FCP protocols in future natural history studies and clinical trials. Accordingly, this review describes the theoretical and technical background of FCP, its prior application in clinical and research settings, data that qualify the application of FCP as an outcome measure in clinical trials as well as ongoing and future developments.
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Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, Stanford, USA
| | - Jasleen Kaur Jolly
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eleonora M Lad
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, USA.
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14
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Shinojima A, Sawa M, Mori R, Sekiryu T, Oshima Y, Kato A, Hara C, Saito M, Sugano Y, Ashikari M, Hirano Y, Asato H, Nakamura M, Matsuno K, Kuno N, Kimura E, Nishiyama T, Yuzawa M, Ishibashi T, Ogura Y, Iida T, Gomi F, Yasukawa T. Five-year follow-up of fundus autofluorescence and retinal sensitivity in the fellow eye in exudative age-related macular degeneration in Japan. PLoS One 2020; 15:e0229694. [PMID: 32142523 PMCID: PMC7059919 DOI: 10.1371/journal.pone.0229694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the 5-year change in abnormal fundus autofluorescence (FAF) patterns and retinal sensitivity in the fellow eye of Japanese patients with unilateral exudative age-related macular degeneration (AMD). METHODS Patients with unilateral exudative AMD who developed abnormal FAF in the fellow eyes were enrolled. FAF imaging and microperimetry were performed at baseline and follow-ups. FAF findings were classified into 8 patterns based on the International Fundus Autofluorescence Classification Group to assess retinal sensitivity. Forty-five points covering the central 12 degrees on microperimetry were superimposed onto the FAF images. Each point was classified depending on the distance from the abnormal FAF. "Close" was defined as the portion within 1 degree from the border of any abnormal FAF, and "Distant" was defined as the portion over 1 degree from the border of abnormal FAF. To investigate the association between the retinal sensitivity and distance from the abnormal FAF, hierarchical linear mixed-effect models were used with the distance, time and time squared from baseline (months), and angle (degrees) as fixed effects. Differences among patients, eyes, and test point locations were considered successively nested random effects. RESULTS We studied 66 fellow eyes with abnormal FAF. Twenty-seven eyes were followed-up during the 5 years. In the 13 of 27 eyes (48%), the abnormal FAF patterns had changed during the 5 years. We found retinal sensitivity was associated significantly with the distance from the abnormal FAF ("Distant": p<0.001, time2 from baseline: p<0.001, angle: p<0.001). The mean retinal sensitivity of the "Close" tended to deteriorate after the third year and eventually showed the similar sensitivity as the portion within the abnormal FAF. CONCLUSION FAF patterns can change about half during the 5 years and the retinal sensitivity near abnormal FAF tends to deteriorate after the third year.
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Affiliation(s)
- Ari Shinojima
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Miki Sawa
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryusaburo Mori
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuji Oshima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Aki Kato
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Chikako Hara
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaaki Saito
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, Akita University, Akita, Japan
| | - Yukinori Sugano
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masayuki Ashikari
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshio Hirano
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hitomi Asato
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Noriyuki Kuno
- Santen Pharmaceutical Co., Ltd., Ikoma, Japan
- Japan Innovative Therapeutics, Inc., Nagoya, Japan
| | | | - Takeshi Nishiyama
- Department of Public Health, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mitsuko Yuzawa
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
| | - Tatsuro Ishibashi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Ophthalmology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- * E-mail:
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15
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MESOPIC AND DARK-ADAPTED TWO-COLOR FUNDUS-CONTROLLED PERIMETRY IN GEOGRAPHIC ATROPHY SECONDARY TO AGE-RELATED MACULAR DEGENERATION. Retina 2020; 40:169-180. [DOI: 10.1097/iae.0000000000002337] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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16
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Cassels NK, Wild JM, Margrain TH, Blyth C, Chong V, Acton JH. Microperimetry in Age-Related Macular Degeneration: An Evidence-Base for Pattern Deviation Probability Analysis in Microperimetry. Transl Vis Sci Technol 2019; 8:48. [PMID: 31921516 PMCID: PMC6944141 DOI: 10.1167/tvst.8.6.48] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/29/2019] [Indexed: 12/04/2022] Open
Abstract
Purpose The “traffic light” color designation of differential light sensitivity used in a number of microperimeters does not encompass the conventional Total and Pattern Deviation probability analyses adopted by standard automated perimetry. We determined whether the color designation is indicative of abnormality as represented by the “gold standard” Pattern Deviation probability analysis. Methods Total and Pattern Deviation probability levels, using two different methods, were derived at each of 40 stimulus locations, within 7° eccentricity, from 66 ocular healthy individuals (66 eyes) who had undergone microperimetry with the Macular Integrity Assessment microperimeter. The probability levels were applied to the corresponding fields from each of 45 individuals (45 eyes) with age-related macular degeneration (AMD) and evaluated in relation to the color designation. Results Sensitivities designated in orange encompassed the entire range of Pattern Deviation probability levels (from normal to P ≤ 1%). Those designated in green were mostly normal; those in red/black generally corresponded to the ≤1% probability level. Conclusions The green and the red/black designations are generally indicative of normal and abnormal probability values, respectively. The orange designation encompassed all probability outcomes and should not be relied upon for visual field interpretation. The evidence base indicates replacement of the color designation of sensitivity in AMD by Total Deviation and Pattern Deviation analyses. Translational Relevance The use of Total and Pattern Deviation probability analyses is not universal in all microperimeters, and the derivation of these values indicates that color coding will lead to errors in evaluating visual field loss.
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Affiliation(s)
- Nicola K Cassels
- College of Biological and Life Sciences, Cardiff University, Cardiff, UK
| | - John M Wild
- College of Biological and Life Sciences, Cardiff University, Cardiff, UK
| | - Tom H Margrain
- College of Biological and Life Sciences, Cardiff University, Cardiff, UK
| | - Chris Blyth
- Department of Ophthalmology, University Hospital of Wales, Cardiff, UK
| | - Victor Chong
- Department of Ophthalmology, University of Oxford, Oxford, UK
| | - Jennifer H Acton
- College of Biological and Life Sciences, Cardiff University, Cardiff, UK
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17
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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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18
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Pfau M, von der Emde L, Dysli C, Thiele S, Möller PT, Lindner M, Nadal J, Schmid M, Schmitz-Valckenberg S, Holz FG, Fleckenstein M. Light Sensitivity Within Areas of Geographic Atrophy Secondary to Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2019; 60:3992-4001. [DOI: 10.1167/iovs.19-27178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Maximilian Pfau
- University of Bonn, Department of Ophthalmology, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | | | - Chantal Dysli
- University of Bonn, Department of Ophthalmology, Bonn, Germany
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sarah Thiele
- University of Bonn, Department of Ophthalmology, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | - Philipp T. Möller
- University of Bonn, Department of Ophthalmology, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | - Moritz Lindner
- The Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jennifer Nadal
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Germany
| | | | - Frank G. Holz
- University of Bonn, Department of Ophthalmology, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
| | - Monika Fleckenstein
- University of Bonn, Department of Ophthalmology, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
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19
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Wu Z, Cimetta R, Caruso E, Guymer RH. Performance of a Defect-Mapping Microperimetry Approach for Characterizing Progressive Changes in Deep Scotomas. Transl Vis Sci Technol 2019; 8:16. [PMID: 31388468 PMCID: PMC6675515 DOI: 10.1167/tvst.8.4.16] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose To examine whether a microperimetry testing strategy based on quantifying the spatial extent of functional abnormalities (termed “defect-mapping” strategy) could improve the detection of progressive changes in deep scotomas compared to the conventional thresholding strategy. Methods A total of 30 healthy participants underwent two microperimetry examinations, each using the defect-mapping and thresholding strategies at the first visit to examine the test–retest variability of each method. Testing was performed using an isotropic stimulus pattern centered on the optic nerve head (ONH), which acted as a model of a deep scotoma. These tests were repeated at a second visit, except using a smaller stimulus pattern and thereby increasing the proportion of test locations falling within the ONH (to simulate the progressive enlargement of a deep scotoma). The extent of change detected between visits relative to measurement variability was compared between the two strategies. Results Relative to their effective dynamic ranges, the test–retest variability of the defect-mapping strategy (1.8%) was significantly lower compared to the thresholding strategy (3.3%; P < 0.001). The defect-mapping strategy also captured a significantly greater extent of change between visits relative to variability (−4.70 t−1) compared to the thresholding strategy (2.74 t−1; P < 0.001). Conclusions A defect-mapping microperimetry testing strategy shows promise for capturing the progressive enlargement of deep scotomas more effectively than the conventional thresholding strategy. Translational Relevance Microperimetry testing with the defect-mapping strategy could provide a more accurate clinical trial outcome measure for capturing progressive changes in deep scotomas in eyes with atrophic retinal diseases, warranting further investigations.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Roberta Cimetta
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Emily Caruso
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
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Abstract
Supplemental Digital Content is Available in the Text. High-resolution histology at the border of geographic atrophy (or complete retinal pigment epithelium and outer retinal atrophy) secondary to age-related macular degeneration reveals marked gliosis and near-total photoreceptor depletion, abundant extracellular deposits, and long-standing abnormalities of Bruch membrane and choriocapillaris, indicating severe and potentially irreversible tissue damage at this stage of the disease. Purpose: To systematically characterize histologic features of multiple chorioretinal layers in eyes with geographic atrophy, or complete retinal pigment epithelium (RPE) and outer retinal atrophy, secondary to age-related macular degeneration, including Henle fiber layer and outer nuclear layer; and to compare these changes to those in the underlying RPE-Bruch membrane—choriocapillaris complex and associated extracellular deposits. Methods: Geographic atrophy was delimited by the external limiting membrane (ELM) descent towards Bruch membrane. In 13 eyes, histologic phenotypes and/or thicknesses of Henle fiber layer, outer nuclear layer, underlying supporting tissues, and extracellular deposits at four defined locations on the non-atrophic and atrophic sides of the ELM descent were assessed and compared across other tissue layers, with generalized estimating equations and logit models. Results: On the non-atrophic side of the ELM descent, distinct Henle fiber layer and outer nuclear layer became dyslaminated, cone photoreceptor inner segment myoids shortened, photoreceptor nuclei and mitochondria translocated inward, and RPE was dysmorphic. On the atrophic side of the ELM descent, all measures of photoreceptor health declined to zero. Henle fiber layer/outer nuclear layer thickness halved, and only Müller cells remained, in the absence of photoreceptors. Sub-RPE deposits remained, Bruch membrane thinned, and choriocapillaris density decreased. Conclusion: The ELM descent sharply delimits an area of marked gliosis and near-total photoreceptor depletion clinically defined as Geographic atrophy (or outer retinal atrophy), indicating severe and potentially irreversible tissue damage. Degeneration of supporting tissues across this boundary is gradual, consistent with steady age-related change and suggesting that RPE and Müller cells subsequently respond to a threshold of stress. Novel clinical trial endpoints should be sought at age-related macular degeneration stages before intense gliosis and thick deposits impede therapeutic intervention.
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Csaky KG, Patel PJ, Sepah YJ, Birch DG, Do DV, Ip MS, Guymer RH, Luu CD, Gune S, Lin H, Ferrara D. Microperimetry for geographic atrophy secondary to age-related macular degeneration. Surv Ophthalmol 2019; 64:353-364. [PMID: 30703401 DOI: 10.1016/j.survophthal.2019.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 01/06/2023]
Abstract
Geographic atrophy (GA) is a progressive, advanced form of age-related macular degeneration leading to visual function impairment and irreversible vision loss. Standard clinical tests to evaluate visual function in patients with GA provide poor anatomic-functional correlation, whereas fundus imaging does not assess the visual function deficit. Microperimetry is a psychophysical visual function test that spatially maps retinal sensitivity and allows for identification of correlation of anatomic features with visual function. In this review, we present an overview of mesopic microperimetry for GA, including commercially available microperimetry devices, strategies to capture a mesopic microperimetry test, and strategies to assess and interpret microperimetry data in patients with GA. We demonstrate the importance of microperimetry data for assessing GA progression and for evaluating visual function loss through anatomic-functional correlations. Although valuable, current microperimetry tests require an extensive time commitment from the patient and examiner, and the development of faster, more reproducible and accessible methods is important to enable broader use of microperimetry in both clinical and research settings.
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Affiliation(s)
- Karl G Csaky
- Texas Retina Associates, Dallas, Texas, USA; Retina Foundation of the Southwest, Dallas, Texas, USA.
| | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - David G Birch
- Retina Foundation of the Southwest, Dallas, Texas, USA
| | - Diana V Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael S Ip
- Doheny Eye Institute, Los Angeles, California, USA
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; Department of Surgery (Ophthalmology), University of Melbourne, Victoria, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; Department of Surgery (Ophthalmology), University of Melbourne, Victoria, Australia
| | - Shamika Gune
- Genentech, Inc., South San Francisco, California, USA
| | - Hugh Lin
- Genentech, Inc., South San Francisco, California, USA
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22
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Tomiyasu T, Hirano Y, Suzuki N, Esaki Y, Yasuda Y, Uemura A, Yasukawa T, Yoshida M, Ogura Y. Structural and Functional Analyses of Retinal Ischemia in Eyes with Retinal Vein Occlusion: Relationship with Macular Edema or Microaneurysm Formation. Ophthalmic Res 2018; 61:218-225. [PMID: 30359965 DOI: 10.1159/000493489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To study the structural and functional changes of retinal ischemia and investigate their association with macular edema (ME) or microaneurysm (MA) formation in eyes with retinal vein occlusion (RVO). METHODS Sixty eyes of 30 patients (27 eyes with branch [b]RVO, 3 with central RVO, and 30 fellow eyes) were retrospectively reviewed. Optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry were performed simultaneously to measure retinal thickness and sensitivity. The presence of ME or MA was also assessed using OCT and fluorescein angiography. RESULTS The mean retinal sensitivity in the nonperfused areas (NPAs) deteriorated, and this was significantly (r = -0.379, p = 0.0391*) and inversely correlated with duration from disease onset. ME and MA were unlikely to be observed around the area where the retinal sensitivity decreased. In the NPAs, the mean retinal thickness of the superficial capillary plexus (SCP) (p < 0.0001), deep capillary plexus (DCP) (p = 0.0323), and outer retina (p = 0.0008) were significantly thinner than those in the fellow eyes, respectively. Multivariate regression analysis revealed that the thicknesses of the DCP (β: 0.3107, p = 0.0007) and outer retina (β: 0.3482, p = 0.0001) were the independent correlative factors of the retinal sensitivity, but that SCP thickness was not. CONCLUSION Deep retinal thinning in NPAs was correlated significantly with a decreased retinal sensitivity, which might be a negative predictor of ME and MA in eyes with RVO.
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Affiliation(s)
- Taneto Tomiyasu
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshio Hirano
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan,
| | - Norihiro Suzuki
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuya Esaki
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Yasuda
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akiyoshi Uemura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsutomu Yasukawa
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Munenori Yoshida
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuichiro Ogura
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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23
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Borrelli E, Nittala MG, Abdelfattah NS, Lei J, Hariri AH, Shi Y, Fan W, Cozzi M, Sarao V, Lanzetta P, Staurenghi G, Sadda SR. Comparison of short-wavelength blue-light autofluorescence and conventional blue-light autofluorescence in geographic atrophy. Br J Ophthalmol 2018; 103:bjophthalmol-2018-311849. [PMID: 29871967 PMCID: PMC6709768 DOI: 10.1136/bjophthalmol-2018-311849] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS To systematically compare the intermodality and inter-reader agreement for two blue-light confocal fundus autofluorescence (FAF) systems. METHODS Thirty eyes (21 patients) with a diagnosis of geographic atrophy (GA) were enrolled. Eyes were imaged using two confocal blue-light FAF devices: (1) Spectralis device with a 488 nm excitation wavelength (488-FAF); (2) EIDON device with 450 nm excitation wavelength and the capability for 'colour' FAF imaging including both the individual red and green components of the emission spectrum. Furthermore, a third imaging modality (450-RF image) isolating and highlighting the red emission fluorescence component (REFC) was obtained and graded. Each image was graded by two readers to assess inter-reader variability and a single image for each modality was used to assess the intermodality variability. RESULTS The 95% coefficient of repeatability (1.35 mm2 for the 488-FAF-based grading, 8.13 mm2 for the 450-FAF-based grading and 1.08 mm2 for the 450-RF-based grading), the coefficient of variation (1.11 for 488-FAF, 2.05 for 450-FAF, 0.92 for 450-RF) and the intraclass correlation coefficient (0.994 for 488-FAF, 0.711 for 450-FAF, 0.997 for 450-RF) indicated that 450-FAF-based and 450-RF-based grading have the lowest and highest inter-reader agreements, respectively. The GA area was larger for 488-FAF images (median (IQR) 2.1 mm2 (0.8-6.4 mm2)) than for 450-FAF images (median (IQR) 1.0 mm2 (0.3-4.3 mm2); p<0.0001). There was no significant difference in lesion area measurement between 488-FAF-based and 450-RF-based grading (median (IQR) 2.6 mm2 (0.8-6.8 mm2); p=1.0). CONCLUSION The isolation of the REFC from the 450-FAF images allowed for a reproducible quantification of GA. This assessment had good comparability with that obtained with 488-FAF images.
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Affiliation(s)
- Enrico Borrelli
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Muneeswar Gupta Nittala
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nizar Saleh Abdelfattah
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jianqin Lei
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Amir H Hariri
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yue Shi
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Wenying Fan
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mariano Cozzi
- Department of Medicine and Ophthalmology, University of Udine Piazzale S. Maria della Misericordia, Udine, Italy
| | - Valentina Sarao
- Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
- Eye Clinic, Department of Biomedical and Clinical Science 'Luigi Sacco', Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Paolo Lanzetta
- Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
- Eye Clinic, Department of Biomedical and Clinical Science 'Luigi Sacco', Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Department of Medicine and Ophthalmology, University of Udine Piazzale S. Maria della Misericordia, Udine, Italy
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Lee J, Asano S, Inoue T, Fujino Y, Matsuura M, Kitamoto K, Hashimoto Y, Ogawa A, Yanagisawa M, Azuma K, Murata H, Obata R, Asaoka R. Investigating the Usefulness of Fundus Autofluorescence in Retinitis Pigmentosa. Ophthalmol Retina 2018; 2:1062-1070. [PMID: 31047495 DOI: 10.1016/j.oret.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the relationship between visual field (VF) loss and the rings of the ellipsoid zone (EZ) and autofluorescence (AF) in patients with retinitis pigmentosa (RP). DESIGN Cross-sectional study. PARTICIPANTS A total of 28 eyes of 15 patients with a clinical diagnosis of RP. METHODS The VF was measured at a 1-degree interval on the horizontal or vertical lines, within the central 10 degrees from fixation, using MP-3 microperimetry (Nidek Co. Ltd., Aichi, Japan), and the sensitivity deviation from the normative database was calculated. OCT was performed, and the EZ was identified. Fundus AF was also measured, and the AF ring was identified. The VF test points were categorized according to their relationship with the EZ line and AF ring. The relationship between mean retinal sensitivity deviations on both the horizontal and vertical lines and the diameters of the EZ line and the AF ring in the corresponding directions was analyzed. The relationship between visual sensitivity deviation and the locations against EZ line and AF rings was also investigated. MAIN OUTCOME MEASURES The relationship between the visual sensitivity deviation and the locations against EZ line and AF rings. RESULTS The diameter of the AF ring had a significantly stronger relationship with mean retinal sensitivity deviation compared with the diameter of the EZ line in both the horizontal and vertical directions. Test point location inside/on/outside the AF ring was significantly related to retinal sensitivity deviation independent of the location inside/outside the EZ line (P < 0.001, linear mixed model). CONCLUSIONS Visual sensitivity damage is significantly associated with the EZ lines and AF rings. The development of the AF ring is related to the decrease of visual function independent of and stronger than the EZ line.
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Affiliation(s)
- Jinhee Lee
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Shotaro Asano
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Yuri Fujino
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Masato Matsuura
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Kodai Kitamoto
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Asako Ogawa
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Mieko Yanagisawa
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Keiko Azuma
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Ryo Obata
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
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25
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Katschke KJ, Xi H, Cox C, Truong T, Malato Y, Lee WP, McKenzie B, Arceo R, Tao J, Rangell L, Reichelt M, Diehl L, Elstrott J, Weimer RM, van Lookeren Campagne M. Classical and alternative complement activation on photoreceptor outer segments drives monocyte-dependent retinal atrophy. Sci Rep 2018; 8:7348. [PMID: 29743491 PMCID: PMC5943270 DOI: 10.1038/s41598-018-25557-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/19/2018] [Indexed: 01/13/2023] Open
Abstract
Geographic atrophy (GA), the advanced form of dry age-related macular degeneration (AMD), is characterized by progressive loss of retinal pigment epithelium cells and photoreceptors in the setting of characteristic extracellular deposits and remains a serious unmet medical need. While genetic predisposition to AMD is dominated by polymorphisms in complement genes, it remains unclear how complement activation contributes to retinal atrophy. Here we demonstrate that complement is activated on photoreceptor outer segments (POS) in the retina peripheral to atrophic lesions associated with GA. When exposed to human serum following outer blood-retinal barrier breakdown, POS act as potent activators of the classical and alternative complement pathway. In mouse models of retinal degeneration, classical and alternative pathway complement activation on photoreceptors contributed to the loss of photoreceptor function. This was dependent on C5a-mediated recruitment of peripheral blood monocytes but independent of resident microglia. Genetic or pharmacologic inhibition of both classical and alternative complement C3 and C5 convertases was required to reduce progressive degeneration of photoreceptor rods and cones. Our study implicates systemic classical and alternative complement proteins and peripheral blood monocytes as critical effectors of localized retinal degeneration with potential relevance for the contribution of complement activation to GA.
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Affiliation(s)
- Kenneth J Katschke
- Department of Immunology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Hongkang Xi
- Department of Immunology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Christian Cox
- Department of Immunology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Tom Truong
- Department of Translational Immunology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Yann Malato
- Department of Translational Immunology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Wyne P Lee
- Department of Translational Immunology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Brent McKenzie
- Department of Translational Immunology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Rommel Arceo
- Department of Pathology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Jianhua Tao
- Department of Pathology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Linda Rangell
- Department of Pathology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Mike Reichelt
- Department of Pathology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Lauri Diehl
- Department of Pathology, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Justin Elstrott
- Department of Biomedical Imaging, Genentech, Inc, South San Francisco, CA, 94080, USA
| | - Robby M Weimer
- Department of Biomedical Imaging, Genentech, Inc, South San Francisco, CA, 94080, USA
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SCOTOMA CHARACTERISTICS IN MACULAR TELANGIECTASIA TYPE 2: MacTel Project Report No. 7-The MacTel Research Group. Retina 2018; 38 Suppl 1:S14-S19. [PMID: 28609329 DOI: 10.1097/iae.0000000000001693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize scotomas in macular telangiectasia Type 2 (MacTel). METHODS Five of the 27 centers performed microperimetry as part of the MacTel Natural History Observation Study. Data were analyzed in the Moorfields Eye Hospital Reading Centre. The number of stimuli under a threshold of 12, 10, 8, and <0 dB were counted (thresholding) and compared with one another. RESULTS A total of 565 examinations were gradable, received from 632 eyes of 322 participants (age 61.1 ± 9.1 years, 62% females). The authors found absolute scotomas in 243 eyes (43%), 98% of these affected the temporal quadrant, and 99.5% were unifocal. Growth of absolute scotomas was limited to an extent of approximately 40 deg. Although transition from functionally unimpaired retina to absolute scotomas is generally steeply sloped, the larger a scotoma, the steeper it is. CONCLUSION Scotoma features were consistent throughout a large MacTel cohort. The temporal quadrant was confirmed as predominantly affected, which might result from vascular or metabolic asymmetry. Functional loss did not exceed an area of 5° × 8° however advanced the disorder. Different MacTel phenotypes seem likely and point toward different types of progression; identifying these would improve planning for clinical trials and might lead to better understanding patient outcome.
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27
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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: 304] [Impact Index Per Article: 43.4] [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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Borrelli E, Lei J, Balasubramanian S, Uji A, Cozzi M, Sarao V, Lanzetta P, Staurenghi G, Sadda SR. Green emission fluorophores in eyes with atrophic age-related macular degeneration: a colour fundus autofluorescence pilot study. Br J Ophthalmol 2017; 102:827-832. [DOI: 10.1136/bjophthalmol-2017-310881] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 11/03/2022]
Abstract
Background/AimsTo investigate the presence of short-wave fluorophores within regions of age-related macular degeneration (AMD)-associated macular atrophy (MA) area.MethodsThis is a prospective, observational, cross-sectional case series. 25 eyes (18 patients) with late AMD and clinically identified MA were enrolled. Eyes were imaged using a confocal light-emitting diode blue-light fundus autofluorescence (FAF) device (EIDON, CenterVue, Padua, Italy) with 450 nm excitation wavelength and the capability for ‘colour’ FAF imaging, including both the individual red and green components of the emission spectrum. To produce images with a high contrast for isolating the green component, the red component was subtracted from the total FAF image. The main outcome measure was the presence of green emission fluorescence component (GEFC) within the MA area. Volume spectral domain optical coherence tomography (SD-OCT) scans were obtained through the macula and the OCT was correlated with the MA lesions identified on the FAF images, including regions of increased GEFC.ResultsOf the investigated eyes, 11 out of 25 (44.0 %) showed the absence of GEFC in the MA area, whereas 14 eyes (56.0%) were characterised by GEFC within the MA area. The presence and distribution of GEFC in the MA area correlated with the presence of hyper-reflective material over Bruch’s membrane on the corresponding SD-OCT scans.ConclusionShort-wave fluorophores, which contribute to the GEFC, are present in the MA area and appear to correspond to residual debris or drusenoid material. Short-wavelength fluorophores revealed by colour FAF imaging may warrant further study.
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The use of microperimetry in assessing visual function in age-related macular degeneration. Surv Ophthalmol 2017; 63:40-55. [PMID: 28579549 DOI: 10.1016/j.survophthal.2017.05.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/23/2022]
Abstract
Microperimetry is a novel technique for assessing visual function that appears particularly suitable for age-related macular degeneration (AMD). Compared with standard automated perimetry, microperimetry offers several unique features. It simultaneously images the fundus, incorporates an eye-tracking system to correct the stimulus location for fixation loss, and identifies any preferred retinal loci. We identified 52 articles that met the inclusion criteria for a systematic review of microperimetry in the assessment of visual function in AMD. We discuss microperimetry and AMD in relation to disease severity, structural imaging outcomes, other measures of visual function, and evaluation of the efficacy of surgical and/or medical therapies in clinical trials. The evidence for the use of microperimetry in the functional assessment of AMD is encouraging. Disruptions of the ellipsoid zone band and retinal pigment epithelium are clearly associated with reduced differential light sensitivity despite the maintenance of good visual acuity. Reduced differential light sensitivity is also associated with outer segment thinning and retinal pigment epithelium thickening in early AMD and with both a thickening and a thinning of the whole retina in choroidal neovascularization. Microperimetry, however, lacks the robust diffuse and focal loss age-corrected probability analyses associated with standard automated perimetry, and the technique is currently limited by this omission.
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Midena E, Pilotto E. Microperimetry in age: related macular degeneration. Eye (Lond) 2017; 31:985-994. [PMID: 28257134 DOI: 10.1038/eye.2017.34] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/18/2017] [Indexed: 11/09/2022] Open
Abstract
Age-related macular degeneration (AMD) is one of the major causes of visual loss and legal blindness in people over 55. Visual function tests are the cornerstone of visual function investigation and any therapeutic approach to AMD implies, as primary endpoint, the maintenance or improvement of visual function. The progression of visual impairment and the quantification of final residual visual function are currently determined by means of visual acuity quantification. The quantification of high-contrast visual acuity though has many drawbacks and cannot be considered a complete functional examination. Microperimetry is a non-invasive method used to analyse fixation and central visual field defects in a topographic related manner. The introduction of mesopic and more recently scotopic microperimetry, in research and clinical practice of macular disorders, now allows us to better investigate macular function as it strictly relates to macular morphology. We therefore can monitor the functional natural history and quantify the beneficial or detrimental effects of different therapies. The application of microperimetry in clinical studies has provided interesting diagnostic and prognostic information on functional macular changes in AMD patients. The present review brings new updates on the correlation between macular changes, mainly described with optical coherence tomography, and microperimetry changes in patients with AMD.
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Affiliation(s)
- E Midena
- Department of Ophthalmology, University of Padova, Padova, Italy.,GB Bietti Foundation, IRCCS, Rome, Italy
| | - E Pilotto
- Department of Ophthalmology, University of Padova, Padova, Italy
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