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Schmidt-Erfurth U, Riedl S. [Complement inhibition treatment for geographic atrophy (GA): functional and morphological efficacy and relevant biomarkers in clinical practice]. DIE OPHTHALMOLOGIE 2024; 121:476-481. [PMID: 38691156 DOI: 10.1007/s00347-024-02039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
The approval of complement inhibitory therapeutic agents for the treatment of geographic atrophy (GA) has highlighted the need for reliable and reproducible measurement of disease progression and therapeutic efficacy. Due to its availability and imaging characteristics optical coherence tomography (OCT) is the method of choice. Using OCT analysis based on artificial intelligence (AI), the therapeutic efficacy of pegcetacoplan was demonstrated at the levels of both the retinal pigment epithelium (RPE) and photoreceptors (PR). Cloud-based solutions that enable monitoring of GA are already available.
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Affiliation(s)
- Ursula Schmidt-Erfurth
- Medizinische Universität Wien, Universitätsklinik für Augenheilkunde und Optometrie, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Sophie Riedl
- Medizinische Universität Wien, Universitätsklinik für Augenheilkunde und Optometrie, Währinger Gürtel 18-20, 1090, Wien, Österreich
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2
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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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3
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Danzig CJ, Khanani AM, Kaiser PK, Chang MA, Kovach JL, Lally DR, Rachitskaya A, Sheth VS, Vajzovic L, Clark J, Tang J, Zhu L, Desai D, Chakravarthy U. Vision Loss Reduction with Avacincaptad Pegol for Geographic Atrophy: A 12-Month Post Hoc Analysis of the GATHER1 and GATHER2 Trials. Ophthalmol Retina 2024:S2468-6530(24)00224-0. [PMID: 38719191 DOI: 10.1016/j.oret.2024.04.023] [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: 08/24/2023] [Revised: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To evaluate the impact of reduction in geographic atrophy (GA) lesion growth on visual acuity in the GATHER trials using categorical outcome measures. DESIGN Randomized, double-masked, sham-controlled phase 3 trials. PARTICIPANTS Aged ≥50 years with noncenter point-involving GA and best-corrected visual acuity (BCVA) of 25 to 80 ETDRS letters in the study eye. METHODS GATHER1 consisted of 2 parts. In part 1, 77 patients were randomized 1:1:1 to avacincaptad pegol (ACP) 1 mg, ACP 2 mg, and sham. In part 2, 209 patients were randomized 1:2:2 to ACP 2 mg, ACP 4 mg, and sham. In GATHER2, patients were randomized 1:1 to ACP 2 mg (n = 225) and sham (n = 223). A post hoc analysis of 12-month data for pooled ACP 2 mg and sham groups is reported. MAIN OUTCOME MEASURES Proportion of study eyes that experienced ≥10-, ≥15-, or ≥20-BCVA ETDRS letter loss from baseline to month 12; time-to-event analysis of persistent vision loss of ≥10, ≥15, or≥ 20 BCVA letters from baseline at ≥2 consecutive visits over 12 months; proportion of study eyes with BCVA loss to a level below driving eligibility threshold at month 12 among those eligible to drive at baseline. RESULTS Lower proportions of study eyes experienced ≥10-, ≥15-, or ≥20-BCVA letter loss from baseline over 12 months with ACP 2 mg (11.6%, 4.0%, and 1.6%, respectively) versus sham (14.1%, 7.6%, and 4.5%, respectively). There was a reduction in the risk of persistent loss of ≥15 BCVA ETDRS letters with ACP 2 mg (3.4%) versus sham (7.8%) through 12 months. A lower proportion of study eyes treated with ACP 2 mg reached the threshold for driving ineligibility versus sham by 12 months. CONCLUSIONS Treatment with ACP 2 mg delayed the risk of progression to persistent vision loss (i.e., ≥10-, ≥15-, and ≥20-BCVA letter loss or BCVA loss to a level below driving eligibility threshold) versus sham over 12 months. 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)
- Carl J Danzig
- Rand Eye Institute, Deerfield Beach, Florida; Florida Atlantic University, Charles E. Schmidt School of Medicine, Boca Raton, Florida
| | - Arshad M Khanani
- Sierra Eye Associates, Reno, Nevada; University of Nevada, Reno School of Medicine, Reno, Nevada
| | | | | | - Jaclyn L Kovach
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - David R Lally
- New England Retina Consultants, Springfield, Massachusetts
| | | | | | | | - Julie Clark
- Iveric Bio, an Astellas Company, Parsippany, New Jersey
| | - Justin Tang
- Iveric Bio, an Astellas Company, Parsippany, New Jersey
| | - Liansheng Zhu
- Iveric Bio, an Astellas Company, Parsippany, New Jersey
| | - Dhaval Desai
- Iveric Bio, an Astellas Company, Parsippany, New Jersey
| | - Usha Chakravarthy
- Queen's University of Belfast, Royal Victoria Hospital, Belfast, United Kingdom.
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Iliescu DA, Ghita AC, Ilie LA, Voiculescu SE, Geamanu A, Ghita AM. Non-Neovascular Age-Related Macular Degeneration Assessment: Focus on Optical Coherence Tomography Biomarkers. Diagnostics (Basel) 2024; 14:764. [PMID: 38611677 PMCID: PMC11011935 DOI: 10.3390/diagnostics14070764] [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: 02/28/2024] [Revised: 03/27/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
The imagistic evaluation of non-neovascular age-related macular degeneration (AMD) is crucial for diagnosis, monitoring progression, and guiding management of the disease. Dry AMD, characterized primarily by the presence of drusen and retinal pigment epithelium atrophy, requires detailed visualization of the retinal structure to assess its severity and progression. Several imaging modalities are pivotal in the evaluation of non-neovascular AMD, including optical coherence tomography, fundus autofluorescence, or color fundus photography. In the context of emerging therapies for geographic atrophy, like pegcetacoplan, it is critical to establish the baseline status of the disease, monitor the development and expansion of geographic atrophy, and to evaluate the retina's response to potential treatments in clinical trials. The present review, while initially providing a comprehensive description of the pathophysiology involved in AMD, aims to offer an overview of the imaging modalities employed in the evaluation of non-neovascular AMD. Special emphasis is placed on the assessment of progression biomarkers as discerned through optical coherence tomography. As the landscape of AMD treatment continues to evolve, advanced imaging techniques will remain at the forefront, enabling clinicians to offer the most effective and tailored treatments to their patients.
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Affiliation(s)
- Daniela Adriana Iliescu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Bld., 050474 Bucharest, Romania; (S.E.V.); (A.M.G.)
- Ocularcare Ophthalmology Clinic, 128 Ion Mihalache Bld., 012244 Bucharest, Romania; (A.C.G.); (L.A.I.)
| | - Ana Cristina Ghita
- Ocularcare Ophthalmology Clinic, 128 Ion Mihalache Bld., 012244 Bucharest, Romania; (A.C.G.); (L.A.I.)
| | - Larisa Adriana Ilie
- Ocularcare Ophthalmology Clinic, 128 Ion Mihalache Bld., 012244 Bucharest, Romania; (A.C.G.); (L.A.I.)
| | - Suzana Elena Voiculescu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Bld., 050474 Bucharest, Romania; (S.E.V.); (A.M.G.)
| | - Aida Geamanu
- Ophthalmology Department, Bucharest University Emergency Hospital, 169 Independence Street, 050098 Bucharest, Romania;
| | - Aurelian Mihai Ghita
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 8 Eroii Sanitari Bld., 050474 Bucharest, Romania; (S.E.V.); (A.M.G.)
- Ocularcare Ophthalmology Clinic, 128 Ion Mihalache Bld., 012244 Bucharest, Romania; (A.C.G.); (L.A.I.)
- Ophthalmology Department, Bucharest University Emergency Hospital, 169 Independence Street, 050098 Bucharest, Romania;
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Wu Z, Glover EK, Gee EE, Hodgson LA, Guymer RH. Functional Evaluation of Retinal Pigment Epithelium and Outer Retinal Atrophy by High-Density Targeted Microperimetry Testing. OPHTHALMOLOGY SCIENCE 2024; 4:100425. [PMID: 38192684 PMCID: PMC10772812 DOI: 10.1016/j.xops.2023.100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/19/2023] [Accepted: 11/01/2023] [Indexed: 01/10/2024]
Abstract
Purpose Complete retinal pigment epithelium (RPE) and outer retinal atrophy (cRORA) on OCT imaging has recently been proposed to describe end-stage atrophy in age-related macular degeneration (AMD) by international consensus and expected to be associated with a dense scotoma, but such functional evidence is lacking. This study sought to examine the visual sensitivity defects associated with cRORA and to determine OCT features associated with deep defects. Design Observational study. Participants Sixty eyes from 53 participants, including 342 microperimetry tests over 171 study visits. Methods Participants underwent targeted high-density threshold-based microperimetry testing of atrophic lesions (with at least incomplete RPE and outer retinal atrophy [iRORA]) with a 3.5° diameter grid. The maximum extent of signs of atrophy for all lesions was graded on OCT imaging. Main Outcome Measures Number of deep visual sensitivity defects (threshold ≤ 10 decibels [dB]). Results Presence of choroidal signal hypertransmission ≥ 500 μm, complete RPE loss ≥250 μm, and inner nuclear layer and outer plexiform layer subsidence, and hyporeflective wedge-shaped band (defined as nascent geographic atrophy [nGA]) ≥ 500 μm (P ≤ 0.020), but not RPE attenuation or disruption (P ≥ 0.192), were all independently associated with a significant increase in the number of deep visual sensitivity defects ≤ 10 dB. Only cRORA lesions with hypertransmission ≥ 500 μm or complete RPE loss ≥ 250 μm, or with both of these features (P < 0.001), but not lesions with only hypertransmission 250-499 μm (P = 0.303), had significantly more deep visual sensitivity defects ≤ 10 dB compared with iRORA lesions. Lesions with nGA ≥ 500 μm, irrespective of the presence of hypertransmission ≥ 500 μm and/or complete RPE loss ≥ 250 μm, also showed a higher number of deep visual sensitivity defects ≤ 10 dB compared with lesions without nGA ≥ 500 μm (P ≤ 0.011). Conclusions Not all cRORA lesions show a difference in the number of deep visual sensitivity defects compared with iRORA. Instead, hypertransmission ≥ 500 μm, complete RPE loss ≥ 250 μm, and nGA ≥ 500 μm are all OCT features independently associated with deep visual sensitivity detects that could help inform the definition of end-stage atrophy on OCT imaging. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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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
| | - 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
| | - 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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Bandello F, Borrelli E, Trevisi M, Lattanzio R, Sacconi R, Querques G. Imaging Biomarkers of Mesopic and Dark-Adapted Macular Functions in Eyes With Treatment-Naïve Mild Diabetic Retinopathy. Am J Ophthalmol 2023; 253:56-64. [PMID: 37059317 DOI: 10.1016/j.ajo.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE To investigate the relationship between imaging biomarkers and mesopic and dark-adapted (ie, scotopic) functions in patients with treatment-naïve mild diabetic retinopathy (DR) and normal visual acuity. DESIGN Prospective cross-sectional study. METHODS In this study, 60 patients with treatment-naïve mild DR (Early Treatment of Diabetic Retinopathy Study levels 20-35) and 30 healthy control subjects underwent microperimetry, structural optical coherence tomography (OCT), and OCT angiography (OCTA). RESULTS The foveal mesopic (22.4 ± 4.5 dB and 25.8 ± 2.0 dB, P = .005), parafoveal mesopic (23.2 ± 3.8 and 25.8 ± 1.9, P < .0001), and parafoveal dark-adapted (21.1 ± 2.8 dB and 23.2 ± 1.9 dB, P = .003) sensitivities were reduced in DR eyes. For foveal mesopic sensitivity, the regression analysis showed a significant topographic association with choriocapillaris flow deficits percentage (CC FD%; β = -0.234, P = .046) and ellipsoid zone (EZ) normalized reflectivity (β = 0.282, P = .048). Parafoveal mesopic sensitivity was significantly topographically associated with inner retinal thickness (β = 0.253, P = .035), deep capillary plexus (DCP) vessel length density (VLD; β = 0.542, P = .016), CC FD% (β = -0.312, P = .032), and EZ normalized reflectivity (β = 0.328, P = .031). Similarly, parafoveal dark-adapted sensitivity was topographically associated with inner retinal thickness (β = 0.453, P = .021), DCP VLD (β = 0.370, P = .030), CC FD% (β = -0.282, P = .048), and EZ normalized reflectivity (β = 0.295, P = .042). CONCLUSIONS In treatment-naïve mild DR eyes, both rod and cone functions are affected and they are associated with both DCP and CC flow impairment, which suggests that a macular hypoperfusion at these levels might implicate a reduction in photoreceptor function. Normalized EZ reflectivity may be a valuable structural biomarker for assessing photoreceptor function in DR. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Francesco Bandello
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Enrico Borrelli
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Trevisi
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosangela Lattanzio
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Sacconi
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- From the Vita-Salute San Raffaele University Milan and the IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kiraly P, Habjan MŠ, Smrekar J, Mekjavić PJ. Functional Outcomes and Safety Profile of Trans-Foveal Subthreshold Micropulse Laser in Persistent Central Serous Chorioretinopathy. Life (Basel) 2023; 13:life13051194. [PMID: 37240839 DOI: 10.3390/life13051194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Our study evaluated visual function changes after subthreshold micropulse laser (SML) treatment in persistent central serous chorioretinopathy (CSC) and SML safety profile. We conducted a prospective study including 31 fovea-involving CSC patients. The natural course was observed for the first 3 months, SML was performed at 3 months, and SML effectiveness was observed at 6 months. At all three clinical visits, optical coherence tomography (OCT), best corrected visual acuity (BCVA), contrast sensitivity (CS) in five spatial frequencies (1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd)), microperimetry (MP), and multifocal electroretinography (mfERG) were performed. The SML safety profile was evaluated with functional and morphological parameters. In the cohort of all CSC patients treated with SML, the statistically significant average improvement was observed in BCVA (p = 0.007), CS-1.5 (p = 0.020), CS-3.0 (p = 0.050), CS-12.0 (p < 0.001), CS-18.0 (p = 0.002), CS (CS-A) (p < 0.001), MP in the central ring (MP-C) (p = 0.020), peripheral ring (MP-P) (p = 0.042), and average retinal sensitivity (MP-A) (p = 0.010). After the SML treatment, mean changes in mfERG amplitudes and implicit times in our cohort were not statistically significant. No morphological or functional adverse effects of SML treatment were observed. SML treatment in persistent CSC episodes leads to significant functional improvement and has an excellent safety profile.
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Affiliation(s)
- Peter Kiraly
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Maja Šuštar Habjan
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jaka Smrekar
- Faculty of Mathematics and Physics, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Jožef Stefan Institute, 1000 Ljubljana, Slovenia
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8
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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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9
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Pfau M, Schmitz-Valckenberg S, Ribeiro R, Safaei R, McKeown A, Fleckenstein M, Holz FG. Association of complement C3 inhibitor pegcetacoplan with reduced photoreceptor degeneration beyond areas of geographic atrophy. Sci Rep 2022; 12:17870. [PMID: 36284220 PMCID: PMC9596427 DOI: 10.1038/s41598-022-22404-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/14/2022] [Indexed: 01/20/2023] Open
Abstract
Preservation of photoreceptors beyond areas of retinal pigment epithelium atrophy is a critical treatment goal in eyes with geographic atrophy (GA) to prevent vision loss. Thus, we assessed the association of treatment with the complement C3 inhibitor pegcetacoplan with optical coherence tomography (OCT)-based photoreceptor laminae thicknesses in this post hoc analysis of the FILLY trial (NCT02503332). Retinal layers in OCT were segmented using a deep-learning-based pipeline and extracted along evenly spaced contour-lines surrounding areas of GA. The primary outcome measure was change from baseline in (standardized) outer nuclear layer (ONL) thickness at the 5.16°-contour-line at month 12. Participants treated with pegcetacoplan monthly had a thicker ONL along the 5.16° contour-line compared to the pooled sham arm (mean difference [95% CI] + 0.29 z-score units [0.16, 0.42], P < 0.001). The same was evident for eyes treated with pegcetacoplan every other month (+ 0.26 z-score units [0.13, 0.4], P < 0.001). Additionally, eyes treated with pegcetacoplan exhibited a thicker photoreceptor inner segment layer along the 5.16°-contour-line at month 12. These findings suggest that pegcetacoplan could slow GA progression and lead to reduced thinning of photoreceptor layers beyond the GA boundary. Future trials in earlier disease stages, i.e., intermediate AMD, aiming to slow photoreceptor degeneration warrant consideration.
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Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
- GRADE Reading Center, Bonn, Germany.
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, UT, 84312, USA.
| | | | | | | | - Monika Fleckenstein
- GRADE Reading Center, Bonn, Germany
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, 65 North Mario Capecchi Drive, Salt Lake City, UT, 84312, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- GRADE Reading Center, Bonn, Germany
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10
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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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Two-Photon Vision in Age-Related Macular Degeneration: A Translational Study. Diagnostics (Basel) 2022; 12:diagnostics12030760. [PMID: 35328313 PMCID: PMC8947013 DOI: 10.3390/diagnostics12030760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022] Open
Abstract
The recently introduced term “two-photon vision” relates to the visual perception resulting from a simultaneous absorption of two photons by photoreceptors. In this study, we determined two-photon retinal sensitivity in age-related macular degeneration (AMD) and compared it that in normal aging. Microperimetry was performed with visible (white) light and infrared (IR) light, which was perceived as green in the two-photon stimulation. In total, 45 subjects were included with one (better) eye studied. Furthermore, best-corrected visual acuity (VA) and ocular straylight were assessed. AMD resulted in decreased median (interquartile range) logMAR VA, i.e., 0.15 (0.05; 0.24), which in normal eyes was −0.02 (−0.06; 0.02). The two groups showed comparable straylight levels. Sensitivity to IR light was significantly lower in the AMD group (p < 0.001): 8.3 (7.4, 9.3) dB than in controls 10.7 (9.7, 11.2) dB. AMD also significantly affected visible light sensitivity (p < 0.001): 14.0 (11.0; 15.5) dB vs. 18.0 (16.3; 18.9) dB. Notably, the two-photon approach yielded a lower data spread. In conclusion, AMD considerably impairs retinal sensitivity measured in the single- and two-photon realm. However, two-photon-vision microperimetry may improve the testing accuracy and offer an additional diagnostic parameter (beyond VA measurements) for retinal function assessment.
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12
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Lee KE, Heitkotter H, Carroll J. Challenges Associated With Ellipsoid Zone Intensity Measurements Using Optical Coherence Tomography. Transl Vis Sci Technol 2021; 10:27. [PMID: 34665233 PMCID: PMC8543396 DOI: 10.1167/tvst.10.12.27] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/16/2021] [Indexed: 12/11/2022] Open
Abstract
Translational Relevance Qualitative evaluation of the ellipsoid zone band on optical coherence tomography is a valuable clinical tool for assessing photoreceptor structure, though more quantitative metrics are emerging. Awareness of the challenges involved in interpreting quantitative metrics is important for their clinical translation.
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Affiliation(s)
- Karen E. Lee
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Heather Heitkotter
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Carroll
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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13
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Di Perna L, Melillo P, Gesualdo C, Palmieri F, Testa F, Bifani M, Rossi S, Simonelli F. Correlation Between Choriocapillaris Density and Retinal Sensitivity in Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:2. [PMID: 34061948 PMCID: PMC8185398 DOI: 10.1167/tvst.10.7.2] [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 The purpose of this study was to investigate the relationship between perfusion of the choriocapillaris (CC) and retinal sensitivity in eyes with intermediate age-related macular degeneration (iAMD). Methods This prospective study included patients with iAMD and healthy controls. All enrolled subjects underwent optical coherence tomography angiography (OCT-A) in order to compute the percent perfused choriocapillaris area (PPCA). In patients with iAMD, microperimetry (MP) testing was performed in order to quantify: mean retinal sensitivity (MRS), over an area of 10 degrees; mean macular sensitivity (MMS), over the macular area scanned with OCT-A; and retinal sensitivity (RS) in each macular point. Results Eighteen eyes of 13 patients were included in the analysis. In addition, 18 eyes of 12 healthy subjects were enrolled as controls. No statistically significant difference (P value > 0.2) was observed in age between patients (73.9 ± 2.0 years) and controls (70.1 ± 2.8 years). We observed significantly lower values of PPCA between patients with iAMD and healthy controls (42.0% ± 3.8% vs. 66.4% ± 3.0%; -β = 23.8%; P value < 0.001). Among iAMD eyes, higher values of PPCA were significantly associated with higher values of MRS (P value = 0.002) and MMS (P value = 0.013). Finally, higher values of RS in each macular point analyzed with MP were significantly (P value < 0.001) associated with higher values of PPCA computed in circular regions of interest (ROIs) centered in each analyzed MP point with radii of 0.5 degrees and 1.0 degree. Conclusions Using OCT-A, we demonstrated a significant association between CC impairment and macular dysfunction, quantified by MP, in iAMD eyes. Translational Relevance OCT-A could be a useful tool for detecting CC alterations and to monitor disease progression.
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Affiliation(s)
- Luigi Di Perna
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Paolo Melillo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Carlo Gesualdo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Filomena Palmieri
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Mario Bifani
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Settimio Rossi
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Via S. Pansini 5, Naples, Italy
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Abstract
PURPOSE To investigate the relationship between choriocapillaris (CC) hypoperfusion and photoreceptor alterations in eyes with nonproliferative diabetic retinopathy (NPDR). METHODS In this prospective, observational, case-control study, 30 eyes (30 patients) with NPDR and 30 healthy eyes from 30 controls were enrolled at the University G. d'Annunzio, Chieti-Pescara, Italy. This study cohort underwent an ophthalmologic examination, including optical coherence tomography and optical coherence tomography angiography. The main outcome measures were as follows: 1) "normalized" reflectivity of en face image segmented at the ellipsoid zone level, which was calculated to quantify the photoreceptor damage, and 2) CC perfusion density. Secondary outcome measures were as follows: 1) superficial retinal capillary plexus (SCP), intermediate retinal capillary plexus (ICP), and deep retinal capillary plexus (DCP) perfusion density (based on the area of vessels); 2) SCP, ICP, and DCP vessel length density (based on a map with vessels of 1-pixel width); and 3) SCP, ICP, and DCP vessel diameter. RESULTS Mean ± SD age was 58.9 ± 11.1 years (range 38-79 years) in the NPDR group and 61.7 ± 11.3 years (range 39-87 years) in the control group (P > 0.05 for all the comparisons). Compared with controls, NPDR eyes displayed a lower "normalized" reflectivity (0.96 ± 0.25 in controls and 0.73 ± 0.19 in the NPDR group, P < 0.0001). Moreover, the NPDR group was characterized by an impaired perfusion in both the retinal and choroidal vasculature. In multiple regression analysis, ellipsoid zone "normalized" reflectivity displayed a significant direct association with CC perfusion density in patients with NPDR (P = 0.025 and P = 0.476, in NPDR and controls, respectively). CONCLUSION Eyes with NPDR are affected by macular hypoperfusion and photoreceptor damage, the latter investigated as ellipsoid zone "normalized" reflectivity. The diabetic choroidopathy seems to be strongly associated with photoreceptor damage.
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15
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CLINICAL UTILITY OF MORPHOFUNCTIONAL CORRELATION OF MICROPERIMETRY AND OPTICAL COHERENCE TOMOGRAPHY. Retina 2021; 41:1026-1036. [PMID: 33149098 DOI: 10.1097/iae.0000000000003009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To demonstrate the clinical and research value of a simplified technique enabling alignment of functional microperimetry data with retinal structure imaged by eye-tracked optical coherence tomography (OCT) in eyes with macular disease. METHODS Normal and diseased eyes underwent sequential Spectralis OCT macular raster scans and Macular Integrity Assessment microperimetry using both standard central 10° analysis and custom scan patterns. The microperimetry data were imported into Spectralis research software program, which was automatically registered to the scanning laser ophthalmoscopy near-infrared reflectance image obtained during OCT acquisition. The OCT B-scans were directly correlated with the microperimetry data so that retina sensitivity and retinal microstructure at corresponding points could be evaluated simultaneously. RESULTS Seventy eyes of 41 patients (110 studies) aged 22 years to 95 years (mean 63.5 ± 18.0 years) with both normal and pathologic macular changes were included. The mean Macular Integrity Assessment retina sensitivity of all 110 studies was 22.2 ± 4.9 (range: 0.1-30.3). Retinal sensitivity showed good correspondence in structural changes seen on OCT B-scans. CONCLUSION We demonstrate a practical method to align retina sensitivity data to anatomical tomographic findings. This technique provides data not obtainable with standard visual acuity measures.
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16
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Pfau M, von der Emde L, de Sisternes L, Hallak JA, Leng T, Schmitz-Valckenberg S, Holz FG, Fleckenstein M, Rubin DL. Progression of Photoreceptor Degeneration in Geographic Atrophy Secondary to Age-related Macular Degeneration. JAMA Ophthalmol 2021; 138:1026-1034. [PMID: 32789526 DOI: 10.1001/jamaophthalmol.2020.2914] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Sensitive outcome measures for disease progression are needed for treatment trials in geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Objective To quantify photoreceptor degeneration outside regions of GA in eyes with nonexudative AMD, to evaluate its association with future GA progression, and to characterize its spatio-temporal progression. Design, Setting, and Participants Monocenter cohort study (Directional Spread in Geographic Atrophy [NCT02051998]) and analysis of data from a normative data study at a tertiary referral center. One hundred fifty-eight eyes of 89 patients with a mean (SD) age of 77.7 (7.1) years, median area of GA of 8.87 mm2 (IQR, 4.09-15.60), and median follow-up of 1.1 years (IQR, 0.52-1.7 years), as well as 93 normal eyes from 93 participants. Exposures Longitudinal spectral-domain optical coherence tomography (SD-OCT) volume scans (121 B-scans across 30° × 25°) were segmented with a deep-learning pipeline and standardized in a pointwise manner with age-adjusted normal data (z scores). Outer nuclear layer (ONL), photoreceptor inner segment (IS), and outer segment (OS) thickness were quantified along evenly spaced contour lines surrounding GA lesions. Linear mixed models were applied to assess the association between photoreceptor-related imaging features and GA progression rates and characterize the pattern of photoreceptor degeneration over time. Main Outcomes and Measures Association of ONL thinning with follow-up time (after adjusting for age, retinal topography [z score], and distance to the GA boundary). Results The study included 158 eyes of 89 patients (51 women and 38 men) with a mean (SD) age of 77.7 (7.1) years. The fully automated B-scan segmentation was accurate (dice coefficient, 0.82; 95% CI, 0.80-0.85; compared with manual markings) and revealed a marked interpatient variability in photoreceptor degeneration. The ellipsoid zone (EZ) loss-to-GA boundary distance and OS thickness were prognostic for future progression rates. Outer nuclear layer and IS thinning over time was significant even when adjusting for age and proximity to the GA boundary (estimates of -0.16 μm/y; 95% CI, -0.30 to -0.02; and -0.17 μm/y; 95% CI, -0.26 to -0.09). Conclusions and Relevance Distinct and progressive alterations of photoreceptor laminae (exceeding GA spatially) were detectable and quantifiable. The degree of photoreceptor degeneration outside of regions of retinal pigment epithelium atrophy varied markedly between eyes and was associated with future GA progression. Macula-wide photoreceptor laminae thinning represents a potential candidate end point to monitor treatment effects beyond mere GA lesion size progression.
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Affiliation(s)
- Maximilian Pfau
- Department of Biomedical Data Science, Stanford University, Stanford, California.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Luis de Sisternes
- Research and Development, Carl Zeiss Meditec Inc, Dublin, California
| | - Joelle A Hallak
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,John A. Moran Eye Center, University of Utah, Salt Lake City
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, California
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17
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Logan AJ, Gordon GE, Loffler G. The Effect of Age-Related Macular Degeneration on Components of Face Perception. Invest Ophthalmol Vis Sci 2021; 61:38. [PMID: 32543666 PMCID: PMC7415315 DOI: 10.1167/iovs.61.6.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Patients with age-related macular degeneration (AMD) experience difficulty with discriminating between faces. We aimed to use a new clinical test to quantify the impact of AMD on face perception and to determine the specific aspects that are affected. Methods The Caledonian face test uses an adaptive procedure to measure face discrimination thresholds: the minimum difference required between faces for reliable discrimination. Discrimination thresholds were measured for full-faces, external features (head-shape and hairline), internal features (nose, mouth, eyes, and eyebrows) and shapes (non-face task). Participants were 20 patients with dry AMD (logMAR VA = 0.14 to 0.62), 20 patients with wet AMD (0.10 to 0.60), and 20 age-matched control subjects (−0.18 to +0.06). Results Relative to controls, full-face discrimination thresholds were, on average, 1.76 and 1.73 times poorer in participants with dry and wet AMD, respectively. AMD also reduced sensitivity to face features, but discrimination of the internal, relative to external, features was disproportionately impaired. Both distance VA and contrast sensitivity were significant independent predictors of full-face discrimination thresholds (R2 = 0.66). Sensitivity to full-faces declined by a factor of approximately 1.19 per 0.1 logMAR reduction in VA. Conclusions Both dry and wet AMD significantly reduce sensitivity to full-faces and their component parts to similar extents. Distance VA and contrast sensitivity are closely associated with face discrimination sensitivity. These results quantify the extent of sensitivity impairment in patients with AMD and predict particular difficulty in everyday tasks that rely on internal feature information, including recognition of familiar faces and facial expressions.
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18
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Mehta N, Lavinsky F, Larochelle R, Rebhun C, Mehta NB, Yanovsky RL, Cohen MN, Lee GD, Dedania V, Ishikawa H, Wollstein G, Schuman JS, Waheed N, Modi Y. ASSESSING THE ABILITY OF PREOPERATIVE QUANTITATIVE SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY CHARACTERISTICS TO PREDICT VISUAL OUTCOME IN IDIOPATHIC MACULAR HOLE SURGERY. Retina 2021; 41:29-36. [PMID: 32251240 PMCID: PMC7529763 DOI: 10.1097/iae.0000000000002797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine which spectral domain optical coherence tomography biomarkers of idiopathic macular hole (MH) correlate with the postoperative best-corrected visual acuity (BCVA) in anatomically closed MH. METHODS Retrospective analysis of spectral domain optical coherence tomography scans of 44 patients presenting with MH followed for a mean of 17 months. Widths of MH aperture, base, and ellipsoid zone disruption were calculated from presenting foveal spectral domain optical coherence tomography B-scans. Macular hole base area and ellipsoid zone disruption area were calculated through the custom in-house software. RESULTS Poorer postoperative BCVA correlated with increased preoperative choroidal hypertransmission (r = 0.503, P = 0.0005), minimum diameter (r = 0.491, P = 0.0007), and base diameter (r = 0.319, P = 0.0348), but not with preoperative ellipsoid zone width (r = 0.199, P = 0.2001). Applying en-face analysis, the BCVA correlated weakly with preoperative ellipsoid zone loss area (r = 0.380, P = 0.013), but not with preoperative MH base area (r = 0.253, P = 0.1058). CONCLUSION Increased MH minimum diameter, base diameter, base area, and choroidal hypertransmission are correlated with a poorer postoperative BCVA. Ellipsoid zone loss measurements were not consistently correlated with a BCVA. Choroidal hypertransmission width may be an easy-to-visualize predictive imaging biomarker in MH surgery.
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Affiliation(s)
- Nitish Mehta
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Fabio Lavinsky
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Ryan Larochelle
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Carl Rebhun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Nihaal B Mehta
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | | | - Michael N Cohen
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Gregory D Lee
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Vaidehi Dedania
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Hiroshi Ishikawa
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
| | - Nadia Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Yasha Modi
- Department of Ophthalmology, NYU Langone Health, New York, New York; and
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19
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Borrelli E, Sacconi R, Zuccaro B, Cavalleri M, Bordato A, Zucchiatti I, Querques L, Bandello F, Querques G. Photoreceptor alteration in intermediate age-related macular degeneration. Sci Rep 2020; 10:21036. [PMID: 33273666 PMCID: PMC7713116 DOI: 10.1038/s41598-020-78201-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/23/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to analyze photoreceptor alterations occurring in eyes with intermediate age-related macular degeneration (AMD) and to investigate their associations with choriocapillaris (CC) flow. In this retrospective case-control study, we collected data from 35 eyes with intermediate AMD from 35 patients who had swept source optical coherence tomography structural and angiography imaging obtained. A control group of 35 eyes from 35 healthy subjects was included for comparison. Our main outcome measure for comparison between groups was the normalized reflectivity of en face image segmented at the ellipsoid zone (EZ) level, which was calculated to quantify the photoreceptor damage. OCTA metrics to quantify CC flow signal were also computed. These metrics were measured in a circle centered on the fovea and with a diameter of 5 mm. In intermediate AMD eyes, the macular area occupied by drusen was identified. Therefore, the EZ reflectivity and CC flow signal were separately measured in regions without drusen ("drusen-free" region). Measurements were generated using previously published algorithms. Mean ± SD age was 74.1 ± 6.8 years in the intermediate AMD group and 72.1 ± 6.0 years in the control group (p = 0.206). The normalized EZ reflectivity was 0.76 ± 0.10 in the intermediate AMD group and 0.85 ± 0.08 in the control group (p < .0001). In the "drusen-free" region, the normalized EZ reflectivity was 0.77 ± 0.10 (p < .0001 vs. healthy controls) and was positively correlated with the CC flow signal density (ρ = - 0.340 and p = 0.020). In conclusion, eyes with intermediate AMD exhibit a diffuse reduced EZ normalized reflectivity, and this reduction is correlated with CC flow signal in the regions without drusen. This study supports the concept of the damage of the unit comprised of photoreceptor, CC, and intervening tissues as an early event in AMD.
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Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Michele Cavalleri
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Bordato
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Zucchiatti
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy. .,IRCCS San Raffaele Scientific Institute, Milan, Italy.
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20
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Nagasato D, Muraoka Y, Osaka R, Iida-Miwa Y, Mitamura Y, Tabuchi H, Kadomoto S, Murakami T, Ooto S, Suzuma K, Tsujikawa A. Factors associated with extremely poor visual outcomes in patients with central retinal vein occlusion. Sci Rep 2020; 10:19667. [PMID: 33184484 PMCID: PMC7665063 DOI: 10.1038/s41598-020-76840-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Here, we examined prognostic factors for extremely poor visual outcomes in patients with central retinal vein occlusion (CRVO) in actual practices. We included 150 consecutive eyes with treatment-naïve acute CRVO from four different facilities and observed them for over 24 months. Macular edema (ME) was treated with one or three monthly anti-vascular endothelial growth factor injections (1 or 3 + pro re nata). According to the final Snellen visual acuity (VA), we divided the patients into very poor VA (< 20/200) and control (≥ 20/200) groups and examined risk factors for poor final visual outcomes. The baseline Snellen VA was hand motion to 20/13. The mean number of anti-VEGF injections for ME was 5.3 ± 3.7 during the follow-up period. In total, 49 (32.7%) patients exhibited a very poor final VA; this group comprised significantly older patients with a significantly poorer baseline VA (P < 0.01 for both) than the control group. Comorbid internal carotid artery disease and diabetic retinopathy were significantly associated with a poor final VA. In actual clinical practice, visual outcomes may be extremely poor despite ME treatment in certain patients with CRVO, with advanced age, poor baseline VA, and comorbid internal carotid artery disease and diabetic retinopathy being significant risk factors.
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Affiliation(s)
- Daisuke Nagasato
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Hyogo, Japan.,Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yuki Muraoka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Rie Osaka
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Yuko Iida-Miwa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Hyogo, Japan
| | - Shin Kadomoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kiyoshi Suzuma
- Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Sharing of fake news on social media: Application of the honeycomb framework and the third-person effect hypothesis. JOURNAL OF RETAILING AND CONSUMER SERVICES 2020; 57:102197. [PMCID: PMC7340407 DOI: 10.1016/j.jretconser.2020.102197] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 05/22/2023]
Abstract
Sharing of fake news on social media platforms is a global concern, with research offering little insight into the motives behind such sharing. This study adopts a mixed-method approach to explore fake-news sharing behaviour. To begin with, qualitative data from 58 open-ended essays was analysed to identify six behavioural manifestations associated with sharing fake news. Thereafter, research model hypothesizing the association between these behaviours was proposed using the honeycomb framework and the third-person effect hypothesis. Age and gender were the control variables. Two data sets obtained from cross-sectional surveys with 471 and 374 social media users were utilized to test the proposed model. The study results suggest that instantaneous sharing of news for creating awareness had positive effect on sharing fake news due to lack of time and religiosity. However, authenticating news before sharing had no effect on sharing fake news due to lack of time and religiosity. The study results also suggest that social media users who engage in active corrective action are unlikely to share fake news due to lack of time. These results have significant theoretical and practical implications.
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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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23
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Pfau M, von der Emde L, Dysli C, Möller PT, Thiele S, Lindner M, Schmid M, Rubin DL, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Determinants of Cone and Rod Functions in Geographic Atrophy: AI-Based Structure-Function Correlation. Am J Ophthalmol 2020; 217:162-173. [PMID: 32289293 DOI: 10.1016/j.ajo.2020.04.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the association between retinal microstructure and cone and rod function in geographic atrophy (GA) secondary to age-related macular degeneration (AMD) by using artificial intelligence (AI) algorithms. DESIGN Prospective, observational case series. METHODS A total of 41 eyes of 41 patients (75.8 ± 8.4 years old; 22 females) from a tertiary referral hospital were included. Mesopic, dark-adapted (DA) cyan and red sensitivities were assessed by using fundus-controlled perimetry ("microperimetry"); and retinal microstructure was assessed by using spectral-domain optical-coherence-tomography (SD-OCT), fundus autofluorescence (FAF), and near-infrared-reflectance (IR) imaging. Layer thicknesses and intensities and FAF and IR intensities were extracted for each test point. The cross-validated mean absolute error (MAE) was evaluated for random forest-based predictions of retinal sensitivity with and without patient-specific training data and percentage of increased mean-squared error (%IncMSE) as measurement of feature importance. RESULTS Retinal sensitivity was predicted with a MAE of 4.64 dB for mesopic, 4.89 dB for DA cyan, and 4.40 dB for DA red testing in the absence of patient-specific data. Partial addition of patient-specific sensitivity data to the training sets decreased the MAE to 2.89 dB, 2.86 dB, and 2.77 dB. For all 3 types of testing, the outer nuclear layer thickness constituted the most important predictive feature (35.0, 42.22, and 53.74 %IncMSE). Spatially resolved mapping of "inferred sensitivity" revealed regions with differential degrees of mesopic and DA cyan sensitivity loss outside of the GA lesions. CONCLUSIONS "Inferred sensitivity" accurately reflected retinal function in patients with GA. Mapping of "inferred sensitivity" could facilitate monitoring of disease progression and serve as "quasi functional" surrogate outcome in clinical trials, especially in consideration of retinal regions beyond areas of GA.
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Affiliation(s)
- Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany; Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | | | - Chantal Dysli
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Departments of Ophthalmology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Philipp T Möller
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Moritz Lindner
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Department of Neurophysiology, Institute of Physiology and Pathophysiology, Philipps University, Marburg, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; GRADE Reading Center, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA.
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Nuzzi R, Dallorto L, Vitale A. Cerebral Modifications and Visual Pathway Reorganization in Maculopathy: A Systematic Review. Front Neurosci 2020; 14:755. [PMID: 32973424 PMCID: PMC7472840 DOI: 10.3389/fnins.2020.00755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background Macular degeneration (MD) is one of the most frequent causes of visual deficit, resulting in alterations affecting not only the retina but also the entire visual pathway up to the brain areas. This would seem related not just to signal deprivation but also to a compensatory neuronal reorganization, having significant implications in terms of potential rehabilitation of the patient and therapeutic perspectives. Objective This paper aimed to outline, by analyzing the existing literature, the current understanding of brain structural and functional changes detected with neuroimaging techniques in subjects affected by juvenile and age-related maculopathy. Methods Articles using various typologies of central nervous system (CNS) imaging in at least six patients affected by juvenile or age-related maculopathy were considered. A total of 142 were initially screened. Non-pertinent articles and duplicates were rejected. Finally, 19 articles, including 649 patients, were identified. Results In these sources, both structural and functional modifications were found in MD subjects' CNS. Changes in visual cortex gray matter volume were observed in both age-related MD (AMD) and juvenile MD (JMD); in particular, an involvement of not only its posterior part but also the anterior one suggests further causes besides an input-deprivation mechanism only. White matter degeneration was also found, more severe in JMD than in AMD. Moreover, functional analysis revealed differences in cortical activation patterns between MD and controls, suggesting neuronal circuit reorganization. Interestingly, attention and oculomotor training allowed better visual performances and correlated to a stronger cortical activation, even of the area normally receiving inputs from lesioned macula. Conclusion In MD, structural and functional changes in cerebral circuits and visual pathway can happen, involving both cerebral volume and activation patterns. These modifications, possibly due to neuronal plasticity (already observed and described for several brain areas), can allow patients to compensate for macular damage and gives therapeutic perspectives which could be achievable through an association between oculomotor training and biochemical stimulation of neuronal plasticity.
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Affiliation(s)
- Raffaele Nuzzi
- Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Laura Dallorto
- Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessio Vitale
- Eye Clinic, Department of Surgical Sciences, University of Turin, Turin, Italy
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Automated Quantification of Photoreceptor alteration in macular disease using Optical Coherence Tomography and Deep Learning. Sci Rep 2020; 10:5619. [PMID: 32221349 PMCID: PMC7101374 DOI: 10.1038/s41598-020-62329-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/03/2020] [Indexed: 02/03/2023] Open
Abstract
Diabetic macular edema (DME) and retina vein occlusion (RVO) are macular diseases in which central photoreceptors are affected due to pathological accumulation of fluid. Optical coherence tomography allows to visually assess and evaluate photoreceptor integrity, whose alteration has been observed as an important biomarker of both diseases. However, the manual quantification of this layered structure is challenging, tedious and time-consuming. In this paper we introduce a deep learning approach for automatically segmenting and characterising photoreceptor alteration. The photoreceptor layer is segmented using an ensemble of four different convolutional neural networks. En-face representations of the layer thickness are produced to characterize the photoreceptors. The pixel-wise standard deviation of the score maps produced by the individual models is also taken to indicate areas of photoreceptor abnormality or ambiguous results. Experimental results showed that our ensemble is able to produce results in pair with a human expert, outperforming each of its constitutive models. No statistically significant differences were observed between mean thickness estimates obtained from automated and manually generated annotations. Therefore, our model is able to reliable quantify photoreceptors, which can be used to improve prognosis and managment of macular diseases.
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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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FIXATION STATUS AFTER RESOLUTION OF MACULAR EDEMA ASSOCIATED WITH BRANCH RETINAL VEIN OCCLUSION. Retina 2019; 39:1896-1905. [DOI: 10.1097/iae.0000000000002250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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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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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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Wada I, Oshima Y, Shiose S, Kano K, Nakao S, Kaizu Y, Yoshida S, Ishibashi T, Sonoda KH. Five-year treatment outcomes following intravitreal ranibizumab injections for neovascular age-related macular degeneration in Japanese patients. Graefes Arch Clin Exp Ophthalmol 2019; 257:1411-1418. [PMID: 31119425 DOI: 10.1007/s00417-019-04361-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To assess the real-world 5-year treatment outcomes of ranibizumab therapy in Japanese patients with neovascular age-related macular degeneration (AMD). METHODS This was a retrospective, observational, and open-label effectiveness study that included 295 eyes. The participants were patients with treatment-naïve neovascular AMD who received intravitreal ranibizumab (IVR) monthly injection at least three times as the loading phase, followed by further injections as needed (pro re nata (PRN)) and follow-up assessments for 5 years. Outcomes were determined at least 5 years after the first ranibizumab injection. RESULTS Mean logMAR best-corrected visual acuity (BCVA) at baseline was 0.52. The mean BCVA significantly improved after three loading injections; however, it declined gradually. The BCVA at 1 year was significantly better than the baseline BCVA, whereas the 3-year, 4-year, and 5-year BCVA values were significantly lower than the baseline values. The average central foveal thickness improved significantly from 366 ± 125 μm to 268 ± 134 μm (p < 0.0001). Macular atrophy was significantly more likely to occur in cases with classic choroidal neovascularization (CNV) than in cases with other AMD (p = 0.01). CONCLUSIONS IVR is well tolerated in eyes with AMD. However, a PRN regimen for AMD may have limited real-world effectiveness for long-term maintenance of improved visual acuity. Macular atrophy may occur more frequently in classic CNV. To maintain good vision, IVR treatment should be started earlier and performed continuously.
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Affiliation(s)
- Iori Wada
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuji Oshima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Department of Ophthalmology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
| | - Satomi Shiose
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kumiko Kano
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Kaizu
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shigeo Yoshida
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuro Ishibashi
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koh-Hei Sonoda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Nomura Y, Inoue T, Asano S, Shimizu-Asano K, Azuma K, Ogawa A, Murata H, Asaoka R, Obata R. Retinal sensitivity in angioid streaks. Graefes Arch Clin Exp Ophthalmol 2019; 257:1591-1599. [PMID: 31044269 DOI: 10.1007/s00417-019-04332-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate retinal sensitivity in eyes with angioid streaks (AS). METHODS This study was a retrospective observational case series. A total of 13 eyes from 9 patients with AS underwent ophthalmologic examination, including fundus autofluorescence (FAF), spectral domain optical tomography (SD-OCT), and microperimetry. Retinal pigment epithelium (RPE) atrophy was assessed using FAF. Outer retinal atrophy, more specifically, disruption of the ellipsoid zone, was evaluated using SD-OCT images. The association between retinal sensitivity, RPE atrophy or outer retinal atrophy, and patient demographic characteristics or ophthalmologic findings were investigated. RESULTS The mean area of outer retinal atrophy was 14.5 ± 12.9 mm2, significantly larger than the mean area of RPE atrophy (9.0 ± 9.0 mm2; P = 0.0028). The average retinal sensitivity in the area of RPE atrophy was 2.4 ± 5.6 dB, that in the area of outer retinal atrophy outside RPE atrophy was 14.6 ± 7.5 dB, and that in the area without any atrophy was 25.6 ± 5.1 dB. Reticular pseudodrusen (RPD) was observed in 5 eyes. Eyes with RPD showed a greater extent of both outer retinal atrophy and RPE atrophy than those without RPD and a greater decrease in mean retinal sensitivity. CONCLUSIONS In eyes with AS, especially in those with RPD, large areas of outer retinal atrophy and RPE atrophy were observed, and the retinal sensitivity in the areas was correspondingly decreased.
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Affiliation(s)
- Yoko Nomura
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shotaro Asano
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kimiko Shimizu-Asano
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Azuma
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Asako Ogawa
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Obata
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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32
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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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Oura Y, Nakamura M, Takigawa T, Fukushima Y, Wakabayashi T, Tsujikawa M, Nishida K. High-Temperature Requirement A 1 Causes Photoreceptor Cell Death in Zebrafish Disease Models. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:2729-2744. [PMID: 30273602 DOI: 10.1016/j.ajpath.2018.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/28/2018] [Accepted: 08/23/2018] [Indexed: 02/06/2023]
Abstract
Age-related macular degeneration (AMD) is an important cause of blindness. It is characterized by a retinal pigment epithelium (RPE) disorder that leads to death of photoreceptor cells (PRCs). AMD has a strong genetic association with high-temperature requirement A 1 (HTRA1). The relationship between HTRA1 and the AMD phenotype is unknown. In this study, we show that the expression of HTRA1 in PRCs, as well as in RPE, is increased by the disease-associated HTRA1 mutation and aging. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay and quantitative PCR of apoptosis-associated caspases confirmed that PRC-specific overexpression of HTRA1 induced PRC death. Transgenic zebrafish overexpressing human HTRA1 in rod PRCs showed morphologic changes of the RPE, including PRC death and lipofuscin accumulation, features similar to those of early AMD. htra1 expression was also increased in a retinitis pigmentosa zebrafish model compared with wild type. In both fish lines, PRC death was rescued by the suppression of htra1 by the inhibitor 6-boroV. AKT-forkhead box O3 signaling downstream of HTRA1 was activated via a tumor growth factor β signal, resulting in PRC death. These findings suggest that HTRA1 derived from PRCs is associated with early AMD via PRC death. HTRA1 is a potentially effective target for neuroprotective therapy of early AMD and other degenerative diseases of PRCs.
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Affiliation(s)
- Yoshihito Oura
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
| | - Machiko Nakamura
- Pain and Neuroscience Laboratories, Daiichi Sankyo Co, Ltd, Tokyo, Japan
| | - Tohru Takigawa
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
| | - Yoko Fukushima
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
| | - Taku Wakabayashi
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
| | - Motokazu Tsujikawa
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Medical School, Suita, Japan
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Spaide RF, Ooto S, Curcio CA. Subretinal drusenoid deposits AKA pseudodrusen. Surv Ophthalmol 2018; 63:782-815. [PMID: 29859199 DOI: 10.1016/j.survophthal.2018.05.005] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 01/30/2023]
Abstract
A distinction between conventional drusen and pseudodrusen was first made in 1990, and more recently knowledge of pseudodrusen, more accurately called subretinal drusenoid deposits (SDDs), has expanded. Pseudodrusen have a bluish-white appearance by biomicroscopy and color fundus photography. Using optical coherence tomography, pseudodrusen were found to be accumulations of material internal to the retinal pigment epithelium that could extend internally through the ellipsoid zone. These deposits are more commonly seen in older eyes with thinner choroids. Histologic evaluation of these deposits revealed aggregations of material in the subretinal space between photoreceptors and retinal pigment epithelium. SDDs contain some proteins in common with soft drusen but differ in lipid composition. Many studies reported that SDDs are strong independent risk factors for late age-related macular degeneration. Geographic atrophy and type 3 neovascularization are particularly associated with SDD. Unlike conventional drusen, eyes with SDD show slow dark adaptation and poor contrast sensitivity. Outer retinal atrophy develops in eyes with regression of SDD, a newly recognized form of late age-related macular degeneration. Advances in imaging technology have enabled many insights into this condition, including associated photoreceptor, retinal pigment epithelium, and underlying choroidal changes.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.
| | - Sotaro Ooto
- Vitreous Retina Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA; Department of Ophthalmology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Christine A Curcio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabamas, USA
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EVALUATION OF MACULAR ISCHEMIA IN EYES WITH BRANCH RETINAL VEIN OCCLUSION: An Optical Coherence Tomography Angiography Study. Retina 2018; 38:272-282. [PMID: 28221256 DOI: 10.1097/iae.0000000000001541] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To quantitatively assess macular morphology and perfusion status using optical coherence tomography, and optical coherence tomography angiography in eyes with branch retinal vein occlusion when macular edema has completely resolved, and to investigate the impact on visual function. METHODS Thirty consecutive eyes with branch retinal vein occlusion-macular edema that resolved after treatment with intravitreal ranibizumab injections were included. Macular sensitivity was measured by microperimetry; defect length of foveal ellipsoid zone band was measured using optical coherence tomography; foveal avascular zone and parafoveal nonperfusion areas (NPA) were measured by optical coherence tomography angiography. RESULTS The logarithm of minimum angle of resolution visual acuity was significantly associated with the defect length of the foveal ellipsoid zone band (P = 0.005), the parafoveal NPA in the superficial capillary plexus (P = 0.007), and the parafoveal NPA in the deep capillary plexus (P = 0.006). Macular sensitivity correlated with parafoveal thickness on the affected side (P = 0.034), the defect length of the foveal ellipsoid zone band (P = 0.048), parafoveal NPA in the superficial capillary plexus (P = 0.008), and parafoveal NPA in the deep capillary plexus (P = 0.012). Multivariate analysis where the only significant parameters in the univariate analyses were used as the independent variables showed that parafoveal NPA was most significantly associated with the logarithm of minimum angle of resolution visual acuity (β = 0.500, P = 0.005) and macular sensitivity (β = -0.480, P = 0.007). CONCLUSION In eyes with branch retinal vein occlusion-macular edema resolved by intravitreal ranibizumab treatments, visual function was strongly associated with parafoveal NPA size.
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Takahashi A, Ooto S, Yamashiro K, Tamura H, Oishi A, Miyata M, Hata M, Yoshikawa M, Yoshimura N, Tsujikawa A. Pachychoroid Geographic Atrophy. ACTA ACUST UNITED AC 2018; 2:295-305. [DOI: 10.1016/j.oret.2017.08.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/13/2017] [Accepted: 08/15/2017] [Indexed: 02/04/2023]
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Abstract
PURPOSE To investigate the relationship between ganglion cell complex (GCC) thickness and photoreceptor alterations in eyes with intermediate age-related macular degeneration (AMD). DESIGN Retrospective case-control study. METHODS We collected data from 68 eyes with intermediate AMD from 68 patients with spectral-domain optical coherence tomography (SDOCT) imaging. A control group of 50 eyes from 50 healthy subjects was included for comparison. Our main outcome measures for comparison between groups were (1) the average and minimum GCC thickness and (2) the "normalized" reflectivity of the ellipsoid zone (EZ) en face image. RESULTS The average and minimum GCC thicknesses were thinner in AMD patients (69.54 ± 9.30 μm and 63.22 ± 14.11 μm, respectively) than in healthy controls (78.57 ± 6.28 μm and 76.28 ± 6.85 μm, P < .0001 and P < .0001, respectively). Agreement was found to be excellent in the "normalized" EZ reflectivity assessment (intraclass correlation coefficient = 0.986, coefficient of variation = 1.11). The EZ "normalized" reflectivity was 0.67 ± 0.11 in controls and 0.61 ± 0.09 in the AMD group (P = .006). In univariate analysis, EZ "normalized" reflectivity was found to have a significant direct relationship with average (P < .0001) and minimum (P < .0001) GCC thickness in AMD patients, but not in controls (P = .852 and P = .892, respectively). CONCLUSIONS Eyes with intermediate AMD exhibit GCC thinning, as well as a reduced EZ "normalized" reflectivity, and these parameters are correlated. This study supports the concept of postreceptor retinal neuronal loss as a contributor to retinal thinning in intermediate AMD.
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Laíns I, Miller JB, Park DH, Tsikata E, Davoudi S, Rahmani S, Pierce J, Silva R, Chen TC, Kim IK, Vavvas D, Miller JW, Husain D. Structural Changes Associated with Delayed Dark Adaptation in Age-Related Macular Degeneration. Ophthalmology 2017; 124:1340-1352. [PMID: 28501377 DOI: 10.1016/j.ophtha.2017.03.061] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To examine the relationship between dark adaptation (DA) and optical coherence tomography (OCT)-based macular morphology in age-related macular degeneration (AMD). DESIGN Prospective, cross-sectional study. PARTICIPANTS Patients with AMD and a comparison group (>50 years) without any vitreoretinal disease. METHODS All participants were imaged with spectral-domain OCT and color fundus photographs, and then staged for AMD (Age-related Eye Disease Study system). Both eyes were tested with the AdaptDx (MacuLogix, Middletown, PA) DA extended protocol (20 minutes). A software program was developed to map the DA testing spot (2° circle, 5° superior to the fovea) to the OCT B-scans. Two independent graders evaluated the B-scans within this testing spot, as well as the entire macula, recording the presence of several AMD-associated abnormalities. Multilevel mixed-effects models (accounting for correlated outcomes between 2 eyes) were used for analyses. MAIN OUTCOME MEASURES The primary outcome was rod-intercept time (RIT), defined in minutes, as a continuous variable. For subjects unable to reach RIT within the 20 minutes of testing, the value of 20 was assigned. RESULTS We included 137 eyes (n = 77 subjects), 72.3% (n = 99 eyes) with AMD and the remainder belonging to the comparison group. Multivariable analysis revealed that even after adjusting for age and AMD stage, the presence of any abnormalities within the DA testing spot (ß = 4.8, P < 0.001), as well as any abnormalities in the macula (ß = 2.4, P = 0.047), were significantly associated with delayed RITs and therefore impaired DA. In eyes with no structural changes within the DA testing spot (n = 76, 55.5%), the presence of any abnormalities in the remaining macula was still associated with delayed RITs (ß = 2.00, P = 0.046). Presence of subretinal drusenoid deposits and ellipsoid zone disruption were a consistent predictor of RIT, whether located within the DA testing spot (P = 0.001 for both) or anywhere in the macula (P < 0.001 for both). Within the testing spot, the presence of classic drusen or serous pigment epithelium detachment was also significantly associated with impairments in DA (P ≤ 0.018). CONCLUSIONS Our results suggest a significant association between macular morphology evaluated by OCT and time to dark-adapt. Subretinal drusenoid deposits and ellipsoid zone changes seem to be strongly associated with impaired dark adaptation.
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Affiliation(s)
- Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light, AIBILI, Coimbra, Portugal; Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Dong H Park
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, School of Medicine, Kyungpook National University, South Korea
| | - Edem Tsikata
- Glaucoma Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Samaneh Davoudi
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Safa Rahmani
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Pierce
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Rufino Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light, AIBILI, Coimbra, Portugal; Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa C Chen
- Glaucoma Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ivana K Kim
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Demetrios Vavvas
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, Harvard Ophthalmology AMD Center of Excellence, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
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Quantitative analysis of photoreceptor layer reflectivity on en-face optical coherence tomography as an estimator of cone density. Graefes Arch Clin Exp Ophthalmol 2017; 255:2119-2126. [DOI: 10.1007/s00417-017-3761-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022] Open
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Ferrara D, Silver RE, Louzada RN, Novais EA, Collins GK, Seddon JM. Optical Coherence Tomography Features Preceding the Onset of Advanced Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2017; 58:3519-3529. [PMID: 28715590 PMCID: PMC5512971 DOI: 10.1167/iovs.17-21696] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose Age-related macular degeneration (AMD) is a progressive disease with multifactorial etiology. There is a need to identify clinical features that are harbingers of advanced disease. We evaluated morphologic features of the retina and choroid on optical coherence tomography (OCT) to determine if they predict progression to advanced disease. Methods Progressors transitioned from early or intermediate AMD to advanced disease (n = 40 eyes), and were matched on baseline AMD grade and follow-up interval to nonprogressors who did not develop advanced AMD (n = 40 eyes). Features of the neurosensory retina, photoreceptors, retinal pigment epithelium (RPE), and choroid were evaluated. Logistic regression was used to evaluate univariate associations between features and progression to overall advanced AMD, geographic atrophy (GA), and neovascular disease (NV). Multivariate associations based on stepwise regression models were also assessed. Results Ellipsoid zone disruption was associated with progression to overall advanced AMD and NV (odds ratios [ORs]: 17.9 and 30.6; P < 0.001), with a similar trend observed for GA. Drusenoid RPE detachment, RPE thickening, and retinal pigmentary hyperreflective material were significantly associated with higher risk of progression to advanced AMD (ORs: 5.0–8.5) and NV (ORs: 10.8–17.2). Pigmentary hyperreflective material was associated with progression to GA (OR: 7.5, P = 0.009). Total retinal thickness, pigmentary hyperreflective material, nascent GA features, and choroidal vessel abnormalities were independently associated with progression to advanced AMD in a multivariate stepwise model. Conclusions Abnormalities in the photoreceptors, retinal thickness, RPE, and choroid were associated with higher risk of developing advanced AMD. These findings provide insights into disease progression, and may be helpful to identify earlier endpoints for clinical studies.
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Affiliation(s)
- Daniela Ferrara
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Rachel E Silver
- Ophthalmic Epidemiology and Genetics Service, New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Ricardo N Louzada
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States 3Department of Ophthalmology, Federal University of Goiás, Goiânia, Brazil
| | - Eduardo A Novais
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States 4Federal University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Giliann K Collins
- Ophthalmic Epidemiology and Genetics Service, New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Johanna M Seddon
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, United States 2Ophthalmic Epidemiology and Genetics Service, New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States 5Sackler School of Graduate Biomedical Sciences and Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States
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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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