1
|
Guymer RH. Ageing and retinal thickness: An important association. Clin Exp Ophthalmol 2024; 52:505-506. [PMID: 38950907 DOI: 10.1111/ceo.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 05/04/2024] [Indexed: 07/03/2024]
Affiliation(s)
- 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
| |
Collapse
|
2
|
Yang H, Rees JP, Sanchez FG, Gardiner SK, Mansberger SL. OCT Segmentation Errors with Bruch's Membrane Opening-Minimum Rim Width as Compared with Retinal Nerve Fiber Layer Thickness. Ophthalmol Glaucoma 2024; 7:308-315. [PMID: 38104770 DOI: 10.1016/j.ogla.2023.12.002] [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: 08/04/2023] [Revised: 11/15/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To compare the magnitude and location of automated segmentation errors of the Bruch's membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT). DESIGN Cross-sectional study. PARTICIPANTS We included 162 glaucoma suspect or open-angle glaucoma eyes from 162 participants. METHODS We used spectral-domain optic coherence tomography (Spectralis 870 nm, Heidelberg Engineering) to image the optic nerve with 24 radial optic nerve head B-scans and a 12-degree peripapillary circle scan, and exported the native "automated segmentation only" results for BMO-MRW and RNFLT. We also exported the results after "manual refinement" of the measurements. MAIN OUTCOME MEASURES We calculated the absolute and proportional error globally and within the 12 30-degree sectors of the optic disc. We determined whether the glaucoma classifications were different between BMO-MRW and RNFLT as a result of manual and automatic segmentation. RESULTS The absolute error mean was larger for BMO-MRW than for RNFLT (10.8 μm vs. 3.58 μm, P < 0.001). However, the proportional errors were similar (4.3% vs. 4.4%, P = 0.47). In a multivariable regression model, errors in BMO-MRW were not significantly associated with age, location, magnitude, or severity of glaucoma loss (all P ≥ 0.05). However, larger RNFLT errors were associated with the superior and inferior sector location, thicker nerve fiber layer, and worse visual field (all P < 0.05). Errors in BMO-MRW and RNFLT were not likely to occur in the same sector location (R2 = 0.001; P = 0.15). With manual refinement, the glaucoma classification changed in 7.8% and 6.2% of eyes with BMO-MRW and RNFLT, respectively. CONCLUSIONS Both BMO-MRW and RNFLT measurements included segmentation errors, which did not seem to have a common location, and may result in differences in glaucoma classification. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Hongli Yang
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon
| | - Jack P Rees
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon
| | - Facundo G Sanchez
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon
| | - Stuart K Gardiner
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon
| | - Steven L Mansberger
- Devers Eye Institute Discoveries in Sight Research Laboratories, Legacy Research Institute, Portland, Oregon.
| |
Collapse
|
3
|
Gardiner SK, Cull G, Fortune B. Retinal Vessel Pulsatile Characteristics Associated With Vascular Stiffness Can Predict the Rate of Functional Progression in Glaucoma Suspects. Invest Ophthalmol Vis Sci 2023; 64:30. [PMID: 37335567 PMCID: PMC10284309 DOI: 10.1167/iovs.64.7.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
Purpose Tissue stiffening and alterations in retinal blood flow have both been suggested as causative mechanisms of glaucomatous damage. We tested the hypothesis that retinal blood vessels also stiffen, using laser speckle flowgraphy (LSFG) to characterize vascular resistance. Methods In the longitudinal Portland Progression Project, 231 eyes of 124 subjects received LSFG scans of the optic nerve head (ONH) and automated perimetry every 6 months for six visits. Eyes were classified as either "glaucoma suspect" or "glaucoma" eyes based on the presence of functional loss on the first visit. Vascular resistance was quantified using the mean values of several instrument-defined parameterizations of the pulsatile waveform measured by LSFG, either in major vessels within the ONH (serving the retina) or in capillaries within ONH tissue, and age-adjusted using a separate group of 127 healthy eyes of 63 individuals. Parameters were compared against the severity and rate of change of functional loss using mean deviation (MD) over the six visits, within the two groups. Results Among 118 "glaucoma suspect" eyes (average MD, -0.4 dB; rate, -0.45 dB/y), higher vascular resistance was related to faster functional loss, but not current severity of loss. Parameters measured in major vessels were stronger predictors of rate than parameters measured in tissue. Among 113 "glaucoma" eyes (average MD, -4.3 dB; rate, -0.53 dB/y), higher vascular resistance was related to more severe current loss but not rate of loss. Conclusions Higher retinal vascular resistance and, by likely implication, stiffer retinal vessels were associated with more rapid functional loss in eyes without significant existing loss at baseline.
Collapse
Affiliation(s)
| | - Grant Cull
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| |
Collapse
|
4
|
Mauschitz MM, Lohner V, Koch A, Stöcker T, Reuter M, Holz FG, Finger RP, Breteler MMB. Retinal layer assessments as potential biomarkers for brain atrophy in the Rhineland Study. Sci Rep 2022; 12:2757. [PMID: 35177781 PMCID: PMC8854401 DOI: 10.1038/s41598-022-06821-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/20/2022] [Indexed: 01/09/2023] Open
Abstract
Retinal assessments have been discussed as biomarkers for brain atrophy. However, available studies did not investigate all retinal layers due to older technology, reported inconsistent results, or were based on small sample sizes. We included 2872 eligible participants of the Rhineland Study with data on spectral domain-optical coherence tomography (SD-OCT) and brain magnetic resonance imaging (MRI). We used multiple linear regression to examine relationships between retinal measurements and volumetric brain measures as well as fractional anisotropy (FA) as measure of microstructural integrity of white matter (WM) for different brain regions. Mean (SD) age was 53.8 ± 13.2 years (range 30-94) and 57% were women. Volumes of the inner retina were associated with total brain and grey matter (GM) volume, and even stronger with WM volume and FA. In contrast, the outer retina was mainly associated with GM volume, while both, inner and outer retina, were associated with hippocampus volume. While we extend previously reported associations between the inner retina and brain measures, we found additional associations of the outer retina with parts of the brain. This indicates that easily accessible retinal SD-OCT assessments may serve as biomarkers for clinical monitoring of neurodegenerative diseases and merit further research.
Collapse
Affiliation(s)
- Matthias M. Mauschitz
- grid.424247.30000 0004 0438 0426Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1/99, 53127 Bonn, Germany ,grid.15090.3d0000 0000 8786 803XDepartment of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Valerie Lohner
- grid.424247.30000 0004 0438 0426Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1/99, 53127 Bonn, Germany
| | - Alexandra Koch
- grid.424247.30000 0004 0438 0426Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1/99, 53127 Bonn, Germany
| | - Tony Stöcker
- grid.424247.30000 0004 0438 0426MR Physics, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany ,grid.10388.320000 0001 2240 3300Department of Physics and Astronomy, University of Bonn, Bonn, Germany
| | - Martin Reuter
- grid.424247.30000 0004 0438 0426Image Analysis, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Frank G. Holz
- grid.15090.3d0000 0000 8786 803XDepartment of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Robert P. Finger
- grid.15090.3d0000 0000 8786 803XDepartment of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Monique M. B. Breteler
- grid.424247.30000 0004 0438 0426Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1/99, 53127 Bonn, Germany ,grid.10388.320000 0001 2240 3300Institute for Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| |
Collapse
|
5
|
Hong KL, Burkemper B, Urrea AL, Chang BR, Lee JC, LeTran VH, Chu Z, Zhou X, Xu BY, Wong BJ, Song BJ, Jiang X, Wang RK, Varma R, Richter GM. Hemiretinal Asymmetry in Peripapillary Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes. Am J Ophthalmol 2021; 230:156-165. [PMID: 34102157 DOI: 10.1016/j.ajo.2021.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate hemiretinal asymmetry in radial peripapillary capillary vessel area density (VAD) of healthy, glaucoma suspect, and glaucoma eyes of varying severity and its diagnostic utility for glaucoma. DESIGN Population-based, cross-sectional study. METHODS Optic disc scans (6 × 6 mm) were collected on optical coherence tomography angiography (OCTA) to obtain VAD and on optical coherence tomography (OCT) to measure circumpapillary retinal nerve fiber layer (RNFL) thickness. Hemiretinal difference in VAD (hdVAD) was defined as the absolute difference between superior and inferior hemiretinal VAD. Age-adjusted multivariable linear regression of hdVAD on glaucoma severity was performed. Areas under curves (AUCs) were calculated from predicted probabilities generated by multiple logistic regression of glaucoma severity on age-adjusted single and combined parameters. RESULTS A total of 1,043 eyes of 1,043 participants (587 healthy, 270 suspect, 67 mild, 54 moderate, 65 severe glaucoma) were included. After age adjustment, mean hdVAD was similar between healthy and suspect (P = .225), higher in mild vs suspect (P < .001), and higher in moderate vs mild (P = .018), but lower in severe vs moderate (P = .001). AUCs of hdVAD were highest for discriminating mild (0.685) and moderate (0.681) glaucoma from healthy. Combining hdVAD and global RNFL (gRNFL) yielded the highest AUCs of all parameters for mild (0.818) and any POAG (0.859) and resulted in significantly better diagnostic accuracy than either hdVAD or gRNFL alone (P < .05 for all comparisons). CONCLUSIONS hdVAD is higher in early glaucoma and may help with early detection when damage is focal, but its diagnostic ability appears less robust in advanced glaucoma when damage is diffuse.
Collapse
|
6
|
Koenig SF, Hirneiss CW. Changes of Neuroretinal Rim and Retinal Nerve Fiber Layer Thickness Assessed by Optical Coherence Tomography After Filtration Surgery in Glaucomatous Eyes. Clin Ophthalmol 2021; 15:2335-2344. [PMID: 34113077 PMCID: PMC8184240 DOI: 10.2147/opth.s298045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose Lowering the intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) with filtration surgery can induce morphological changes to the bulbus and structures of the retina. In this study, we have evaluated changes of Bruch's membrane-based parameters and retinal nerve fiber layer (RNFL) derived by spectral-domain optical coherence tomography (SD-OCT) in eyes that have undergone glaucoma filtration surgery. Patients and Methods SD-OCT imaging of the optic nerve head (ONH) and of the RNFL was performed in 54 eyes of 54 patients with medically uncontrolled POAG before and after IOP-lowering surgery (trabeculectomy or deep sclerectomy). The ONH parameter minimum rim width (MRW) and the size of the Bruch's membrane opening (BMO-Area) were derived from 24 radial B-scans centered on the ONH. Results The average preoperative IOP was 23.1 ± 7.5 mmHg. One month postoperatively, the average IOP decreased to 12.1 ± 4.6 mmHg (p < 0.01), which caused a significant increase in the thickness of neuroretinal rim. There was no significant change in the automatically detected BMO-Area (p = 0.32). The pressure-related increase in MRW correlated well with the postoperative IOP and cup-to-disc ratio (CDR). In regression analysis, the alteration in thickness of the neuroretinal rim could be well predicted in a model including CDR, change of IOP and mean deviation (MD) (R2 = 0.414, p < 0.001). RNFL showed a significant increase as well. Conclusion IOP-lowering surgery in patients with medically uncontrolled POAG causes an increased thickness of the SD-OCT derived ONH parameters. The changes of the RNFL after surgery showed no significant correlations with IOP changes. In contrast to this, highly significant correlations of MRW values with the IOP could be observed. The BMO-Area remained completely stable A preferred use of RNFL for follow-up should be discussed.
Collapse
|
7
|
Gardiner SK, Mansberger SL, Fortune B. Time Lag Between Functional Change and Loss of Retinal Nerve Fiber Layer in Glaucoma. Invest Ophthalmol Vis Sci 2021; 61:5. [PMID: 33141891 PMCID: PMC7645201 DOI: 10.1167/iovs.61.13.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose It is often suggested that structural change is detectable before functional change in glaucoma. However, this may be related to the lower variability and hence narrower normative limits of structural tests. In this study, we ask whether a time lag exists between the true rates of change in structure and function, regardless of clinical detectability of those changes. Methods Structural equation models were used to determine whether the rate of change in function (mean linearized total deviation, AveTDLin) or structure (retinal nerve fiber layer thickness [RNFLT]) was predicted by the concurrent or previous rate for the other modality, after adjusting for its own rate in the previous time interval. Rates were calculated over 1135 pairs of consecutive visits from 318 eyes of 164 participants in the Portland Progression Project, with mean 207 days between visits. Results The rate of change of AveTDLin was predicted by its own rate in the previous time interval, but not by rates of RNFLT change in either the concurrent or previous time interval (both P > 0.05). Similarly, the rate of RNFLT change was not predicted by concurrent AveTDLin change after adjusting for its own previous rate. However, the rate of AveTDLin change in the previous time interval did significantly improve prediction of the current rate for RNFLT, with P = 0.005, suggesting a time lag of around six months between changes in AveTDLin and RNFLT. Conclusions Although RNFL thinning may be detectable sooner, true functional change appears to predict and precede thinning of the RNFL in glaucoma.
Collapse
Affiliation(s)
- Stuart K Gardiner
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Steven L Mansberger
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute, Legacy Research Institute, Portland, Oregon, United States
| |
Collapse
|
8
|
Fieß A, Nickels S, Urschitz MS, Münzel T, Wild PS, Beutel ME, Lackner KJ, Hoffmann EM, Pfeiffer N, Schuster AK. Association of Birth Weight with Peripapillary Retinal Nerve Fiber Layer Thickness in Adulthood—Results from a Population-Based Study. ACTA ACUST UNITED AC 2020; 61:4. [PMID: 35917383 PMCID: PMC7425698 DOI: 10.1167/iovs.61.8.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose Low birth weight is associated with altered retinal development in childhood, including reduced peripapillary retinal nerve fiber layer (pRNFL) thickness. However, to the best of our knowledge, no population-based study has analyzed the relationship of low birth weight to pRNFL thickness in adulthood. The purpose of this study was to investigate whether birth weight has a long-term effect on pRNFL thickness in adulthood. Methods In the German population-based Gutenberg Health Study (GHS), participants were examined with spectral-domain optical coherence tomography using a peripapillary scan and automated measurement of pRNFL thickness as a global parameter and in six sectors. The association between self-reported birth weight and the different pRNFL sectors were analyzed with multivariable linear regression, adjusted for potential confounders including sex, age, axial length, self-reported age-related macular degeneration, and glaucoma. Results In 3,028 participants, self-reported birth weight was documented and pRNFL measurements were successfully performed (1632 females, ages 54.9 ± 10.0 years). After adjustment for several confounders in the multivariable model, a positive association was observed between birth weight and pRNFL thickness in the global sector (β = 0.13 µm/100 g; 95% CI, 0.08–0.18; P < 0.001; R2 = 0.007) and especially in the inferotemporal sector (β = 0.22 µm/100 g; 95% CI, 0.15–0.29; P < 0.001; R2 = 0.008) and inferonasal sector (β = 0.28 µm/100 g; 95% CI, 0.17–0.39; P < 0.001; R2 = 0.005). Conclusions Our data show that there is a weak relationship between birth weight and pRNFL thickness in adulthood. This weak association is particularly present in the inferior part of the optic nerve head. Therefore, low birth weight may have an impact on optic nerve head development and potentially on ocular disease development.
Collapse
Affiliation(s)
- Achim Fieß
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Nickels
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael S. Urschitz
- Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology–Cardiology I, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine/Center for Cardiology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Esther M. Hoffmann
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander K. Schuster
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| |
Collapse
|
9
|
Ward DD, Mauschitz MM, Bönniger MM, Merten N, Finger RP, Breteler MMB. Association of retinal layer measurements and adult cognitive function: A population-based study. Neurology 2020; 95:e1144-e1152. [PMID: 32586900 DOI: 10.1212/wnl.0000000000010146] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/03/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To quantify the associations of peripapillary retinal nerve fiber layer (pRNFL) thickness and macular ganglion cell layer (mGCL) volume with cognitive functioning and to investigate how demographic and vascular health factors affect these associations in a population-based sample of adults. METHODS The sample included the first 3,000 participants (age range 30-95 years) of the Rhineland Study (recruited from March 2016 to December 2018) who underwent spectral-domain optical coherence tomography and cognitive assessment at 1 of 2 identical study centers in Bonn, Germany. We used multiple linear regression models to examine the relationships between retinal layer measurements and cognitive functioning after adjustment for confounders, and we examined the moderating effects of demographic and vascular health factors. RESULTS The analytical sample included 2,483 participants who were 54.3 years old (SD 13.8 years) on average. After full adjustment, each 1-SD decrease in mGCL volume was associated with a greater decrease in global function than that of pRNFL thickness (β = -0.048 [95% confidence interval (CI) -0.077 to -0.018] vs β = -0.021 [95% CI -0.049 to 0.007]). These relationships increased in strength with advancing age, were stronger in participants with hypertension, and were reversed in current smokers relative to nonsmokers. CONCLUSIONS mGCL volume is more strongly related to adult cognitive functioning than pRNFL thickness, making it a better potential biomarker of neurodegeneration. Age and vascular health factors play important roles in determining the strength and direction of this association.
Collapse
Affiliation(s)
- David D Ward
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Matthias M Mauschitz
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Meta M Bönniger
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Natascha Merten
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Robert P Finger
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison
| | - Monique M B Breteler
- From Population Health Sciences (D.D.W., M.M.M., M.M.B., N.M., M.M.B.B.), German Center for Neurodegenerative Diseases; Department of Ophthalmology (M.M.M., R.P.F.) and Institute for Medical Biometry, Informatics and Epidemiology (M.M.B.B.), Faculty of Medicine, University of Bonn, Germany; and Department of Population Health Sciences (N.M.), School of Medicine and Public Health, University of Wisconsin-Madison.
| |
Collapse
|
10
|
Optical Coherence Tomography Segmentation Errors of the Retinal Nerve Fiber Layer Persist Over Time. J Glaucoma 2020; 28:368-374. [PMID: 30855415 DOI: 10.1097/ijg.0000000000001222] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRéCIS:: There are errors in automated segmentation of the retinal nerve fiber layer (RNFL) in glaucoma suspects or patients with mild glaucoma that appear to persist over time; however, automated segmentation has greater repeatability than manual segmentation. PURPOSE To identify whether optical coherence tomography (OCT) segmentation errors in RNFL thickness measurements persist longitudinally. METHODS This was a cohort study. We used spectral domain OCT (Spectralis) to measure RNFL thickness in a 6-degree peripapillary circle, and exported the native "automated segmentation only" results. In addition, we exported RNFL thickness results after "manual refinement" to correct errors in the automated segmentation, and used the differences in these measurements as "error" in segmentation. We used Bland-Altman plots and linear regression to determine the magnitude, location, and repeatability of RNFL thickness error in all twelve 30-degree sectors and compared the error at baseline to follow-up time points at 6 months, 2 years, 3 years, and 4 years. RESULTS We included 406 eyes from 213 participants. The 95% confidence interval for errors at baseline was -6.5 to +13.2 μm. The correlation between the baseline error and the errors in the follow-up time periods were high (r>0.5, P<0.001 for all). Automated segmentation had a smaller SD of residuals from the longitudinal trend line when compared to manual refinement (1.56 vs. 1.80 μm, P<0.001), and a higher ability (P=0.009) to monitor progression using an analysis of a longitudinal signal-to-noise ratio. CONCLUSIONS Errors in automated segmentation remain relatively stable, and baseline error is highly likely to persist in the same direction and magnitude in subsequent time periods. However, automated segmentation (without manual refinement) is more repeatable and may be more sensitive to glaucomatous progression. Future segmentation algorithms could exploit these findings to improve automated segmentation in the future.
Collapse
|
11
|
Gardiner SK, Cull G, Fortune B, Wang L. Increased Optic Nerve Head Capillary Blood Flow in Early Primary Open-Angle Glaucoma. Invest Ophthalmol Vis Sci 2019; 60:3110-3118. [PMID: 31323681 PMCID: PMC6645706 DOI: 10.1167/iovs.19-27389] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Blood flow in the optic nerve head (ONH) is known to be reduced in eyes with advanced glaucoma. However, experimental results from non-human primates suggest an initial increase in ONH blood flow at the earliest stages of damage. This study assesses flow and pulsatile hemodynamics across a range of severities to test the hypothesis that this also occurs in human glaucoma. Methods Laser speckle flowgraphy was used to measure average mean blur rate (MBRave) within ONH tissue (a correlate of capillary blood flow) and the pulsatile waveform in 93 eyes with functional loss and 74 glaucoma suspect/fellow eyes without functional loss. These were compared against results from 92 healthy control eyes. Parameters produced by the instrument's software were age-corrected, then compared between groups using generalized estimating equation models. Results The mean MBRave in the control eyes was 12.5 units. In glaucoma suspect/fellow eyes, the mean was 16.4 units, higher with P < 0.0001. In eyes with functional loss, the mean was 13.8 units, lower than eyes without functional loss with P < 0.0001, although still higher than control eyes with P = 0.0096. Analysis of the pulsatile waveform suggested that the deceleration in flow as it approaches its maximum across the cardiac cycle was delayed in glaucoma. Conclusions Blood flow within ONH capillaries was higher in glaucoma suspect eyes than in healthy controls. It was less elevated in eyes that had developed functional loss. The mechanisms causing these changes and their relation to concurrent changes in pulsatile hemodynamics remain under investigation.
Collapse
Affiliation(s)
- Stuart K Gardiner
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Grant Cull
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Brad Fortune
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| | - Lin Wang
- Devers Eye Institute, Legacy Health, Portland, Oregon, United States
| |
Collapse
|
12
|
Mauschitz MM, Holz FG, Finger RP, Breteler MMB. Determinants of Macular Layers and Optic Disc Characteristics on SD-OCT: The Rhineland Study. Transl Vis Sci Technol 2019; 8:34. [PMID: 31183250 PMCID: PMC6549562 DOI: 10.1167/tvst.8.3.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/17/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate variation and determinants of macular layers, peripapillary retinal nerve fiber layer (pRNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) in the general population. Methods In 1306 participants, we performed spectral domain optical coherence tomography (SD-OCT) scans of the macula, pRNFL, and BMO-MRW, and assessed their determinants using multivariable regression. Intraindividual interocular differences were analyzed using Spearman's rank correlation analysis. Results Participant age ranged from 30 to 95 years (mean ± standard deviation, 56.1 ± 13.9) and 56% were women. Interocular correlation ranged from 0.63 to 0.93. Differences increased with age and were larger in persons with glaucoma or prior stroke. pRNFL and BMO-MRW decreased with increasing age. Except for RNFL, volumes of various inner macular layers and the outer nuclear layer (ONL) decreased with increasing age, more negative spherical equivalent (SE), and were lower in women compared to men. For some layers, age effects amplified over the life course. History of stroke was associated with smaller volumes of various layers, without reaching statistical significance. We found no association of further systemic parameters with any SD-OCT parameter. Conclusions We provide large-scale normative data from a Caucasian general population for various SD-OCT measures. Interocular variability increased with age and specific pathology. Factors, such as age, sex, refraction, and a history of stroke, were associated with various retinal assessments. Translational Relevance In clinical routine, our findings should be considered on a per eye basis when interpreting SD-OCT volumes, pRNFL, or BMO-MRW to avoid confounded results.
Collapse
Affiliation(s)
- Matthias M Mauschitz
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Ophthalmology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Monique M B Breteler
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Institute for Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| |
Collapse
|
13
|
Rao A, Kaza H, Padhy D, Das G, Sarangi S. Anatomical Characterization of an Optic Disc Notch Using SD-OCT in Glaucoma. Semin Ophthalmol 2018; 33:878-885. [PMID: 30395770 DOI: 10.1080/08820538.2018.1540709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To characterize anatomical dimensions of a disc notch using novel methods using spectral domain optical coherence tomography (SD-OCT). PARTICIPANTS All age- and severity-matched glaucoma patients with disc notch (defined as complete loss of neural rim with no residual rim between disc and cup) seen from 2014 to 2015 who underwent enhanced depth imaging with SD-OCT (Cirrus HD-OCT version 6.5, Carl Zeiss, USA) were included for this retrospective observational study. METHODS Using known dimensions of the 200 * 200 optic disc cube (6 * 6 mm), the notch width was calculated from the margins of the notch on either side using ImageJ software. The height was calculated from the lowest margin of the cup to the lowest point of the defect on the optic disc. These were compared with the quadrant retinal nerve fiber layer (qRNFT) and sectoral retinal nerve fiber layer (sRNFLT) thickness in notch and the sector 2 clock hours adjacent to the notch region (SaRNFLT). RESULTS The height and width of the notch in 31 eyes of 27 patients were 2.6 ± 0.48 mm and 2.23 ± 0.31 mm. The RNFL thickness in the same sector as that of the notch was 41 ± 21.06 µm while the adjacent two sectors measured 62 ± 26.5 and 64 ± 26.5 µm on either sides of the sector of the notch. The difference between the sRNFLT and saRNFLT ranged from -9 to 67 and -13 to 50 µm, respectively. This difference was significantly associated with height of the notch (R2 = 20.8, p = 0.01). CONCLUSION Automated analysis of a notch and RNFL thickness in that sector can help in precise glaucoma monitoring in the region of interest.
Collapse
Affiliation(s)
- Aparna Rao
- a Glaucoma service , LV Prasad Eye Institute , Bhubaneswar , India
| | - Hrishikesh Kaza
- a Glaucoma service , LV Prasad Eye Institute , Bhubaneswar , India
| | - Debananda Padhy
- a Glaucoma service , LV Prasad Eye Institute , Bhubaneswar , India
| | - Gopinath Das
- a Glaucoma service , LV Prasad Eye Institute , Bhubaneswar , India
| | - Sarada Sarangi
- a Glaucoma service , LV Prasad Eye Institute , Bhubaneswar , India
| |
Collapse
|
14
|
Structural Reversal of Disc Cupping After Trabeculectomy Alters Bruch Membrane Opening-Based Parameters to Assess Neuroretinal Rim. Am J Ophthalmol 2018; 194:143-152. [PMID: 30053469 DOI: 10.1016/j.ajo.2018.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/13/2018] [Accepted: 07/15/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the impact of trabeculectomy for glaucoma on morphometric neuroretinal parameters of the optic nerve head (ONH) using spectral-domain optical coherence tomography (SD-OCT). DESIGN Retrospective, interventional case series. METHODS Participants: Eighty-eight eyes of 88 patients who underwent trabeculectomy with mitomycin C in 2016. INTERVENTION All patients underwent trabeculectomy in 1 eye (study eye) and had evaluable SD-OCT examinations of the ONH to measure neuroretinal tissue before and at least at 1 of the 3-, 6-, and 12-month follow-up time points after surgery. MAIN OUTCOME MEASURES Longitudinal change in Bruch membrane opening minimum rim width (BMO-MRW), Bruch membrane opening minimum rim area (BMO-MRA), peripapillary retinal nerve fiber layer (RNFL) thickness, intraocular pressure (IOP), and mean deviation in perimetry. RESULTS In study eyes, BMO-MRW significantly increased postsurgically comparing baseline and follow-up examinations at 3 months (P = .012), at 6 months (P = .007), and at 1 year (P = .010) after trabeculectomy. The increase in BMO-MRW 6 months after surgery correlated with IOP reduction (r = 0.48; P = .001). BMO-MRA showed an equal increase (P ≤ .034). RNFL thickness remained stable between baseline and follow-up at 3, 6, and 12 months and showed a moderate loss after 18 months (P = .021) of follow-up. CONCLUSIONS Structural reversal of disc cupping after trabeculectomy markedly influences Bruch membrane opening-based parameters for up to more than 1 year. Improvement in morphometry seems to correlate with the reduction of IOP while visual field function appears not to be influenced. In longitudinal follow-up of glaucoma patients by SD-OCT, evaluation of BMO-based parameters necessitates to reflect bias caused by surgery.
Collapse
|
15
|
Subramaniam S, Jeoung JW, Lee WJ, Kim YK, Park KH. Three dimensional neuro-retinal rim thickness and retinal nerve fiber layer thickness using high-definition optical coherence tomography for open-angle glaucoma. Jpn J Ophthalmol 2018; 62:634-642. [PMID: 30229404 DOI: 10.1007/s10384-018-0620-7] [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: 12/28/2017] [Accepted: 08/06/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the diagnostic capability of three-dimensional (3D) neuro-retinal rim thickness (NRR) with existing optic nerve head and retinal nerve fiber layer (RNFL) scan parameters using high-definition optical coherence tomography (HD-OCT). DESIGN Retrospective study. METHODS Based on the mean deviation (MD) of the Humphrey Field Analyzer (HFA), the 152 subjects were categorized into mild (MD > - 6 dB, 100), moderate (MD - 6 to - 12 dB, 26), and severe (MD < - 12 dB, 26) glaucoma. The HD-OCT values of NRR, RNFL and ganglion cell inner plexiform layer (GCIPL) thicknesses, along with those of other parameters (rim area, disc area) were obtained, and the average NRR thickness was calculated. RESULTS For all of the HD-OCT parameters, RNFL thickness showed a higher area under the ROC (AUROC) curve (range: 0.937-1.000) than did NRR thickness (range: 0.827-1.000). There were significant RNFL, NRR, and GCIPL AUROC curve differences among the mild, moderate and severe glaucoma groups. RNFL thickness for mild glaucoma showed a significantly larger area than did NRR thickness [area difference: 0.110 (± 0.025); p value < 0.0001). Furthermore, RNFL relative to NRR thickness yielded higher sensitivity (85-100% vs. 72-100%) and specificity (89-100% vs. 84-100%) for diagnosis of glaucoma. CONCLUSION RNFL thickness remains significantly better than 3D NRR thickness in terms of glaucoma-diagnostic capability in HD-OCT.
Collapse
Affiliation(s)
- Suresh Subramaniam
- Department of Ophthalmology, Seoul National University Hospital, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Star, Kedah, Malaysia
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Won June Lee
- Department of Ophthalmology, Seoul National University Hospital, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
16
|
Rampersad N, Hansraj R. Repeatability and reproducibility of retinal nerve fibre layer thickness measurements with the iVue-100 optical coherence tomographer. Afr Health Sci 2018; 18:304-312. [PMID: 30602957 PMCID: PMC6306963 DOI: 10.4314/ahs.v18i2.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Accurate and repeatable measurements of the retinal nerve fibre layer (RNFL) thickness are important in the diagnosis and management of glaucoma and other disorders. OBJECTIVE To assess the repeatability and reproducibility of the iVue-100 optical coherence tomographer (OCT). METHODS The thickness of the RNFL was measured for 50 healthy participants using the iVue-100 OCT. Although both eyes per participant were measured, only right eyes were analysed here. Repeatability and reproducibility of the iVue-100 OCT were assessed using the intraclass correlation coefficient (ICC), coefficient of variation (CoV), paired t-tests and Bland-Altman analysis. RESULTS Good intra-observer repeatability was obtained as indicated by the ICC of observer 1 (range: 0.941 - 0.976) and observer 2 (range: 0.829 - 0.953) as well by the CoV of observer 1 (range: 0.098 - 0.137) and observer 2 (0.091 - 0.132). In terms of inter-observer reproducibility, significant differences (p< 0.05) in mean measurements between the observers were noted for the average RNFL readings and in the superior and inferior quadrants as assessed with paired t-tests. Even though significant inter-session differences were found for the average RNFL thickness and the superior quadrant (p = 0.003 and p = 0.013, respectively), excellent ICCs were obtained for inter-session reproducibility (range: 0.914 - 0.979). CONCLUSION The iVue-100 OCT demonstrated good repeatability and reproducibility for RNFL thickness measurements.
Collapse
Affiliation(s)
- Nishanee Rampersad
- Discipline of Optometry School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rekha Hansraj
- Discipline of Optometry School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
17
|
Mauschitz MM, Bonnemaijer PWM, Diers K, Rauscher FG, Elze T, Engel C, Loeffler M, Colijn JM, Ikram MA, Vingerling JR, Williams KM, Hammond CJ, Creuzot-Garcher C, Bron AM, Silva R, Nunes S, Delcourt C, Cougnard-Grégoire A, Holz FG, Klaver CCW, Breteler MMB, Finger RP. Systemic and Ocular Determinants of Peripapillary Retinal Nerve Fiber Layer Thickness Measurements in the European Eye Epidemiology (E3) Population. Ophthalmology 2018; 125:1526-1536. [PMID: 29716786 DOI: 10.1016/j.ophtha.2018.03.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate systemic and ocular determinants of peripapillary retinal nerve fiber layer thickness (pRNFLT) in the European population. DESIGN Cross-sectional meta-analysis. PARTICIPANTS A total of 16 084 European adults from 8 cohort studies (mean age range, 56.9±12.3-82.1±4.2 years) of the European Eye Epidemiology (E3) consortium. METHODS We examined associations with pRNFLT measured by spectral-domain OCT in each study using multivariable linear regression and pooled results using random effects meta-analysis. MAIN OUTCOME MEASURES Determinants of pRNFLT. RESULTS Mean pRNFLT ranged from 86.8±21.4 μm in the Rotterdam Study I to 104.7±12.5 μm in the Rotterdam Study III. We found the following factors to be associated with reduced pRNFLT: Older age (β = -0.38 μm/year; 95% confidence interval [CI], -0.57 to -0.18), higher intraocular pressure (IOP) (β = -0.36 μm/mmHg; 95% CI, -0.56 to -0.15), visual impairment (β = -5.50 μm; 95% CI, -9.37 to -1.64), and history of systemic hypertension (β = -0.54 μm; 95% CI, -1.01 to -0.07) and stroke (β = -1.94 μm; 95% CI, -3.17 to -0.72). A suggestive, albeit nonsignificant, association was observed for dementia (β = -3.11 μm; 95% CI, -6.22 to 0.01). Higher pRNFLT was associated with more hyperopic spherical equivalent (β = 1.39 μm/diopter; 95% CI, 1.19-1.59) and smoking (β = 1.53 μm; 95% CI, 1.00-2.06 for current smokers compared with never-smokers). CONCLUSIONS In addition to previously described determinants such as age and refraction, we found that systemic vascular and neurovascular diseases were associated with reduced pRNFLT. These may be of clinical relevance, especially in glaucoma monitoring of patients with newly occurring vascular comorbidities.
Collapse
Affiliation(s)
- Matthias M Mauschitz
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Pieter W M Bonnemaijer
- Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Kersten Diers
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Franziska G Rauscher
- Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Tobias Elze
- Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts
| | - Christoph Engel
- Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Markus Loeffler
- Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Johanna Maria Colijn
- Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Katie M Williams
- Section of Academic Ophthalmology, School of Life Course Sciences, FoLSM, King's College London, London, United Kingdom
| | - Christopher J Hammond
- Section of Academic Ophthalmology, School of Life Course Sciences, FoLSM, King's College London, London, United Kingdom
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, University Hospital Dijon, Dijon, France; Eye and Nutrition Research Group, University of Bourgogne Franche Comté, Dijon, France
| | - Alain M Bron
- Department of Ophthalmology, University Hospital Dijon, Dijon, France; Eye and Nutrition Research Group, University of Bourgogne Franche Comté, Dijon, France
| | - Rufino Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Institute for Biomedical Imaging and Life Sciences, Coimbra, Portugal; Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Sandrina Nunes
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Cécile Delcourt
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, Bordeaux, France
| | - Audrey Cougnard-Grégoire
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, Bordeaux, France
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Monique M B Breteler
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
| | | |
Collapse
|