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Hermas A, Tsilfidis C, Karanjia R, Miller G, Kantungane AL, El-Salibi A, Kherani IN, Bali S, Coupland S. Sensitivity and specificity of the uniform field electroretinogram in glaucoma detection in comparison to the pattern electroretinogram. Doc Ophthalmol 2024; 148:97-106. [PMID: 38243039 DOI: 10.1007/s10633-023-09960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/06/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE To determine the ability of the photopic negative response (PhNR) of the uniform field electroretinogram (UF-ERG) to identify early glaucomatous changes in comparison to the checkerboard and bar stimuli of the pattern electroretinogram (PERG). METHODS Forty-nine glaucoma patients were classified into two groups: glaucoma-suspect (23 eyes) and early to moderate glaucoma (30 eyes), based on their clinical examination and the results of standard automated perimetry. Thirty patients (30 eyes) with intraocular pressures (IOP) of 21 mmHg or less, with no history of reported high IOP, were included as controls. PERG and UF-ERG recordings were obtained on a Diagnosys D-341 Attaché-Envoy System. Visual field testing was done only for glaucoma-suspect and glaucoma patients. RESULTS All three tests (PERG bar stimulus, PERG checkerboard stimulus and PhNR) displayed significantly prolonged peak times for glaucoma and glaucoma-suspect patients, with delays ranging from 7.8 to 14.8%, depending on the test. The PERG bar stimulus also showed a significantly lower N95 amplitude for both glaucoma groups (with reductions of 26.0% and 33.0% for glaucoma-suspect and glaucoma groups, respectively). The PERG checkerboard N95 amplitude component had high sensitivity for detecting glaucoma patients but a low specificity (97% and 37%, respectively; AUC = 0.61). Overall, the PhNR peak time showed the highest sensitivity and specificity (77% and 90%, respectively; AUC = 0.87). CONCLUSIONS PERG bar stimuli and the PhNR of the UF-ERG can be used in the clinical setting to detect glaucoma-related changes in glaucoma-suspect and glaucoma patients. However, our data confirm that the PhNR peak time has the best combined sensitivity and specificity.
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Affiliation(s)
- Asma Hermas
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Catherine Tsilfidis
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rustum Karanjia
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Garfield Miller
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Ange-Lynca Kantungane
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| | | | - Irfan N Kherani
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada
| | - Shveta Bali
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Stuart Coupland
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
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Seo H, Chung WG, Kwon YW, Kim S, Hong YM, Park W, Kim E, Lee J, Lee S, Kim M, Lim K, Jeong I, Song H, Park JU. Smart Contact Lenses as Wearable Ophthalmic Devices for Disease Monitoring and Health Management. Chem Rev 2023; 123:11488-11558. [PMID: 37748126 PMCID: PMC10571045 DOI: 10.1021/acs.chemrev.3c00290] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Indexed: 09/27/2023]
Abstract
The eye contains a complex network of physiological information and biomarkers for monitoring disease and managing health, and ocular devices can be used to effectively perform point-of-care diagnosis and disease management. This comprehensive review describes the target biomarkers and various diseases, including ophthalmic diseases, metabolic diseases, and neurological diseases, based on the physiological and anatomical background of the eye. This review also includes the recent technologies utilized in eye-wearable medical devices and the latest trends in wearable ophthalmic devices, specifically smart contact lenses for the purpose of disease management. After introducing other ocular devices such as the retinal prosthesis, we further discuss the current challenges and potential possibilities of smart contact lenses.
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Affiliation(s)
- Hunkyu Seo
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Won Gi Chung
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Yong Won Kwon
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Sumin Kim
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Yeon-Mi Hong
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Wonjung Park
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Enji Kim
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Jakyoung Lee
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Sanghoon Lee
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Moohyun Kim
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Kyeonghee Lim
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Inhea Jeong
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Hayoung Song
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
| | - Jang-Ung Park
- Department
of Materials Science and Engineering, Yonsei
University, Seoul 03722, Republic
of Korea
- Department
of Neurosurgery, Yonsei University College
of Medicine, Seoul 03722, Republic of Korea
- Center
for Nanomedicine, Institute for Basic Science (IBS), Yonsei University, Seoul 03722, Republic
of Korea
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Hathibelagal AR, Bharadwaj SR, Jalali S, Subramanian A, Barbur JL. Evaluation of photoreceptor function in inherited retinal diseases using rod- and cone-enhanced flicker stimuli. Ophthalmic Physiol Opt 2021; 41:874-884. [PMID: 33834501 DOI: 10.1111/opo.12799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/21/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Clinical assessment of rod and cone photoreceptor sensitivity often involves the use of extended dark adaptation times to minimise cone involvement or the use of bright adapting backgrounds to saturate rods. In this study we examine a new rod/cone sensitivity test, which requires minimal dark adaptation. The aim was to establish whether rod/cone sensitivity losses could be measured reliably in patients with retinal diseases that selectively affect rods or cones when compared to age-matched subjects with normal vision. METHODS Flicker modulation thresholds (FMTs) were measured psychophysically, using cone- and rod-enhanced stimuli located centrally, and in four quadrants, at 5° retinal eccentricity in 20 patients (age range: 10-41 years) with cone-dominated (Stargardt's disease or macular dystrophy; n = 13) and rod-dominated (retinitis pigmentosa; n = 7) disease. These data were compared against age-matched normals tested with identical stimuli. RESULTS Across all retinal locations, cone FMTs in cone-dominated diseases (Median ± IQR: 32.32 ± 28.15% for central location) were greater than a majority (83%; 49/59) of corresponding rod FMTs (18.7 ± 3.29%; p = 0.05) and cone FMTs of controls (4.24 ± 2.00%). Similarly, rod FMTs in rod-dominant disease (14.99 ± 22.58%) were greater than a majority (88%; 29/39) of the corresponding cone FMTs (9.09 ± 10.33%) (p = 0.13) and rod FMT of controls (6.80 ± 2.60 %). CONCLUSIONS Cone-specific deficits were larger than rod-specific deficits in cone-dominated diseases, and vice versa in rod-dominated disease. These results suggest that the new method of assessing photoreceptor sensitivity has potential application in detecting specific rod/cone losses without the need for dark adaptation.
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Affiliation(s)
- Amithavikram R Hathibelagal
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.,Prof. Brien Holden Eye Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Shrikant R Bharadwaj
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.,Prof. Brien Holden Eye Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Subhadra Jalali
- Srimati. Kanuri Santamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Jasti V Ramanamma Children's Eye Care Centre, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Ahalya Subramanian
- Centre for Applied Vision Research, School of Health Sciences, City, University of London, London, UK
| | - John L Barbur
- Centre for Applied Vision Research, School of Health Sciences, City, University of London, London, UK
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Kim K, Kim B, Lee CH. Printing Flexible and Hybrid Electronics for Human Skin and Eye-Interfaced Health Monitoring Systems. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1902051. [PMID: 31298450 DOI: 10.1002/adma.201902051] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/02/2019] [Indexed: 05/27/2023]
Abstract
Advances in printing materials and techniques for flexible and hybrid electronics in the domain of connected healthcare have enabled rapid development of innovative body-interfaced health monitoring systems at a tremendous pace. Thin, flexible, and stretchable biosensors that are printed on a biocompatible soft substrate provide the ability to noninvasively and unobtrusively integrate with the human body for continuous monitoring and early detection of diseases and other conditions affecting health and well being. Hybrid integration of such biosensors with extremely well-established silicon-based microcircuit chips offers a viable route for in-sensor data processing and wireless transmission in many medical and clinical settings. Here, a set of advanced and hybrid printing techniques is summarized, covering diverse aspects ranging from active electronic materials to process capability, for their use in human skin and eye-interfaced health monitoring systems with different levels of complexity. Essential components of the devices, including constituent biomaterials, structural layouts, assembly methods, and power and data processing configurations, are outlined and discussed in a categorized manner tailored to specific clinical needs. Perspectives on the benefits and challenges of these systems in basic and applied biomedical research are presented and discussed.
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Affiliation(s)
- Kyunghun Kim
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Bongjoong Kim
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, 47907, USA
| | - Chi Hwan Lee
- Weldon School of Biomedical Engineering, School of Mechanical Engineering, Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, 47907, USA
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Soft transparent graphene contact lens electrodes for conformal full-cornea recording of electroretinogram. Nat Commun 2018; 9:2334. [PMID: 29899545 PMCID: PMC5998030 DOI: 10.1038/s41467-018-04781-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/18/2018] [Indexed: 01/23/2023] Open
Abstract
Visual electrophysiology measurements are important for ophthalmic diagnostic testing. Electrodes with combined optical transparency and softness are highly desirable, and sometimes indispensable for many ocular electrophysiology measurements. Here we report the fabrication of soft graphene contact lens electrodes (GRACEs) with broad-spectrum optical transparency, and their application in conformal, full-cornea recording of electroretinography (ERG) from cynomolgus monkeys. The GRACEs give higher signal amplitude than conventional ERG electrodes in recordings of various full-field ERG responses. High-quality topographic mapping of multifocal ERG under simultaneous fundus monitoring is realized. A conformal and tight interface between the GRACEs and cornea is revealed. Neither corneal irritation nor abnormal behavior of the animals is observed after ERG measurements with GRACEs. Furthermore, spatially resolved ERG recordings on rabbits with graphene multi-electrode array reveal a stronger signal at the central cornea than the periphery. These results demonstrate the unique capabilities of the graphene-based electrodes for in vivo visual electrophysiology studies.
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Dielectric relaxation of normothermic and hypothermic rat corneas. Bioelectrochemistry 2015; 101:132-7. [DOI: 10.1016/j.bioelechem.2014.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/29/2014] [Accepted: 08/31/2014] [Indexed: 12/22/2022]
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Carpi F, Benini G, Tomei F, Figliuzzi RM, De Napoli A. Electroretinographic wet electrode. Med Eng Phys 2009; 31:923-9. [PMID: 19501539 DOI: 10.1016/j.medengphy.2009.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 04/24/2009] [Accepted: 05/13/2009] [Indexed: 11/26/2022]
Abstract
This paper presents the first systematic characterisation of a new electroretinographic (ERG) electrode, recently described. The new 'wet' electrode uses a conducting liquid as a distributed electrical interface between the eye and a solid electronic conductor; the latter detects the ERG potential without any direct contact with the ocular surface. This technique avoids the contact-induced discomfort of both corneal and conjunctival standard electrodes. The wet electrode was tested on 10 volunteers, in comparison with a conjunctival electrode (HK loop), as the most comfortable standard. It was also compared with a cutaneous (cup) electrode, which is even more comfortable, although not standard. Results showed the efficacy of the wet electrode for detecting morphologically accurate ERG responses, with amplitudes respectively analogous and higher of those measured by the conjunctival and cutaneous electrodes. Properties of wet electrodes include: no solid interface with the eye, no need for anaesthesia, intrinsic safety, mechanical and electrical stability against ocular movements, tolerance to misplacements and immunity to lacrimation. As a drawback, the liquid can still be a source of discomfort for some patients and it requires care against possible leakage. All these features suggest a possible use of wet electrodes as an additional tool for ERG procedures, although limited to tests of short duration.
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Affiliation(s)
- Federico Carpi
- Interdepartmental Research Center E. Piaggio, School of Engineering, University of Pisa, Pisa, Italy.
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