1
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Gaire BP, Koronyo Y, Fuchs DT, Shi H, Rentsendorj A, Danziger R, Vit JP, Mirzaei N, Doustar J, Sheyn J, Hampel H, Vergallo A, Davis MR, Jallow O, Baldacci F, Verdooner SR, Barron E, Mirzaei M, Gupta VK, Graham SL, Tayebi M, Carare RO, Sadun AA, Miller CA, Dumitrascu OM, Lahiri S, Gao L, Black KL, Koronyo-Hamaoui M. Alzheimer's disease pathophysiology in the Retina. Prog Retin Eye Res 2024; 101:101273. [PMID: 38759947 DOI: 10.1016/j.preteyeres.2024.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
The retina is an emerging CNS target for potential noninvasive diagnosis and tracking of Alzheimer's disease (AD). Studies have identified the pathological hallmarks of AD, including amyloid β-protein (Aβ) deposits and abnormal tau protein isoforms, in the retinas of AD patients and animal models. Moreover, structural and functional vascular abnormalities such as reduced blood flow, vascular Aβ deposition, and blood-retinal barrier damage, along with inflammation and neurodegeneration, have been described in retinas of patients with mild cognitive impairment and AD dementia. Histological, biochemical, and clinical studies have demonstrated that the nature and severity of AD pathologies in the retina and brain correspond. Proteomics analysis revealed a similar pattern of dysregulated proteins and biological pathways in the retina and brain of AD patients, with enhanced inflammatory and neurodegenerative processes, impaired oxidative-phosphorylation, and mitochondrial dysfunction. Notably, investigational imaging technologies can now detect AD-specific amyloid deposits, as well as vasculopathy and neurodegeneration in the retina of living AD patients, suggesting alterations at different disease stages and links to brain pathology. Current and exploratory ophthalmic imaging modalities, such as optical coherence tomography (OCT), OCT-angiography, confocal scanning laser ophthalmoscopy, and hyperspectral imaging, may offer promise in the clinical assessment of AD. However, further research is needed to deepen our understanding of AD's impact on the retina and its progression. To advance this field, future studies require replication in larger and diverse cohorts with confirmed AD biomarkers and standardized retinal imaging techniques. This will validate potential retinal biomarkers for AD, aiding in early screening and monitoring.
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Affiliation(s)
- Bhakta Prasad Gaire
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dieu-Trang Fuchs
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Haoshen Shi
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Altan Rentsendorj
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ron Danziger
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jean-Philippe Vit
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nazanin Mirzaei
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jonah Doustar
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julia Sheyn
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harald Hampel
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Andrea Vergallo
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Miyah R Davis
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ousman Jallow
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Filippo Baldacci
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | | | - Ernesto Barron
- Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Los Angeles, CA, USA
| | - Mehdi Mirzaei
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Vivek K Gupta
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Stuart L Graham
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia; Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - Mourad Tayebi
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Roxana O Carare
- Department of Clinical Neuroanatomy, University of Southampton, Southampton, UK
| | - Alfredo A Sadun
- Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Los Angeles, CA, USA
| | - Carol A Miller
- Department of Pathology Program in Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Shouri Lahiri
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Liang Gao
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Keith L Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Division of Applied Cell Biology and Physiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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2
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Messica S, Presil D, Hoch Y, Lev T, Hadad A, Katz O, Owens DR. Enhancing stroke risk and prognostic timeframe assessment with deep learning and a broad range of retinal biomarkers. Artif Intell Med 2024; 154:102927. [PMID: 38991398 DOI: 10.1016/j.artmed.2024.102927] [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: 01/22/2024] [Revised: 06/15/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024]
Abstract
Stroke stands as a major global health issue, causing high death and disability rates and significant social and economic burdens. The effectiveness of existing stroke risk assessment methods is questionable due to their use of inconsistent and varying biomarkers, which may lead to unpredictable risk evaluations. This study introduces an automatic deep learning-based system for predicting stroke risk (both ischemic and hemorrhagic) and estimating the time frame of its occurrence, utilizing a comprehensive set of known retinal biomarkers from fundus images. Our system, tested on the UK Biobank and DRSSW datasets, achieved AUROC scores of 0.83 (95% CI: 0.79-0.85) and 0.93 (95% CI: 0.9-0.95), respectively. These results not only highlight our system's advantage over established benchmarks but also underscore the predictive power of retinal biomarkers in assessing stroke risk and the unique effectiveness of each biomarker. Additionally, the correlation between retinal biomarkers and cardiovascular diseases broadens the potential application of our system, making it a versatile tool for predicting a wide range of cardiovascular conditions.
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Affiliation(s)
| | - Dan Presil
- NEC Israeli Research Center, Herzliya, Israel
| | - Yaacov Hoch
- NEC Israeli Research Center, Herzliya, Israel
| | - Tsvi Lev
- NEC Israeli Research Center, Herzliya, Israel
| | - Aviel Hadad
- Ophthalmology Department, Soroka University Medical Center, Be'er Sheva, South District, Israel
| | - Or Katz
- NEC Israeli Research Center, Herzliya, Israel
| | - David R Owens
- Swansea University Medical School, Swansea, Wales, UK
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3
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Kong M, Song SJ. Artificial Intelligence Applications in Diabetic Retinopathy: What We Have Now and What to Expect in the Future. Endocrinol Metab (Seoul) 2024; 39:416-424. [PMID: 38853435 PMCID: PMC11220221 DOI: 10.3803/enm.2023.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/11/2024] [Accepted: 04/03/2024] [Indexed: 06/11/2024] Open
Abstract
Diabetic retinopathy (DR) is a major complication of diabetes mellitus and is a leading cause of vision loss globally. A prompt and accurate diagnosis is crucial for ensuring favorable visual outcomes, highlighting the need for increased access to medical care. The recent remarkable advancements in artificial intelligence (AI) have raised high expectations for its role in disease diagnosis and prognosis prediction across various medical fields. In addition to achieving high precision comparable to that of ophthalmologists, AI-based diagnosis of DR has the potential to improve medical accessibility, especially through telemedicine. In this review paper, we aim to examine the current role of AI in the diagnosis of DR and explore future directions.
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Affiliation(s)
- Mingui Kong
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Biomedical Institute for Convergence (BICS), Sungkyunkwan University, Suwon, Korea
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4
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Tan YY, Kang HG, Lee CJ, Kim SS, Park S, Thakur S, Da Soh Z, Cho Y, Peng Q, Tham YC, Rim TH, Cheng CY. Prognostic potentials of AI in ophthalmology: systemic disease forecasting via retinal imaging. EYE AND VISION (LONDON, ENGLAND) 2024; 11:17. [PMID: 38711111 PMCID: PMC11071258 DOI: 10.1186/s40662-024-00384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Artificial intelligence (AI) that utilizes deep learning (DL) has potential for systemic disease prediction using retinal imaging. The retina's unique features enable non-invasive visualization of the central nervous system and microvascular circulation, aiding early detection and personalized treatment plans for personalized care. This review explores the value of retinal assessment, AI-based retinal biomarkers, and the importance of longitudinal prediction models in personalized care. MAIN TEXT This narrative review extensively surveys the literature for relevant studies in PubMed and Google Scholar, investigating the application of AI-based retina biomarkers in predicting systemic diseases using retinal fundus photography. The study settings, sample sizes, utilized AI models and corresponding results were extracted and analysed. This review highlights the substantial potential of AI-based retinal biomarkers in predicting neurodegenerative, cardiovascular, and chronic kidney diseases. Notably, DL algorithms have demonstrated effectiveness in identifying retinal image features associated with cognitive decline, dementia, Parkinson's disease, and cardiovascular risk factors. Furthermore, longitudinal prediction models leveraging retinal images have shown potential in continuous disease risk assessment and early detection. AI-based retinal biomarkers are non-invasive, accurate, and efficient for disease forecasting and personalized care. CONCLUSION AI-based retinal imaging hold promise in transforming primary care and systemic disease management. Together, the retina's unique features and the power of AI enable early detection, risk stratification, and help revolutionizing disease management plans. However, to fully realize the potential of AI in this domain, further research and validation in real-world settings are essential.
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Affiliation(s)
| | - Hyun Goo Kang
- Division of Retina, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Soo Kim
- Division of Retina, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yunnie Cho
- Mediwhale Inc, Seoul, Republic of Korea
- Department of Education and Human Resource Development, Seoul National University Hospital, Seoul, South Korea
| | - Qingsheng Peng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Mediwhale Inc, Seoul, Republic of Korea
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Mediwhale Inc, Seoul, Republic of Korea.
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Centre for Innovation and Precision Eye Health and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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5
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Zhao Y, Dong D, Yan D, Yang B, Gui W, Ke M, Xu A, Tan Z. Increased retinal venule diameter as a prognostic indicator for recurrent cerebrovascular events: a prospective observational study. Neural Regen Res 2024; 19:1156-1160. [PMID: 37862222 PMCID: PMC10749590 DOI: 10.4103/1673-5374.382863] [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: 01/02/2023] [Revised: 03/27/2023] [Accepted: 06/28/2023] [Indexed: 10/22/2023] Open
Abstract
Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations. However, the ability of retinal vasculature changes, specifically focusing on retinal vessel diameter, to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively. While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events, they have not incorporated this information into a predictive model. Therefore, this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke. Additionally, we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors. We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University. All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years. We found that, after adjusting for related risk factors, patients with acute ischemic stroke with mean arteriolar diameter within 0.5-1.0 disc diameters of the disc margin (MAD0.5-1.0DD) of ≥ 74.14 μm and mean venular diameter within 0.5-1.0 disc diameters of the disc margin (MVD0.5-1.0DD) of ≥ 83.91 μm tended to experience recurrent cerebrovascular events. We established three multivariate Cox proportional hazard regression models: model 1 included traditional risk factors, model 2 added MAD0.5-1.0DD to model 1, and model 3 added MVD0.5-1.0DD to model 1. Model 3 had the greatest potential to predict subsequent cerebrovascular events, followed by model 2, and finally model 1. These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke, and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.
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Affiliation(s)
- Ying Zhao
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Dawei Dong
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Ding Yan
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Bing Yang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Weirong Gui
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Man Ke
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Anding Xu
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
- Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Zefeng Tan
- Department of Neurology, the First People’s Hospital of Foshan, Foshan, Guangdong Province, China
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Csiszar A, Ungvari A, Patai R, Gulej R, Yabluchanskiy A, Benyo Z, Kovacs I, Sotonyi P, Kirkpartrick AC, Prodan CI, Liotta EM, Zhang XA, Toth P, Tarantini S, Sorond FA, Ungvari Z. Atherosclerotic burden and cerebral small vessel disease: exploring the link through microvascular aging and cerebral microhemorrhages. GeroScience 2024:10.1007/s11357-024-01139-7. [PMID: 38639833 DOI: 10.1007/s11357-024-01139-7] [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: 02/20/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Cerebral microhemorrhages (CMHs, also known as cerebral microbleeds) are a critical but frequently underestimated aspect of cerebral small vessel disease (CSVD), bearing substantial clinical consequences. Detectable through sensitive neuroimaging techniques, CMHs reveal an extensive pathological landscape. They are prevalent in the aging population, with multiple CMHs often being observed in a given individual. CMHs are closely associated with accelerated cognitive decline and are increasingly recognized as key contributors to the pathogenesis of vascular cognitive impairment and dementia (VCID) and Alzheimer's disease (AD). This review paper delves into the hypothesis that atherosclerosis, a prevalent age-related large vessel disease, extends its pathological influence into the cerebral microcirculation, thereby contributing to the development and progression of CSVD, with a specific focus on CMHs. We explore the concept of vascular aging as a continuum, bridging macrovascular pathologies like atherosclerosis with microvascular abnormalities characteristic of CSVD. We posit that the same risk factors precipitating accelerated aging in large vessels (i.e., atherogenesis), primarily through oxidative stress and inflammatory pathways, similarly instigate accelerated microvascular aging. Accelerated microvascular aging leads to increased microvascular fragility, which in turn predisposes to the formation of CMHs. The presence of hypertension and amyloid pathology further intensifies this process. We comprehensively overview the current body of evidence supporting this interconnected vascular hypothesis. Our review includes an examination of epidemiological data, which provides insights into the prevalence and impact of CMHs in the context of atherosclerosis and CSVD. Furthermore, we explore the shared mechanisms between large vessel aging, atherogenesis, microvascular aging, and CSVD, particularly focusing on how these intertwined processes contribute to the genesis of CMHs. By highlighting the role of vascular aging in the pathophysiology of CMHs, this review seeks to enhance the understanding of CSVD and its links to systemic vascular disorders. Our aim is to provide insights that could inform future therapeutic approaches and research directions in the realm of neurovascular health.
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Affiliation(s)
- Anna Csiszar
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Ungvari
- Department of Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary.
| | - Roland Patai
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rafal Gulej
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Zoltan Benyo
- Institute of Translational Medicine, Semmelweis University, 1094, Budapest, Hungary
- Cerebrovascular and Neurocognitive Disorders Research Group, HUN-REN, Semmelweis University, 1094, Budapest, Hungary
| | - Illes Kovacs
- Department of Ophthalmology, Semmelweis University, 1085, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Peter Sotonyi
- Department of Vascular and Endovascular Surgery, Heart and Vascular Centre, Semmelweis University, 1122, Budapest, Hungary
| | - Angelia C Kirkpartrick
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Eric M Liotta
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xin A Zhang
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Peter Toth
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Farzaneh A Sorond
- Department of Neurology, Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College/Department of Public Health, Semmelweis University, Budapest, Hungary
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Pan R, Ye C, Zhang Z, Kwapong WR, Wang R, Lu K, Liao L, Yan Y, Yang T, Cao L, Jiang S, Zhang X, Liu J, Tao W, Wu B. Distinct alterations of retinal structure between thalamic and extra-thalamic subcortical infarction patients: A cross-sectional and longitudinal study. CNS Neurosci Ther 2024; 30:e14543. [PMID: 38018655 PMCID: PMC11017429 DOI: 10.1111/cns.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
AIMS Cerebrovascular lesions in the primary visual cortex, the lateral geniculate nucleus, and the optic tract have been associated with retinal neurodegeneration via the retrograde degeneration (RD) mechanism. We aimed to use optical coherence tomography (OCT) to assess the effects of the strategic single subcortical infarction (SSI) location on retinal neurodegeneration and its longitudinal impacts. METHODS Patients with SSI were enrolled and stratified by lesion location on cerebral MRI into the thalamic infarction group and extra-thalamic infarction group. Healthy controls from the native communities were also recruited. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) were quantified using OCT. Generalized estimating equation (GEE) models were used for cross-sectional analyses and linear mixed models for longitudinal analyses. P < 0.05 was considered statistically significant. RESULTS We included a total of 283 eyes from 149 SSI patients. Of these, 115 eyes of 60 patients with follow-up were included in the longitudinal analyses. Cross-sectionally, thalamic-infarction patients had reduced retinal thickness compared with extra-thalamic infarction patients after adjustment for age, gender, disease duration, and vascular risk factors (p = 0.026 for RNFL, and p = 0.026 for GCIPL). Longitudinally, SSI patients showed greater retinal thinning compared with healthy controls over time (p = 0.040 for RNFL, and p < 0.001 for GCIPL), and thalamic infarction patients exhibited faster rates of GCIPL thinning in comparison with extra-thalamic infarction patients (p < 0.001). CONCLUSION Our study demonstrates a distinct effect of subcortical infarction lesion site on the retina both at the early stage of disease and at the 1-year follow-up time. These results present evidence of significant associations between strategic infarction locations and retinal neurodegeneration. It may provide novel insights for further research on RD in stroke patients and ultimately facilitate individualized recovery therapeutic strategy.
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Affiliation(s)
- Ruosu Pan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Chen Ye
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Zhimeng Zhang
- West China School of MedicineSichuan UniversityChengduChina
| | | | - Ruilin Wang
- Department of OphthalmologyWest China Hospital, Sichuan UniversityChengduChina
| | - Kun Lu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Lanhua Liao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Yuying Yan
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Tang Yang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Le Cao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Shuai Jiang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Xuening Zhang
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
| | - Junfeng Liu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Wendan Tao
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
| | - Bo Wu
- Department of NeurologyWest China Hospital, Sichuan UniversityChengduChina
- Center of Cerebrovascular DiseasesWest China Hospital, Sichuan UniversityChengduChina
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8
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Ciudin A, Hernández C, Simó-Servat O, Simó R. The usefulness of the retina for identifying people with type 2 diabetes with prodromal stages of dementia. Neurosci Biobehav Rev 2024; 159:105592. [PMID: 38365136 DOI: 10.1016/j.neubiorev.2024.105592] [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: 08/28/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
Type 2 diabetes (T2D) is associated with cognitive impairment and dementia. The detection of cognitive impairment is important because this population is at higher risk of experiencing difficulties in the self-management of diabetes. Mild cognitive impairment (MCI) often remains undiagnosed due to lack of simple tools for screening at large scale. This represents an important gap in the patients' management because subjects with diabetes and MCI are at high risk of progressing to dementia. Due to its developmental origin as a brain-derived tissue, the retina has been proposed as a potential means of non-invasive and readily accessible exploration of brain pathology. Recent evidence showed that retinal imaging and/or functional tests are correlated with the cognitive function and brain changes in T2D. Simple retinal functional tests (i.e. retinal microperimetry) have proven to be useful as reliable tool for the cognitive evaluation and monitoring in patients with T2D>65 years. This review gives an overall update on the usefulness of retinal imaging in identifying patients with T2D at risk of developing dementia.
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Affiliation(s)
- Andreea Ciudin
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Endocrinology Department, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid 28029, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Endocrinology Department, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid 28029, Spain
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Endocrinology Department, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid 28029, Spain
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute (VHIR), Endocrinology Department, Vall d'Hebron University Hospital, Autonomous University Barcelona, Barcelona 08035, Spain; CIBERDEM (Instituto de Salud Carlos III), Madrid 28029, Spain.
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9
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Chen R, Zhang S, Peng G, Meng W, Borchert G, Wang W, Yu Z, Liao H, Ge Z, He M, Zhu Z. Deep neural network-estimated age using optical coherence tomography predicts mortality. GeroScience 2024; 46:1703-1711. [PMID: 37733221 PMCID: PMC10828229 DOI: 10.1007/s11357-023-00920-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
The concept of biological age has emerged as a measurement that reflects physiological and functional decline with ageing. Here we aimed to develop a deep neural network (DNN) model that predicts biological age from optical coherence tomography (OCT). A total of 84,753 high-quality OCT images from 53,159 individuals in the UK Biobank were included, among which 12,631 3D-OCT images from 8,541 participants without any reported medical conditions at baseline were used to develop an age prediction model. For the remaining 44,618 participants, OCT age gap, the difference between the OCT-predicted age and chronological age, was calculated for each participant. Cox regression models assessed the association between OCT age gap and mortality. The DNN model predicted age with a mean absolute error of 3.27 years and showed a strong correlation of 0.85 with chronological age. After a median follow-up of 11.0 years (IQR 10.9-11.1 years), 2,429 deaths (5.44%) were recorded. For each 5-year increase in OCT age gap, there was an 8% increased mortality risk (hazard ratio [HR] = 1.08, CI:1.02-1.13, P = 0.004). Compared with an OCT age gap within ± 4 years, OCT age gap less than minus 4 years was associated with a 16% decreased mortality risk (HR = 0.84, CI: 0.75-0.94, P = 0.002) and OCT age gap more than 4 years showed an 18% increased risk of death incidence (HR = 1.18, CI: 1.02-1.37, P = 0.026). OCT imaging could serve as an ageing biomarker to predict biological age with high accuracy and the OCT age gap, defined as the difference between the OCT-predicted age and chronological age, can be used as a marker of the risk of mortality.
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Affiliation(s)
- Ruiye Chen
- Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Guankai Peng
- Guangzhou Vision Tech Medical Technology Co., Ltd, GuangZhou, China
| | - Wei Meng
- Guangzhou Vision Tech Medical Technology Co., Ltd, GuangZhou, China
| | - Grace Borchert
- Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Zhen Yu
- Central Clinical School, Monash University, Melbourne, Australia
| | - Huan Liao
- Epigenetics and Neural Plasticity Laboratory, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Zongyuan Ge
- Faculty of IT, Monash University, Melbourne, Australia
- Monash Medical AI, Monash University, Melbourne, Australia
| | - Mingguang He
- Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia.
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia.
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
| | - Zhuoting Zhu
- Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia.
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia.
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
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10
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van Gennip ACE, Gupta MD, Houben AJHM, Berendschot TTJM, Webers CAB, van Greevenbroek MMJ, van der Kallen CJH, Koster A, Wesselius A, Eussen SJPM, Schalkwijk CG, de Galan BE, Köhler S, Schram MT, Stehouwer CDA, van Sloten TT. Retinal microvascular function and incidence and trajectories of clinically relevant depressive symptoms: the Maastricht Study. Psychol Med 2024:1-10. [PMID: 38469703 DOI: 10.1017/s0033291724000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Cerebral microvascular dysfunction may contribute to depression via disruption of brain structures involved in mood regulation, but evidence is limited. We investigated the association of retinal microvascular function, a proxy for microvascular function in the brain, with incidence and trajectories of clinically relevant depressive symptoms. METHODS Longitudinal data are from The Maastricht Study of 5952 participants (59.9 ± 8.5 years/49.7% women) without clinically relevant depressive symptoms at baseline (2010-2017). Central retinal arteriolar equivalent and central retinal venular equivalent (CRAE and CRVE) and a composite score of flicker light-induced retinal arteriolar and venular dilation were assessed at baseline. We assessed incidence and trajectories of clinically relevant depressive symptoms (9-item Patient Health Questionnaire score ⩾10). Trajectories included continuously low prevalence (low, n = 5225 [87.8%]); early increasing, then chronic high prevalence (early-chronic, n = 157 [2.6%]); low, then increasing prevalence (late-increasing, n = 247 [4.2%]); and remitting prevalence (remitting, n = 323 [5.4%]). RESULTS After a median follow-up of 7.0 years (range 1.0-11.0), 806 (13.5%) individuals had incident clinically relevant depressive symptoms. After full adjustment, a larger CRAE and CRVE were each associated with a lower risk of clinically relevant depressive symptoms (hazard ratios [HRs] per standard deviation [s.d.]: 0.89 [95% confidence interval (CI) 0.83-0.96] and 0.93 [0.86-0.99], respectively), while a lower flicker light-induced retinal dilation was associated with a higher risk of clinically relevant depressive symptoms (HR per s.d.: 1.10 [1.01-1.20]). Compared to the low trajectory, a larger CRAE was associated with lower odds of belonging to the early-chronic trajectory (OR: 0.83 [0.69-0.99]) and a lower flicker light-induced retinal dilation was associated with higher odds of belonging to the remitting trajectory (OR: 1.23 [1.07-1.43]). CONCLUSIONS These findings support the hypothesis that cerebral microvascular dysfunction contributes to the development of depressive symptoms.
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Affiliation(s)
- April C E van Gennip
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Monideepa D Gupta
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Alfons J H M Houben
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Tos T J M Berendschot
- School for Mental Health and Neuroscience, MHENS, Maastricht University, Maastricht, Netherlands
- Ophthalmology, Maastricht University Medical Centre, Maastricht, Netherlands
- School of Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht University, Maastricht, Netherlands
| | - Carroll A B Webers
- Ophthalmology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marleen M J van Greevenbroek
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Carla J H van der Kallen
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute, CAPHRI, Maastricht University, Maastricht, Netherlands
- Social Medicine, Maastricht University, Maastricht, Netherlands
| | - Anke Wesselius
- School of Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht University, Maastricht, Netherlands
- Genetics and Cell Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Simone J P M Eussen
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute, CAPHRI, Maastricht University, Maastricht, Netherlands
- Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Casper G Schalkwijk
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
| | - Bastiaan E de Galan
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
- Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, MHENS, Maastricht University, Maastricht, Netherlands
- Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Miranda T Schram
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience, MHENS, Maastricht University, Maastricht, Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Coen D A Stehouwer
- Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School for Cardiovascular Diseases, CARIM, Maastricht University, Maastricht, Netherlands
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11
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Zhang Q, Zhang C, Wang Y, Cong L, Liu K, Xu Z, Jiang C, Zhou W, Zhang C, Dong Y, Feng J, Qiu C, Du Y. Quantitative assessments of retinal macular structure among rural-dwelling older adults in China: a population-based, cross-sectional, optical coherence tomography study. BMJ Open 2024; 14:e079006. [PMID: 38320838 PMCID: PMC10860037 DOI: 10.1136/bmjopen-2023-079006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES To quantitatively assess and compare retinal macular structures of rural-dwelling older adults in China using two different optical coherence tomography (OCT) scanners and to examine their associations with demographic, lifestyle, clinical and ocular factors. DESIGN, SETTING AND PARTICIPANTS This population-based, cross-sectional study included 971 participants (age ≥60 years) derived from the Multimodal Interventions to Delay Dementia and Disability in Rural China study. We collected data on demographics, lifestyle factors, clinical conditions (eg, cardiovascular disease (CVD)) and ocular factors (eg, visual acuity and spherical equivalent). We used two models of spectral-domain OCT to measure macular parameters in nine Early Treatment Diabetic Retinopathy Study subfields. Data were analysed using the multiple general linear models. RESULTS Spectralis OCT demonstrated higher macular thickness but a lower macular volume than Primus 200 OCT (p<0.05). Nasal quadrant of the inner and outer subfields was the thickest, followed by superior quadrant. Adjusting for multiple potential confounding variables, older age was significantly correlated with lower average inner and outer macular thicknesses and overall macular volume. Men had higher macular parameters than women. The presence of CVD was correlated with lower central macular thickness (β=-6.83; 95% CI: -13.08 to -0.58; p=0.032). Middle school or above was associated with higher average inner macular thickness (β=7.85; 95% CI: 1.14 to 14.55; p=0.022) and higher spherical equivalent was correlated with lower average inner macular thickness (β=-1.78; 95% CI: -3.50 to -0.07; p=0.042). CONCLUSIONS Macular thickness and volume assessed by Spectralis and Primus 200 OCT scanners differ. Older age and female sex are associated with lower macular thickness and volume. Macular parameters are associated with education, CVD and spherical equivalent. TRIAL REGISTERATION NUMBER MIND-China study (ChiCTR1800017758).
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Affiliation(s)
- Qinghua Zhang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Cong Zhang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Keke Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhe Xu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Chunyan Jiang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Weiyan Zhou
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Ophthalmology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, JInan, Shandong, People's Republic of China
| | - Chunxiao Zhang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Ophthalmology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, JInan, Shandong, People's Republic of China
| | - Yi Dong
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
| | - Jianli Feng
- Department of Neurology, Shandong Provincial ENT Hospital, Jinan, Shandong, China
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurobiology, Aging Research Center and Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - YiFeng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
- Shandong Provincial Clinical Research Center for Geriatric Neurological Diseases, Jinan, Shandong, P. R. China
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12
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Beran M, van Gennip AC, Stehouwer CD, Jansen JF, Gupta MD, Houben AJ, Berendschot TT, Webers CA, Wesselius A, Schalkwijk CG, Backes WH, de Jong JJ, van der Kallen CJ, van Greevenbroek MM, Köhler S, Vonk JM, Geerlings MI, Schram MT, van Sloten TT. Microvascular Dysfunction and Whole-Brain White Matter Connectivity: The Maastricht Study. J Am Heart Assoc 2024; 13:e9112. [PMID: 38240213 PMCID: PMC11056139 DOI: 10.1161/jaha.123.031573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/16/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Microvascular dysfunction is involved in the development of various cerebral disorders. It may contribute to these disorders by disrupting white matter tracts and altering brain connectivity, but evidence is scarce. We investigated the association between multiple biomarkers of microvascular function and whole-brain white matter connectivity. METHODS AND RESULTS Cross-sectional data from The Maastricht Study, a Dutch population-based cohort (n=4326; age, 59.4±8.6 years; 49.7% women). Measures of microvascular function included urinary albumin excretion, central retinal arteriolar and venular calibers, composite scores of flicker light-induced retinal arteriolar and venular dilation, and plasma biomarkers of endothelial dysfunction (intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, and von Willebrand factor). White matter connectivity was calculated from 3T diffusion magnetic resonance imaging to quantify the number (average node degree) and organization (characteristic path length, global efficiency, clustering coefficient, and local efficiency) of white matter connections. A higher plasma biomarkers of endothelial dysfunction composite score was associated with a longer characteristic path length (β per SD, 0.066 [95% CI, 0.017-0.114]) after adjustment for sociodemographic, lifestyle, and cardiovascular factors but not with any of the other white matter connectivity measures. After multiple comparison correction, this association was nonsignificant. None of the other microvascular function measures were associated with any of the connectivity measures. CONCLUSIONS These findings suggest that microvascular dysfunction as measured by indirect markers is not associated with whole-brain white matter connectivity.
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Affiliation(s)
- Magdalena Beran
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - April C.E. van Gennip
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Jacobus F.A. Jansen
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- Department of Electrical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Monideepa D. Gupta
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Alfons J.H.M. Houben
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Tos T.J.M. Berendschot
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of OphthalmologyMaastricht University Medical Centre (MUMC+)MaastrichtThe Netherlands
| | - Carroll A.B. Webers
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of OphthalmologyMaastricht University Medical Centre (MUMC+)MaastrichtThe Netherlands
| | - Anke Wesselius
- Department of EpidemiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Casper G. Schalkwijk
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Walter H. Backes
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
| | - Joost J.A. de Jong
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
| | - Carla J.H. van der Kallen
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Marleen M.J. van Greevenbroek
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Alzheimer Centrum LimburgMaastricht University Medical Center+ (MUMC+)MaastrichtThe Netherlands
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine & Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Jet M.J. Vonk
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Memory and Aging Center, Department of NeurologyUniversity of California San FranciscoSan FranciscoCAUSA
| | - Mirjam I. Geerlings
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of General PracticeAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized MedicineAmsterdamThe Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and SleepAmsterdamThe Netherlands
| | - Miranda T. Schram
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- School for Mental Health and Neuroscience (MHeNS)Maastricht UniversityMaastrichtThe Netherlands
- Heart and Vascular Centre, Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Thomas T. van Sloten
- Department of Internal MedicineMaastricht University Medical Centre+ (MUMC+)MaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
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13
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Matulevičiūtė I, Tatarūnas V, Skipskis V, Čiapienė I, Veikutienė A, Lesauskaitė V, Dobilienė O, Žaliūnienė D. Coronary artery disease, its associations with ocular, genetic and blood lipid parameters. Eye (Lond) 2024; 38:372-379. [PMID: 37587376 PMCID: PMC10810895 DOI: 10.1038/s41433-023-02703-9] [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: 03/13/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND/OBJECTIVES To investigate the associations between ophthalmic parameters, CYP4F2 (rs2108622) and ABCA1 (rs1883025) polymorphisms and coronary artery disease, considering the accessibility, non-invasive origin of retinal examination and its possible resemblance to coronary arteries. SUBJECTS/METHODS Overall 165 participants divided into groups based on the coronary angiography results and clinical status: control group (N = 73), MI group (N = 63), 3VD (three vessel disease) (N = 24). All the participants underwent total ophthalmic examination - optical coherence tomography (OCT) and OCT angiography of the macula region were performed and evaluated. Total cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride cholesterol (Tg-C) were tested. A standard manufacturer's protocol for CYP4F2 (rs2108622) and ABCA1 (rs1883025) was used for genotyping with TaqMan probes. RESULTS GCL+ layer was thicker in control group vs. 3VD group (74.00; 62.67-94.67 (median; min.-max.) vs. 71.06; 51.33-78.44, p = 0.037). T allele carriers under ABCA1 rs1883025 dominant model were shown to have ticker retina and smaller foveal avascular zone in superficial capillary plexus and smaller Tg-C concentration. ABCA1 rs1883025 was associated with retinal thickness (OR = 0.575, 95% CI 0.348-0.948, p = 0.030). Univariate logistic regression showed that ABCA1 rs1883025 CT genotype is associated with decreased risk for coronary artery disease development under overdominant genetic model (OR = 0.498, 95% CI 0.254-0.976; p = 0.042) and codominant genetic model (OR = 0.468, 95% CI 0.232-0.945, p = 0.034). CONCLUSIONS Results of this study confirmed that non-invasive methods such as OCT of eye might be used for identification of patients at risk of CAD.
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Affiliation(s)
- Indrė Matulevičiūtė
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Vacis Tatarūnas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vilius Skipskis
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ieva Čiapienė
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Audronė Veikutienė
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vaiva Lesauskaitė
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Olivija Dobilienė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Žaliūnienė
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Wang J, Gao Y, Wang F, Zeng S, Li J, Miao H, Wang T, Zeng J, Baptista-Hon D, Monteiro O, Guan T, Cheng L, Lu Y, Luo Z, Li M, Zhu JK, Nie S, Zhang K, Zhou Y. Accurate estimation of biological age and its application in disease prediction using a multimodal image Transformer system. Proc Natl Acad Sci U S A 2024; 121:e2308812120. [PMID: 38190540 PMCID: PMC10801873 DOI: 10.1073/pnas.2308812120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 01/10/2024] Open
Abstract
Aging in an individual refers to the temporal change, mostly decline, in the body's ability to meet physiological demands. Biological age (BA) is a biomarker of chronological aging and can be used to stratify populations to predict certain age-related chronic diseases. BA can be predicted from biomedical features such as brain MRI, retinal, or facial images, but the inherent heterogeneity in the aging process limits the usefulness of BA predicted from individual body systems. In this paper, we developed a multimodal Transformer-based architecture with cross-attention which was able to combine facial, tongue, and retinal images to estimate BA. We trained our model using facial, tongue, and retinal images from 11,223 healthy subjects and demonstrated that using a fusion of the three image modalities achieved the most accurate BA predictions. We validated our approach on a test population of 2,840 individuals with six chronic diseases and obtained significant difference between chronological age and BA (AgeDiff) than that of healthy subjects. We showed that AgeDiff has the potential to be utilized as a standalone biomarker or conjunctively alongside other known factors for risk stratification and progression prediction of chronic diseases. Our results therefore highlight the feasibility of using multimodal images to estimate and interrogate the aging process.
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Affiliation(s)
- Jinzhuo Wang
- Department of Big Data and Biomedical AI, College of Future Technology, Peking University, Beijing100871, China
| | - Yuanxu Gao
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
| | - Fangfei Wang
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
- Guangzhou National Laboratory, Guangzhou510005, China
| | - Simiao Zeng
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou510623, China
| | - Jiahui Li
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou510623, China
| | - Hanpei Miao
- Dongguan People’s Hospital, Southern Medical University, Dongguan523059, China
| | - Taorui Wang
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou510623, China
| | - Jin Zeng
- Guangzhou National Laboratory, Guangzhou510005, China
| | - Daniel Baptista-Hon
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
| | - Olivia Monteiro
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
| | - Taihua Guan
- Guangzhou National Laboratory, Guangzhou510005, China
| | - Linling Cheng
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
| | - Yuxing Lu
- Department of Big Data and Biomedical AI, College of Future Technology, Peking University, Beijing100871, China
| | - Zhengchao Luo
- Department of Big Data and Biomedical AI, College of Future Technology, Peking University, Beijing100871, China
| | - Ming Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou325027, China
| | - Jian-kang Zhu
- Institute of Advanced Biotechnology and School of Life Sciences, Southern University of Science and Technology, Shenzhen518055, China
| | - Sheng Nie
- National Clinical Research Center for Kidney Diseases, State Key Laboratory for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou510515, China
| | - Kang Zhang
- Department of Big Data and Biomedical AI, College of Future Technology, Peking University, Beijing100871, China
- Macau Institute for AI in Medicine and Zhuhai People’s Hospital and the First Affiliated Hospital of Faculty of Medicine, Macau University of Science and Technology, Macau999087, China
- Guangzhou National Laboratory, Guangzhou510005, China
- Dongguan People’s Hospital, Southern Medical University, Dongguan523059, China
| | - Yong Zhou
- Clinical Research Institute, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai201620, China
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Heger KA, Waldstein SM. Artificial intelligence in retinal imaging: current status and future prospects. Expert Rev Med Devices 2024; 21:73-89. [PMID: 38088362 DOI: 10.1080/17434440.2023.2294364] [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: 10/29/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The steadily growing and aging world population, in conjunction with continuously increasing prevalences of vision-threatening retinal diseases, is placing an increasing burden on the global healthcare system. The main challenges within retinology involve identifying the comparatively few patients requiring therapy within the large mass, the assurance of comprehensive screening for retinal disease and individualized therapy planning. In order to sustain high-quality ophthalmic care in the future, the incorporation of artificial intelligence (AI) technologies into our clinical practice represents a potential solution. AREAS COVERED This review sheds light onto already realized and promising future applications of AI techniques in retinal imaging. The main attention is directed at the application in diabetic retinopathy and age-related macular degeneration. The principles of use in disease screening, grading, therapeutic planning and prediction of future developments are explained based on the currently available literature. EXPERT OPINION The recent accomplishments of AI in retinal imaging indicate that its implementation into our daily practice is likely to fundamentally change the ophthalmic healthcare system and bring us one step closer to the goal of individualized treatment. However, it must be emphasized that the aim is to optimally support clinicians by gradually incorporating AI approaches, rather than replacing ophthalmologists.
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Affiliation(s)
- Katharina A Heger
- Department of Ophthalmology, Landesklinikum Mistelbach-Gaenserndorf, Mistelbach, Austria
| | - Sebastian M Waldstein
- Department of Ophthalmology, Landesklinikum Mistelbach-Gaenserndorf, Mistelbach, Austria
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16
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He HL, Liu YX, Song H, Xu TZ, Wong TY, Jin ZB. Initiation of China Alliance of Research in High Myopia (CHARM): protocol for an AI-based multimodal high myopia research biobank. BMJ Open 2023; 13:e076418. [PMID: 38151272 PMCID: PMC10753734 DOI: 10.1136/bmjopen-2023-076418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION High myopia is a pressing public health concern due to its increasing prevalence, younger trend and the high risk of blindness, particularly in East Asian countries, including China. The China Alliance of Research in High Myopia (CHARM) is a newly established consortium that includes more than 100 hospitals and institutions participating across the nation, aiming to promote collaboration and data sharing in the field of high myopia screening, classification, diagnosis and therapeutic development. METHODS AND ANALYSIS The CHARM project is an ongoing study, and its initiation is distinguished by its unprecedented scale, encompassing plans to involve over 100 000 Chinese patients. This initiative stands out not only for its extensive scope but also for its innovative application of artificial intelligence (AI) to assist in diagnosis and treatment decisions. The CHARM project has been carried out using a 'three-step' strategy. The first step involves the collection of basic information, refraction, axial length and fundus photographs from participants with high myopia. In the second step, we will collect multimodal imaging data to expand the scope of clinical information, for example, optical coherence tomography and ultra-widefield fundus images. In the final step, genetic testing will be conducted by incorporating patient family histories and blood samples. The majority of data collected by CHARM is in the form of images that will be used to detect and predict the progression of high myopia through the identification and quantification of biomarkers such as fundus tessellation, optic nerve head and vascular parameters. ETHICS AND DISSEMINATION The study has received approval from the Ethics Committee of Beijing Tongren Hospital (TREC2022-KY045). The establishment of CHARM represents an opportunity to create a collaborative platform for myopia experts and facilitate the dissemination of research findings to the global community through peer-reviewed publications and conference presentations. These insights can inform clinical decision-making and contribute to the development of new treatment modalities that may benefit patients worldwide. TRIAL REGISTRATION NUMBER ChiCTR2300071219.
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Affiliation(s)
- Hai-Long He
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yi-Xin Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hao Song
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tian-Ze Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tien-Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, People's Republic of China
- Duke-National University of Singapore Medical School, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
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Xie H, Pan Z, Xue CC, Chen D, Jonas JB, Wu X, Wang YX. Arterial hypertension and retinal layer thickness: the Beijing Eye Study. Br J Ophthalmol 2023; 108:105-111. [PMID: 36428008 DOI: 10.1136/bjo-2022-322229] [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: 07/14/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate relationships between blood pressure and the thickness of single retinal layers in the macula. METHODS Participants of the population-based Beijing Eye Study, free of retinal or optic nerve disease, underwent medical and ophthalmological examinations including optical coherence tomographic examination of the macula. Applying a multiple-surface segmentation solution, we automatically segmented the retina into its various layers. RESULTS The study included 2237 participants (mean age 61.8±8.4 years, range 50-93 years). Mean thicknesses of the retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), inner plexiform layer, inner nuclear layer (INL), outer plexiform layer, outer nuclear layer/external limiting membrane, ellipsoid zone, photoreceptor outer segments (POS) and retinal pigment epithelium-Bruch membrane were 31.1±2.3 µm, 39.7±3.5 µm, 38.4±3.3 µm, 34.8±2.0 µm, 28.1±3.0 µm, 79.2±7.3 µm, 22.9±0.6 µm, 19.2±3.3 µm and 20.7±1.4 µm, respectively. In multivariable analysis, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) were associated with thinner GCL and thicker INL, after adjusting for age, sex and axial length (all p<0.0056). Higher SBP was additionally associated with thinner POS and higher DBP with thinner RNFL. For an elevation of SBP/DBP by 10 mm Hg, the RNFL, GCL, INL and POS changed by 2.0, 3.0, 1.5 and 2.0 µm, respectively. CONCLUSIONS Thickness of RNFL, GCL and POS was inversely and INL thickness was positively associated with higher blood pressure, while the thickness of the other retinal layers was not significantly correlated with blood pressure. The findings may be helpful for refinement of the morphometric detection of retinal diseases.
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Affiliation(s)
- Hui Xie
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
| | - Zhe Pan
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Can Can Xue
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Danny Chen
- Department of Computer Science and Engineering, University of Notre Dame, Notre Dame, Indiana, USA
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
- Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas & Panda, Heidelberg, Germany
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Xiaodong Wu
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Agrawal A, Mailankody P, Battu R, Bhattacharya A, Shereef Pm M, Kamble N, Yadav R, Pal PK. Looking beyond the brain: Insights into vascular parkinsonism with optical coherence tomography. Parkinsonism Relat Disord 2023; 117:105902. [PMID: 37922634 DOI: 10.1016/j.parkreldis.2023.105902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Vascular Parkinsonism (VP) is characterized by rigidity and bradykinesia predominantly affecting the lower limbs. Optical Coherence tomography (OCT) facilitates the visualization of retina and choroid and may help in delineating differential involvement of retina and choroid in patients with VP. In this study, we report the pattern of changes in the retinal and choroidal layers in patients with VP with the help of spectral domain OCT (SD-OCT). METHODS We adopted a case-control design and evaluated 24 patients with VP with complete history, clinical examination, Montreal Cognitive Assessment (MOCA), Unified Parkinson's Disease Rating Scale (UPDRS) motor part in OFF state, and retinal and choroidal imaging with SD-OCT. The peripapillary retinal nerve fiber layer (RNFL) thickness, peripapillary choroidal layer thickness (PPChT), central macular thickness (CMT) and subfoveal choroid thickness (SFChT) were assessed. Twenty-two age and gender-matched healthy control subjects were also recruited. RESULTS The peripapillary RNFL, in most of the segments and CMT were significantly thinner in patients with VP compared to controls. The subfoveal and peripapillary ChT did not differ significantly between patients and controls. CONCLUSION This is the first study that has evaluated the role of OCT in patients with VP and these patients have significant involvement of the retina. In addition to providing pathophysiological insights, OCT parameters may serve as disease biomarkers in VP. This study lays the foundation for carrying out future studies with larger sample sizes and a longitudinal design.
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Affiliation(s)
- Aakash Agrawal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Rajani Battu
- Centre for Eye Genetics & Research, Bangalore, India
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Mohammed Shereef Pm
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, 560029, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neuro Sciences, Hosur Road, Bangalore, 560029, Karnataka, India.
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19
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Gao Y, Zhang X, Wu D, Wu C, Ren C, Meng T, Ji X. Evaluation of peripapillary retinal nerve fiber layer thickness in intracranial atherosclerotic stenosis. BMC Ophthalmol 2023; 23:455. [PMID: 37957614 PMCID: PMC10641930 DOI: 10.1186/s12886-023-03196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE To evaluate the peripapillary retinal nerve fiber layer thickness (pRNFL) in patients with intracranial atherosclerotic stenosis (ICAS). METHODS A cross-sectional study was performed in a general hospital. The intracranial atherosclerotic stenosis was evaluated by digital subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance angiography (MRA). High-definition optical coherence tomography (HD-OCT) was used to evaluate the peripapillary retinal nerve fiber layer thickness. RESULTS A total of 102 patients, including 59(57.8%) patients with ICAS and 43(42.2%) patients without ICAS, were finally analysed in the study. The peripapillary retinal nerve fiber layer thickness (pRNFL) was reduced significantly in the average, the superior and the inferior quadrants of the ipsilateral eyes and in the superior quadrant of the contralateral eyes in patients with ICAS compared with patients without ICAS. After multivariate analysis, only the superior pRNFL thickness in the ipsilateral eyes was significantly associated with ICAS (OR,0.968; 95% CI,0.946-0.991; p = 0.006). The area under receiver operator curve was 0.679 (95% CI,0.576-0.782) for it to identify the presence of ICAS. The cut-off value of the superior pRNFL was 109.5 μm, and the sensitivity and specificity were 50.8% and 83.7%, respectively. CONCLUSION The superior pRNFL in the ipsilateral eye was significantly associated with ICAS in this study. Larger studies are needed to explore the relation between pRNFL and ICAS further.
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Affiliation(s)
- Yuan Gao
- Department of Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
- Department of Ophthalmology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Xuxiang Zhang
- Department of Ophthalmology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Di Wu
- China-America Institute of Neuroscience, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Tingting Meng
- Department of Ophthalmology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China
| | - Xunming Ji
- Department of Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.
- Department of Neurology, Xuanwu hospital, Capital Medical University, 100053, Beijing, China.
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20
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Ebrahimi M, Thompson P, Lauer AK, Sivaprasad S, Perry G. The retina-brain axis and diabetic retinopathy. Eur J Ophthalmol 2023; 33:2079-2095. [PMID: 37259525 DOI: 10.1177/11206721231172229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Diabetic retinopathy (DR) is a major contributor to permanent vision loss and blindness. Changes in retinal neurons, glia, and microvasculature have been the focus of intensive study in the quest to better understand DR. However, the impact of diabetes on the rest of the visual system has received less attention. There are reports of associations of changes in the visual system with preclinical and clinical manifestations of diabetes. Simultaneous investigation of the retina and the brain may shed light on the mechanisms underlying neurodegeneration in diabetics. Additionally, investigating the links between DR and other neurodegenerative disorders of the brain including Alzheimer's and Parkinson's disease may reveal shared mechanisms for neurodegeneration and potential therapy options.
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Affiliation(s)
- Moein Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy, and Autoimmunity, Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Paul Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andreas K Lauer
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Sobha Sivaprasad
- National Institute of Health and Care Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - George Perry
- Department of Neuroscience, Developmental and Regenerative Biology, University of Texas and San Antonio, San Antonio, TX, USA
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21
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Gao H, Zhao S, Zheng G, Wang X, Zhao R, Pan Z, Li H, Lu F, Shen M. Using a dual-stream attention neural network to characterize mild cognitive impairment based on retinal images. Comput Biol Med 2023; 166:107411. [PMID: 37738896 DOI: 10.1016/j.compbiomed.2023.107411] [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: 05/09/2023] [Revised: 08/08/2023] [Accepted: 08/27/2023] [Indexed: 09/24/2023]
Abstract
Mild cognitive impairment (MCI) is a critical transitional stage between normal cognition and dementia, for which early detection is crucial for timely intervention. Retinal imaging has been shown as a promising potential biomarker for MCI. This study aimed to develop a dual-stream attention neural network to classify individuals with MCI based on multi-modal retinal images. Our approach incorporated a cross-modality fusion technique, a variable scale dense residual model, and a multi-classifier mechanism within the dual-stream network. The model utilized a residual module to extract image features and employed a multi-level feature aggregation method to capture complex context information. Self-attention and cross-attention modules were utilized at each convolutional layer to fuse features from optical coherence tomography (OCT) and fundus modalities, resulting in multiple output losses. The neural network was applied to classify individuals with MCI, Alzheimer's disease, and control participants with normal cognition. Through fine-tuning the pre-trained model, we classified community-dwelling participants into two groups based on cognitive impairment test scores. To identify retinal imaging biomarkers associated with accurate prediction, we used the Gradient-weighted Class Activation Mapping technique. The proposed method achieved high precision rates of 84.96% and 80.90% in classifying MCI and positive test scores for cognitive impairment, respectively. Notably, changes in the optic nerve head on fundus photographs or OCT images among patients with MCI were not used to discriminate patients from the control group. These findings demonstrate the potential of our approach in identifying individuals with MCI and emphasize the significance of retinal imaging for early detection of cognitive impairment.
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Affiliation(s)
- Hebei Gao
- School of Artificial Intelligence, Wenzhou Polytechnic, Wenzhou, 325035, China; Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China
| | - Shuaiye Zhao
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, 325035, China
| | - Gu Zheng
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China
| | - Xinmin Wang
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China
| | - Runyi Zhao
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China
| | - Zhigeng Pan
- School of Artificial Intelligence, Nanjing University of Information Science & Technology, Nanjing, 210044, China
| | - Hong Li
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, 325035, China.
| | - Fan Lu
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Meixiao Shen
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Eye Hospital, Wenzhou Medical University, Wenzhou, 325000, China.
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22
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Cheung CY, Zhang XJ, Chan HN, Zhang Y, Yuen VL, Hsu W, Lee ML, Xu D, Wong J, Tang FY, Kam KW, Young A, Ng MP, Ip P, Chen LJ, Wong TY, Pang CP, Tham CC, Yam JC. Influence of secondhand smoke exposure on the retinal vasculature of children in Hong Kong. COMMUNICATIONS MEDICINE 2023; 3:155. [PMID: 37884789 PMCID: PMC10603154 DOI: 10.1038/s43856-023-00389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND A recent prospective demonstrated that cardiovascular risk factors in early childhood were associated with later cardiovascular events. However, the impact of secondhand smoke (SHS) on children is unclear. The aims of this study is to determine the effects of SHS exposure on the retinal vasculature of children. METHODS This is a population-based cross-sectional study of children aged 6 to 8 years. All participants received comprehensive ophthalmic examinations and retinal photography. Data on SHS exposure was derived from a validated questionnaire. A validated deep-learning system was used to automatically estimate retinal arteriolar and venular calibers from retinal photographs. Associations of quantitative retinal vessel caliber values with SHS exposure, number of smokers in the household, and total number of cigarettes smoked were determined by analyses of covariance (ANCOVA) after adjusting for potential confounders. Test of trend was determined by treating categorical risk factors as continuous ordinal variables. RESULTS Here we show children exposed to SHS have wider retinal arteriolar (CRAE 152.1 µm vs. 151.3 µm, p < 0.001) and venular (CRVE 216.7 µm vs. 215.5 µm, p < 0.001) calibers compared to those in smoke-free homes, after adjustment for different factors. Wider arteriolar and venular calibers are also associated with increasing number of smokers in the family (p trend < 0.001) and more cigarettes smoked among family smokers (p trend<0.001). CONCLUSIONS Exposure to SHS at home is associated with changes in retinal vasculature among children. This reinforces the adverse effect of secondhand smoking around children though further research incorporating comprehensive assessment of potential confounders is necessary.
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Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hei-Nga Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wynne Hsu
- School of Computing, National University of, Singapore, Singapore
| | - Mong Li Lee
- School of Computing, National University of, Singapore, Singapore
| | - Dejiang Xu
- School of Computing, National University of, Singapore, Singapore
| | - Jason Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Alvin Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Mandy P Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
- Tsinghua Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China.
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China.
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23
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Wang T, Li S, Li XM, Li C, Wang F, Jiang Q. Targeting circular RNA-Glra2 alleviates retinal neurodegeneration induced by ocular hypertension. Aging (Albany NY) 2023; 15:10705-10731. [PMID: 37819813 PMCID: PMC10599745 DOI: 10.18632/aging.205108] [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: 06/06/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Glaucoma is a leading cause of irreversible vision loss characterized by retinal neurodegeneration. Circular RNAs (circRNAs) have emerged as the potential biomarkers and therapeutic targets for neurodegenerative diseases. However, the expression profiling of circRNAs in glaucomatous neurodegeneration has not been fully understood. In this study, we built a glaucomatous neurodegeneration model via the injection of microbeads into anterior chamber. circRNA expression profile and bioinformatics analysis revealed that compared with normal retinas, 171 circRNAs were dysregulated in the glaucomatous retinas, including 101 up-regulated circRNAs and 70 down-regulated circRNAs. Detecting the level of circular RNA-glycine receptor α2 subunit gene (cGlra2) in aqueous humor made it possible to distinguish glaucoma patients from cataract patients. Silencing of cGlra2 protected against oxidative stress- or hydrostatic pressure-induced retinal ganglion cell (RGC) injury in vitro. Moreover, silencing of cGlra2 retarded ocular hypertension-induced retinal neurodegeneration in vivo as shown by increased TUJ1 staining, reduced reactive gliosis, decreased retinal cell apoptosis, enhanced visual acuity, and improved retinal function. cGlra2 acted as a miRNA sponge to regulate RGC function through cGlra2/miR-144/BCL2L11 signaling axis. Collectively, this study provides novel insights into the underlying mechanism of retinal neurodegeneration and highlights the potential of cGlra2 as a target for the diagnosis and treatment of glaucoma.
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Affiliation(s)
- Ting Wang
- Department of Ophthalmology, The Affiliated Huaian No. 1 Hospital of Nanjing Medical University, Huai’an, Jiangsu 223300, China
| | - Shuyan Li
- Department of Ophthalmology, The Affiliated Huaian No. 1 Hospital of Nanjing Medical University, Huai’an, Jiangsu 223300, China
| | - Xiu-Miao Li
- Department of Ophthalmology and Optometry, The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Chaopeng Li
- Department of Ophthalmology, The Affiliated Huaian No. 1 Hospital of Nanjing Medical University, Huai’an, Jiangsu 223300, China
| | - Fang Wang
- Department of Ophthalmology, Clinical Medical College of Shanghai 10th People’s Hospital of Nanjing Medical University, Nanjing, Shanghai 200072, China
| | - Qin Jiang
- Department of Ophthalmology and Optometry, The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
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24
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Fasoula NA, Xie Y, Katsouli N, Reidl M, Kallmayer MA, Eckstein HH, Ntziachristos V, Hadjileontiadis L, Avgerinos DV, Briasoulis A, Siasos G, Hosseini K, Doulamis I, Kampaktsis PN, Karlas A. Clinical and Translational Imaging and Sensing of Diabetic Microangiopathy: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:383. [PMID: 37754812 PMCID: PMC10531807 DOI: 10.3390/jcdd10090383] [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: 05/31/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Microvascular changes in diabetes affect the function of several critical organs, such as the kidneys, heart, brain, eye, and skin, among others. The possibility of detecting such changes early enough in order to take appropriate actions renders the development of appropriate tools and techniques an imperative need. To this end, several sensing and imaging techniques have been developed or employed in the assessment of microangiopathy in patients with diabetes. Herein, we present such techniques; we provide insights into their principles of operation while discussing the characteristics that make them appropriate for such use. Finally, apart from already established techniques, we present novel ones with great translational potential, such as optoacoustic technologies, which are expected to enter clinical practice in the foreseeable future.
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Affiliation(s)
- Nikolina-Alexia Fasoula
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Yi Xie
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Nikoletta Katsouli
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Mario Reidl
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Michael A. Kallmayer
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
| | - Vasilis Ntziachristos
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
| | - Leontios Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates;
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | - Alexandros Briasoulis
- Aleksandra Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Gerasimos Siasos
- Sotiria Hospital, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece;
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran 1411713138, Iran;
| | - Ilias Doulamis
- Department of Surgery, The Johns Hopkins Hospital, School of Medicine, Baltimore, MD 21287, USA;
| | | | - Angelos Karlas
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, 85764 Neuherberg, Germany; (N.-A.F.); (Y.X.); (N.K.); (V.N.)
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany; (M.A.K.); (H.-H.E.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany
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25
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Feng J, Huang C, Liang L, Li C, Wang X, Ma J, Guan X, Jiang B, Huang S, Qin P. The Association Between Eye Disease and Incidence of Dementia: Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:1363-1373.e6. [PMID: 37527793 DOI: 10.1016/j.jamda.2023.06.025] [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: 03/09/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To better demonstrate the relationship between common eye diseases and the risk of dementia, we conducted a systematic review and meta-analysis of cohort studies to investigate the relationship between common eye diseases and dementia. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Patients with common eye diseases. METHODS We conducted a systematic search of articles published up to August 25, 2022, of online databases including PubMed, EMBASE, and Web of Science. We included cohort studies that evaluated the association of glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and cataracts with all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD). Relative risks (RRs) and 95% CIs were pooled using random effects model, and heterogeneity was assessed by the I2 statistic. Subgroup analysis and sensitivity analysis were also performed. RESULTS In total, 25 studies were included in the meta-analysis, with a total of 11,410,709 participants. Pooled estimates suggested an increased risk of all-cause dementia associated with AMD (RR, 1.29; 95% CI, 1.13-1.48), glaucoma (RR, 1.16; 95% CI, 1.03-1.32), DR (RR, 1.40; 95% CI, 1.21-1.63), and cataract (RR,1.23; 95% CI, 1.09-1.40); an increased risk of AD associated with AMD (RR, 1.27; 95% CI, 1.06-1.52), glaucoma (RR, 1.18; 95% CI, 1.02-1.38), DR (RR, 1.21; 95% CI, 1.04-1.41), and cataracts (RR,1.22; 95% CI, 1.07-1.38). No association was observed between incident VaD and any eye diseases. The results of subgroup analyses were consistent with those in meta-analysis of DR and risk of all-cause dementia. Meta-regressions suggested geographic regions as potential sources of heterogeneity for the association between AMD and all-cause dementia, AMD and AD, glaucoma and dementia, glaucoma, and AD, respectively. CONCLUSIONS AND IMPLICATIONS AMD, glaucoma, DR, and cataract may be associated with an increased risk of all-cause dementia and AD, but not VaD. However, the results should be interpreted cautiously because of the high heterogeneity and unstable findings in some subgroup analyses.
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Affiliation(s)
- Jiayi Feng
- Center for Clinical Epidemiology and Evidence-based Medicine, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China; College of Medicine, Shantou University, Shantou, Guangdong, China
| | - Cuihong Huang
- Center for Clinical Epidemiology and Evidence-based Medicine, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China; Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Lei Liang
- Center for Clinical Epidemiology and Evidence-based Medicine, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Chuang Li
- Center for Clinical Epidemiology and Evidence-based Medicine, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China; College of Medicine, Shantou University, Shantou, Guangdong, China
| | - Xiaojie Wang
- Department of Neurology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Jianping Ma
- Center for Clinical Epidemiology and Evidence-based Medicine, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Xinhui Guan
- Ophthalmology Department, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Bin Jiang
- Department of Neurology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Shaofen Huang
- Department of Public Health, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China
| | - Pei Qin
- Center for Clinical Epidemiology and Evidence-based Medicine, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong, China.
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26
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Lima Rebouças SC, Crivello F, Tsuchida A, Tzourio C, Schweitzer C, Korobelnik J, Delcourt C, Helmer C. Association of retinal nerve layers thickness and brain imaging in healthy young subjects from the i-Share-Bordeaux study. Hum Brain Mapp 2023; 44:4722-4737. [PMID: 37401639 PMCID: PMC10400793 DOI: 10.1002/hbm.26412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023] Open
Abstract
Given the anatomical and functional similarities between the retina and the brain, the retina could be a "window" for viewing brain structures. We investigated the association between retinal nerve fiber layers (peripapillary retinal nerve fiber layer, ppRNFL; macular ganglion cell-inner plexiform layer, GC-IPL; and macular ganglion cell complex, GCC), and brain magnetic resonance imaging (MRI) parameters in young health adults. We included 857 students (mean age: 23.3 years, 71.3% women) from the i-Share study. We used multivariate linear models to study the cross-sectional association of each retinal nerve layer thickness assessed by spectral-domain optical coherence tomography (SD-OCT) with structural (volumes and cortical thickness), and microstructural brain markers, assessed on MRI globally and regionally. Microstructural MRI parameters included diffusion tensor imaging (DTI) and Neurite Orientation Dispersion and Density Imaging (NODDI). On global brain analysis, thicker ppRNFL, GC-IPL and GCC were all significantly associated with patterns of diffusion metrics consistent with higher WM microstructural integrity. In regional analyses, after multiple testing corrections, our results suggested significant associations of some retinal nerve layers with brain regional gray matter occipital volumes and with diffusion MRI parameters in a region involved in the visual pathway and in regions containing associative tracts. No associations were found with global volumes or with global or regional cortical thicknesses. Results of this study suggest that some retinal nerve layers may reflect brain structures. Further studies are needed to confirm these results in young subjects.
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Affiliation(s)
| | | | - Ami Tsuchida
- University of Bordeaux, CNRS, CEA, IMN, GINBordeauxFrance
| | | | - Cédric Schweitzer
- Department of OphthalmologyBordeaux University HospitalBordeauxFrance
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27
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Chen S, Zhang D, Zheng H, Cao T, Xia K, Su M, Meng Q. The association between retina thinning and hippocampal atrophy in Alzheimer's disease and mild cognitive impairment: a meta-analysis and systematic review. Front Aging Neurosci 2023; 15:1232941. [PMID: 37680540 PMCID: PMC10481874 DOI: 10.3389/fnagi.2023.1232941] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction The retina is the "window" of the central nervous system. Previous studies discovered that retinal thickness degenerates through the pathological process of the Alzheimer's disease (AD) continuum. Hippocampal atrophy is one of the typical clinical features and diagnostic criteria of AD. Former studies have described retinal thinning in normal aging subjects and AD patients, yet the association between retinal thickness and hippocampal atrophy in AD is unclear. The optical coherence tomography (OCT) technique has access the non-invasive to retinal images and magnetic resonance imaging can outline the volume of the hippocampus. Thus, we aim to quantify the correlation between these two parameters to identify whether the retina can be a new biomarker for early AD detection. Methods We systematically searched the PubMed, Embase, and Web of Science databases from inception to May 2023 for studies investigating the correlation between retinal thickness and hippocampal volume. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess the study quality. Pooled correlation coefficient r values were combined after Fisher's Z transformation. Moderator effects were detected through subgroup analysis and the meta-regression method. Results Of the 1,596 citations initially identified, we excluded 1,062 studies after screening the titles and abstract (animal models, n = 99; irrelevant literature, n = 963). Twelve studies met the inclusion criteria, among which three studies were excluded due to unextractable data. Nine studies were eligible for this meta-analysis. A positive moderate correlation between the retinal thickness was discovered in all participants of with AD, mild cognitive impairment (MCI), and normal controls (NC) (r = 0.3469, 95% CI: 0.2490-0.4377, I2 = 5.0%), which was significantly higher than that of the AD group (r = 0.1209, 95% CI:0.0905-0.1510, I2 = 0.0%) (p < 0.05). Among different layers, the peripapillary retinal nerve fiber layer (pRNFL) indicated a moderate positive correlation with hippocampal volume (r = 0.1209, 95% CI:0.0905-0.1510, I2 = 0.0%). The retinal pigmented epithelium (RPE) was also positively correlated [r = 0.1421, 95% CI:(-0.0447-0.3192), I2 = 84.1%]. The retinal layers and participants were the main overall heterogeneity sources. Correlation in the bilateral hemisphere did not show a significant difference. Conclusion The correlation between RNFL thickness and hippocampal volume is more predominant in both NC and AD groups than other layers. Whole retinal thickness is positively correlated to hippocampal volume not only in AD continuum, especially in MCI, but also in NC. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, CRD42022328088.
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Affiliation(s)
- Shuntai Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Dian Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Honggang Zheng
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tianyu Cao
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kun Xia
- Department of Respiratory, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mingwan Su
- Department of Respiratory, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qinggang Meng
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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28
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Sparks S, Pinto J, Hayes G, Spitschan M, Bulte DP. The impact of Alzheimer's disease risk factors on the pupillary light response. Front Neurosci 2023; 17:1248640. [PMID: 37650103 PMCID: PMC10463762 DOI: 10.3389/fnins.2023.1248640] [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: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia, and its prevalence is increasing and is expected to continue to increase over the next few decades. Because of this, there is an urgent requirement to determine a way to diagnose the disease, and to target interventions to delay and ideally stop the onset of symptoms, specifically those impacting cognition and daily livelihood. The pupillary light response (PLR) is controlled by the sympathetic and parasympathetic branches of the autonomic nervous system, and impairments to the pupillary light response (PLR) have been related to AD. However, most of these studies that assess the PLR occur in patients who have already been diagnosed with AD, rather than those who are at a higher risk for the disease but without a diagnosis. Determining whether the PLR is similarly impaired in subjects before an AD diagnosis is made and before cognitive symptoms of the disease begin, is an important step before using the PLR as a diagnostic tool. Specifically, identifying whether the PLR is impaired in specific at-risk groups, considering both genetic and non-genetic risk factors, is imperative. It is possible that the PLR may be impaired in association with some risk factors but not others, potentially indicating different pathways to neurodegeneration that could be distinguished using PLR. In this work, we review the most common genetic and lifestyle-based risk factors for AD and identify established relationships between these risk factors and the PLR. The evidence here shows that many AD risk factors, including traumatic brain injury, ocular and intracranial hypertension, alcohol consumption, depression, and diabetes, are directly related to changes in the PLR. Other risk factors currently lack sufficient literature to make any conclusions relating directly to the PLR but have shown links to impairments in the parasympathetic nervous system; further research should be conducted in these risk factors and their relation to the PLR.
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Affiliation(s)
- Sierra Sparks
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Joana Pinto
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Genevieve Hayes
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Manuel Spitschan
- TUM Department of Sport and Health Sciences (TUM SG), Chronobiology and Health, Technical University of Munich, Munich, Germany
- TUM Institute for Advanced Study (TUM-IAS), Technical University of Munich, Garching, Germany
- Max Planck Institute for Biological Cybernetics, Translational Sensory and Circadian Neuroscience, Tübingen, Germany
| | - Daniel P. Bulte
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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29
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Gao Y, Xu L, He N, Ding Y, Zhao W, Meng T, Li M, Wu J, Haddad Y, Zhang X, Ji X. A narrative review of retinal vascular parameters and the applications (Part II): Diagnosis in stroke. Brain Circ 2023; 9:129-134. [PMID: 38020952 PMCID: PMC10679631 DOI: 10.4103/bc.bc_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 12/01/2023] Open
Abstract
The retina, as an external extension of the diencephalon, can be directly, noninvasively observed by ocular fundus photography. Therefore, it offers a convenient and feasible mode to study nervous system diseases. Caliber, tortuosity, and fractal dimension, as three commonly used retinal vascular parameters, are not only the reflection of structural changes in the retinal microcirculation but also capture the branching pattern or density changes of the retinal microvascular network. Therefore, it contributes to better reflecting the subclinical pathological changes (e.g., lacunar stroke and small cerebral vascular disease) and predicting the risk of incident stroke and recurrent stroke.
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Affiliation(s)
- Yuan Gao
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Department of Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lijun Xu
- Department of School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Ning He
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, Xi’an, Shaanxi, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tingting Meng
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Wu
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yazeed Haddad
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Xuxiang Zhang
- Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Biomedical Engineering, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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30
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Yang S, Zhu Z, Yuan Y, Chen S, Shang X, Bulloch G, He M, Wang W. Analysis of Plasma Metabolic Profile on Ganglion Cell-Inner Plexiform Layer Thickness With Mortality and Common Diseases. JAMA Netw Open 2023; 6:e2313220. [PMID: 37191963 DOI: 10.1001/jamanetworkopen.2023.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Importance The neural retina is considered a unique window to systemic health, but its biological link with systemic health remains unknown. Objective To investigate the independent associations of retinal ganglion cell-inner plexiform layer thickness (GCIPLT) metabolic profiles with rates of mortality and morbidity of common diseases. Design, Setting, and Participants This cohort study evaluated UK Biobank participants enrolled between 2006 and 2010, and prospectively followed them up for multidisease diagnosis and mortality. Additional participants from the Guangzhou Diabetes Eye Study (GDES) underwent optical coherence tomography scanning and metabolomic profiling and were included for validation. Main Outcomes and Measures Systematic analysis of circulating plasma metabolites to identify GCIPLT metabolic profiles; prospective associations of these profiles with mortality and morbidity of 6 common diseases with their incremental discriminative value and clinical utility. Results Among 93 838 community-based participants (51 182 [54.5%] women), the mean (SD) age was 56.7 (8.1) years and mean (SD) follow-up was 12.3 (0.8) years. Of 249 metabolic metrics, 37 were independently associated with GCIPLT, including 8 positive and 29 negative associations, and most were associated with the rates of future mortality and common diseases. These metabolic profiles significantly improved the models for discriminating type 2 diabetes over clinical indicators (C statistic: 0.862; 95% CI, 0.852-0.872 vs clinical indicators only, 0.803; 95% CI, 0.792-0.814; P < .001), myocardial infarction (0.792; 95% CI, 0.775-0.808 vs 0.768; 95% CI, 0.751-0.786; P < .001), heart failure (0.803; 95% CI, 0.786-0.820 vs 0.790; 95% CI, 0.773-0.807; P < .001), stroke (0.739; 95% CI, 0.714-0.764 vs 0.719; 95% CI, 0.693-0.745; P < .001), all-cause mortality (0.747; 95% CI, 0.734-0.760 vs 0.724; 95% CI, 0.711-0.738; P < .001), and cardiovascular disease mortality (0.790; 95% CI, 0.767-0.812 vs 0.763; 95% CI, 0.739-0.788; P < .001). Additionally, the potential of GCIPLT metabolic profiles for risk stratification of cardiovascular diseases were further confirmed in the GDES cohort using a different metabolomic approach. Conclusions and Relevance In this prospective study of multinational participants, GCIPLT-associated metabolites demonstrated the potential to inform mortality and morbidity risks. Incorporating information on these profiles may facilitate individualized risk stratification for these health outcomes.
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Affiliation(s)
- Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Yixiong Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shida Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xianwen Shang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Gabriella Bulloch
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Mong MA. Vitamin K and the Visual System-A Narrative Review. Nutrients 2023; 15:nu15081948. [PMID: 37111170 PMCID: PMC10143727 DOI: 10.3390/nu15081948] [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: 02/01/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
Vitamin K occupies a unique and often obscured place among its fellow fat-soluble vitamins. Evidence is mounting, however, that vitamin K (VK) may play an important role in the visual system apart from the hepatic carboxylation of hemostatic-related proteins. However, to our knowledge, no review covering the topic has appeared in the medical literature. Recent studies have confirmed that matrix Gla protein (MGP), a vitamin K-dependent protein (VKDP), is essential for the regulation of intraocular pressure in mice. The PREDIMED (Prevención con Dieta Mediterránea) study, a randomized trial involving 5860 adults at risk for cardiovascular disease, demonstrated a 29% reduction in the risk of cataract surgery in participants with the highest tertile of dietary vitamin K1 (PK) intake compared with those with the lowest tertile. However, the specific requirements of the eye and visual system (EVS) for VK, and what might constitute an optimized VK status, is currently unknown and largely unexplored. It is, therefore, the intention of this narrative review to provide an introduction concerning VK and the visual system, review ocular VK biology, and provide some historical context for recent discoveries. Potential opportunities and gaps in current research efforts will be touched upon in the hope of raising awareness and encouraging continued VK-related investigations in this important and highly specialized sensory system.
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Affiliation(s)
- Michael A Mong
- Department of Ophthalmology, Veteran Affairs North Texas Health Care Medical Center, Dallas, TX 75216, USA
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Zhang Q, Yang Y, Cao KJ, Chen W, Paidi S, Xia CH, Kramer RH, Gong X, Ji N. Retinal microvascular and neuronal pathologies probed in vivo by adaptive optical two-photon fluorescence microscopy. eLife 2023; 12:84853. [PMID: 37039777 PMCID: PMC10089658 DOI: 10.7554/elife.84853] [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: 11/10/2022] [Accepted: 03/19/2023] [Indexed: 04/12/2023] Open
Abstract
The retina, behind the transparent optics of the eye, is the only neural tissue whose physiology and pathology can be non-invasively probed by optical microscopy. The aberrations intrinsic to the mouse eye, however, prevent high-resolution investigation of retinal structure and function in vivo. Optimizing the design of a two-photon fluorescence microscope (2PFM) and sample preparation procedure, we found that adaptive optics (AO), by measuring and correcting ocular aberrations, is essential for resolving putative synaptic structures and achieving three-dimensional cellular resolution in the mouse retina in vivo. Applying AO-2PFM to longitudinal retinal imaging in transgenic models of retinal pathology, we characterized microvascular lesions with sub-capillary details in a proliferative vascular retinopathy model, and found Lidocaine to effectively suppress retinal ganglion cell hyperactivity in a retinal degeneration model. Tracking structural and functional changes at high-resolution longitudinally, AO-2PFM enables microscopic investigations of retinal pathology and pharmacology for disease diagnosis and treatment in vivo.
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Affiliation(s)
- Qinrong Zhang
- Department of Physics, University of California, Berkeley, United States
- Department of Molecular and Cell Biology, University of California, Berkeley, United States
| | - Yuhan Yang
- Department of Physics, University of California, Berkeley, United States
| | - Kevin J Cao
- Department of Molecular and Cell Biology, University of California, Berkeley, United States
- Helen Wills Neuroscience Institute, University of California, Berkeley, United States
| | - Wei Chen
- Department of Physics, University of California, Berkeley, United States
- Department of Molecular and Cell Biology, University of California, Berkeley, United States
| | - Santosh Paidi
- School of Optometry, University of California, Berkeley, United States
| | - Chun-Hong Xia
- School of Optometry, University of California, Berkeley, United States
- Vision Science Program, University of California, Berkeley, United States
| | - Richard H Kramer
- Department of Molecular and Cell Biology, University of California, Berkeley, United States
- Helen Wills Neuroscience Institute, University of California, Berkeley, United States
- Vision Science Program, University of California, Berkeley, United States
| | - Xiaohua Gong
- School of Optometry, University of California, Berkeley, United States
- Vision Science Program, University of California, Berkeley, United States
| | - Na Ji
- Department of Physics, University of California, Berkeley, United States
- Department of Molecular and Cell Biology, University of California, Berkeley, United States
- Helen Wills Neuroscience Institute, University of California, Berkeley, United States
- Vision Science Program, University of California, Berkeley, United States
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, United States
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Li Y, Liu Y, Liu S, Gao M, Wang W, Chen K, Huang L, Liu Y. Diabetic vascular diseases: molecular mechanisms and therapeutic strategies. Signal Transduct Target Ther 2023; 8:152. [PMID: 37037849 PMCID: PMC10086073 DOI: 10.1038/s41392-023-01400-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 04/12/2023] Open
Abstract
Vascular complications of diabetes pose a severe threat to human health. Prevention and treatment protocols based on a single vascular complication are no longer suitable for the long-term management of patients with diabetes. Diabetic panvascular disease (DPD) is a clinical syndrome in which vessels of various sizes, including macrovessels and microvessels in the cardiac, cerebral, renal, ophthalmic, and peripheral systems of patients with diabetes, develop atherosclerosis as a common pathology. Pathological manifestations of DPDs usually manifest macrovascular atherosclerosis, as well as microvascular endothelial function impairment, basement membrane thickening, and microthrombosis. Cardiac, cerebral, and peripheral microangiopathy coexist with microangiopathy, while renal and retinal are predominantly microangiopathic. The following associations exist between DPDs: numerous similar molecular mechanisms, and risk-predictive relationships between diseases. Aggressive glycemic control combined with early comprehensive vascular intervention is the key to prevention and treatment. In addition to the widely recommended metformin, glucagon-like peptide-1 agonist, and sodium-glucose cotransporter-2 inhibitors, for the latest molecular mechanisms, aldose reductase inhibitors, peroxisome proliferator-activated receptor-γ agonizts, glucokinases agonizts, mitochondrial energy modulators, etc. are under active development. DPDs are proposed for patients to obtain more systematic clinical care requires a comprehensive diabetes care center focusing on panvascular diseases. This would leverage the advantages of a cross-disciplinary approach to achieve better integration of the pathogenesis and therapeutic evidence. Such a strategy would confer more clinical benefits to patients and promote the comprehensive development of DPD as a discipline.
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Affiliation(s)
- Yiwen Li
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yanfei Liu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China
- The Second Department of Gerontology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Shiwei Liu
- Department of Nephrology and Endocrinology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Mengqi Gao
- Department of Nephrology and Endocrinology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Wenting Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Keji Chen
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.
| | - Luqi Huang
- China Center for Evidence-based Medicine of TCM, China Academy of Chinese Medical Sciences, Beijing, 100010, China.
| | - Yue Liu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Barrett-Young A, Ambler A, Cheyne K, Guiney H, Kokaua J, Tham YC, Williams MJA, Wilson GA, Wong TY, Poulton R. Childhood Social Isolation as a Predictor of Retinal Neuronal Thickness in Middle Age: A Lifecourse Birth Cohort Study. Psychosom Med 2023; 85:238-249. [PMID: 36800261 PMCID: PMC10073287 DOI: 10.1097/psy.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE We investigated whether childhood social isolation was associated with retinal neural layer changes in adulthood, and whether this association was independent of other childhood or adulthood risk factors, including adult social isolation. METHODS Participants were members of the Dunedin Multidisciplinary Health and Development Study, a longitudinal population-based birth cohort from Aotearoa New Zealand ( n = 1037), born 1972 to 1973 and followed until age 45 years, with 94% of the living cohort still participating. Social isolation was recorded prospectively at ages 5, 7, 9, and 11 years, from teacher and parent report. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer thicknesses were measured via optical coherence tomography at age 45 years. RESULTS Childhood social isolation was associated with thinner average RNFL ( B = -0.739, p = .02), nasal RNFL ( B = -1.118, p = .005), and inferior RNFL ( B = -1.524, p = .007), although only nasal RNFL remained significant after adjustment. These associations were not fully explained by other psychosocial or physical health risk factors in childhood or adulthood, nor were they mediated by adult loneliness or social support. CONCLUSIONS Childhood social isolation was an independent predictor of RNFL thickness in middle age. Highlighting prospective links between childhood psychosocial adversity and retinal neuronal measures will help to inform future research into the utility of retinal neuronal thickness as a biomarker for neurodegeneration.
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Affiliation(s)
- Ashleigh Barrett-Young
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Antony Ambler
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kirsten Cheyne
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Hayley Guiney
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Jesse Kokaua
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
- Va’a O Tautai—Centre for Pacific Health, University of Otago, Dunedin, New Zealand
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Graham A. Wilson
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
- Department of Psychology, University of Otago, Dunedin, New Zealand
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35
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Barrett-Young A, Abraham WC, Cheung CY, Gale J, Hogan S, Ireland D, Keenan R, Knodt AR, Melzer TR, Moffitt TE, Ramrakha S, Tham YC, Wilson GA, Wong TY, Hariri AR, Poulton R. Associations Between Thinner Retinal Neuronal Layers and Suboptimal Brain Structural Integrity in a Middle-Aged Cohort. Eye Brain 2023; 15:25-35. [PMID: 36936476 PMCID: PMC10018220 DOI: 10.2147/eb.s402510] [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: 01/12/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose The retina has potential as a biomarker of brain health and Alzheimer's disease (AD) because it is the only part of the central nervous system which can be easily imaged and has advantages over brain imaging technologies. Few studies have compared retinal and brain measurements in a middle-aged sample. The objective of our study was to investigate whether retinal neuronal measurements were associated with structural brain measurements in a middle-aged population-based cohort. Participants and Methods Participants were members of the Dunedin Multidisciplinary Health and Development Study (n=1037; a longitudinal cohort followed from birth and at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, 32, 38, and most recently at age 45, when 94% of the living Study members participated). Retinal nerve fibre layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness were measured by optical coherence tomography (OCT). Brain age gap estimate (brainAGE), cortical surface area, cortical thickness, subcortical grey matter volumes, white matter hyperintensities, were measured by magnetic resonance imaging (MRI). Results Participants with both MRI and OCT data were included in the analysis (RNFL n=828, female n=413 [49.9%], male n=415 [50.1%]; GC-IPL n=825, female n=413 [50.1%], male n=412 [49.9%]). Thinner retinal neuronal layers were associated with older brain age, smaller cortical surface area, thinner average cortex, smaller subcortical grey matter volumes, and increased volume of white matter hyperintensities. Conclusion These findings provide evidence that the retinal neuronal layers reflect differences in midlife structural brain integrity consistent with increased risk for later AD, supporting the proposition that the retina may be an early biomarker of brain health.
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Affiliation(s)
| | | | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong
| | - Jesse Gale
- Department of Surgery & Anaesthesia, University of Otago, Wellington, New Zealand
| | - Sean Hogan
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - David Ireland
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Ross Keenan
- Department of Radiology, Christchurch Hospital, Christchurch, New Zealand
- Pacific Radiology Group, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Annchen R Knodt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Tracy R Melzer
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sandhya Ramrakha
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Graham A Wilson
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Tien Yin Wong
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Ahmad R Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Richie Poulton
- Department of Psychology, University of Otago, Dunedin, New Zealand
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36
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Yuan Y, Bulloch G, Zhang S, Chen Y, Yang S, Wang W, Zhu Z, He M. Consumption of Coffee and Tea Is Associated with Macular Retinal Nerve Fiber Layer Thickness: Results from the UK Biobank. Nutrients 2023; 15:nu15051196. [PMID: 36904194 PMCID: PMC10005476 DOI: 10.3390/nu15051196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Coffee and tea drinking are thought to be protective for the development and progression of neurodegenerative disorders. This study aims to investigate associations between coffee and tea consumption with macular retinal nerve fiber layer (mRNFL) thickness, a marker of neurodegeneration. After quality control and eligibility screening, 35,557 out of 67,321 United Kingdom (UK) Biobank participants from six assessment centers were included in this cross-sectional study. In the touchscreen questionnaire, participants were asked how many cups of coffee and tea were consumed daily on average over the last year. Self-reported coffee and tea consumption were divided into four categories including 0 cup/day, 0.5-1 cups/day, 2-3 cups/day, and ≥4 cups/day, respectively. The mRNFL thickness was measured by the optical coherence tomography (Topcon 3D OCT-1000 Mark II) and automatically analyzed by segmentation algorithms. After adjusting for covariates, coffee consumption was significantly associated with an increased mRNFL thickness (β = 0.13, 95% CI = 0.01~0.25), which was more prominent in those who drank 2~3 cups coffee per day (β = 0.16, 95% CI = 0.03~0.30). The mRNFL thickness was also significantly increased in tea drinkers (β = 0.13, 95% CI = 0.01~0.26), especially for those who drank more than 4 cups of tea per day (β = 0.15, 95% CI = 0.01~0.29). The positive associations with mRNFL thickness, indicating that both coffee and tea consumptions had likely neuroprotective potentials. Causal links and underlying mechanisms for these associations should be explored further.
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Affiliation(s)
- Yixiong Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Gabriella Bulloch
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia
| | - Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Yanping Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
- Correspondence: (W.W.); (Z.Z.)
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Correspondence: (W.W.); (Z.Z.)
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Ryan AK, Rich W, Reilly MA. Oxidative stress in the brain and retina after traumatic injury. Front Neurosci 2023; 17:1021152. [PMID: 36816125 PMCID: PMC9935939 DOI: 10.3389/fnins.2023.1021152] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
The brain and the retina share many physiological similarities, which allows the retina to serve as a model of CNS disease and disorder. In instances of trauma, the eye can even indicate damage to the brain via abnormalities observed such as irregularities in pupillary reflexes in suspected traumatic brain injury (TBI) patients. Elevation of reactive oxygen species (ROS) has been observed in neurodegenerative disorders and in both traumatic optic neuropathy (TON) and in TBI. In a healthy system, ROS play a pivotal role in cellular communication, but in neurodegenerative diseases and post-trauma instances, ROS elevation can exacerbate neurodegeneration in both the brain and the retina. Increased ROS can overwhelm the inherent antioxidant systems which are regulated via mitochondrial processes. The overabundance of ROS can lead to protein, DNA, and other forms of cellular damage which ultimately result in apoptosis. Even though elevated ROS have been observed to be a major cause in the neurodegeneration observed after TON and TBI, many antioxidants therapeutic strategies fail. In order to understand why these therapeutic approaches fail further research into the direct injury cascades must be conducted. Additional therapeutic approaches such as therapeutics capable of anti-inflammatory properties and suppression of other neurodegenerative processes may be needed for the treatment of TON, TBI, and neurodegenerative diseases.
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Affiliation(s)
- Annie K. Ryan
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Wade Rich
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Matthew A. Reilly
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States,Department of Ophthalmology and Visual Sciences, The Ohio State University, Columbus, OH, United States,*Correspondence: Matthew A. Reilly,
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Chan RNF, Tang Z, Chan VTT, Chan RNC, Cheng ETW, Ng NCY, Cheung CY. The cross-sectional and longitudinal relationship of diabetic retinopathy to cognitive impairment: a systematic review and meta-analysis. Eye (Lond) 2023; 37:220-227. [PMID: 35501601 PMCID: PMC9873601 DOI: 10.1038/s41433-022-02033-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To establish a potential relationship between diabetic retinopathy (DR) and different stages of cognitive impairment METHODS: Literature searches were conducted on PubMed and EMBASE, with keywords "diabetic retinopathy" and "cognitive impairment". Inclusion criteria were original human studies, and English language. Quality of studies was assessed by the Newcastle-Ottawa Quality Assessment (NOSGEN). The register number of this study on the International Prospective Register of Systematic Reviews (PROSPERO) is CRD42021236747. The main outcome measures were odds ratios (OR) and risk ratios (RR) for cross-sectional and longitudinal studies, respectively. Meta-regression was performed to evaluate the effects of potential moderator variables, including, age, onset age of diabetes mellitus (DM), duration of DM, and HbA1c. RESULTS Twenty-five studies (17 cross-sectional and 8 longitudinal studies) with a total of 1,963,914 subjects, were included. Among the cross-sectional studies, the pooled ORs of any cognitive impairment, early stage of cognitive impairment and dementia in subjects with DR (95% confidence interval) were 1.48 (1.08-2.02), 1.59 (1.01-2.51), and 1.13 (0.86-1.50), respectively. Among the longitudinal studies, the pooled RRs of any cognitive impairment, early stage of cognitive impairment, and dementia in subjects with DR (95% confidence interval) were 1.35 (1.12-1.65), 1.50 (1.06-2.12), and 1.31 (1.03-1.66), respectively. Meta-regression showed age, onset age of DM, duration of DM, and glycated hemoglobin (HbA1c) were not statistically associated with the outcomes. CONCLUSIONS The presence of DR in DM patients indicates both higher odds of prevalent cognitive impairment and escalated risks of developing cognitive impairment in the future.
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Affiliation(s)
- Robert N F Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Victor T T Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Raymond N C Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Esther T W Cheng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Natalie C Y Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.
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39
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Yin GS, van der Heide F, Littlejohns TJ, Kuźma E, Hayat S, Brayne C, Foster PJ, Luben R, Khawaja AP. Association Between Retinal Nerve Fiber Layer Thickness and Incident Dementia in the European Prospective Investigation into Cancer in Norfolk Cohort. J Alzheimers Dis 2023; 95:691-702. [PMID: 37574729 DOI: 10.3233/jad-230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Retinal nerve fiber layer (RNFL) thickness may reflect cerebral status. OBJECTIVE This study assessed the relationship between RNFL thickness and incident all-cause dementia in the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) Eye Study. METHODS Glaucoma detection with variable corneal compensation (GDx-VCC) and Heidelberg Retinal Tomograph II (HRT II) derived global mean RNFL thickness from dementia-free participants at baseline within the EPIC-Norfolk Eye Study were analyzed. Incident dementia was identified through linkage to electronic medical records. Cox proportional hazard mixed-effects regression models adjusted for key confounders were used to examine the associations between RNFL thickness and incident dementia in four separate models. RESULTS 6,239 participants were included with 322 cases of incident dementia and mean age of 67.5-years old, with 49.7% women (median follow-up 13.2-years, interquartile range (11.7 to 14.6 years). Greater RNFL thickness (GDx-VCC) was not significantly associated with a lower risk of incident dementia in the full adjusted model [HR per quartile increase 0.95; 95% CI 0.82-1.10]. Similarly, RNFL thickness assessed with HRT II was also not associated with incident dementia in any model (full adjusted model; HR per quartile increase: 1.06; [95% CI 0.93-1.19]. Gender did not modify any associations under study. CONCLUSION GDx-VCC and HRT II derived RNFL thickness are unlikely to be useful predictors of incident dementia. Higher resolution optical imaging technologies may clarify whether there are useful relationships between neuro-retinal morphology and brain measures.
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Affiliation(s)
- Grace S Yin
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Frank van der Heide
- Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, the Netherlands
| | | | - Elżbieta Kuźma
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany
| | - Shabina Hayat
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, England, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Robert Luben
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Anthony P Khawaja
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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de Almeida Faria ACR, Dall'Agnol JF, Gouveia AM, De Paiva CI, Segalla VC, Ogata FE, Baena CP. Cognitive Performance and Diabetic Retinopathy: What Your Eyes Can Reveal About Your Brain. Curr Diabetes Rev 2023; 19:e050822207323. [PMID: 35929625 PMCID: PMC10617788 DOI: 10.2174/1573399819666220805154638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) is a chronic diabetes complication. People with Type 2 Diabetes Mellitus (T2DM) have two times the risk for dementia, suggesting it is a new chronic diabetes complication. OBJECTIVE Evaluate the association of DR with cognitive performance in a T2DM population. METHODS Cross-sectional study with 400 T2DM adults from whom socio-demographic, clinical, laboratory data were collected, and screening test for depression symptoms (Patient Health Questionaire- 9 (PHQ-9)), Mini-Mental State Examination (MMSE), Semantic Verbal Fluency Test, Trail Making Test A and B, Word Memory test were performed. All cognitive test scores were converted into Global Cognition z-Score (GCS(z)). The association between GCS(z) < 0 with DR was performed using a multivariate binary logistic regression model adjusted for age ≥ 65 years, school years ≤ 6 years, DM duration ≥ 10 years, depression symptoms score > 9 at PHQ-9, arterial hypertension, physical activity, diabetic retinopathy, macular edema, and cardiovascular disease. RESULTS After exclusions, the 251 eligible patients were 56.6% female, with a mean age of 61.1 (±9.8) years, DM duration of 12.6 (±8.9) years, and 7.6 (±4.2) years of school education. DR prevalence was 46.5%. Multivariate Logistic Regression Model showed an association between DR and GCS(z) < 0, with odds ratio (CI95%) of 2.50 (1.18-5.34), adjusted for age, low education level, arterial hypertension and depression symptoms (OD and CI95% respectively: 5.46(2.42-12.34); 12.19 (5.62-26.46); 2.55 (0.88-7.39); 3.53 (1.55-8.07)). CONCLUSION In this T2DM population, having DR increased the chance for worse cognitive performance even when adjusted for age, low education level, presence of arterial hypertension, and depression symptoms.
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Affiliation(s)
- Ana Cristina Ravazzani de Almeida Faria
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Paraná, (PUCPR), Curitiba, Paraná, Brazil
- Department of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Joceline Franco Dall'Agnol
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Paraná, (PUCPR), Curitiba, Paraná, Brazil
| | - Aline Maciel Gouveia
- Department of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Clara Inácio De Paiva
- Department of Medicine, Pontifical Catholic University of Paraná (PUCPR), Curitiba, Paraná, Brazil
| | | | | | - Cristina Pellegrino Baena
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Paraná, (PUCPR), Curitiba, Paraná, Brazil
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41
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Hilal S, Cheung CY, Wong TY, Schmetterer L, Chen C. Retinal parameters, cortical cerebral microinfarcts, and their interaction with cognitive impairment. Int J Stroke 2023; 18:70-77. [PMID: 35450485 DOI: 10.1177/17474930221097737] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Quantitative changes in retinal vessels and thinning of optic nerves have been associated with subclinical (atherosclerosis, inflammation) and clinical age-related brain pathologies (stroke and neurodegeneration). However, data on the association between both retinal vascular and neuronal parameters with cortical cerebral microinfarcts (CMIs) and how these factors jointly influence cognition are lacking. AIM We investigated the association of retinal vascular and neuronal changes with CMIs on 3 T MRI and explored their interaction with cognitive impairment in a memory-clinic population. METHODS A total of 538 participants were included. Retinal vascular parameters (caliber, tortuosity, and fractal dimension) were measured from retinal fundus photographs using a semi-automated computer-assisted program. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses were obtained from optical coherence tomography. Cortical CMIs were defined as hypointense on T1-weighted MRI, <5 mm in diameter and restricted to the cortex. Cognition was assessed using Clinical Dementia Rating Sum-of-Boxes (CDR-SoB) score and detailed neuropsychological test. Multivariable regression analysis was conducted adjusting for age, sex, hypertension, hyperlipidemia, diabetes mellitus, smoking, diagnosis, white matter hyperintensities volume, lacunes, and cerebral microbleeds. RESULTS Larger venular caliber (Rate ratios (RR): 1.15, 95% CI: 1.01-1.38, p = 0.014), increased venular fractal dimension (RR: 1.58, 95% CI: 1.31-1.91, p ⩽ 0.001), increased venular tortuosity (RR: 1.54, 95% CI: 1.35-1.75, p ⩽ 0.001), and thinner GC-IPL (RR: 1.24, 95% CI: 1.13-1.36, p ⩽ 0.001) were associated with CMI counts. Among individuals in highest tertile of retinal parameters, a significant interaction was observed between venular tortuosity (RR: 1.12, 95% CI: 1.02-1.22, p-interaction = 0.014) and GC-IPL (RR: 1.05, 95% CI: 1.01-1.11, p-interaction < 0.001) with CMIs on CDR-SoB. CONCLUSION Retinal vascular and neuronal parameters are associated with cortical CMIs, and persons with both pathologies are likely to have cognitive impairment. Further studies may be warranted to evaluate the clinical utility of retinal parameters and CMI in risk prediction for cognitive dysfunction.
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Affiliation(s)
- Saima Hilal
- Memory Aging and Cognition Center, National University Health System, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Christopher Chen
- Memory Aging and Cognition Center, National University Health System, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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42
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Hui HYH, Ran AR, Dai JJ, Cheung CY. Deep Reinforcement Learning-Based Retinal Imaging in Alzheimer's Disease: Potential and Perspectives. J Alzheimers Dis 2023; 94:39-50. [PMID: 37212112 DOI: 10.3233/jad-230055] [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] [Indexed: 05/23/2023]
Abstract
Alzheimer's disease (AD) remains a global health challenge in the 21st century due to its increasing prevalence as the major cause of dementia. State-of-the-art artificial intelligence (AI)-based tests could potentially improve population-based strategies to detect and manage AD. Current retinal imaging demonstrates immense potential as a non-invasive screening measure for AD, by studying qualitative and quantitative changes in the neuronal and vascular structures of the retina that are often associated with degenerative changes in the brain. On the other hand, the tremendous success of AI, especially deep learning, in recent years has encouraged its incorporation with retinal imaging for predicting systemic diseases. Further development in deep reinforcement learning (DRL), defined as a subfield of machine learning that combines deep learning and reinforcement learning, also prompts the question of how it can work hand in hand with retinal imaging as a viable tool for automated prediction of AD. This review aims to discuss potential applications of DRL in using retinal imaging to study AD, and their synergistic application to unlock other possibilities, such as AD detection and prediction of AD progression. Challenges and future directions, such as the use of inverse DRL in defining reward function, lack of standardization in retinal imaging, and data availability, will also be addressed to bridge gaps for its transition into clinical use.
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Affiliation(s)
- Herbert Y H Hui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jia Jia Dai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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43
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Li HY, Wang DX, Dong L, Wei WB. Deep learning algorithms for detection of diabetic macular edema in OCT images: A systematic review and meta-analysis. Eur J Ophthalmol 2023; 33:278-290. [PMID: 35473414 DOI: 10.1177/11206721221094786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Artificial intelligence (AI) can detect diabetic macular edema (DME) from optical coherence tomography (OCT) images. We aimed to evaluate the performance of deep learning neural networks in DME detection. METHODS Embase, Pubmed, the Cochrane Library, and IEEE Xplore were searched up to August 14, 2021. We included studies using deep learning algorithms to detect DME from OCT images. Two reviewers extracted the data independently, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess the risk of bias. The study is reported according to Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). RESULTS Ninteen studies involving 41005 subjects were included. The pooled sensitivity and specificity were 96.0% (95% confidence interval (CI): 93.9% to 97.3%) and 99.3% (95% CI: 98.2% to 99.7%), respectively. Subgroup analyses found that data set selection, sample size of training set and the choice of OCT devices contributed to the heterogeneity (all P < 0.05). While there was no association between the diagnostic accuracy and transfer learning adoption or image management (all P > 0.05). CONCLUSIONS Deep learning methods, particularly the convolutional neural networks (CNNs) could effectively detect clinically significant DME, which can provide referral suggestions to the patients.
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Affiliation(s)
- He-Yan Li
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, 117902Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dai-Xi Wang
- 12517Capital Medical University, Beijing, China
| | - Li Dong
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, 117902Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wen-Bin Wei
- Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, 117902Beijing Tongren Hospital, Capital Medical University, Beijing, China
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44
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Dağ Şeker E, Erbahçeci Timur İE. Assessment of early and long-COVID related retinal neurodegeneration with optical coherence tomography. Int Ophthalmol 2022; 43:2073-2081. [PMID: 36567371 PMCID: PMC9790812 DOI: 10.1007/s10792-022-02607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/02/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study is to investigate short-term and long-term effects of coronovirus 19 disease (COVID-19) at inner and outer retinal layers of patients recovered from COVID-19 with Spectral Domain Optical Coherence Tomography (SD-OCT) and compare these to healthy subjects. METHODS Twenty-seven patients recovered from COVID-19, and age- and gender-matched 27 healthy controls were included in this study. Macular and peripapillary retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), inner nuclear layer (INL), outer plexiform layer (OPL) and outer nuclear layer (ONL) were analyzed with SD-OCT 1 month (V1 visit) and 12 months (V2 visit) after negative result of reverse transcriptase-polymerase chain reaction test. RESULTS Macular RNFL thickness in outer ring was thinner at V1 and V2 visits than healthy control (p = 0.049 and p = 0.005). Central and inferonasal quadrants of peripapillary RNFL thicknesses were reduced at V1 and V2 visits compared to controls (p = 0.001 and p = 0.024 for V1 visit; p = 0.001 and p = 0.006 for V2 visit). Thinning in ONL thickness in inner ring was observed at V1 and V2 visits than healthy subjects (p = 0.006 and p = 0.001). CONCLUSION Subclinical localized changes in macular and peripapillary RNFL and outer nuclear layer were demonstrated in early and 12-months follow-up after COVID-19 recovery.
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Affiliation(s)
- Esra Dağ Şeker
- Ankara City Hospital Ophthalmology Department, Universiteler Mah. 1604. Cad. No 9 Bilkent, Ankara, Turkey
| | - İnci Elif Erbahçeci Timur
- Ankara City Hospital Ophthalmology Department, Universiteler Mah. 1604. Cad. No 9 Bilkent, Ankara, Turkey
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45
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Hua R, Xiong J, Li G, Zhu Y, Ge Z, Ma Y, Fu M, Li C, Wang B, Dong L, Zhao X, Ma Z, Chen J, Gao X, He C, Wang Z, Wei W, Wang F, Gao X, Chen Y, Zeng Q, Xie W. Development and validation of a deep learning algorithm based on fundus photographs for estimating the CAIDE dementia risk score. Age Ageing 2022; 51:6936402. [PMID: 36580391 DOI: 10.1093/ageing/afac282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/08/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score is a recognised tool for dementia risk stratification. However, its application is limited due to the requirements for multidimensional information and fasting blood draw. Consequently, an effective and non-invasive tool for screening individuals with high dementia risk in large population-based settings is urgently needed. METHODS a deep learning algorithm based on fundus photographs for estimating the CAIDE dementia risk score was developed and internally validated by a medical check-up dataset included 271,864 participants in 19 province-level administrative regions of China, and externally validated based on an independent dataset included 20,690 check-up participants in Beijing. The performance for identifying individuals with high dementia risk (CAIDE dementia risk score ≥ 10 points) was evaluated by area under the receiver operating curve (AUC) with 95% confidence interval (CI). RESULTS the algorithm achieved an AUC of 0.944 (95% CI: 0.939-0.950) in the internal validation group and 0.926 (95% CI: 0.913-0.939) in the external group, respectively. Besides, the estimated CAIDE dementia risk score derived from the algorithm was significantly associated with both comprehensive cognitive function and specific cognitive domains. CONCLUSIONS this algorithm trained via fundus photographs could well identify individuals with high dementia risk in a population setting. Therefore, it has the potential to be utilised as a non-invasive and more expedient method for dementia risk stratification. It might also be adopted in dementia clinical trials, incorporated as inclusion criteria to efficiently select eligible participants.
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Affiliation(s)
- Rong Hua
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing 100191, China.,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
| | | | - Gail Li
- Departments of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA
| | - Yidan Zhu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing 100191, China.,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
| | - Zongyuan Ge
- Beijing Airdoc Technology Co., Ltd., Beijing, China
| | - Yanjun Ma
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing 100191, China.,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
| | - Meng Fu
- Beijing Airdoc Technology Co., Ltd., Beijing, China
| | - Chenglong Li
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing 100191, China.,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
| | - Bin Wang
- Beijing Airdoc Technology Co., Ltd., Beijing, China
| | - Li Dong
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing, China
| | - Xin Zhao
- Beijing Airdoc Technology Co., Ltd., Beijing, China
| | - Zhiqiang Ma
- iKang Guobin Healthcare Group Co., Ltd., Beijing, China
| | - Jili Chen
- Shibei Hospital, Jingan District, Shanghai, China
| | - Xinxiao Gao
- Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chao He
- Beijing Airdoc Technology Co., Ltd., Beijing, China
| | - Zhaohui Wang
- iKang Guobin Healthcare Group Co., Ltd., Beijing, China
| | - Wenbin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing, China
| | - Fei Wang
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiangyang Gao
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Yuzhong Chen
- Beijing Airdoc Technology Co., Ltd., Beijing, China
| | - Qiang Zeng
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing 100191, China.,PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
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46
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Advanced Optical Wavefront Technologies to Improve Patient Quality of Vision and Meet Clinical Requests. Polymers (Basel) 2022; 14:polym14235321. [PMID: 36501713 PMCID: PMC9741482 DOI: 10.3390/polym14235321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/09/2022] Open
Abstract
Adaptive optics (AO) is employed for the continuous measurement and correction of ocular aberrations. Human eye refractive errors (lower-order aberrations such as myopia and astigmatism) are corrected with contact lenses and excimer laser surgery. Under twilight vision conditions, when the pupil of the human eye dilates to 5-7 mm in diameter, higher-order aberrations affect the visual acuity. The combined use of wavefront (WF) technology and AO systems allows the pre-operative evaluation of refractive surgical procedures to compensate for the higher-order optical aberrations of the human eye, guiding the surgeon in choosing the procedure parameters. Here, we report a brief history of AO, starting from the description of the Shack-Hartmann method, which allowed the first in vivo measurement of the eye's wave aberration, the wavefront sensing technologies (WSTs), and their principles. Then, the limitations of the ocular wavefront ascribed to the IOL polymeric materials and design, as well as future perspectives on improving patient vision quality and meeting clinical requests, are described.
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47
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Xu GX, Ren CX. SPNet: A novel deep neural network for retinal vessel segmentation based on shared decoder and pyramid-like loss. Neurocomputing 2022. [DOI: 10.1016/j.neucom.2022.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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48
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Zhu Z, Hu W, Chen R, Xiong R, Wang W, Shang X, Chen Y, Kiburg K, Shi D, He S, Huang Y, Zhang X, Tang S, Zeng J, Yu H, Yang X, He M. Retinal age gap as a predictive biomarker of stroke risk. BMC Med 2022; 20:466. [PMID: 36447293 PMCID: PMC9710167 DOI: 10.1186/s12916-022-02620-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/20/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The aim of this study is to investigate the association of retinal age gap with the risk of incident stroke and its predictive value for incident stroke. METHODS A total of 80,169 fundus images from 46,969 participants in the UK Biobank cohort met the image quality standard. A deep learning model was constructed based on 19,200 fundus images of 11,052 disease-free participants at baseline for age prediction. Retinal age gap (retinal age predicted based on the fundus image minus chronological age) was generated for the remaining 35,917 participants. Stroke events were determined by data linkage to hospital records on admissions and diagnoses, and national death registers, whichever occurred earliest. Cox proportional hazards regression models were used to estimate the effect of retinal age gap on risk of stroke. Logistic regression models were used to estimate the predictive value of retinal age and well-established risk factors in 10-year stroke risk. RESULTS A total of 35,304 participants without history of stroke at baseline were included. During a median follow-up of 5.83 years, 282 (0.80%) participants had stroke events. In the fully adjusted model, each one-year increase in the retinal age gap was associated with a 4% increase in the risk of stroke (hazard ratio [HR] = 1.04, 95% confidence interval [CI]: 1.00-1.08, P = 0.029). Compared to participants with retinal age gap in the first quintile, participants with retinal age gap in the fifth quintile had significantly higher risks of stroke events (HR = 2.37, 95% CI: 1.37-4.10, P = 0.002). The predictive capability of retinal age alone was comparable to the well-established risk factor-based model (AUC=0.676 vs AUC=0.661, p=0.511). CONCLUSIONS We found that retinal age gap was significantly associated with incident stroke, implying the potential of retinal age gap as a predictive biomarker of stroke risk.
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Affiliation(s)
- Zhuoting Zhu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Wenyi Hu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Ruiye Chen
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Ruilin Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xianwen Shang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Yifan Chen
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Katerina Kiburg
- Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Danli Shi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shuang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yu Huang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xueli Zhang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Shulin Tang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Jieshan Zeng
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.
| | - Mingguang He
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China. .,Centre for Eye Research Australia, Ophthalmology, University of Melbourne, Melbourne, Australia. .,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia. .,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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García-Sierra R, López-Lifante VM, Isusquiza Garcia E, Heras A, Besada I, Verde Lopez D, Alzamora MT, Forés R, Montero-Alia P, Ugarte Anduaga J, Torán-Monserrat P. Automated Systems for Calculating Arteriovenous Ratio in Retinographies: A Scoping Review. Diagnostics (Basel) 2022; 12:diagnostics12112865. [PMID: 36428925 PMCID: PMC9689345 DOI: 10.3390/diagnostics12112865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
There is evidence of an association between hypertension and retinal arteriolar narrowing. Manual measurement of retinal vessels comes with additional variability, which can be eliminated using automated software. This scoping review aims to summarize research on automated retinal vessel analysis systems. Searches were performed on Medline, Scopus, and Cochrane to find studies examining automated systems for the diagnosis of retinal vascular alterations caused by hypertension using the following keywords: diagnosis; diagnostic screening programs; image processing, computer-assisted; artificial intelligence; electronic data processing; hypertensive retinopathy; hypertension; retinal vessels; arteriovenous ratio and retinal image analysis. The searches generated 433 articles. Of these, 25 articles published from 2010 to 2022 were included in the review. The retinographies analyzed were extracted from international databases and real scenarios. Automated systems to detect alterations in the retinal vasculature are being introduced into clinical practice for diagnosis in ophthalmology and other medical specialties due to the association of such changes with various diseases. These systems make the classification of hypertensive retinopathy and cardiovascular risk more reliable. They also make it possible for diagnosis to be performed in primary care, thus optimizing ophthalmological visits.
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Affiliation(s)
- Rosa García-Sierra
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Mataró, Spain
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Campus Bellaterra, 08193 Barcelona, Spain
- Primary Care Group, Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Victor M. López-Lifante
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Mataró, Spain
- Palau-solità i Plegamans Primary Healthcare Centre, Palau-solità i Plegamans, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08184 Barcelona, Spain
- Correspondence:
| | | | - Antonio Heras
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Mataró, Spain
- Primary Healthcare Centre Riu Nord-Riu Sud, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Santa Coloma de Gramenet, 08921 Barcelona, Spain
| | - Idoia Besada
- ULMA Medical Technologies, S. Coop, 20560 Onati, Spain
| | - David Verde Lopez
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain
| | - Maria Teresa Alzamora
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Mataró, Spain
- Primary Healthcare Centre Riu Nord-Riu Sud, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Santa Coloma de Gramenet, 08921 Barcelona, Spain
| | - Rosa Forés
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Mataró, Spain
| | - Pilar Montero-Alia
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Mataró, Spain
| | | | - Pere Torán-Monserrat
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Mataró, Spain
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Primary Care Group, Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Girona, 17004 Girona, Spain
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Duan H, Xie J, Zhou Y, Zhang H, Liu Y, Tang C, Zhao Y, Qi H. Characterization of the Retinal Microvasculature and FAZ Changes in Ischemic Stroke and Its Different Types. Transl Vis Sci Technol 2022; 11:21. [PMID: 36239966 PMCID: PMC9586132 DOI: 10.1167/tvst.11.10.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to assess morphological changes in the retinal microvasculature and foveal avascular zone (FAZ) in patients with ischemic stroke and its different subtypes. Methods Thirty-three patients with ischemic stroke (14 with nonlacunar infarction and 19 with lacunar infarction) and 27 control participants were enrolled in this study. Based on optical coherence tomography angiography (OCTA), three vascular parameters, including vascular area density, vascular fractal dimension (VFD), and vascular orientation distribution (VOD), and four FAZ-related parameters, including FAZ area, FAZ axis ratio (FAR), FAZ circularity (FC), and FAZ roundness, in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were extracted and analyzed. Results Logistic regression results showed that worse best-corrected visual acuity (odds ratio [OR], 0.21), higher FAR (OR, 2.77) and lower FC (OR, 0.36) of the DCP were associated with ischemic stroke. Furthermore, lower VOD of the SCP was significantly associated with lacunar infarction compared with nonlacunar infarction. Conclusions Our study shows that the FAR and FC of the DCP may be potential biomarkers of ischemic stroke. Moreover, we demonstrated that OCT showed specific damage patterns in retinal microvascular and macular morphology in different subtypes of ischemic stroke. Translational Relevance This work lays the foundation for the pathophysiological characteristics of cerebrovascular diseases assisted by retinal imaging and artificial intelligence.
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Affiliation(s)
- Hongyu Duan
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.,Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Jianyang Xie
- Cixi Institute of BioMedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Yifan Zhou
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Hui Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Yiyun Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Chuhao Tang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Yitian Zhao
- Cixi Institute of BioMedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Hong Qi
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.,Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
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