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Lommatzsch C, van Oterendorp C. Current Status and Future Perspectives of Optic Nerve Imaging in Glaucoma. J Clin Med 2024; 13:1966. [PMID: 38610731 PMCID: PMC11012267 DOI: 10.3390/jcm13071966] [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: 01/26/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Being the primary site of degeneration, the optic nerve has always been the focus of structural glaucoma assessment. The technical advancements, mainly of optical coherence tomography (OCT), now allow for a very precise quantification of the optic nerve head and peripapillary retina morphology. By far the most commonly used structural optic nerve parameter is the thickness of the parapapillary retinal nerve fiber, which has great clinical utility but also suffers from significant limitations, mainly in advanced glaucoma. Emerging novel imaging technologies, such as OCT angiography, polarization-sensitive or visible-light OCT and adaptive optics, offer new biomarkers that have the potential to significantly improve structural glaucoma diagnostics. Another great potential lies in the processing of the data already available. Artificial intelligence does not only help increase the reliability of current biomarkers but can also integrate data from various imaging modalities and other clinical measures to increase diagnostic accuracy. And it can, in a more efficient way, draw information from available datasets, such as an OCT scan, compared to the current concept of biomarkers, which only use a fraction of the whole dataset.
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Affiliation(s)
- Claudia Lommatzsch
- Department of Ophthalmology, St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
- Department of Ophthalmology, University of Luebeck, 23562 Luebeck, Germany
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Cost-Effectiveness of Screening for Open Angle Glaucoma Compared With Opportunistic Case Finding. J Glaucoma 2023; 32:72-79. [PMID: 36696355 DOI: 10.1097/ijg.0000000000002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/21/2022] [Indexed: 01/26/2023]
Abstract
PRCIS The manuscript evaluates cost-effectiveness of glaucoma screening with imaging devices and telemedicine based on a screening campaign performed in Spain. The screening strategy implemented in our analysis was cost-effective compared with opportunistic case finding. INTRODUCTION Open angle glaucoma is an asymptomatic ocular disease that represents one of the first causes of blindness. Diagnosis is currently made by opportunistic case finding, usually by community optometrists or general ophthalmologists. The aim of this study was to assess the cost-effectiveness of a screening strategy based on optical coherence tomography and fundus photographs in glaucoma detection. MATERIALS AND METHODS A cost-effectiveness analysis was carried out to compare 2 alternative strategies: opportunistic finding versus screening. A Markov tree model was carried out with 10 health states according to disease progression. Quality-adjusted life years (QALYs) were used as a measure of effectiveness. We included short-term and long-term direct health costs and a discount rate of 3%. We performed a probabilistic sensitivity analysis and several 1-way sensitivity analyses. RESULTS The cohort in the screening program entailed an increase in 0.097 QALYs and additional costs of €1187 versus opportunistic finding, with an incremental cost-effectiveness ratio of about €12.214/QALY. The 1-way sensitivity analysis showed that inputs related to age and screening program (cost and detection rate) were those most strongly influencing the results of the analysis. Probabilistic sensitivity analyses showed that the model was robust to significant changes in the main variables of the analysis. CONCLUSIONS The screening strategy implemented in our analysis was cost-effective compared with opportunistic finding in patients with glaucoma in this Spanish setting.
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Jaumandreu L, Antón A, Pazos M, Rodriguez-Uña I, Rodriguez Agirretxe I, Martinez de la Casa JM, Ayala ME, Parrilla-Vallejo M, Dyrda A, Díez-Álvarez L, Rebolleda G, Muñoz-Negrete FJ. Glaucoma progression. Clinical practice guide. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:40-57. [PMID: 36089479 DOI: 10.1016/j.oftale.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.
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Affiliation(s)
- L Jaumandreu
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - A Antón
- Institut Català de la Retina (ICR), Barcelona, Spain; Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Pazos
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Rodriguez-Uña
- Instituto Oftalmológico Fernández-Vega, Universidad de Oviedo, Oviedo, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - I Rodriguez Agirretxe
- Servicio de Oftalmología, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - J M Martinez de la Casa
- Servicio de Oftalmología, Hospital Clinico San Carlos, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IsISSC), IIORC, Universidad Complutense de Madrid, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M E Ayala
- Institut Català de la Retina (ICR), Barcelona, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Parrilla-Vallejo
- Servicio de Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - A Dyrda
- Institut Català de la Retina (ICR), Barcelona, Spain
| | - L Díez-Álvarez
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Ramachandran R, Joiner DB, Patel V, Popplewell D, Misra P, Kaplan CM, Hood DC, Al-Aswad LA. Comparison between the Recommendations of Glaucoma Specialists and OCT Report Specialists for Further Ophthalmic Evaluation in a Community-Based Screening Study. Ophthalmol Glaucoma 2022; 5:602-613. [PMID: 35688330 DOI: 10.1016/j.ogla.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To compare glaucoma referral patterns between glaucoma and OCT report specialists and to determine what influence, if any, a designated OCT reading could have on a glaucoma specialist's judgments. DESIGN Retrospective, exploratory study. SUBJECTS We included 483 eyes (243 individuals) from high-risk New York City neighborhoods screened as part of a mobile van glaucoma screening study from July 2017 to October 2017. METHODS All participants underwent comprehensive testing, including visual acuity, commercial OCT imaging, gonioscopy, intraocular pressure, frequency-doubling testing, and funduscopic assessment. Three glaucoma specialists independently evaluated all the collected data to determine whether a further glaucoma workup referral was recommended. Two OCT report specialists evaluated only the OCT image for each eye using the commercial report as well as a specialized, customized report. In phase II, the glaucoma specialists then re-evaluated a subset of these eyes, this time with an OCT report specialist's judgments made available. MAIN OUTCOME MEASURES Comparison of glaucoma specialist referrals made by glaucoma specialists versus OCT report specialists. RESULTS Intergrader agreement between glaucoma specialists was 60% (κ = 0.43) and between report specialists was 95% (κ = 0.77). There was an agreement between a single OCT report specialist and the consensus (2 of 3) of glaucoma specialists in 74% of eyes (κ= 0.32). Of the eyes studied, 25% were referred for further glaucoma evaluation by the glaucoma specialists alone and 1% were referred for further glaucoma workup by only the report specialist. With the addition of the report specialist's judgments, referral pattern changes varied by glaucoma specialist but overall agreement increased to 85% (κ = 0.53). CONCLUSIONS There was a fair level of agreement regarding glaucoma referral recommendations between glaucoma specialists with access to comprehensive screening data and OCT report specialists with access to only OCT data. Overall agreement increased when the designated OCT evaluation was made available to the glaucoma specialists. These results may aid in the design of future large-scale glaucoma screening studies.
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Affiliation(s)
| | - Devon B Joiner
- Department of Psychology, Columbia University, New York, New York
| | - Vipul Patel
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | | | - Poonam Misra
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - Chad M Kaplan
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - Donald C Hood
- Department of Psychology, Columbia University, New York, New York; Department of Ophthalmology, Columbia University, New York, New York
| | - Lama A Al-Aswad
- Department of Ophthalmology, NYU Langone Health, New York, New York; Department of Ophthalmology, Columbia University, New York, New York.
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Kourkoutas D, Triantafyllopoulos G, Georgiou I, Karamaounas A, Karamaounas N, Sotiropulos K, Kapralos D. Comparison of Diagnostic Ability Between Wide-Field Swept-Source Optical Coherence Tomography Imaging Maps and Heidelberg Retina Tomograph 3 Optic Nerve Head Assessment to Discriminate Glaucomatous and Non-glaucomatous Eyes. Cureus 2022; 14:e28188. [PMID: 36158420 PMCID: PMC9482818 DOI: 10.7759/cureus.28188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background In this study, we aimed to determine the diagnostic performance of optic nerve head (ONH), macular, and circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements of wide-field maps (12 × 9 mm) using swept-source optical coherence tomography (SS-OCT) compared to measurements of the ONH and RNFL parameters measured by Heidelberg Retina Tomograph (HRT3). Methodology This case-control study included 39 eyes of 39 glaucoma patients and 36 eyes of 36 normal subjects (control group). All participants underwent standard automated perimetry (SAP) as well as structural measurements by SS-OCT (DRI-OCT, Triton; Topcon Inc., Tokyo, Japan) and HRT3 (Heidelberg Engineering, Heidelberg, Germany). The abilities of the continuous parameters to discriminate between glaucoma and control groups were assessed using areas under the receiver operating characteristic curves (AUCs). To assess the glaucoma diagnostic abilities of each of the categorical variables, sensitivity, specificity, positive predictive value, and negative predictive value were tested. Results The highest sensitivities were achieved by the DRI-OCT categorical parameters of Superpixel-200 map and cpRNFL (12 sectors) thickness analysis. The best performing HRT3 continuous parameter was rim volume (AUC = 0.829, 95% confidence interval (CI) = 0.735-0.922), and the best continuous parameter for DRI-OCT wide-field was vertical cdr (AUC = 0.883, 95% CI = 0.805-0.951), followed by total cpRNFL thickness (AUC = 0.862, 95% CI = 0.774-0.951). AUCs for disc area, rim area, linear cdr, and RNFL thickness were not significantly different between the two technologies. Using either the most or the least specific criteria, SuperPixel-200 map always showed the highest sensitivity among the categorical parameters of both technologies (82.1% and 89.7%, respectively). The highest sensitivity among HRT3 classification parameters was shown by MRA and GPS classification algorithms. Conclusions Both wide-field DRI-OCT maps and HRT3 showed good diagnostic performance in discriminating glaucoma. Although DRI-OCT thickness values and normative diagnostic classification showed the best performance, more studies are required to determine the clinical role of wide-field DRI-OCT scan in glaucoma diagnosis.
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Anton A, Nolivos K, Pazos M, Fatti G, Ayala ME, Martínez-Prats E, Peral O, Poposki V, Tsiroukis E, Morilla-Grasa A, Comas M, Castells X. Diagnostic Accuracy and Detection Rate of Glaucoma Screening with Optic Disk Photos, Optical Coherence Tomography Images, and Telemedicine. J Clin Med 2021; 11:jcm11010216. [PMID: 35011957 PMCID: PMC8746039 DOI: 10.3390/jcm11010216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the diagnostic accuracy of optical coherence tomography (OCT) and retinography in the detection of glaucoma through a telemedicine program. Methods: A population-based sample of 4113 persons was randomly selected. The screening examination included a fundus photograph and OCT images. Images were evaluated on a deferred basis. All participants were then invited to a complete glaucoma examination, including gonioscopy, visual field, and dilated fundus examination. The detection rate, sensitivity, specificity, and positive and negative predictive values were calculated. Results: We screened 1006 persons. Of these, 201 (19.9%) were classified as glaucoma suspects; 20.4% were identified only by retinographs, 11.9% only by OCT images, and 46.3% by both. On ophthalmic examination at the hospital (n = 481), confirmed glaucoma was found in 58 (12.1%), probable glaucoma in 76 (15.8%), and ocular hypertension in 10 (2.1%), and no evidence of glaucoma was found in 337 (70.0%). The detection rate for confirmed or probable glaucoma was 9.2%. Sensitivity ranged from 69.4% to 86.2% and specificity from 82.1% to 97.4%, depending on the definition applied. Conclusions: The combination of OCT images and fundus photographs yielded a detection rate of 9.2% in a population-based screening program with moderate sensitivity, high specificity, and predictive values of 84–96%.
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Affiliation(s)
- Alfonso Anton
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
- Medical School, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
- Correspondence: ; Tel.: +34-93-254-0565 (ext. 4000-4002); Fax: +34-93-254-0567
| | - Karen Nolivos
- Department of Medicine, Institut Mar d’Investigacions Mèdiques (IMIM), 08005 Barcelona, Spain;
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
| | - Marta Pazos
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic de Barcelona, Institut d’Investigacions Mèdiques, 08036 Barcelona, Spain;
| | - Gianluca Fatti
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
| | - Miriam Eleonora Ayala
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | | | | | - Vladimir Poposki
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
- Ophthalmology Service, Parc de Salut Mar, 08005 Barcelona, Spain;
| | - Evangelos Tsiroukis
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | - Antonio Morilla-Grasa
- Research Department, Institut Català de la Retina (ICR), 08017 Barcelona, Spain; (M.E.A.); (V.P.); (E.T.); (A.M.-G.)
| | - Merce Comas
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Parc Salut Mar, 08005 Barcelona, Spain; (M.C.); (X.C.)
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Liu H, Liao F, Blanco R, de la Villa P. Multifocal Visual Evoked Potentials (mfVEP) for the Detection of Visual Field Defects in Glaucoma: Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10184165. [PMID: 34575285 PMCID: PMC8465367 DOI: 10.3390/jcm10184165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Some discrepancies have been observed in the diagnostic efficacy of multifocal visual evoked potential (mfVEP) when evaluating visual field defects in glaucoma patients. Therefore, we evaluated the diagnostic precision of the mfVEP in glaucoma to find its best diagnostic indicator. A systematic review and meta-analysis of quantitative studies published up to 1 April 2021 was performed. The methodological quality of the included articles was assessed. Publication bias analysis and heterogeneity tests were performed. The sensitivity, specificity and diagnostic odds ratio were calculated. The area under the curve (AUC) was calculated using the summary of receiver operating characteristics curve. Six studies with a total of 241 patients were included according to the inclusion and exclusion criteria. The AUC was 0.98. There was no evidence of publication bias or threshold effect. The pooled sensitivity and pooled specificity of the mfVEP amplitude for detection of visual field defects in all studies was 0.93 and 0.89, respectively. The positive and negative likelihood ratios of mfVEP amplitude were 6.56 and 0.08, respectively. The amplitude of mfVEP showed a good diagnostic precision in the prediction of visual field defects. Interocular mfVEP amplitude analysis can be a good diagnostic indicator for visual field study.
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Affiliation(s)
- Haitao Liu
- Physiology Unit, Department of Systems Biology, School of Medicine, University of Alcalá, 28005 Madrid, Spain; (H.L.); (F.L.)
| | - Fei Liao
- Physiology Unit, Department of Systems Biology, School of Medicine, University of Alcalá, 28005 Madrid, Spain; (H.L.); (F.L.)
| | - Román Blanco
- Department of Surgery, School of Medicine, University of Alcalá, 28005 Madrid, Spain;
- Visual Neurophysiology Group-IRYCIS, 28034 Madrid, Spain
| | - Pedro de la Villa
- Physiology Unit, Department of Systems Biology, School of Medicine, University of Alcalá, 28005 Madrid, Spain; (H.L.); (F.L.)
- Visual Neurophysiology Group-IRYCIS, 28034 Madrid, Spain
- Correspondence:
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Interobserver and Intertest Agreement in Telemedicine Glaucoma Screening with Optic Disk Photos and Optical Coherence Tomography. J Clin Med 2021; 10:jcm10153337. [PMID: 34362120 PMCID: PMC8347319 DOI: 10.3390/jcm10153337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose: To evaluate interobserver and intertest agreement between optical coherence tomography (OCT) and retinography in the detection of glaucoma through a telemedicine program. Methods: A stratified sample of 4113 individuals was randomly selected, and those who accepted underwent examination including visual acuity, intraocular pressure (IOP), non-mydriatic retinography, and imaging using a portable OCT device. Participants’ data and images were uploaded and assessed by 16 ophthalmologists on a deferred basis. Two independent evaluations were performed for all participants. Agreement between methods was assessed using the kappa coefficient and the prevalence-adjusted bias-adjusted kappa (PABAK). We analyzed potential factors possibly influencing the level of agreement. Results: The final sample comprised 1006 participants. Of all suspected glaucoma cases (n = 201), 20.4% were identified in retinographs only, 11.9% in OCT images only, 46.3% in both, and 21.4% were diagnosed based on other data. Overall interobserver agreement outcomes were moderate to good with a kappa coefficient of 0.37 and a PABAK index of 0.58. Higher values were obtained by experienced evaluators (kappa = 0.61; PABAK = 0.82). Kappa and PABAK values between OCT and photographs were 0.52 and 0.82 for the first evaluation. Conclusion: In a telemedicine screening setting, interobserver agreement on diagnosis was moderate but improved with greater evaluator expertise.
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Cheloni R, Dewsbery SD, Denniss J. A Simple Subjective Evaluation of Enface OCT Reflectance Images Distinguishes Glaucoma From Healthy Eyes. Transl Vis Sci Technol 2021; 10:31. [PMID: 34036303 PMCID: PMC8161697 DOI: 10.1167/tvst.10.6.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/16/2021] [Indexed: 01/06/2023] Open
Abstract
Purpose We present a subjective approach to detecting glaucomatous defects in enface images and assess its diagnostic performance. We also test the hypothesis that if reflectivity changes precede thickness changes in glaucoma there should be reduced correlation between the modalities in glaucoma compared to controls. Methods Twenty glaucoma participants and 20 age-matched controls underwent high-resolution OCT scans of one eye. 4 µm-thick enface slabs were constructed through the retina. Enface indices were depths of first gap in visible retinal nerve fiber bundles (RNFBs) and last visible bundle, subjectively evaluated in six sectors of a 3.5 mm circle around the optic disc. Retinal nerve fiber layer thickness (RNFLT) along the same circle was extracted at angles corresponding to enface indices. Between-group differences were tested by linear mixed models. Diagnostic performance was measured by partial receiver operating characteristic area (pAUC). Results First gap and last visible bundle were closer to the inner limiting membrane in glaucoma eyes (both P < 0.0001). Enface indices showed excellent diagnostic performance (pAUCs 0.63-1.00), similar to RNFLT (pAUCs 0.63-0.95). Correlation between enface and RNFLT parameters was strong in healthy (r = 0.81-0.92) and glaucoma eyes (r = 0.73-0.80). Conclusions This simple subjective method reliably identifies glaucomatous defects in enface images with diagnostic performance at least as good as existing thickness indices. Thickness and reflectivity were similarly related in healthy and glaucoma eyes, providing no strong evidence of reflectivity loss preceding thinning. Objective analyses may realize further potential of enface OCT images in glaucoma. Translational Relevance Novel enface OCT indices may aid glaucoma diagnosis.
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Affiliation(s)
- Riccardo Cheloni
- School of Optometry and Vision Science, University of Bradford, UK
| | - Simon D. Dewsbery
- Ophthalmology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan Denniss
- School of Optometry and Vision Science, University of Bradford, UK
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Bulut E, Celebi ARC, Dokur M, Dayi O. Analysis of trending topics in glaucoma articles from an altmetric perspective. Int Ophthalmol 2021; 41:2125-2137. [PMID: 33928474 DOI: 10.1007/s10792-021-01770-9] [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: 06/26/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Altmetric analyses are a new way of assessing and sharing scientific knowledge. Traditional metrics and altmetric analyses highlight key publications. The primary objective of this study was to evaluate the social attention paid to highly cited articles related to glaucoma in the recent English literature and compare with traditional citation metrics. MATERIALS AND METHODS "Glaucoma" was entered as a search term into Thomson Reuter's Web of Science database, and all articles related to the topic in the last decade were identified. The 50 highly cited articles (T50 list) were analyzed by topic, journal name, author name, year of the publication and Altmetric Attention Score (AAS). Descriptive statistics and Spearman correlation test were determined with the use of SPSS. RESULTS According to bibliometric criteria, there were 31,370 eligible articles and the median (range) citation number was recorded as 181.5 (158.75-250.75). The T50 list was ranked with AASs between 176 and 0. The median AAS was 5 (2.75-10). The main subjects of the top 10 highly cited articles were mostly related to follow-up and prognostics about glaucoma (n = 3), while the main subjects of the top 10 articles with the highest AAS were related to genetics in glaucoma pathogenesis (n = 2), treatment modalities (n = 2) and pathophysiology with therapeutics of glaucoma disease (n = 2). AASs and citation number showed a positive moderate correlation (r = 0.403 p = 0.004), although AASs did not correlate with journal impact factor (r = 0.36 p = 0.01). No statistically significant correlation was found for ASSs and citation numbers with H-index of the journals on the T50 list. CONCLUSIONS Bibliometric-based altmetric analyses offer important but different perspectives regarding article impact. This study provides valuable information about trending topics related to glaucoma research and its impact in both the academic literature and social media CLINICAL TRIAL REGISTRATION: With regard to the data characteristics of the manuscript, which is mainly retrospective and international, the clinical trial registration process is theoretically not applicable to this study.
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Affiliation(s)
- Erkan Bulut
- Department of Ophthalmology, Beylikduzu Public Hospital, Istanbul, Turkey.
| | - Ali Riza Cenk Celebi
- Department of Ophthalmology, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Dokur
- Department of Emergency Medicine, Biruni University Faculty of Medicine, Istanbul, Turkey
| | - Ozlem Dayi
- Department of Ophthalmology, Beylikduzu Public Hospital, Istanbul, Turkey
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Michelessi M, Li T, Miele A, Azuara-Blanco A, Qureshi R, Virgili G. Accuracy of optical coherence tomography for diagnosing glaucoma: an overview of systematic reviews. Br J Ophthalmol 2021; 105:490-495. [PMID: 32493760 PMCID: PMC7876780 DOI: 10.1136/bjophthalmol-2020-316152] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 01/06/2023]
Abstract
AIMS To assess the diagnostic accuracy (DTA) of optical coherence tomography (OCT) for detecting glaucoma by systematically searching and appraising systematic reviews (SRs) on this issue. METHODS We searched a database of SRs in eyes and vision maintained by the Cochrane Eyes and Vision United States on the DTA of OCT for detecting glaucoma. Two authors working independently screened the records, abstracted data and assessed the risk of bias using the Risk of Bias in Systematic Reviews checklist. We extracted quantitative DTA estimates as well as qualitative statements on their relevance to practice. RESULTS We included four SRs published between 2015 and 2018. These SRs included between 17 and 113 studies on OCT for glaucoma diagnosis. Two reviews were at low risk of bias and the other two had two to four domains at high or unclear risk of bias with concerns on applicability. The two reliable SRs reported the accuracy of average retinal nerve fibre layer (RNFL) thickness and found a sensitivity of 0.69 (0.63 to 0.73) and 0.78 (0.74 to 0.83) and a specificity of 0.94 (0.93 to 0.95) and 0.93 (0.92 to 0.95) in 57 and 50 studies, respectively. Only one review included a clear specification of the clinical pathway. Both reviews highlighted the limitations of primary DTA studies on this topic. CONCLUSIONS The quality of published DTA reviews on OCT for diagnosing glaucoma was mixed. Two reliable SRs found moderate sensitivity at high specificity for average RNFL thickness in diagnosing manifest glaucoma. Our overview suggests that the methodological quality of both primary and secondary DTA research on glaucoma is in need of improvement.
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Affiliation(s)
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alba Miele
- Eye Clinic, Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Riaz Qureshi
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gianni Virgili
- Eye Clinic, Department of NEUROFARBA, University of Florence, Florence, Italy
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Arnould L, De Lazzer A, Seydou A, Binquet C, Bron AM, Creuzot‐Garcher C. Diagnostic ability of spectral-domain optical coherence tomography peripapillary retinal nerve fiber layer thickness to discriminate glaucoma patients from controls in an elderly population (The MONTRACHET study). Acta Ophthalmol 2020; 98:e1009-e1016. [PMID: 32333503 DOI: 10.1111/aos.14448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the capacity of retinal nerve fibre layer (RNFL) thickness measured by SD-OCT to discriminate glaucoma patients from controls in an elderly population. METHODS The MONTRACHET (Maculopathy, Optic Nerve, nuTRition, neurovAsCular and HEarT diseases) Study is a population-based study including participants aged 75 years and over. All participants underwent a complete eye examination with optic nerve photographs, visual field testing and OCT peripapillary RNFL thickness measurement. Glaucoma was defined according to the ISGEO (International Society for Epidemiologic and Geographical Ophthalmology) classification. Performance indicators were calculated including area under the receiver operating characteristics curves (AUC), likelihood ratios (LR) and diagnostic odds ratios (DOR). RESULTS In total, 1061 participants were included in the study, of whom 89 were classified as having glaucoma and 972 were classified as normal. The mean (SD) age of the population was 82.3 (3.7) years. The average RNFL thickness was significantly lower in the glaucoma group than in controls 64.0 (14.9) µm versus 88.9 (12.4) µm, respectively, p < 0.001) and in all sectors compared with controls. The average RNFL thickness had the highest AUC (0.901) followed by the temporal-inferior (0.879) and temporal-superior sectors (0.862). When RNFL thickness was classified as abnormal by SD-OCT, the average RNFL thickness had the best sensitivity (83.75%) followed by the temporal-inferior sector (75.64%). The specificity for these two parameters was 87.34% and 91.08%, respectively. The highest DOR was 28.70 for average RNFL thickness and reached 34.84 when using the reference database of the OCT manufacturer. CONCLUSION This study confirms that SD-OCT could be useful as an additional test to discriminate glaucoma patients from controls in an elderly population.
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Affiliation(s)
- Louis Arnould
- Department of Ophthalmology University Hospital Dijon France
| | | | - Alassane Seydou
- Institut National de la Santé et de la Recherche Médicale (INSERM) Clinical Center Investigation Clinical Epidemiology/Clinical Trials Unit University Hospital Dijon France
| | - Christine Binquet
- Institut National de la Santé et de la Recherche Médicale (INSERM) Clinical Center Investigation Clinical Epidemiology/Clinical Trials Unit University Hospital Dijon France
| | - Alain M. Bron
- Department of Ophthalmology University Hospital Dijon France
- Centre des Sciences du Goût et de l'Alimentation AgroSup Dijon CNRS INRAE Université Bourgogne Franche‐Comté Dijon France
| | - Catherine Creuzot‐Garcher
- Department of Ophthalmology University Hospital Dijon France
- Centre des Sciences du Goût et de l'Alimentation AgroSup Dijon CNRS INRAE Université Bourgogne Franche‐Comté Dijon France
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13
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Cheloni R, Denniss J. Depth-resolved variations in visibility of retinal nerve fibre bundles across the retina in enface OCT images of healthy eyes. Ophthalmic Physiol Opt 2020; 41:179-191. [PMID: 33150636 DOI: 10.1111/opo.12756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE Recent developments in optical coherence tomography (OCT) technology enable direct enface visualisation of retinal nerve fibre bundle (RNFB) loss in glaucoma. However, the optimum depth at which to visualise RNFBs across the retina is unknown. We aimed to evaluate the range of depths and optimum depth at which RNFBs can be visualised across the retina in healthy eyes. METHODS The central ± 25° retina of 10 healthy eyes from 10 people aged 57-75 years (median 68.5 years) were imaged with spectral domain OCT. Slab images of maximum axial resolution (4 μm) containing depth-resolved attenuation coefficients were extracted from 0 to 193.5 μm below the inner limiting membrane (ILM). Bundle visibility within 10 regions of a superimposed grid was assessed subjectively by trained optometrists (n = 8), according to written instructions. Anterior and posterior limits of RNFB visibility and depth of best visibility were identified for each grid sector. Effects of retinal location and individual eye on RNFB visibility were explored using linear mixed modelling with likelihood ratio tests. Intraclass correlation coefficient (ICC) was used to measure overall agreement and repeatability of grading. Spearman's correlation was used to measure correlation between depth range of visible RNFBs and retinal nerve fibre layer thickness (RNFLT). RESULTS Retinal location and individual eye affected anterior limit of visibility (χ2 (9) = 58.6 and 60.5, both p < 0.0001), but none of the differences exceeded instrument resolution, making anterior limit consistent across the retina and different eyes. Greater differences were observed in the posterior limit of visibility across retinal areas (χ2 (9) = 1671.1, p < 0.0001) and different eyes (χ2 (9) = 88.7, p < 0.0001). Optimal depth for visualisation of RNFBs was around 20 µm below the ILM in most regions. It varied slightly with retinal location (χ2 (9) = 58.8, p < 0.0001), but it was not affected by individual eye (χ2 (9) = 10.7, p = 0.29). RNFB visibility showed good agreement between graders (ICC 0.89, 95%CI 0.87-0.91), and excellent repeatability (ICC 0.96-0.99). Depth range of visible RNFBs was highly correlated with RNFLT (ρ = 0.9, 95%CI: 0.86-0.95). CONCLUSIONS The range of depths with visible RNFBs varies markedly across the healthy retina, consistently with RNFLT. To extract all RNFB information consistently across the retina, slab properties should account for differences across retinal locations and between individual eyes.
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Affiliation(s)
- Riccardo Cheloni
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Jonathan Denniss
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
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14
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Zhou Z, Li B, Su J, Fan X, Chen L, Tang S, Zheng J, Zhang T, Meng Z, Chen Z, Deng H, Hu J, Zhao J. An artificial intelligence model for the simulation of visual effects in patients with visual field defects. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:703. [PMID: 32617323 PMCID: PMC7327351 DOI: 10.21037/atm.2020.02.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background This study aimed to simulate the visual field (VF) effects of patients with VF defects using deep learning and computer vision technology. Methods We collected 3,660 Humphrey visual fields (HVFs) as data samples, including 3,263 reliable 24-2 HVFs. The convolutional neural network (CNN) analyzed and converted the grayscale map of reliable samples into structured data. The artificial intelligence (AI) simulations were developed using computer vision technology. In statistical analyses, the pilot study determined 687 reliable samples to conduct clinical trials, and the two independent sample t-tests were used to calculate the difference of the cumulative gray values. Three volunteers evaluated the matching degree of shape and position between the grayscale map and the AI simulation, which was graded from 0 to100 scores. Based on the average ranking, the proportion of good and excellent grades was determined, and thus the reliability of the AI simulations was assessed. Results The reliable samples in the experimental data consisted of 1,334 normal samples and 1,929 abnormal samples. Based on the existing mature CNN model, the fully connected layer was integrated to analyze the VF damage parameters of the input images, and the prediction accuracy of the damage type of the VF defects was up to 89%. By mapping the area and damage information in the VF damage parameter quintuple data set into the real scene image and adjusting the darkening effect according to the damage parameter, the visual effects in patients were simulated in the real scene image. In the clinical validation, there was no statistically significant difference in the cumulative gray value (P>0.05). The good and excellent proportion of the average scores reached 96.0%, thus confirming the accuracy of the AI model. Conclusions An AI model with high accuracy was established to simulate the visual effects in patients with VF defects.
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Affiliation(s)
- Zhan Zhou
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Bingbing Li
- The Second Affiliated Hospital of Fujian Medical University, Fujian Province University Engineering Research Center of Assistive Technology for Visual Impairment, Quanzhou, China
| | - Jinyu Su
- The Second Affiliated Hospital of Fujian Medical University, Fujian Province University Engineering Research Center of Assistive Technology for Visual Impairment, Quanzhou, China
| | - Xianming Fan
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Liang Chen
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Song Tang
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Jianqing Zheng
- The Second Affiliated Hospital of Fujian Medical University, Fujian Province University Engineering Research Center of Assistive Technology for Visual Impairment, Quanzhou, China
| | - Tong Zhang
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Zhiyong Meng
- The Second Affiliated Hospital of Fujian Medical University, Fujian Province University Engineering Research Center of Assistive Technology for Visual Impairment, Quanzhou, China
| | - Zhimeng Chen
- The Second Affiliated Hospital of Fujian Medical University, Fujian Province University Engineering Research Center of Assistive Technology for Visual Impairment, Quanzhou, China
| | - Hongwei Deng
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Jianmin Hu
- The Second Affiliated Hospital of Fujian Medical University, Fujian Province University Engineering Research Center of Assistive Technology for Visual Impairment, Quanzhou, China
| | - Jun Zhao
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen Eye Institute, Shenzhen, China.,School of Optometry Affiliated to Shenzhen University, Shenzhen, China
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15
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Mocan MC, Machen L, Jang I, Cao D. The Relationship Between Optic Nerve Cup-to-Disc Ratio and Retinal Nerve Fiber Layer Thickness in Suspected Pediatric Glaucoma. J Pediatr Ophthalmol Strabismus 2020; 57:90-96. [PMID: 32203592 DOI: 10.3928/01913913-20200117-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/03/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the relationship between optic nerve cup-to-disc ratio and peripapillary retinal nerve fiber layer (RNFL) thickness in suspected pediatric glaucoma with large cup-to-disc ratios. METHODS This was a retrospective study undertaken at a single academic institution. Eighty-six eyes of 43 patients who presented with large (≥ 0.5) cup-to-disc ratios in both eyes and without elevated intraocular pressure were evaluated using spectral-domain optical coherence tomography. Global and sectoral peripapillary RNFL thickness measurements, Bruch's membrane opening size, refractive error in spherical equivalents, and intraocular pressure levels were recorded for all patients. Cup-to-disc ratios were manually derived using digital fundus images (D-cup-to-disc ratio). Parameters were compared between gender or race by t tests or analysis of variance. The differences in the relationship among the clinical parameters between two eyes were assessed using generalized estimation equation modeling followed by Pearson's correlation analysis. RESULTS Forty-three patients (25 boys and 18 girls) with a mean age of 9.3 ± 2.7 years (range: 5 to 15 years) were included. The mean global peripapillary RNFL thickness and the D-cup-to-disc ratio of study eyes were 99.0 ± 9.2 µm and 0.66 ± 0.03, respectively. The peripapillary RNFL thickness was found to be correlated with refractive error (r = 0.404; P = .008) and Bruch's membrane opening size (r = 0.410; P = .008) but not with cup-to-disc ratios (r = 0.029; P = .858) or patient age (r = -0.044; P = .797). CONCLUSIONS In patients with suspected pediatric glaucoma who present with large cup-to-disc ratios, RNFL thickness does not correlate with the degree of optic nerve cupping. Myopic refractive errors and Bruch's membrane opening size need to be taken into consideration to prevent misinterpretation of peripapillary RNFL measurements. [J Pediatr Ophthalmol Strabismus. 2020;57(2):90-96.].
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Karvonen E, Stoor K, Luodonpää M, Hägg P, Lintonen T, Liinamaa J, Tuulonen A, Saarela V. Diagnostic performance of modern imaging instruments in glaucoma screening. Br J Ophthalmol 2020; 104:1399-1405. [PMID: 31949097 DOI: 10.1136/bjophthalmol-2019-314795] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 11/04/2022]
Abstract
AIM To evaluate the applicability of imaging devices (spectral-domain optical coherence tomography (Cirrus SD-OCT), scanning laser polarimetry (GDx) and scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph, HRT3)) for glaucoma screening in a middle-aged unselected population. METHODS Participants of the population-based Northern Finland Birth Cohort Eye Study, aged 45 to 49 years, underwent a comprehensive eye examination including modern imaging with five methods (retinal nerve fibre layer (RNFL) and macular ganglion cell layer +inner plexiform layer (GCIPL) analysis and their combination with SD-OCT, GDx and HRT). The performance of the automated classification of the imaging devices was assessed using a clinical glaucoma diagnosis as reference, that is, the '2 out of 3' rule based on the evaluation of optic nerve head and RNFL photographs and visual fields. RESULTS We examined 6060 eyes of 3039 subjects; in the clinical evaluation, glaucomatous damage was found in 33 subjects (1.1%) in 43 eyes. The following sensitivities were obtained; RNFL analysis (53%), GCIPL analysis (50%), OCT combination analysis (61%), GDx (56%) and HRT (31%) with corresponding specificities of 95%, 92%, 90%, 88% and 96%. The area under the curve values were 0.76, 0.73, 0.75, 0.75 and 0.73, respectively. Post-test probabilities of glaucoma after positive imaging finding with each of these methods in this unselected population were 11%, 7%, 6%, 5% and 7%, respectively. CONCLUSION Screening capabilities of the OCT, GDx and HRT were rather similar. The accuracy of all evaluated parameters was only moderate and thus screening with these parameters alone is not reliable.
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Affiliation(s)
- Elina Karvonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland .,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Katri Stoor
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Marja Luodonpää
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Pasi Hägg
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Timo Lintonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
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17
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Juliana FR, Kesse S, Boakye-Yiadom KO, Veroniaina H, Wang H, Sun M. Promising Approach in the Treatment of Glaucoma Using Nanotechnology and Nanomedicine-Based Systems. Molecules 2019; 24:E3805. [PMID: 31652593 PMCID: PMC6833088 DOI: 10.3390/molecules24203805] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 12/14/2022] Open
Abstract
Glaucoma is considered a leading cause of blindness with the human eye being one of the body's most delicate organs. Ocular diseases encompass diverse diseases affecting the anterior and posterior ocular sections, respectively. The human eye's peculiar and exclusive anatomy and physiology continue to pose a significant obstacle to researchers and pharmacologists in the provision of efficient drug delivery. Though several traditional invasive and noninvasive eye therapies exist, including implants, eye drops, and injections, there are still significant complications that arise which may either be their low bioavailability or the grave ocular adverse effects experienced thereafter. On the other hand, new nanoscience technology and nanotechnology serve as a novel approach in ocular disease treatment. In order to interact specifically with ocular tissues and overcome ocular challenges, numerous active molecules have been modified to react with nanocarriers. In the general population of glaucoma patients, disease growth and advancement cannot be contained by decreasing intraocular pressure (IOP), hence a spiking in future research for novel drug delivery systems and target therapeutics. This review focuses on nanotechnology and its therapeutic and diagnostic prospects in ophthalmology, specifically glaucoma. Nanotechnology and nanomedicine history, the human eye anatomy, research frontiers in nanomedicine and nanotechnology, its imaging modal quality, diagnostic and surgical approach, and its possible application in glaucoma will all be further explored below. Particular focus will be on the efficiency and safety of this new therapy and its advances.
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Affiliation(s)
| | - Samuel Kesse
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China.
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China.
| | - Kofi Oti Boakye-Yiadom
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China.
- Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China.
| | - Hanitrarimalala Veroniaina
- State Key Laboratory of Modern Chinese Medicine, China Pharmaceutical University, Nanjing 210009, China.
| | - Huihui Wang
- College of Chemistry and Life Sciences, Zhejiang Normal University, Jinhua 321004, China.
| | - Meihao Sun
- College of Chemistry and Life Sciences, Zhejiang Normal University, Jinhua 321004, China.
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Bhojwani D, Vasavada S, Sudhalkar A, Vasavada V, Vasavada AR. Acute full-thickness macular hole after uneventful femtosecond-assisted cataract surgery and its spontaneous closure. Indian J Ophthalmol 2018; 66:848-849. [PMID: 29785998 PMCID: PMC5989512 DOI: 10.4103/ijo.ijo_1177_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Deepak Bhojwani
- Iladevi Cataract and IOL Research Centre, Ahmedabad, Gujarat, India
| | - Shail Vasavada
- Iladevi Cataract and IOL Research Centre, Ahmedabad, Gujarat, India
| | - Aditya Sudhalkar
- Iladevi Cataract and IOL Research Centre, Ahmedabad, Gujarat, India
| | - Viraj Vasavada
- Iladevi Cataract and IOL Research Centre, Ahmedabad, Gujarat, India
| | - Abhay R Vasavada
- Iladevi Cataract and IOL Research Centre, Ahmedabad, Gujarat, India
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Qiu K, Wang G, Lu X, Zhang R, Sun L, Zhang M. Application of the ISNT rules on retinal nerve fibre layer thickness and neuroretinal rim area in healthy myopic eyes. Acta Ophthalmol 2018; 96:161-167. [PMID: 29197157 DOI: 10.1111/aos.13586] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/09/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE We determined the applicability of inferior > superior > nasal > temporal (ISNT) rules on retinal nerve fibre layer (RNFL) thickness and rim area and evaluated the impact of various ocular factors on the performance of the ISNT rules in healthy myopic eyes. METHODS A total of 138 eyes from 138 healthy myopic subjects were included in this cross-sectional observational study. The peripapillary RNFL and optic disc in each eye were imaged with Cirrus HD optical coherence tomography (OCT) and Heidelberg Retina Tomograph II (HRT2), respectively. The performance of the inferior > superior (IS), inferior > superior > nasal > temporal (IST) and ISNT rules on RNFL thickness and rim area was determined and compared between low-to-moderate myopia and high myopia. The effects of ocular factors [including axial length, disc area, disc tilt, disc torsion, disc-fovea angle (DFA) and retina artery angle] on the performance of ISNT rules were evaluated with logistic regression analysis. RESULTS The mean axial length and refractive error were 25.57 ± 1.09 mm (range, 22.52-28.77 mm) and -5.12 ± 2.30 D [range, -9.63 to -0.50 dioptres (D)], respectively. Sixty-three per cent of the healthy eyes were compliant with the ISNT rule on rim area, while ISNT rule on RNFL thickness was followed in only 11.6% of the included eyes. For rim area, smaller disc area was significantly associated with increased compliance of the IS rule (odds ratio: 0.46, p = 0.039), IST rule (odds ratio: 0.46, p = 0.037) and ISNT rule (odds ratio: 0.44, p = 0.030). For RNFL thickness, greater DFA was significantly associated with increased compliance of the IS and IST rules (odds ratio: 1.30, p < 0.001; odds ratio: 1.19, p = 0.006, respectively). CONCLUSION In healthy myopic subjects, 88.4% and 37% of eyes did not comply with the ISNT rule on RNFL thickness and rim area, respectively. Due to significant low compliance in healthy eyes, the ISNT rule and its variants have limited potential utility in diagnosing glaucoma in myopic subjects.
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Affiliation(s)
- Kunliang Qiu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou Guangdong Province China
- Department of Ophthalmology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Geng Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou Guangdong Province China
| | - Xuehui Lu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou Guangdong Province China
| | - Riping Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou Guangdong Province China
| | - Lixia Sun
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou Guangdong Province China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou Guangdong Province China
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Optical coherence tomography for glaucoma diagnosis: An evidence based meta-analysis. PLoS One 2018; 13:e0190621. [PMID: 29300765 PMCID: PMC5754143 DOI: 10.1371/journal.pone.0190621] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Early detection, monitoring and understanding of changes in the retina are central to the diagnosis of glaucomatous optic neuropathy, and vital to reduce visual loss from this progressive condition. The main objective of this investigation was to compare glaucoma diagnostic accuracy of commercially available optical coherence tomography (OCT) devices (Zeiss Stratus, Zeiss Cirrus, Heidelberg Spectralis and Optovue RTVue, and Topcon 3D-OCT). Patients 16,104 glaucomatous and 11,543 normal eyes reported in 150 studies. Methods Between Jan. 2017 and Feb 2017, MEDLINE®, EMBASE®, CINAHL®, Cochrane Library®, Web of Science®, and BIOSIS® were searched for studies assessing glaucoma diagnostic accuracy of the aforementioned OCT devices. Meta-analysis was performed pooling area under the receiver operating characteristic curve (AUROC) estimates for all devices, stratified by OCT type (RNFL, macula), and area imaged. Results 150 studies with 16,104 glaucomatous and 11,543 normal control eyes were included. Key findings: AUROC of glaucoma diagnosis for RNFL average for all glaucoma patients was 0.897 (0.887–0.906, n = 16,782 patient eyes), for macula ganglion cell complex (GCC) was 0.885 (0.869–0.901, n = 4841 eyes), for macula ganglion cell inner plexiform layer (GCIPL) was 0.858 (0.835–0.880, n = 4211 eyes), and for total macular thickness was 0.795 (0.754–0.834, n = 1063 eyes). Conclusion The classification capability was similar across all 5 OCT devices. More diagnostically favorable AUROCs were demonstrated in patients with increased glaucoma severity. Diagnostic accuracy of RNFL and segmented macular regions (GCIPL, GCC) scans were similar and higher than total macular thickness. This study provides a synthesis of contemporary evidence with features of robust inclusion criteria and large sample size. These findings may provide guidance to clinicians when navigating this rapidly evolving diagnostic area characterized by numerous options.
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Automatic CDR Estimation for Early Glaucoma Diagnosis. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:5953621. [PMID: 29279773 PMCID: PMC5723944 DOI: 10.1155/2017/5953621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/09/2017] [Accepted: 09/24/2017] [Indexed: 12/23/2022]
Abstract
Glaucoma is a degenerative disease that constitutes the second cause of blindness in developed countries. Although it cannot be cured, its progression can be prevented through early diagnosis. In this paper, we propose a new algorithm for automatic glaucoma diagnosis based on retinal colour images. We focus on capturing the inherent colour changes of optic disc (OD) and cup borders by computing several colour derivatives in CIE L∗a∗b∗ colour space with CIE94 colour distance. In addition, we consider spatial information retaining these colour derivatives and the original CIE L∗a∗b∗ values of the pixel and adding other characteristics such as its distance to the OD centre. The proposed strategy is robust due to a simple structure that does not need neither initial segmentation nor removal of the vascular tree or detection of vessel bends. The method has been extensively validated with two datasets (one public and one private), each one comprising 60 images of high variability of appearances. Achieved class-wise-averaged accuracy of 95.02% and 81.19% demonstrates that this automated approach could support physicians in the diagnosis of glaucoma in its early stage, and therefore, it could be seen as an opportunity for developing low-cost solutions for mass screening programs.
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Ramirez AI, de Hoz R, Salobrar-Garcia E, Salazar JJ, Rojas B, Ajoy D, López-Cuenca I, Rojas P, Triviño A, Ramírez JM. The Role of Microglia in Retinal Neurodegeneration: Alzheimer's Disease, Parkinson, and Glaucoma. Front Aging Neurosci 2017; 9:214. [PMID: 28729832 PMCID: PMC5498525 DOI: 10.3389/fnagi.2017.00214] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/16/2017] [Indexed: 12/12/2022] Open
Abstract
Microglia, the immunocompetent cells of the central nervous system (CNS), act as neuropathology sensors and are neuroprotective under physiological conditions. Microglia react to injury and degeneration with immune-phenotypic and morphological changes, proliferation, migration, and inflammatory cytokine production. An uncontrolled microglial response secondary to sustained CNS damage can put neuronal survival at risk due to excessive inflammation. A neuroinflammatory response is considered among the etiological factors of the major aged-related neurodegenerative diseases of the CNS, and microglial cells are key players in these neurodegenerative lesions. The retina is an extension of the brain and therefore the inflammatory response in the brain can occur in the retina. The brain and retina are affected in several neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), and glaucoma. AD is an age-related neurodegeneration of the CNS characterized by neuronal and synaptic loss in the cerebral cortex, resulting in cognitive deficit and dementia. The extracellular deposits of beta-amyloid (Aβ) and intraneuronal accumulations of hyperphosphorylated tau protein (pTau) are the hallmarks of this disease. These deposits are also found in the retina and optic nerve. PD is a neurodegenerative locomotor disorder with the progressive loss of dopaminergic neurons in the substantia nigra. This is accompanied by Lewy body inclusion composed of α-synuclein (α-syn) aggregates. PD also involves retinal dopaminergic cell degeneration. Glaucoma is a multifactorial neurodegenerative disease of the optic nerve, characterized by retinal ganglion cell loss. In this pathology, deposition of Aβ, synuclein, and pTau has also been detected in retina. These neurodegenerative diseases share a common pathogenic mechanism, the neuroinflammation, in which microglia play an important role. Microglial activation has been reported in AD, PD, and glaucoma in relation to protein aggregates and degenerated neurons. The activated microglia can release pro-inflammatory cytokines which can aggravate and propagate neuroinflammation, thereby degenerating neurons and impairing brain as well as retinal function. The aim of the present review is to describe the contribution in retina to microglial-mediated neuroinflammation in AD, PD, and glaucomatous neurodegeneration.
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Affiliation(s)
- Ana I. Ramirez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
- Departamento de Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid (UCM)Madrid, Spain
| | - Rosa de Hoz
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
- Departamento de Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid (UCM)Madrid, Spain
| | - Elena Salobrar-Garcia
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
- Departamento de Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid (UCM)Madrid, Spain
| | - Juan J. Salazar
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
- Departamento de Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid (UCM)Madrid, Spain
| | - Blanca Rojas
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
- Departamento de Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid (UCM)Madrid, Spain
| | - Daniel Ajoy
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
| | - Inés López-Cuenca
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
| | - Pilar Rojas
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
- Servicio de Oftalmología, Hospital Gregorio MarañónMadrid, Spain
| | - Alberto Triviño
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
- Departamento de Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid (UCM)Madrid, Spain
| | - José M. Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo. Universidad Complutense de MadridMadrid, Spain
- Departamento de Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid (UCM)Madrid, Spain
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Allocco AR, Ponce JA, Riera MJ, Magurno MG. Critical pathway for primary open angle glaucoma diagnosis. Int J Ophthalmol 2017; 10:968-972. [PMID: 28730090 DOI: 10.18240/ijo.2017.06.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/07/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To develop a critical pathway for primary open angle glaucoma (POAG) diagnosis intended to be efficient, to unify criteria, reduce resource use and minimize costs to the health system. METHODS We performed a systematic search on PubMed, Cochrane, Embase and ClinicalTrials.org databases and classified the quality of evidence from level I through III. RESULTS A critical pathway was designed by setting a key-decision step by step model on the basis of the best current evidence. CONCLUSION A critical pathway, evidence-based guideline, may be a useful tool intended to reduce costs while maintaining or even improving the quality of care for diagnosing a highly prevalent pathology such as open angle glaucoma.
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Affiliation(s)
- Alejandro R Allocco
- Instituto Santa Lucía Paraná, Alameda de la Federación 493, Paraná 3100, Entre Ríos, Argentina
| | - Julia A Ponce
- Instituto Santa Lucía Paraná, Alameda de la Federación 493, Paraná 3100, Entre Ríos, Argentina
| | - Maria J Riera
- Instituto Santa Lucía Paraná, Alameda de la Federación 493, Paraná 3100, Entre Ríos, Argentina
| | - Mauricio G Magurno
- Instituto Santa Lucía Paraná, Alameda de la Federación 493, Paraná 3100, Entre Ríos, Argentina
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Liu Y, Allingham RR. Major review: Molecular genetics of primary open-angle glaucoma. Exp Eye Res 2017; 160:62-84. [PMID: 28499933 DOI: 10.1016/j.exer.2017.05.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/29/2017] [Accepted: 05/07/2017] [Indexed: 12/13/2022]
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide. Primary open-angle glaucoma (POAG), the most common type, is a complex inherited disorder that is characterized by progressive retinal ganglion cell death, optic nerve head excavation, and visual field loss. The discovery of a large, and growing, number of genetic and chromosomal loci has been shown to contribute to POAG risk, which carry implications for disease pathogenesis. Differential gene expression analyses in glaucoma-affected tissues as well as animal models of POAG are enhancing our mechanistic understanding in this common, blinding disorder. In this review we summarize recent developments in POAG genetics and molecular genetics research.
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Affiliation(s)
- Yutao Liu
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, United States; James & Jean Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States; Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA, United States
| | - R Rand Allingham
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States; Duke - National University of Singapore (Duke-NUS), Singapore.
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