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Sinclair SH, Schwartz S. Diabetic retinopathy: New concepts of screening, monitoring, and interventions. Surv Ophthalmol 2024; 69:882-892. [PMID: 38964559 DOI: 10.1016/j.survophthal.2024.07.001] [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: 03/14/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
The science of diabetes care has progressed to provide a better understanding of the oxidative and inflammatory lesions and pathophysiology of the neurovascular unit within the retina (and brain) that occur early in diabetes, even prediabetes. Screening for retinal structural abnormalities, has traditionally been performed by fundus examination or color fundus photography; however, these imaging techniques detect the disease only when there are sufficient lesions, predominantly hemorrhagic, that are recognized to occur late in the disease process after significant neuronal apoptosis and atrophy, as well as microvascular occlusion with alterations in vision. Thus, interventions have been primarily oriented toward the later-detected stages, and clinical trials, while demonstrating a slowing of the disease progression, demonstrate minimal visual improvement and modest reduction in the continued loss over prolonged periods. Similarly, vision measurement utilizing charts detects only problems of visual function late, as the process begins most often parafoveally with increasing number and progressive expansion, including into the fovea. While visual acuity has long been used to define endpoints of visual function for such trials, current methods reviewed herein are found to be imprecise. We review improved methods of testing visual function and newer imaging techniques with the recommendation that these must be utilized to discover and evaluate the injury earlier in the disease process, even in the prediabetic state. This would allow earlier therapy with ocular as well as systemic pharmacologic treatments that lower the and neuro-inflammatory processes within eye and brain. This also may include newer, micropulsed laser therapy that, if applied during the earlier cascade, should result in improved and often normalized retinal function without the adverse treatment effects of standard photocoagulation therapy.
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Affiliation(s)
| | - Stan Schwartz
- University of Pennsylvania Affiliate, Main Line Health System, USA
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Kowalczuk L, Dornier R, Kunzi M, Iskandar A, Misutkova Z, Gryczka A, Navarro A, Jeunet F, Mantel I, Behar-Cohen F, Laforest T, Moser C. In Vivo Retinal Pigment Epithelium Imaging using Transscleral Optical Imaging in Healthy Eyes. OPHTHALMOLOGY SCIENCE 2022; 3:100234. [PMID: 36545259 PMCID: PMC9762198 DOI: 10.1016/j.xops.2022.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
Objective To image healthy retinal pigment epithelial (RPE) cells in vivo using Transscleral OPtical Imaging (TOPI) and to analyze statistics of RPE cell features as a function of age, axial length (AL), and eccentricity. Design Single-center, exploratory, prospective, and descriptive clinical study. Participants Forty-nine eyes (AL: 24.03 ± 0.93 mm; range: 21.9-26.7 mm) from 29 participants aged 21 to 70 years (37.1 ± 13.3 years; 19 men, 10 women). Methods Retinal images, including fundus photography and spectral-domain OCT, AL, and refractive error measurements were collected at baseline. For each eye, 6 high-resolution RPE images were acquired using TOPI at different locations, one of them being imaged 5 times to evaluate the repeatability of the method. Follow-up ophthalmic examination was repeated 1 to 3 weeks after TOPI to assess safety. Retinal pigment epithelial images were analyzed with a custom automated software to extract cell parameters. Statistical analysis of the selected high-contrast images included calculation of coefficient of variation (CoV) for each feature at each repetition and Spearman and Mann-Whitney tests to investigate the relationship between cell features and eye and subject characteristics. Main Outcome Measures Retinal pigment epithelial cell features: density, area, center-to-center spacing, number of neighbors, circularity, elongation, solidity, and border distance CoV. Results Macular RPE cell features were extracted from TOPI images at an eccentricity of 1.6° to 16.3° from the fovea. For each feature, the mean CoV was < 4%. Spearman test showed correlation within RPE cell features. In the perifovea, the region in which images were selected for all participants, longer AL significantly correlated with decreased RPE cell density (R Spearman, Rs = -0.746; P < 0.0001) and increased cell area (Rs = 0.668; P < 0.0001), without morphologic changes. Aging was also significantly correlated with decreased RPE density (Rs = -0.391; P = 0.036) and increased cell area (Rs = 0.454; P = 0.013). Lower circular, less symmetric, more elongated, and larger cells were observed in those > 50 years. Conclusions The TOPI technology imaged RPE cells in vivo with a repeatability of < 4% for the CoV and was used to analyze the influence of physiologic factors on RPE cell morphometry in the perifovea of healthy volunteers. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Key Words
- AF, autofluorescence
- AL, axial length
- AO, adaptive optics
- Adaptive Optics Transscleral Flood Illumination
- BCVA, best-corrected visual acuity
- CCS, center-to-center spacing
- CoV, coefficient of variation
- D, diopters
- FOV, field of view
- Healthy volunteers
- High resolution retinal imaging
- IOP, intraocular pressure
- NIR, near-infrared
- PRL, preferred retinal locus
- QC, quality criterion
- RE, refractive error
- RPE, retinal pigment epithelium
- Retinal Pigment Epithelium
- SD, standard deviation
- SLO, scanning laser ophthalmoscope
- TOPI, transscleral optical imaging
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Affiliation(s)
- Laura Kowalczuk
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland,Correspondence: Laura Kowalczuk, PhD, École Polytechnique Fédérale de Lausanne, School of Engineering, Institute of Electrical and Micro-engineering, Laboratory of Applied Photonics Devices, BM 4127, Station 17, CH-1015, Lausanne, Switzerland.
| | - Rémy Dornier
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mathieu Kunzi
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Antonio Iskandar
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Zuzana Misutkova
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Aurélia Gryczka
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Aurélie Navarro
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Fanny Jeunet
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Irmela Mantel
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Francine Behar-Cohen
- Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, Paris, France,INSERM U1138, USPC, Université de Paris-Cité, Sorbonne Université, Paris, France,Assistance Publique - Hôpitaux de Paris, Ophtalmopôle, Cochin Hospital, Paris, France,Université Paris Cité, Paris, France,Hôpital Foch, Suresnes, France
| | - Timothé Laforest
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Christophe Moser
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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