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Kananen F, Immonen I. Retinal pigment epithelium-Bruch's membrane volume in grading of age-related macular degeneration. Int J Ophthalmol 2023; 16:1827-1831. [PMID: 38028508 PMCID: PMC10626359 DOI: 10.18240/ijo.2023.11.14] [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: 03/09/2023] [Accepted: 08/28/2023] [Indexed: 12/01/2023] Open
Abstract
AIM To assess the agreement of optical coherence tomography (OCT) algorithm-based retinal pigment epithelium -Bruch's membrane complex volume (RBV) with fundus photograph-based age-related macular degeneration (AMD) grading. METHODS Digital color fundus photographs (CFPs) and spectral domain OCT images were acquired from 96 elderly subjects. CFPs were graded according to Age-Related Eye Disease Study (AREDS) classification. OCT image segmentation and RBV data calculation were done with Orion™ software. Univariate and multivariate analyses were performed to find out whether AMD lesion features associated with higher RBVs. RESULTS RBV correlated with AMD grading (rs=0.338, P=0.001), the correlation was slightly stronger in early AMD (n=52; rs=0.432, P=0.001). RBV was higher in subjects with early AMD compared with those with no AMD lesions evident in fundus photographs (1.05±0.20 vs 0.96±0.13 mm3, P=0.023). In multivariate analysis higher RBVs were associated significantly with higher total drusen (β=0.388, P=0.027) and pigmentation areas (β=0.319, P=0.020) in fundus photographs, whereas depigmentation area (β=-0.295, P=0.015) associated with lower RBV. CONCLUSION RBV correlate with AMD grading status, with a stronger association in patients with moderate, non-late AMD grades. This effect is driven mostly by lesions with drusen or pigmentation. Lesions with depigmentation tend to have lower values. RBV is more comprehensive measurement of the key area of AMD pathogenesis, compared to sole drusen volume analysis. RBV measurements are independent on grader variations and offer a possibility to quantify early and middle grade AMD lesions in a research setting, but may not substitute fundus photograph-based grading in the whole range of AMD spectrum.
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Affiliation(s)
- Fabian Kananen
- Department of Ophthalmology, Örebro University Hospital, Örebro 70185, Sweden
- Department of Ophthalmology and Otorhinolaryngology, Helsinki University, Helsinki 00014, Finland
| | - Ilkka Immonen
- Department of Ophthalmology and Otorhinolaryngology, Helsinki University, Helsinki 00014, Finland
- Department of Ophthalmology, Helsinki University Central Hospital, Helsinki 00014, Finland
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2
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Oncel D, Corradetti G, Wakatsuki Y, Nittala MG, Velaga SB, Stambolian D, Pericak-Vance MA, Haines JL, Sadda SR. Drusen morphometrics on optical coherence tomography in eyes with age-related macular degeneration and normal aging. Graefes Arch Clin Exp Ophthalmol 2023; 261:2525-2533. [PMID: 37133500 PMCID: PMC10527978 DOI: 10.1007/s00417-023-06088-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023] Open
Abstract
PURPOSE To compare drusen size metrics (apical height and basal width) on optical coherence tomography (OCT) B-scans with their size assessed on color photos in eyes with age-related macular degeneration (AMD) and normal aging. METHODS A total of 508 drusen were evaluated in this analysis. Flash color fundus photos (CFP), infrared reflectance (IR) images, and OCT B-scans obtained at the same visit were evaluated. Individual drusen were identified on CFPs and the diameters of the drusen were measured in planimetric grading software. CFPs were manually registered to the IR image with their corresponding OCT volume. After confirming correspondence between the CFP and OCT, the apical height and basal width of the same drusen were measured on OCT B-scans. RESULTS Drusen were divided into small, medium, large, and very large categories based on their diameter on the CFP images (< 63, 63 to 124, 125 to 249, and [Formula: see text] 250 μm, respectively). The OCT apical height of small drusen on CFP ranged from 20 to 31 μm, while medium drusen ranged from 31 to 46 μm, large drusen ranged from 45 μm to 111 µm, and very large drusen ranged from 55 μm to 208 μm. The OCT basal width measured < 99 μm in small drusen, from 99 to 143 μm in medium drusen, from 141 to 407 µm in large drusen, and > 209 µm in very large drusen. CONCLUSION Drusen of different size categories on color photographs may also be separated according to their apical height and basal width on OCT. The apical height and basal width ranges defined in this analysis may be of value in the design of an OCT-based grading scale for AMD.
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Affiliation(s)
- Deniz Oncel
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yu Wakatsuki
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Muneeswar Gupta Nittala
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Swetha Bindu Velaga
- Doheny Eye Institute, Los Angeles, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dwight Stambolian
- Ophthalmology and Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jonathan L Haines
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA, USA.
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, 150 N. Orange Grove Blvd, Suite 232, Pasadena, CA, 91103, USA.
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3
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Riazi Esfahani P, Reddy AJ, Thomas J, Sommer DA, Nguyen A, Farasat V, Nawathey N, Bachir A, Brahmbhatt T, Patel R. An Analysis of the Usage of Retinal Imaging Technology in the Detection of Age-Related Macular Degeneration. Cureus 2023; 15:e40527. [PMID: 37461783 PMCID: PMC10350318 DOI: 10.7759/cureus.40527] [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] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Age-related macular degeneration (AMD) is a disease that worsens the central vision of numerous individuals across the globe. Ensuring that patients are diagnosed accurately and that their symptoms are carefully monitored is essential to ensure that adequate care is delivered. To accomplish this objective, retinal imaging technology is necessary to assess the pathophysiology that is required to give an accurate diagnosis of AMD. The purpose of this review is to assess the ability of various retinal imaging technologies such as optical coherence tomography (OCT), color fundus retinal photography, fluorescein angiography, and fundus photography. The statistical methods that were conducted yielded results that suggested that using OCT in conjunction with other imaging technologies results in a higher detection of symptoms among patients that have AMD. Further investigation should be conducted to ascertain the validity of the conclusions that were stated within the review.
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Affiliation(s)
- Parsa Riazi Esfahani
- Department of Medicine, California University of Science and Medicine, Colton, USA
| | - Akshay J Reddy
- Department of Medicine, California University of Science and Medicine, Colton, USA
| | - Jack Thomas
- Department of Medicine, California University of Science and Medicine, Colton, USA
| | - Dillon A Sommer
- Department of Medicine, California University of Science and Medicine, Colton, USA
| | - Anna Nguyen
- Department of Medicine, California University of Science and Medicine, Colton, USA
| | | | - Neel Nawathey
- Department of Health Sciences, California Northstate University, Rancho Cordova, USA
| | - Alex Bachir
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Telak Brahmbhatt
- Department of Health Sciences, California Northstate University, Rancho Cordova, USA
| | - Rakesh Patel
- Department of Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, USA
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4
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Tan AC, Chee ML, Fenner BJ, Mitchell P, Tham YC, Rim T, Teo K, Sim SS, Cheng CY, Wong TY, Chakravarthy U, Cheung CMG. Six-year incidence of age-related macular degeneration and correlation to OCT-derived drusen volume measurements in a Chinese population. Br J Ophthalmol 2023; 107:392-398. [PMID: 34607789 DOI: 10.1136/bjophthalmol-2021-319290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/18/2021] [Indexed: 11/03/2022]
Abstract
AIMS To report the 6-year incidence of optical coherence tomography (OCT)-derived age-related changes in drusen volume and related systemic and ocular associations. METHODS Chinese adults aged 40 years and older were assessed at baseline and 6 years with colour fundus photography (CFP) and spectral domain (SD) OCT. CFPs were graded for age-related macular degeneration (AMD) features and drusen volume was generated using commercially available automated software. RESULTS A total of 4172 eyes of 2580 participants (mean age 58.12±9.03 years; 51.12% women) had baseline and 6-year follow-up CFP for grading, of these, 2130 eyes of 1305 participants had gradable SD-OCT images, available for analysis. Based on CFP grading, 136 (3.39%) participants developed incident early AMD and 10 (0.25%) late AMD. Concurrently, retinal pigment epithelial-Bruch's membrane (RPE-BrC) volumes decreased, remained stable and increased in 6.8%, 78.5% and 14.7%, respectively, over 6 years. In eyes where RPE-BrC volumes were >0 mm3 at baseline, this was associated with two-fold higher prevalence rate of any AMD at baseline (p<0.001). Multivariable analysis showed that when compared with eyes where RPE-BrC volume was unchanged, volume decrease was significantly associated with older age (OR=1.30; p<0.001), smoking (OR=2.21; p=0.001) and chronic kidney disease (OR=3.4, p=0.008), while increase was associated with older age (OR=1.36; p<0.001) and hypertension (OR=1.43; p=0.016). CONCLUSION AMD incidence detected at 6 years on CFP and correlated OCT-derived drusen volume measurement change is low. Older age and some systemic risk factors are associated with drusen volume change, and our data provide new insights into relationship between systemic risk factors and outer retinal morphology in Asian eyes.
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Affiliation(s)
- Anna Cs Tan
- Singapore National Eye Centre, Singapore.,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | | | - Beau J Fenner
- Singapore National Eye Centre, Singapore.,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Paul Mitchell
- Centre for Vision Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Yih Chung Tham
- Singapore National Eye Centre, Singapore.,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Tyler Rim
- Singapore National Eye Centre, Singapore.,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Kelvin Teo
- Singapore National Eye Centre, Singapore.,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore.,Save Sight Institute, Sydney, New South Wales, Australia
| | - Shaun S Sim
- Singapore National Eye Centre, Singapore.,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Ching Yu Cheng
- Singapore National Eye Centre, Singapore.,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore.,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
| | | | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore .,Duke-NUS, Singapore.,Singapore Eye Research Institute, Singapore
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5
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Morano J, Hervella ÁS, Rouco J, Novo J, Fernández-Vigo JI, Ortega M. Weakly-supervised detection of AMD-related lesions in color fundus images using explainable deep learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107296. [PMID: 36481530 DOI: 10.1016/j.cmpb.2022.107296] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Age-related macular degeneration (AMD) is a degenerative disorder affecting the macula, a key area of the retina for visual acuity. Nowadays, AMD is the most frequent cause of blindness in developed countries. Although some promising treatments have been proposed that effectively slow down its development, their effectiveness significantly diminishes in the advanced stages. This emphasizes the importance of large-scale screening programs for early detection. Nevertheless, implementing such programs for a disease like AMD is usually unfeasible, since the population at risk is large and the diagnosis is challenging. For the characterization of the disease, clinicians have to identify and localize certain retinal lesions. All this motivates the development of automatic diagnostic methods. In this sense, several works have achieved highly positive results for AMD detection using convolutional neural networks (CNNs). However, none of them incorporates explainability mechanisms linking the diagnosis to its related lesions to help clinicians to better understand the decisions of the models. This is specially relevant, since the absence of such mechanisms limits the application of automatic methods in the clinical practice. In that regard, we propose an explainable deep learning approach for the diagnosis of AMD via the joint identification of its associated retinal lesions. METHODS In our proposal, a CNN with a custom architectural setting is trained end-to-end for the joint identification of AMD and its associated retinal lesions. With the proposed setting, the lesion identification is directly derived from independent lesion activation maps; then, the diagnosis is obtained from the identified lesions. The training is performed end-to-end using image-level labels. Thus, lesion-specific activation maps are learned in a weakly-supervised manner. The provided lesion information is of high clinical interest, as it allows clinicians to assess the developmental stage of the disease. Additionally, the proposed approach allows to explain the diagnosis obtained by the models directly from the identified lesions and their corresponding activation maps. The training data necessary for the approach can be obtained without much extra work on the part of clinicians, since the lesion information is habitually present in medical records. This is an important advantage over other methods, including fully-supervised lesion segmentation methods, which require pixel-level labels whose acquisition is arduous. RESULTS The experiments conducted in 4 different datasets demonstrate that the proposed approach is able to identify AMD and its associated lesions with satisfactory performance. Moreover, the evaluation of the lesion activation maps shows that the models trained using the proposed approach are able to identify the pathological areas within the image and, in most cases, to correctly determine to which lesion they correspond. CONCLUSIONS The proposed approach provides meaningful information-lesion identification and lesion activation maps-that conveniently explains and complements the diagnosis, and is of particular interest to clinicians for the diagnostic process. Moreover, the data needed to train the networks using the proposed approach is commonly easy to obtain, what represents an important advantage in fields with particularly scarce data, such as medical imaging.
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Affiliation(s)
- José Morano
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain; VARPA Research Group, Instituto de Investigación Biomédica de A Coruńa (INIBIC), Universidade da Coruña, A Coruña, Spain.
| | - Álvaro S Hervella
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain; VARPA Research Group, Instituto de Investigación Biomédica de A Coruńa (INIBIC), Universidade da Coruña, A Coruña, Spain.
| | - José Rouco
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain; VARPA Research Group, Instituto de Investigación Biomédica de A Coruńa (INIBIC), Universidade da Coruña, A Coruña, Spain.
| | - Jorge Novo
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain; VARPA Research Group, Instituto de Investigación Biomédica de A Coruńa (INIBIC), Universidade da Coruña, A Coruña, Spain.
| | - José I Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Department of Ophthalmology, Centro Internacional de Oftalmología Avanzada, Madrid, Spain.
| | - Marcos Ortega
- Centro de Investigación CITIC, Universidade da Coruña, A Coruña, Spain; VARPA Research Group, Instituto de Investigación Biomédica de A Coruńa (INIBIC), Universidade da Coruña, A Coruña, Spain.
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6
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Wilson GA, Cheyne K, Ramrakha S, Ambler A, Tan GS, Caspi A, Williams B, Sugden K, Houts R, Niederer RL, Wong TY, Moffitt TE, Poulton R. Are macular drusen in midlife a marker of accelerated biological ageing? Clin Exp Optom 2023; 106:41-46. [PMID: 34902293 DOI: 10.1080/08164622.2021.2012428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 01/13/2023] Open
Abstract
CLINICAL RELEVANCE Macular drusen are associated with age-related maculopathy but are not an ocular manifestation or biomarker of systemic ageing. BACKGROUND Macular drusen are the first sign of age-related maculopathy, an eye disease for which age is the strongest risk factor. The aim of this cohort study was to investigate whether macular drusen in midlife - a sign of the earliest stages of age-related macular degeneration (AMD) - are associated with accelerated biological ageing more generally. METHODS Members of the long-running Dunedin Multidisciplinary Health and Development Study (hereafter the Dunedin Study, n = 1037) underwent retinal photography at their most recent assessment at the age of 45 years. Images were graded for the presence of AMD using a simplified scale from the Age-Related Eye Disease Study (AREDS). Accelerated ageing was assessed by (i) a measure of Pace of Ageing defined from a combination of clinical and serum biomarkers obtained at ages 26, 32, 38, and 45 years and (ii) Facial Ageing, defined from photographs obtained at age 38 and 45 years. RESULTS Of the 938 participants who participated at the age 45 assessments, 834 had gradable retinal photographs, and of these 165 (19.8%) had macular drusen. There was no significant difference in Pace of Ageing (p = .743) or Facial Ageing (p = .945) among participants with and without macular drusen. CONCLUSIONS In this representative general population sample, macular drusen in midlife were not associated with accelerated ageing. Future studies tracking longitudinal changes in drusen number and severity at older ages may reveal whether drusen are a biomarker of accelerated ageing.
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Affiliation(s)
- Graham A Wilson
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Kirsten Cheyne
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Antony Ambler
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Gavin Sw Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Ben Williams
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Karen Sugden
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Renate Houts
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Rachael L Niederer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
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7
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Wu Z, Fletcher EL, Kumar H, Greferath U, Guymer RH. Reticular pseudodrusen: A critical phenotype in age-related macular degeneration. Prog Retin Eye Res 2021; 88:101017. [PMID: 34752916 DOI: 10.1016/j.preteyeres.2021.101017] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/07/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022]
Abstract
Reticular pseudodrusen (RPD), or subretinal drusenoid deposits (SDD), refer to distinct lesions that occur in the subretinal space. Over the past three decades, their presence in association with age-related macular degeneration (AMD) has become increasingly recognized, especially as RPD have become more easily distinguished with newer clinical imaging modalities. There is also an increasing appreciation that RPD appear to be a critical AMD phenotype, where understanding their pathogenesis will provide further insights into the processes driving vision loss in AMD. However, key barriers to understanding the current evidence related to the independent impact of RPD include the heterogeneity in defining their presence, and failure to account for the confounding impact of the concurrent presence and severity of AMD pathology. This review thus critically discusses the current evidence on the prevalence and clinical significance of RPD and proposes a clinical imaging definition of RPD that will help move the field forward in gathering further key knowledge about this critical phenotype. It also proposes a putative mechanism for RPD formation and how they may drive progression to vision loss in AMD, through examining current evidence and presenting novel findings from preclinical and clinical studies.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Erica L Fletcher
- Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Himeesh Kumar
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Ursula Greferath
- Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
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8
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Kim DY, Loo J, Farsiu S, Jaffe GJ. COMPARISON OF SINGLE DRUSEN SIZE ON COLOR FUNDUS PHOTOGRAPHY AND SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY. Retina 2021; 41:1715-1722. [PMID: 33411474 DOI: 10.1097/iae.0000000000003099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the relationship of drusen size as determined by spectral-domain optical coherence tomography (SD-OCT) with that measured on registered color fundus photography (CFP) images and to derive an OCT-based classification system that was comparable with that determined by CFP. METHODS Custom software was developed to register CFP images to the scanning laser ophthalmoscopy fundus images obtained simultaneously with the corresponding SD-OCT images, so that individual drusen observed on CFP could be matched with those seen on SD-OCT. Single druse size (diameter, area, volume, and height) on CFP and SD-OCT images from a phase two clinical trial was determined with the Duke OCT Retinal Analysis Program. RESULTS The sizes of 213 individual drusen were measured on CFP and SD-OCT. The drusen diameter measured on CFP was significantly correlated with those determined on SD-OCT (R: 0.879, P < 0.001). Based on the corresponding formula: drusen diameter on SD-OCT = 0.77 × (drusen diameter on CFP) + 50.67 µm, large drusen defined as ≥125 µm on CFP had a diameter ≥145 µm on OCT, medium drusen defined as 63 µm to 124 µm on CFP had diameters 100 µm to 144 µm on OCT, and small drusen defined as <63 µm on CFP had diameters <100 µm on OCT. CONCLUSION With our registration software and imaging processing algorithms, we were able to correlate individual druse sizes measured on CFP with those determined on SD-OCT. These data can be used to develop an SD-OCT-based grading scale, analogous to the CFP Age-Related Eye Disease Study drusen scale that may be useful in the clinic and in clinical trials.
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Affiliation(s)
- Dong Yoon Kim
- Department of Ophthalmology, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, Korea; and
- Departments of Ophthalmology, and
| | - Jessica Loo
- Biomedical Engineering, Duke University, Durham, North Carolina
| | - Sina Farsiu
- Departments of Ophthalmology, and
- Biomedical Engineering, Duke University, Durham, North Carolina
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9
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Yamashiro K, Hosoda Y, Miyake M, Takahashi A, Ooto S, Tsujikawa A. Hypothetical pathogenesis of age-related macular degeneration and pachychoroid diseases derived from their genetic characteristics. Jpn J Ophthalmol 2020; 64:555-567. [PMID: 33006732 DOI: 10.1007/s10384-020-00773-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/16/2020] [Indexed: 12/20/2022]
Abstract
Genetic studies have investigated the pathogenesis of age-related macular degeneration (AMD). The pachychoroid concept has recently garnered attention as a possible explanation for AMD pathogenesis; the genetic characteristics of pachychoroid diseases have also been elucidated. In this review, we summarize previously reported genetic characteristics of AMD and pachychoroid diseases, and analyze these data to understand the pathogenesis of AMD and pachychoroid diseases. Previous studies show that VIPR2 and the CFH I62V A allele promote development of pachychoroid and central serous chorioretinopathy (CSC), while the CFH I62V G allele promotes development of drusen, pachychoroid neovasculopathy (PCN/PNV), and AMD. ARMS2/HTRA1 also promotes development of drusen, PCN/PNV, and AMD. TNFRSF10A and GATA5 are associated with CSC but not with pachychoroid, and TNFRSF10A is associated with AMD that includes PCN/PNV. These genetic characteristics suggest the following mechanisms of developing AMD and pachychoroid diseases. VIPR2 and the CFH I62V A allele promote pachychoroid development, which can result in CSC development. The CFH I62V G allele promotes a common step during PCN/PNV and AMD development induced by pachychoroid or drusen, such as damage of Bruch's membrane or retinal pigment epithelium (RPE). ARMS2/HTRA1 also promotes damage of Bruch's membrane or RPE, while the association with drusen formation is stronger in ARMS2/HTRA1 than in CFH. TNFRSF10A and GATA5 promote blood-retinal-barrier breakdown to induce CSC, which could lead to PCN/PNV development. Furthermore, recently reported genetic associations with the natural course of CSC suggest the importance of reconsidering the subtype classification of CSC. These associations would enable the development of personalized/precision medicine for CSC and.
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Affiliation(s)
- Kenji Yamashiro
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
- Department of Ophthalmology, Japanese Red Cross Otsu Hospital, Otsu, Japan.
| | - Yoshikatsu Hosoda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Ayako Takahashi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Sotaro Ooto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Akitaka Tsujikawa
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Kawahara, Shogoin, Sakyo, Kyoto, 606-8507, Japan
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Optical coherence tomography and color fundus photography in the screening of age-related macular degeneration: A comparative, population-based study. PLoS One 2020; 15:e0237352. [PMID: 32797085 PMCID: PMC7428158 DOI: 10.1371/journal.pone.0237352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/23/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To analyze the individual value and the contribution of color fundus photography (CFP) and optical coherence tomography (OCT) in the screening of age-related macular degeneration (AMD) of an unselected population. Methods CFP and OCT images of 15957 eyes of 8069 subjects older than 55 years, obtained during a population-based screening for AMD using a single diagnostic non-mydriatic imaging device, were analyzed by a blinded examiner. The two techniques were preliminary evaluated considering the dichotomous parameter "gradable/ungradable", then gradable images were classified. CFP were graded according to the standardized classification of AMD lesions. OCT images were also categorized considering the presence of signs of early/intermediate AMD, late AMD, or other retinal diseases. Another blinded operator re-graded 1978 randomly selected images (for both CFP and OCT), to assess test reproducibility. Results Of the 15957 eyes, 8356 CFP (52.4%) and 15594 (97.7%) OCT scans were gradable. Moreover, most of the eyes with ungradable CFP (7339, 96.6%) were gradable at OCT. AMD signs were revealed in 7.4% of gradable CFP and in 10.4% of gradable OCT images. Moreover, at OCT, AMD signs were found in 1110 (6.9%) eyes whose CFP were ungradable or without AMD (847 and 263 eyes, respectively). The inter-operator agreement was good for the gradable versus ungradable parameter, and optimal for the AMD grading parameter of CFP. The agreement was optimal for all OCT parameters. Conclusions OCT provided gradable images in almost all examined eyes, compared to limited CFP efficiency. Moreover, OCT images allowed to detect more AMD eyes compared to gradable photos. OCT imaging appears to significantly improve the power of AMD screening in a general, unselected population, compared to CFP alone.
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Seddon JM, Dossett JP, Widjajahakim R, Rosner B. Association Between Perifoveal Drusen Burden Determined by OCT and Genetic Risk in Early and Intermediate Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2019; 60:4469-4478. [PMID: 31658355 PMCID: PMC6816283 DOI: 10.1167/iovs.19-27475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/09/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose The purpose of this study was to determine associations between macular drusen parameters derived from an automatic optical coherence tomography (OCT) algorithm, nonadvanced age-related macular degeneration (AMD) stage, and genetic variants. Methods Eyes classified as early or intermediate AMD with OCT imaging and genetic data were selected (n = 239 eyes). Drusen area and volume measurements were estimated using the Zeiss Cirrus advanced retinal pigment epithelium analysis algorithm in a perifoveal zone centered on the fovea. Associations between drusen measurements and common genetic variants in the complement and high-density lipoprotein (HDL) lipid pathways and the ARMS2/HTRA1 variant were calculated using generalized estimating equations and linear mixed models adjusting for age, sex, smoking, body mass index, and education. Results Drusen area ≥ the median was independently associated with a higher number of risk alleles for CFH risk score and risk variants in C3 and ARMS2/HTRA1 compared with eyes with no measurable drusen. Similar results were obtained for drusen volume. When all genes were analyzed in the same model, only CFH score and ARMS2/HTRA1 were associated with drusen measurements. HDL pathway genes were not significantly related to drusen parameters. Nonadvanced AMD stages were associated with OCT-derived drusen area and volume. Conclusions Variants in CFH and ARMS2/HTRA1, commonly associated with advanced AMD, were independently associated with an increase in drusen burden determined by OCT in an allele dose dependent manner, in eyes with early and intermediate AMD. Biomarkers such as a quantitative classification of nonadvanced AMD and other OCT-derived subphenotypes could provide earlier anatomic endpoints for clinical trials and facilitate the development of new therapies for AMD.
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Affiliation(s)
- Johanna M. Seddon
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - James P. Dossett
- School of Medicine, Tufts University, Boston, Massachusetts, United States
| | - Rafael Widjajahakim
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Bernard Rosner
- Channing Division of Network Medicine, Harvard Medical School, Boston, Massachusetts, United States
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Majithia S, Tham YC, Chee ML, Teo CL, Chee ML, Dai W, Kumari N, Lamoureux EL, Sabanayagam C, Wong TY, Cheng CY. Singapore Chinese Eye Study: key findings from baseline examination and the rationale, methodology of the 6-year follow-up series. Br J Ophthalmol 2019; 104:610-615. [PMID: 31401553 DOI: 10.1136/bjophthalmol-2019-314760] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS In order to address the eye care needs of the increasing numbers of elderly Chinese globally, there is a need for comprehensive understanding on the longitudinal trends of age-related eye diseases among Chinese. We herein report the key findings from the baseline Singapore Chinese Eye Study (SCES-1), and describe the rationale and methodology of the 6-year follow-up study (SCES-2). METHODS 3353 Chinese adults who participated in the baseline SCES-1 (2009-2011) were invited for the 6-year follow-up SCES-2 (2015-2017). Examination procedures for SCES-2 included standardised ocular, systemic examinations and questionnaires identical to SCES-1. SCES-2 further included new examinations such as optical coherence tomography angiography, and questionnaires to evaluate health impact and economic burden of eye diseases. RESULTS In SCES-1, the age-adjusted prevalence of best-corrected low vision (VA<6/12, better-seeing eye) and blindness (VA<6/60, better-seeing eye) were 3.4% and 0.2%, respectively. The prevalence rates for glaucoma, age related macular degeneration, and diabetic retinopathy (among diabetics) were 3.2%, 6.8%, 26.2%, respectively. Of the 3033 eligible individuals from SCES-1, 2661 participated in SCES-2 (response rate=87.7%). Comparing with those who did not attend SCES-2, those attended were younger, had higher SES (all p<0.001), but less likely to be a current smoker, to have diabetes, hypertension, hyperlipidaemia (all p≤0.025). CONCLUSIONS Building on SCES-1, SCES-2 will be one of the few longitudinal population-based eye studies to report incidence, progression, and risk factors of major age-related eye diseases. Findings from this cohort may offer new insights, and provide useful reference information for other Chinese populations elsewhere.
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Affiliation(s)
- Shivani Majithia
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih Chung Tham
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Miao Li Chee
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Cong Ling Teo
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Miao-Ling Chee
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Wei Dai
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Neelam Kumari
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology, Singapore Khoo Teck Puat Hospital, Singapore
| | - Ecosse Luc Lamoureux
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore .,Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
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