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Zhang Y, Zhao T, Ye L, Yan S, Shentu W, Lai Q, Qiao S. Advances in retinal imaging biomarkers for the diagnosis of cerebrovascular disease. Front Neurol 2024; 15:1393899. [PMID: 39364416 PMCID: PMC11448315 DOI: 10.3389/fneur.2024.1393899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 09/04/2024] [Indexed: 10/05/2024] Open
Abstract
The increasing incidence and mortality rates of cerebrovascular disease impose a heavy burden on both patients and society. Retinal imaging techniques, such as fundus photography, optical coherence tomography, and optical coherence tomography angiography, can be used for rapid, non-invasive evaluation of cerebral microcirculation and brain function since the retina and the central nervous system share similar embryonic origin characteristics and physiological features. This article aimed to review retinal imaging biomarkers related to cerebrovascular diseases and their applications in cerebrovascular diseases (stroke, cerebral small vessel disease [CSVD], and vascular cognitive impairment [VCI]), thus providing reference for early diagnosis and prevention of cerebrovascular diseases.
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Affiliation(s)
- Yier Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Ting Zhao
- Department of Neurology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Ling Ye
- Department of Geriatrics, Jinhua Fifth Hospital, Jinhua, Zhejiang, China
| | - Sicheng Yan
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Wuyue Shentu
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
| | - Qilun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Song Qiao
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
- Department of Neurology, Zhejiang Hospital, Hangzhou, Zhejiang, China
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Wada N, Takagi S, Yoshikawa A, Itokawa T, Maruyama T, Hori Y. Multimodal Imaging of Optic Nerve Head in Retinitis Pigmentosa. Semin Ophthalmol 2024; 39:480-487. [PMID: 38851891 DOI: 10.1080/08820538.2024.2363849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND A pallor optic nerve head (ONH) is one of the three features of retinitis pigmentosa (RP). This study aimed to assess the ONH prospectively by color tone, presence of hyper-reflective tissue, blood flow, retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) and investigate the change in these parameters with and without ONH pallor. METHODS The presence of ONH pallor was assessed by three independent examiners through careful examination using fundus photographs. The presence of a hyper-reflective structure on the ONH was carefully evaluated using a volume scan optical coherence tomography (OCT). RNFL thickness and ellipsoid zone (EZ) width around the macula were also evaluated by OCT. Laser speckle flowgraphy was used to measure the mean blur rate of the entire ONH area, which was subsequently divided into the vessel area (MV) and tissue area (MT). RESULTS Twenty-eight eyes of 28 patients with RP (55.4 ± 16.23 years of age) were included. The pale ONH was observed in 10 (35%) eyes. Hyper-reflective structures were observed in seven (25%) eyes. No significant correlation was found between the pale ONH and the presence of a hyper-reflective structure (Pearson's chi-squared test, p = .364). The average of the ONH area, MV, and MT was 8.65 ± 3.08 AU, 17.81 ± 7.54 AU, and 6.4 ± 2.66 AU, respectively, which significantly decreased in patients with pallor ONH (all p < .05). The global RNFL thickness was 73.54 ± 18.82 μm. The nasal and superior quadrants and global RNFL thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH (all p < .05). The global and superior and inferior GCC thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH(all p < .05).There was no difference in the EZ width between patients with and without a pale ONH (p = .107). CONCLUSION We conducted multiple assessments of the ONH in RP patients and investigated its clinical significance. Our findings suggest that ONH pallor may indicate a comprehensive change that emerges alongside the progression of retinal degeneration in RP. TRIAL REGISTRATION This trial was retrospectively registered in the UMIN Clinical Trial Registry (UMIN ID: 000048168).
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Affiliation(s)
- Naoko Wada
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Seiji Takagi
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Akiko Yoshikawa
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Takashi Itokawa
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Takahiro Maruyama
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
- Department of Ophthalmology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Yuichi Hori
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
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Zhou C, Zhou Z, Feng X, Zou D, Zhou Y, Zhang B, Chen J, Wang F, Liao D, Li J, Jin Z, Ren Q. The retinal oxygen metabolism and hemodynamics as a substitute for biochemical tests to predict nonproliferative diabetic retinopathy. JOURNAL OF BIOPHOTONICS 2024; 17:e202300567. [PMID: 38527858 DOI: 10.1002/jbio.202300567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
Predicting the occurrence of nonproliferative diabetic retinopathy (NPDR) using biochemical parameters is invasive, which limits large-scale clinical application. Noninvasive retinal oxygen metabolism and hemodynamics of 215 eyes from 73 age-matched healthy subjects, 90 diabetic patients without DR, 40 NPDR, and 12 DR with postpanretinal photocoagulation were measured with a custom-built multimodal retinal imaging device. Diabetic patients underwent biochemical examinations. Two logistic regression models were developed to predict NPDR using retinal and biochemical metrics, respectively. The predictive model 1 using retinal metrics incorporated male gender, insulin treatment condition, diastolic duration, resistance index, and oxygen extraction fraction presented a similar predictive power with model 2 using biochemical metrics incorporated diabetic duration, diastolic blood pressure, and glycated hemoglobin A1c (area under curve: 0.73 vs. 0.70; sensitivity: 76% vs. 68%; specificity: 64% vs. 62%). These results suggest that retinal oxygen metabolic and hemodynamic biomarkers may replace biochemical parameters to predict the occurrence of NPDR .
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Affiliation(s)
- Chuanqing Zhou
- College of Medical Instruments, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Zixia Zhou
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ximeng Feng
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
| | - Da Zou
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
| | - Yilin Zhou
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Bin Zhang
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jiabao Chen
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Fei Wang
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dingying Liao
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jinying Li
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zi Jin
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qiushi Ren
- Institute of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- Department of Biomedical Engineering, College of Future Technology, Peking University, Beijing, China
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Jin Z, Chen X, Jiang C, Feng X, Zou D, Lu Y, Li J, Ren Q, Zhou C. Predicting the cognitive impairment with multimodal ophthalmic imaging and artificial neural network for community screening. Br J Ophthalmol 2024:bjo-2023-323283. [PMID: 38697799 DOI: 10.1136/bjo-2023-323283] [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: 01/28/2023] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND/AIMS To investigate the comprehensive prediction ability for cognitive impairment in a general elder population using the combination of the multimodal ophthalmic imaging and artificial neural networks. METHODS Patients with cognitive impairment and cognitively healthy individuals were recruited. All subjects underwent medical history, blood pressure measurement, the Montreal Cognitive Assessment, medical optometry, intraocular pressure and custom-built multimodal ophthalmic imaging, which integrated pupillary light reaction, multispectral imaging, laser speckle contrast imaging and retinal oximetry. Multidimensional parameters were analysed by Student's t-test. Logistic regression analysis and back-propagation neural network (BPNN) were used to identify the predictive capability for cognitive impairment. RESULTS This study included 104 cognitive impairment patients (61.5% female; mean (SD) age, 68.3 (9.4) years), and 94 cognitively healthy age-matched and sex-matched subjects (56.4% female; mean (SD) age, 65.9 (7.6) years). The variation of most parameters including decreased pupil constriction amplitude (CA), relative CA, average constriction velocity, venous diameter, venous blood flow and increased centred retinal reflectance in 548 nm (RC548) in cognitive impairment was consistent with previous studies while the reduced flow acceleration index and oxygen metabolism were reported for the first time. Compared with the logistic regression model, BPNN had better predictive performance (accuracy: 0.91 vs 0.69; sensitivity: 93.3% vs 61.70%; specificity: 90.0% vs 68.66%). CONCLUSIONS This study demonstrates retinal spectral signature alteration, neurodegeneration and angiopathy occur concurrently in cognitive impairment. The combination of multimodal ophthalmic imaging and BPNN can be a useful tool for predicting cognitive impairment with high performance for community screening.
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Affiliation(s)
- Zi Jin
- Department of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Department of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
| | - Xuhui Chen
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Chunxia Jiang
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ximeng Feng
- Department of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Department of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- Department of Biomedical Engineering, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Centre, Beijing, China
| | - Da Zou
- Department of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Department of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- Department of Biomedical Engineering, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Centre, Beijing, China
| | - Yanye Lu
- Department of Biomedical Engineering, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Centre, Beijing, China
| | - Jinying Li
- Department of Ophthalmology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qiushi Ren
- Department of Biomedical Engineering, Peking University Shenzhen Graduate School, Shenzhen, China
- Department of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, China
- Department of Biomedical Engineering, Peking University, Beijing, China
- Institute of Medical Technology, Peking University Health Science Centre, Beijing, China
| | - Chuanqing Zhou
- College of Medical Instruments, Shanghai University of Medicine and Health Sciences, Shanghai, China
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Abu El-Asrar AM, AlBloushi AF, Abouammoh MA, Alzubaidi A, Gikandi PW, Al Faran A, Al-Kharashi AS, Al-Dahmash S. Comparisons of choroidal blood flow velocity between initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease and acute central serous chorioretinopathy. Eye (Lond) 2024; 38:1269-1275. [PMID: 38129662 PMCID: PMC11076456 DOI: 10.1038/s41433-023-02879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Acute central serous chorioretinopathy (CSC) and Vogt-Koyanagi-Harada (VKH) disease in the acute uveitic phase are characterized by serous retinal detachment caused by dysfunction of the choroid. The aim of this study is to compare blood flow velocity and pulse waveform parameters in the choroid between these two diseases. METHODS In this study, 25 patients (50 eyes) with VKH disease, 21 patients (27 eyes) with CSC and 15 healthy controls (30 eyes) were studied. Laser speckle flowgraphy (LSFG) was performed at presentation. RESULTS Choroidal mean blur rate (MBR), representing blood flow velocity in choroidal vessels, was significantly lower in the eyes affected by VKH disease compared with the healthy control and CSC eyes. CSC eyes had a significantly higher MBR compared with healthy controls. Among the analyzed pulse waveform parameters, blow-out time (BOT), falling rate (FR) and flow acceleration index (FAI) changed significantly. BOT value was significantly lower in CSC eyes than in healthy control and VKH eyes. FR and FAI values were significantly lower in VKH eyes than in healthy control and CSC eyes. There was a strong positive correlation between MBR and FAI. CONCLUSIONS Our findings confirm different pathophysiology of these two diseases. Assessment of choroidal blood flow velocity and haemodynamics with LSFG provides useful information to differentiate acute CSC and initial-onset acute uveitis associated with VKH disease.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Dr. Nasser Al-Rashid Research Chair in Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Abdulrahman F AlBloushi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Marwan A Abouammoh
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alzubaidi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Priscilla W Gikandi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Al Faran
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah S Al-Kharashi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Al-Dahmash
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Linton EF, Tedeschi TR, Ahmad NUS, Wang JK, Kardon RH. Retinal arterial-venous pulse delay: a new specific marker for a carotid-cavernous fistula. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1301410. [PMID: 38983038 PMCID: PMC11182162 DOI: 10.3389/fopht.2023.1301410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/20/2023] [Indexed: 07/11/2024]
Abstract
Purpose The purpose of the study was to describe ocular blood flow changes in eyes affected by a carotid-cavernous fistula (CCF) using laser speckle flowgraphy. We hypothesized that imaging blood flow velocity waveforms in the retinal arterioles and venules simultaneously would reveal specific characteristics of an arteriovenous (AV) connection. Design The study was an observational case series, with a retrospective case-control analysis. Methods Five patients with a CCF underwent measurement of ocular blood flow using laser speckle flowgraphy. The blood flow was compared retrospectively between a control group of healthy subjects (n = 32) and patients with an elevated intraocular pressure or venous outflow impairment without an AV fistula (n = 40). The outcomes were derived from the arteriole and venule blood flow velocity waveforms, including an A-V phase delay and flow pulsatility. Results The presence of an active CCF was associated with an increased delay in the peak velocity measured in the retinal venule (10.7% ± 2.2% of the cardiac cycle duration) compared with unaffected fellow eyes (1.8% ± 0.2%; p = 0.05) or control eyes of normal subjects (2.7% ± 0.3%; p = 0.02). This delay disappeared after fistula thrombosis and was not present in eyes with a central retinal vein occlusion (CRVO), glaucoma, non-arteritic anterior ischemic optic neuropathy (NAION), or papilledema. The venule blood flow velocity decreased during systole (and in some cases momentarily stopped), leading to a delayed pulse with a greater amplitude in the venules than in fellow eyes and normal controls after normalizing to the arteriole amplitude (1.71 ± 0.3 vs 0.54 ± 0.03 vs 0.59 ± 0.02; p = 8.0E-12). This specific AV delay could also be identified in a scanning laser ophthalmoscope (SLO; SPECTRALIS®) video. Conclusion Laser speckle flowgraphy reveals dynamic retinal vascular changes in eyes affected by a CCF, which are not present in healthy controls or patients with other eye conditions, and which reverses with treatment.
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Affiliation(s)
- Edward F. Linton
- Department of Ophthalmology and Visual Science, University of Iowa, Iowa City, IA, United States
- Rehabilitation Research and Development, Iowa City Veterans Affairs (VA) Health Care System and Veterans Affairs (VA) Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, United States
| | - Thomas R. Tedeschi
- Department of Ophthalmology and Visual Science, University of Iowa, Iowa City, IA, United States
- Rehabilitation Research and Development, Iowa City Veterans Affairs (VA) Health Care System and Veterans Affairs (VA) Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, United States
- Regeneron Genetics Medicine – Ophthalmology, Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
| | - Noor-Us-Sabah Ahmad
- Department of Ophthalmology and Visual Science, University of Iowa, Iowa City, IA, United States
| | - Jui-Kai Wang
- Department of Ophthalmology and Visual Science, University of Iowa, Iowa City, IA, United States
- Rehabilitation Research and Development, Iowa City Veterans Affairs (VA) Health Care System and Veterans Affairs (VA) Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, United States
| | - Randy H. Kardon
- Department of Ophthalmology and Visual Science, University of Iowa, Iowa City, IA, United States
- Rehabilitation Research and Development, Iowa City Veterans Affairs (VA) Health Care System and Veterans Affairs (VA) Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, United States
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Felder AE, Rahimi M, Nankali A, Matei N, Abdolahi F, Blair NP, Shahidi M. A retinal imaging system for combined measurement of optic nerve head vascular pulsation and stimulated vasodilation in humans. Sci Rep 2023; 13:17149. [PMID: 37816947 PMCID: PMC10564928 DOI: 10.1038/s41598-023-44390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/07/2023] [Indexed: 10/12/2023] Open
Abstract
Vascular pulsation at the optic nerve head (ONH) reflects vessel properties. Reduction in the stimulated retinal vasodilatory capacity has been reported in diabetes, but its relation with vascular pulsation is unknown. Here we report a new retinal imaging system for correlative assessment of ONH vascular pulsation and stimulated retinal vasodilation. Retinal reflectance images were acquired before and during light flicker stimulation to quantify arterial and venous vasodilation (DAR, DVR) in subjects with and without diabetic retinopathy (N = 25). ONH vascular pulsation amplitude and frequency (PA, PF), were quantified by curve fitting of periodic intensity waveforms acquired in retinal vasculature (RV) and ONH tissue (ONHT) regions. The relationships between pulsation metrics, heart rate (HR), intraocular pressure (IOP), and vasodilatory responses were evaluated. Pulsation metrics were not significantly different between regions (p ≥ 0.70). In RV, inter-image variabilities of PA and PF were 10% and 6%, whereas inter-observer variabilities were 7% and 2% respectively. In both regions, PF was correlated with HR (p ≤ 0.001). PA was associated with DAR in both regions (p ≤ 0.03), but only with DVR in RV (p ≤ 0.05). Overall, ONH vascular pulsation was associated with stimulated retinal vasodilation, suggesting diabetes may have concomitant effects on retinal vasculature compliance and neurovascular coupling.
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Affiliation(s)
- Anthony E Felder
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Mansour Rahimi
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, 90033, USA
| | - Amir Nankali
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, 90033, USA
| | - Nathanael Matei
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, 90033, USA
| | - Farzan Abdolahi
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, 90033, USA
| | - Norman P Blair
- Department Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Mahnaz Shahidi
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, 90033, USA.
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Sex differences in the association between systemic oxidative stress status and optic nerve head blood flow in normal-tension glaucoma. PLoS One 2023; 18:e0282047. [PMID: 36827337 PMCID: PMC9955941 DOI: 10.1371/journal.pone.0282047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To investigate the association of systemic oxidative stress markers and optic nerve head (ONH) blood flow in normal-tension glaucoma (NTG) patients, as well as sex differences in this association. METHODS This was a cross-sectional study of 235 eyes with NTG of 134 patients (56 male, 78 female; mean age, 60.9±14.1 years). Laser speckle flowgraphy (LSFG) was used to measure ONH blood flow (mean blur rate in the tissue area of the ONH; MBR-T) and LSFG pulse-waveform parameters, including flow acceleration index in the tissue area of the ONH (FAI-T). Oxidative stress markers, diacron-reactive oxygen metabolites (d-ROMs), and biological antioxidant potential (BAP) were measured with a free radical elective evaluator. Spearman's rank correlation test and a multivariate linear mixed-effect model were used to investigate factors associated with ONH blood flow. RESULTS MBR-T was significantly correlated with age (rs = -0.28, p < 0.001), mean arterial pressure (rs = -0.20, p = 0.002), intraocular pressure (rs = 0.24, p < 0.001), peripapillary retinal nerve fiber layer thickness (rs = 0.62, p < 0.001), and disc area (rs = -0.26, p < 0.001), but not with serum d-ROM level. Separate analyses of the subjects divided by sex showed that BAP was positively correlated to MBR-T (rs = 0.21, p = 0.036) and FAI-T (rs = 0.36, p < 0.001) only in male subjects. Similarly, BAP was significantly associated with MBR-T (β = 0.25, p = 0.026) and FAI-T (β = 0.37, p < 0.001) in male subjects in a multivariate linear mixed-effect model. CONCLUSION A lower serum antioxidant level, as indicated by BAP, was associated with reduced ONH blood flow only in male NTG patients. Our findings suggest that there are sex differences in the involvement of oxidative stress in the pathogenesis of reduced ocular blood flow in NTG.
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Vinnett A, Kandukuri J, Le C, Cho KA, Sinha A, Asanad S, Thompson G, Chen V, Rege A, Saeedi OJ. Dynamic Alterations in Blood Flow in Glaucoma Measured with Laser Speckle Contrast Imaging. Ophthalmol Glaucoma 2022; 5:250-261. [PMID: 34673279 PMCID: PMC9013729 DOI: 10.1016/j.ogla.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the repeatability of blood flow velocity index (BFVi) metrics obtained with a recently Food and Drug Administration-cleared laser speckle contrast imaging device, the XyCAM RI (Vasoptic Medical, Inc), and to characterize differences in these metrics among control, glaucoma suspect, and glaucoma participants. DESIGN Prospective, observational study. PARTICIPANTS Forty-six participants: 20 control, 16 glaucoma suspect, and 10 glaucoma participants, 1 eye per participant. METHODS Key dynamic BFVi metrics-mean, peak, dip, volumetric rise index (VRI), volumetric fall index (VFI), time to rise (TtR), time to fall (TtF), blow-out time (BOT), skew, and acceleration time index-were measured in the optic disc, optic disc vessels, optic disc perfusion region, and macula in 4 imaging sessions on the same day. Intrasession and intersession variability were calculated using the coefficient of variation (CV) for each metric in each region of interest (ROI). Values for each dynamic BFVi variable were compared between glaucoma, glaucoma suspect, and control participants using bivariate and multivariate analysis. Pearson correlation coefficients were used to correlate each variable in each ROI with age, intraocular pressure, cup-to-disc ratio (CDR), mean deviation, pattern standard deviation, retinal nerve fiber layer thickness, and minimum rim width. MAIN OUTCOME MEASURES Coefficient of variation for the intrasession and intersession variability for each dynamic BFVi metric in each ROI and differences in each metric in each ROI between each diagnostic group. RESULTS Intersession CV for mean, peak, dip, VRI, VFI, TtR, and TtF ranged from 3.2 ± 2.5% to 11.0 ± 3.8%. Age, CDR, OCT metrics, and visual field metrics showed significant correlations with dynamic BFVi variables. Peak, mean, dip, VRI, and VFI were significantly lower in patients with glaucoma than in control participants in all ROIs except the fovea. These metrics also were significantly lower in glaucoma patients than glaucoma suspect patients in the disc vessels. CONCLUSIONS Dynamic blood flow metrics measured with the XyCAM RI are reliable, are associated with structural and functional glaucoma metrics, and are significantly different among glaucoma, glaucoma suspect, and control participants. The XyCAM RI may serve as an important tool in glaucoma management in the future.
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Affiliation(s)
- Alfred Vinnett
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland
| | | | - Christopher Le
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland
| | | | | | - Samuel Asanad
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland
| | - Ginger Thompson
- Department of Ophthalmology/Hamilton Eye Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Victoria Chen
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland
| | | | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, Maryland.
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Characteristics of laterality in the optic nerve head microcirculation obtained by laser speckle flowgraphy in healthy subjects. Graefes Arch Clin Exp Ophthalmol 2022; 260:2799-2805. [PMID: 35298697 DOI: 10.1007/s00417-022-05631-8] [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: 11/16/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To determine the characteristics of the laterality of the ocular microcirculation parameters obtained from laser speckle flowgraphy (LSFG) in the optic nerve head (ONH). SUBJECTS AND METHODS We reanalyzed a total of 240 healthy subjects (169 men, 71 women) who had participated in a medical checkup program. We analyzed the average mean blur rate (MBR), maximum MBR (Max-MBR), minimum MBR (Min-MBR), and area ratio of the blood stream (ARBS). As the pulse waveform parameters, we also calculated the skew, blowout score (BOS), blowout time (BOT), rising rate, falling rate, flow acceleration index (FAI), acceleration time index (ATI), resistivity index (RI), and beat strength over MBR (BOM). All parameters were compared between left and right eyes. RESULTS MBR-average, MBR-Max, MBR-Min, ARBS, skew, BOT, rising rate, falling rate, FAI, ATI, and ARBS did not differ significantly between the right and left eyes. The BOS in the right eyes was significantly lower than that of the left eyes, and the RI and BS in the right eyes were significantly higher than those of the left eyes. Similarly, for the whole of the ONH, the BOS in the tissue area (Tissue) and in the vessel area (Vessel) of the right eyes were significantly lower than those of the left eyes, and RI-Tissue, RI-Vessel, BOM-Tissue, and BOM-Vessel in the right eyes were significantly higher than those of the left eyes. CONCLUSION By using LSFG, we observed laterality of the BOS, RI, and BOM, all of which are pulse wave form parameters in the ONH.
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Calzetti G, La Morgia C, Cattaneo M, Carta A, Bosello F, Amore G, Carbonelli M, Cascavilla ML, Gandolfi S, Carelli V, Schmetterer L, Scholl HPN, Barboni P. Longitudinal Study of Optic Disk Perfusion and Retinal Structure in Leber's Hereditary Optic Neuropathy. Invest Ophthalmol Vis Sci 2022; 63:43. [PMID: 35098304 PMCID: PMC8802032 DOI: 10.1167/iovs.63.1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose The purpose of this study was to evaluate optic disk perfusion and neural retinal structure in patients with subacute Leber's hereditary optic neuropathy (LHON) and LHON carriers, as compared with healthy controls. Methods This study included 8 patients with LHON in the subacute stage, 10 asymptomatic carriers of a LHON-associated mitochondrial DNA mutation, and 40 controls. All subjects underwent measurement of the retinal nerve fiber layer (RNFL) thickness, the ganglion cell-inner plexiform layer (GCIPL) thickness using optical coherence tomography and optic disk microvascular perfusion (Mean Tissue [MT]) using laser speckle flowgraphy (LSFG). Patients were re-examined after a median interval of 3 months from the baseline visit. Results LHON carriers had higher values of RNFL thickness, GCIPL thickness, and disk area than controls (P < 0.05), whereas MT was not different between the two groups (P = 0.936). Median MT and RNFL thickness were 32% and 15% higher in the early subacute stage of the disease than in controls (P < 0.001 and P = 0.001). MT declined below the values of controls during the late subacute stage (P = 0.024), whereas RNFL thickness declined later during the dynamic stage (P < 0.001). GCIPL thickness was lower in patients with LHON than in controls independently of the stage of the disease (P < 0.001). Conclusions The high blood flow at the optic disk during the early subacute stage may be the consequence of vasodilation due to nitric oxide release as compensation to mitochondrial impairment. Optic disk perfusion as measured by LSFG is a promising biomarker for LHON diagnosis and monitoring as well as an objective outcome measure for assessing response to therapies.
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Affiliation(s)
- Giacomo Calzetti
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland.,Department of Ophthalmology, University Hospital of Parma, Parma, Italy
| | - Chiara La Morgia
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - Marco Cattaneo
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Arturo Carta
- Department of Ophthalmology, University Hospital of Parma, Parma, Italy
| | - Francesca Bosello
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, Ocular Immunology and Neuroophthalmology Service, AOUI-University of Verona, Verona, Italy
| | - Giulia Amore
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Michele Carbonelli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Maria Lucia Cascavilla
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Gandolfi
- Department of Ophthalmology, University Hospital of Parma, Parma, Italy
| | - Valerio Carelli
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Leopold Schmetterer
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Piero Barboni
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Studio Oculistico d'Azeglio, Bologna, Italy
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