1
|
Ehlers JP, Lunasco LM, Yordi S, Cetin H, Le TK, Sarici K, Kaiser PK, Khanani AM, Talcott KE, Hu J, Meng X, Srivastava SK. Compartmental Exudative Dynamics in Neovascular Age-Related Macular Degeneration: Volumetric Outcomes and Impact of Volatility in a Phase III Clinical Trial. Ophthalmol Retina 2024; 8:765-777. [PMID: 38403242 DOI: 10.1016/j.oret.2024.02.010] [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: 02/22/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To examine retinal feature dynamics in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF therapy and the relationship of these features with visual acuity. DESIGN Post hoc analysis of the phase III, randomized, HAWK nAMD clinical trial. PARTICIPANTS Participants randomized to the brolucizumab 6 mg or aflibercept 2 mg arms of the trial. METHODS Spectral-domain OCT scans collected at 4-week intervals were analyzed using an automated machine learning-enhanced segmentation and feature-extraction platform with manual verification. Quantitative volumetric measures of retinal and exudative features were exported at multiple timepoints over 48 weeks. Volatility of exudative features was calculated as the standard deviation of each feature value during the maintenance phase (week 12-48) of treatment. These features were examined for their associations with anatomic and functional outcomes. MAIN OUTCOME MEASURES Longitudinal intraretinal fluid (IRF) and subretinal fluid (SRF) volume, subretinal hyperreflective material (SHRM) volume, ellipsoid zone (EZ) integrity (EZ-retinal pigment epithelium [RPE] volume/thickness), and correlation with best-corrected visual acuity (BCVA). RESULTS Intraretinal fluid, SRF, and SHRM demonstrated significant volumetric reduction from baseline with anti-VEGF therapy (P < 0.001 at each timepoint). Ellipsoid zone integrity measures demonstrated significant improvement from baseline (P < 0.001 at each timepoint). Both EZ integrity and SHRM measures correlated significantly with BCVA at all timepoints (EZ-RPE volume: 0.38 ≤ r ≤ 0.47; EZ-RPE central subfield thickness: 0.22 ≤ r ≤ 0.41; SHRM volume: -0.33 ≤ r ≤ -0.44). After treatment initiation, correlations of IRF and SRF volume with BCVA were weak or nonsignificant. Eyes with lower volatility of IRF, SRF, and SHRM volumes during the maintenance phase showed greater improvements in EZ integrity (all P < 0.01) and greater gains in BCVA (all P < 0.01) at week 48 compared with eyes with higher volatility in those exudative parameters. CONCLUSIONS Quantitative measures of SHRM volume and EZ integrity correlated more strongly with BCVA than retinal fluid volumes during treatment. High volatility of exudative parameters, including SRF, during the maintenance phase of treatment was associated with loss of EZ integrity and BCVA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Justis P Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Leina M Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sari Yordi
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thuy K Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kubra Sarici
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Arshad M Khanani
- Sierra Eye Associates, Reno, Nevada; University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Katherine E Talcott
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joanne Hu
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Xiangyi Meng
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Sunil K Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
2
|
Schmidt-Erfurth U, Riedl S. [Complement inhibition treatment for geographic atrophy (GA): functional and morphological efficacy and relevant biomarkers in clinical practice]. DIE OPHTHALMOLOGIE 2024; 121:476-481. [PMID: 38691156 DOI: 10.1007/s00347-024-02039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
The approval of complement inhibitory therapeutic agents for the treatment of geographic atrophy (GA) has highlighted the need for reliable and reproducible measurement of disease progression and therapeutic efficacy. Due to its availability and imaging characteristics optical coherence tomography (OCT) is the method of choice. Using OCT analysis based on artificial intelligence (AI), the therapeutic efficacy of pegcetacoplan was demonstrated at the levels of both the retinal pigment epithelium (RPE) and photoreceptors (PR). Cloud-based solutions that enable monitoring of GA are already available.
Collapse
Affiliation(s)
- Ursula Schmidt-Erfurth
- Medizinische Universität Wien, Universitätsklinik für Augenheilkunde und Optometrie, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Sophie Riedl
- Medizinische Universität Wien, Universitätsklinik für Augenheilkunde und Optometrie, Währinger Gürtel 18-20, 1090, Wien, Österreich
| |
Collapse
|
3
|
Berkowitz BA, Paruchuri A, Stanek J, Abdul-Nabi M, Podolsky RH, Bustos AH, Childers KL, Murphy GG, Stangis K, Roberts R. Biomarker evidence of early vision and rod energy-linked pathophysiology benefits from very low dose DMSO in 5xFAD mice. Acta Neuropathol Commun 2024; 12:85. [PMID: 38822433 PMCID: PMC11140992 DOI: 10.1186/s40478-024-01799-8] [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: 03/04/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024] Open
Abstract
Here, we test whether early visual and OCT rod energy-linked biomarkers indicating pathophysiology in nicotinamide nucleotide transhydrogenase (Nnt)-null 5xFAD mice also occur in Nnt-intact 5xFAD mice and whether these biomarkers can be pharmacologically treated. Four-month-old wild-type or 5xFAD C57BL/6 substrains with either a null (B6J) Nnt or intact Nnt gene (B6NTac) and 5xFAD B6J mice treated for one month with either R-carvedilol + vehicle or only vehicle (0.01% DMSO) were studied. The contrast sensitivity (CS), external limiting membrane-retinal pigment epithelium (ELM-RPE) thickness (a proxy for low pH-triggered water removal), profile shape of the hyperreflective band just posterior to the ELM (i.e., the mitochondrial configuration within photoreceptors per aspect ratio [MCP/AR]), and retinal laminar thickness were measured. Both wild-type substrains showed similar visual performance indices and dark-evoked ELM-RPE contraction. The lack of a light-dark change in B6NTac MCP/AR, unlike in B6J mice, is consistent with relatively greater mitochondrial efficiency. 5xFAD B6J mice, but not 5xFAD B6NTac mice, showed lower-than-WT CS. Light-adapted 5xFAD substrains both showed abnormal ELM-RPE contraction and greater-than-WT MCP/AR contraction. The inner retina and superior outer retina were thinner. Treating 5xFAD B6J mice with R-carvedilol + DMSO or DMSO alone corrected CS and ELM-RPE contraction but not supernormal MCP/AR contraction or laminar thinning. These results provide biomarker evidence for prodromal photoreceptor mitochondrial dysfunction/oxidative stress/oxidative damage, which is unrelated to visual performance, as well as the presence of the Nnt gene. This pathophysiology is druggable in 5xFAD mice.
Collapse
Affiliation(s)
- Bruce A Berkowitz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA.
| | - Anuhya Paruchuri
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Josh Stanek
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Mura Abdul-Nabi
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Robert H Podolsky
- Biostatistics and Study Methodology, Children's National Hospital, Silver Spring, MD, USA
| | | | | | - Geoffrey G Murphy
- Department of Molecular and Integrative Physiology, Molecular Behavioral Neuroscience Institute, University of Michigan Medical School, Ann Arbor, MI, USA
- Michigan Neuroscience Institute, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Katherine Stangis
- Michigan Neuroscience Institute, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robin Roberts
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| |
Collapse
|
4
|
Yordi S, Cakir Y, Kalra G, Cetin H, Hu M, Abraham J, Reese J, Srivastava SK, Ehlers JP. Ellipsoid Zone Integrity and Visual Function in Dry Age-Related Macular Degeneration. J Pers Med 2024; 14:543. [PMID: 38793125 PMCID: PMC11122652 DOI: 10.3390/jpm14050543] [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: 03/31/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
In this longitudinal retrospective image analysis, conducted on patients diagnosed with dry age-related macular degeneration (AMD) and 5 years of follow-up imaging data, the study aimed to investigate the relationship between ellipsoid zone (EZ) integrity on spectral domain optical coherence tomography (SD-OCT) and visual acuity (VA). Using a machine learning-enabled feature extraction tool, quantitative EZ parameters were derived from SD-OCT images. The analysis revealed significant correlations between EZ integrity metrics and VA. Eyes with excellent VA (≥20/25 Snellen) exhibited higher EZ integrity, including less EZ attenuation, thicker ellipsoid zone-retinal pigment epithelium (EZ-RPE) thickness, and higher EZ intensity, in contrast to eyes with worse VA (≤20/40 Snellen). Additionally, eyes with geographic atrophy (GA) in the foveal region displayed compromised EZ integrity compared to those without GA. Notably, baseline EZ integrity metrics were predictive of future VA loss. These findings suggest that quantitative SD-OCT measurements of EZ integrity could potentially detect early changes in dry AMD and serve as valuable indicators for predicting future functional outcomes. Furthermore, these measurements hold promise for use in clinical trial screenings, offering insights into the progression of the disease and its impact on visual acuity. This study underscores the importance of EZ integrity assessment in understanding and managing dry AMD.
Collapse
Affiliation(s)
- Sari Yordi
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH 44195, USA; (S.Y.); (Y.C.); (G.K.); (H.C.); (M.H.); (J.R.); (S.K.S.)
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Yavuz Cakir
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH 44195, USA; (S.Y.); (Y.C.); (G.K.); (H.C.); (M.H.); (J.R.); (S.K.S.)
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Gagan Kalra
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH 44195, USA; (S.Y.); (Y.C.); (G.K.); (H.C.); (M.H.); (J.R.); (S.K.S.)
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH 44195, USA; (S.Y.); (Y.C.); (G.K.); (H.C.); (M.H.); (J.R.); (S.K.S.)
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Ming Hu
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH 44195, USA; (S.Y.); (Y.C.); (G.K.); (H.C.); (M.H.); (J.R.); (S.K.S.)
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Joseph Abraham
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Jamie Reese
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH 44195, USA; (S.Y.); (Y.C.); (G.K.); (H.C.); (M.H.); (J.R.); (S.K.S.)
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Sunil K. Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH 44195, USA; (S.Y.); (Y.C.); (G.K.); (H.C.); (M.H.); (J.R.); (S.K.S.)
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Justis P. Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cleveland Clinic, Cleveland, OH 44195, USA; (S.Y.); (Y.C.); (G.K.); (H.C.); (M.H.); (J.R.); (S.K.S.)
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| |
Collapse
|
5
|
Cabral D, Bijon J, Vaz M, Naguib M, Sarraf D, Freund KB. Clinical Implications of Alternating Hypointense Bands on OCT Angiography in Retinal Vascular Occlusive Disease. Ophthalmol Retina 2024:S2468-6530(24)00225-2. [PMID: 38719189 DOI: 10.1016/j.oret.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE To demonstrate the relationship between alternating hypointense signal bands on OCT angiography (OCTA), real-time fluorescein angiography (FA), and structural OCT findings in patients with retinal vascular occlusive disease (RVOD). DESIGN Retrospective, consecutive case series. SUBJECTS Consecutive patients with a clinical diagnosis of acute RVOD and alternating bands of hypointense OCTA flow signal on en face projections. METHODS Complete ophthalmic examination and multimodal imaging, including color fundus photography, real-time FA, spectral-domain OCT, and OCTA performed with different instruments having different scan speeds and acquisition protocols. MAIN OUTCOME MEASURES The primary outcomes were: hypointense OCTA band characteristics (number, width, orientation, and location), OCTA acquisition characteristics (speed and scan direction), and FA findings including delayed arteriovenous (AV) transit and pulsatile flow. Secondary outcomes were: structural OCT changes including retinal fluid, paracentral acute middle maculopathy (PAMM) lesion, and a prominent middle limiting membrane (p-MLM) sign. RESULTS OCT angiography hypointense bands were detected in the superficial and deep vascular plexuses in 9 eyes of 9 patients with either partial central retinal vein occlusion (RVO) or nonischemic RVO. When obtained on the same device, hypointense bands were thinner and more numerous at lower (100 kHz) scan speeds compared with higher (200 kHz) scan speeds. Band orientation was parallel to the OCTA scan direction, and their extent correlated with the area of delayed AV transit on FA. Structural OCT showed multiple PAMM lesions in 78% of cases and a p-MLM sign centered in the fovea in 44% of cases. CONCLUSIONS OCT hypointense bands are a novel biomarker in RVOD indicating delayed AV transit and pulsatile filling without the need for dye angiography. Structural OCT often shows PAMM in these eyes and, less commonly, a p-MLM sign. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Diogo Cabral
- Unidade Local de Saúde Almada-Seixal, Almada, Portugal; NMS Research, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jacques Bijon
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Mariana Vaz
- Unidade Local de Saúde Almada-Seixal, Almada, Portugal
| | - Mina Naguib
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York.
| |
Collapse
|
6
|
Abousy M, Drew-Bear LE, Gibbons A, Pan-Doh N, Li X, Handa JT. In-Depth Analysis of Preoperative OCT Markers as Prognostic Factors for Lamellar Macular Holes and Epiretinal Membrane Foveoschisis. Ophthalmol Retina 2024; 8:465-472. [PMID: 37972892 PMCID: PMC11070309 DOI: 10.1016/j.oret.2023.10.025] [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: 08/04/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To identify preoperative OCT markers that correlate with postoperative visual acuity (VA) changes in eyes with lamellar macular hole (LMH) and epiretinal membrane foveoschisis (ERMF) after pars plana vitrectomy (PPV). DESIGN Cross-sectional retrospective study. SUBJECTS Patients seen at the Wilmer Eye Institute between 2011 and 2021 with an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for "macular hole" that underwent PPV, and demonstrated all OCT criteria present for either LMH or ERMF based on the Hubschman et al (2020) classification. METHODS OCT markers including hole dimensions, retinal layer continuity, and ellipsoid zone (EZ) convexity and pixelated intensity were quantified. Visual acuity immediately before PPV and at the last follow-up date available were both recorded. MAIN OUTCOME MEASURES Preoperative OCT variables that are correlated with postoperative changes in VA. RESULTS Forty-two eyes from 42 patients with LMH (n = 11) and ERMF (n = 31) that underwent PPV were identified. Visual acuity in the ERMF cohort significantly improved at last follow-up compared with preoperative VA (P < 0.001), whereas VA in the LMH cohort did not (P = 0.14). In the LMH cohort, retinal layer continuity at the hole edge was positively correlated with change in VA at final follow-up, whereas hole height was negatively correlated with VA. In the ERMF cohort, preoperative VA was negatively correlated with change in VA at final follow-up. CONCLUSIONS Retinal layer continuity at the hole and hole height are novel preoperative markers that predict postoperative VA change in LMH. After identifying the type of macular lesion, surgeons should consider using these preoperative OCT markers when counseling patients on potential postoperative VA outcomes and when managing patient expectations. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Mya Abousy
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura E Drew-Bear
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Missouri-Kansas City Department of Ophthalmology, Kansas City, Missouri
| | - Alison Gibbons
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan Pan-Doh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ximin Li
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James T Handa
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
7
|
Curcio CA, Kar D, Owsley C, Sloan KR, Ach T. Age-Related Macular Degeneration, a Mathematically Tractable Disease. Invest Ophthalmol Vis Sci 2024; 65:4. [PMID: 38466281 PMCID: PMC10916886 DOI: 10.1167/iovs.65.3.4] [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: 01/02/2024] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
A progression sequence for age-related macular degeneration onset may be determinable with consensus neuroanatomical nomenclature augmented by drusen biology and eye-tracked clinical imaging. This narrative review proposes to supplement the Early Treatment of Diabetic Retinopathy Study (sETDRS) grid with a ring to capture high rod densities. Published photoreceptor and retinal pigment epithelium (RPE) densities in flat mounted aged-normal donor eyes were recomputed for sETDRS rings including near-periphery rich in rods and cumulatively for circular fovea-centered regions. Literature was reviewed for tissue-level studies of aging outer retina, population-level epidemiology studies regionally assessing risk, vision studies regionally assessing rod-mediated dark adaptation (RMDA), and impact of atrophy on photopic visual acuity. The 3 mm-diameter xanthophyll-rich macula lutea is rod-dominant and loses rods in aging whereas cone and RPE numbers are relatively stable. Across layers, the largest aging effects are accumulation of lipids prominent in drusen, loss of choriocapillary coverage of Bruch's membrane, and loss of rods. Epidemiology shows maximal risk for drusen-related progression in the central subfield with only one third of this risk level in the inner ring. RMDA studies report greatest slowing at the perimeter of this high-risk area. Vision declines precipitously when the cone-rich central subfield is invaded by geographic atrophy. Lifelong sustenance of foveal cone vision within the macula lutea leads to vulnerability in late adulthood that especially impacts rods at its perimeter. Adherence to an sETDRS grid and outer retinal cell populations within it will help dissect mechanisms, prioritize research, and assist in selecting patients for emerging treatments.
Collapse
Affiliation(s)
- Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
| | - Kenneth R. Sloan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, United States
| | - Thomas Ach
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
8
|
Liu L, Xu Q, Song X, Zhao Y, Zhang Y, Qu Y. Evaluation of changes in macular structures after subthreshold micropulse laser therapy on chronic central serous chorioretinopathy. Lasers Med Sci 2024; 39:83. [PMID: 38418639 DOI: 10.1007/s10103-024-04030-1] [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: 03/16/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To evaluate the changes in macular structures following subthreshold micropulse laser (SHML) treatment for chronic central serous chorioretinopathy (cCSC). METHODS Data of 33 eyes from 31 cCSC patients treated with SHML and followed up for at least 6 months has been included in this retrospective study. Main outcome measurements include resolution of subretinal fluid (SRF) and pigment epithelial detachment (PED), the recovery of ellipsoid zone (EZ) continuity, and the foveal outer nuclear layer (ONL) thickness along with its ratio. RESULTS Mean observation period is 7.355 months (ranging from 6 to 24 months) and mean number of treatments administered is 1.839 (ranging from 1 to 5). 6 months after SHML treatment, there is a significant decrease in the area of SRF and PED (P < 0.001, P = 0.010, respectively). Additionally, the frequency of continuous EZ and the foveal ONL thickness reveal a significant increase (P<0.001, P = 0.005, respectively). The ratio of foveal ONL thickness is significantly higher after laser treatment, particularly in patients with a disease duration of ≤12 months (p = 0.022, P=0.036, respectively). CONCLUSION SHML treatment proves to be effective in cCSC eyes, leading to satisfactory recovery of macular structures, especially the photoreceptor layer.
Collapse
Affiliation(s)
- Lijun Liu
- Department of Geriatrics, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan, Shandong, 250012, China
| | - Qian Xu
- Department of Geriatrics, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan, Shandong, 250012, China
| | - Xian Song
- Department of Geriatrics, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan, Shandong, 250012, China
| | - Yuqing Zhao
- Department of Geriatrics, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan, Shandong, 250012, China
| | - Yu Zhang
- Department of Geriatrics, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan, Shandong, 250012, China
| | - Yi Qu
- Department of Geriatrics, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan, Shandong, 250012, China.
| |
Collapse
|
9
|
Maloca PM, Pfau M, Janeschitz-Kriegl L, Reich M, Goerdt L, Holz FG, Müller PL, Valmaggia P, Fasler K, Keane PA, Zarranz-Ventura J, Zweifel S, Wiesendanger J, Kaiser P, Enz TJ, Rothenbuehler SP, Hasler PW, Juedes M, Freichel C, Egan C, Tufail A, Scholl HPN, Denk N. Human selection bias drives the linear nature of the more ground truth effect in explainable deep learning optical coherence tomography image segmentation. JOURNAL OF BIOPHOTONICS 2024; 17:e202300274. [PMID: 37795556 DOI: 10.1002/jbio.202300274] [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: 07/15/2023] [Revised: 09/11/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023]
Abstract
Supervised deep learning (DL) algorithms are highly dependent on training data for which human graders are assigned, for example, for optical coherence tomography (OCT) image annotation. Despite the tremendous success of DL, due to human judgment, these ground truth labels can be inaccurate and/or ambiguous and cause a human selection bias. We therefore investigated the impact of the size of the ground truth and variable numbers of graders on the predictive performance of the same DL architecture and repeated each experiment three times. The largest training dataset delivered a prediction performance close to that of human experts. All DL systems utilized were highly consistent. Nevertheless, the DL under-performers could not achieve any further autonomous improvement even after repeated training. Furthermore, a quantifiable linear relationship between ground truth ambiguity and the beneficial effect of having a larger amount of ground truth data was detected and marked as the more-ground-truth effect.
Collapse
Affiliation(s)
- Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Maximilian Pfau
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Lucas Janeschitz-Kriegl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Michael Reich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Philipp L Müller
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Makula Center, Suedblick Eye Centers, Augsburg, Germany
| | - Philippe Valmaggia
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Katrin Fasler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Tim J Enz
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | | | - Pascal W Hasler
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Marlene Juedes
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, Basel, Switzerland
| | - Christian Freichel
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, Basel, Switzerland
| | - Catherine Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Nora Denk
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Pharma Research and Early Development (pRED), Pharmaceutical Sciences (PS), Roche, Innovation Center Basel, Basel, Switzerland
| |
Collapse
|
10
|
Heath Jeffery RC, Lo J, Thompson JA, Lamey TM, McLaren TL, De Roach JN, Ayton LN, Vincent AL, Sharma A, Chen FK. Analysis of the Outer Retinal Bands in ABCA4 and PRPH2-Associated Retinopathy using OCT. Ophthalmol Retina 2024; 8:174-183. [PMID: 37209970 DOI: 10.1016/j.oret.2023.05.010] [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: 04/02/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE To evaluate the outer retinal bands using OCT in ABCA4- and PRPH2-associated retinopathy and develop a novel imaging biomarker to differentiate between these 2 genotypes. DESIGN Multicenter case-control study. PARTICIPANTS Patients with a clinical and genetic diagnosis of ABCA4- or PRPH2-associated retinopathy and an age-matched control group. METHODS Macular OCT was used to measure the thickness of the outer retinal bands 2 and 4 by 2 independent examiners at 4 retinal loci. MAIN OUTCOME MEASURES Outcome measures included the thicknesses of band 2, band 4, and the band 2/band 4 ratio. Linear mixed modeling was used to make comparisons across the 3 groups. Receiver operating characteristic (ROC) analysis determined the optimal cutoff for the band 2/band 4 ratio to distinguish PRPH2- from ABCA4-associated retinopathy. RESULTS We included 45 patients with ABCA4 variants, 45 patients with PRPH2 variants, and 45 healthy controls. Band 2 was significantly thicker in patients with PRPH2 compared with ABCA4 (21.4 vs. 15.9 μm, P < 0.001) variants, whereas band 4 was thicker in patients with ABCA4 variants than those with PRPH2 variants (27.5 vs. 21.7 μm, P < 0.001). Similarly, the band 2/band 4 ratio was significantly different (1.0 vs. 0.6 for PRPH2 vs. ABCA4, P < 0.001). The area under the ROC curve was 0.87 for either band 2 (> 18.58 μm) or band 4 (< 26.17 μm) alone and 0.99 (95% confidence interval: 0.97-0.99) for the band 2/band 4 ratio with a cutoff threshold of 0.79, providing 100% specificity. CONCLUSIONS We report an altered outer retinal band profile whereby the band 2/band 4 ratio was able to discriminate between PRPH2- and ABCA4-associated retinopathy. This may have future clinic utility in predicting the genotype and provide further insight into the anatomic correlate of band 2. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Jennifer A Thompson
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Tina M Lamey
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Terri L McLaren
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - John N De Roach
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea L Vincent
- Department of Ophthalmology, FMHS, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Abhishek Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia; Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia; Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
11
|
Fasih-Ahmad S, Wang Z, Mishra Z, Vatanatham C, Clark ME, Swain TA, Curcio CA, Owsley C, Sadda SR, Hu ZJ. Potential Structural Biomarkers in 3D Images Validated by the First Functional Biomarker for Early Age-Related Macular Degeneration - ALSTAR2 Baseline. Invest Ophthalmol Vis Sci 2024; 65:1. [PMID: 38300559 PMCID: PMC10846345 DOI: 10.1167/iovs.65.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Purpose Lack of valid end points impedes developing therapeutic strategies for early age-related macular degeneration (AMD). Delayed rod-mediated dark adaptation (RMDA) is the first functional biomarker for incident early AMD. The relationship between RMDA and the status of outer retinal bands on optical coherence tomography (OCT) have not been well defined. This study aims to characterize these relationships in early and intermediate AMD. Methods Baseline data from 476 participants was assessed including eyes with early AMD (n = 138), intermediate AMD (n = 101), and normal aging (n = 237). Participants underwent volume OCT imaging of the macula and rod intercept time (RIT) was measured. The ellipsoid zone (EZ) and interdigitation zone (IZ) on all OCT B-scans of the volumes were segmented. The area of detectable EZ and IZ, and mean thickness of IZ within the Early Treatment Diabetic Retinopathy Study (ETDRS) grid were computed and associations with RIT were assessed by Spearman's correlation coefficient and age adjusted. Results Delayed RMDA (longer RIT) was most strongly associated with less preserved IZ area (r = -0.591; P < 0.001), followed by decreased IZ thickness (r = -0.434; P < 0.001), and EZ area (r = -0.334; P < 0.001). This correlation between RIT and IZ integrity was not apparent when considering normal eyes alone within 1.5 mm of the fovea. Conclusions RMDA is correlated with the status of outer retinal bands in early and intermediate AMD eyes, particularly, the status of the IZ. This correlation is consistent with a previous analysis of only foveal B-scans and is biologically plausible given that retinoid availability, involving transfer at the interface attributed to the IZ, is rate-limiting for RMDA.
Collapse
Affiliation(s)
| | - Ziyuan Wang
- Doheny Eye Institute, Pasadena, California, United States
| | - Zubin Mishra
- Doheny Eye Institute, Pasadena, California, United States
| | | | - Mark E Clark
- Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Thomas A Swain
- Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christine A Curcio
- Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cynthia Owsley
- Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | | | | |
Collapse
|
12
|
Ding J, Kim TH, Ma G, Yao X. Intrinsic signal optoretinography of dark adaptation abnormality due to rod photoreceptor degeneration. Exp Biol Med (Maywood) 2024; 249:10024. [PMID: 38463390 PMCID: PMC10911128 DOI: 10.3389/ebm.2024.10024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/04/2024] [Indexed: 03/12/2024] Open
Abstract
This research aims to investigate the potential of using intrinsic optical signal (IOS) optoretinography (ORG) to objectively detect dark adaptation (DA) abnormalities related to rod photoreceptor degeneration. Functional optical coherence tomography (OCT) was employed in both wild-type (WT) and retinal degeneration 10 (rd10) mice to conduct this assessment. Dynamic OCT measurements captured the changes in retinal thickness and reflectance from light-to-dark transition. Comparative analysis revealed significant IOS alterations within the outer retina. Specifically, a reduction in thickness from external limiting membrane (ELM) peak to retinal pigment epithelium (RPE) peak was observed (WT: 1.13 ± 0.69 µm, 30 min DA; rd10: 2.64 ± 0.86 µm, 30 min DA), as well as a decrease in the intensity of the inner segment ellipsoid zone (EZ) in 30 min DA compared to light adaptation (LA). The reduction of relative EZ intensity was notable in rd10 after 5 min DA and in WT after 15 min DA, with a distinguishable difference between rd10 and WT after 10 min DA. Furthermore, our findings indicated a significant decrease in the relative intensity of the hypo-reflective band between EZ and RPE in rd10 retinas during DA, which primarily corresponds to the outer segment (OS) region. In conclusion, the observed DA-IOS abnormalities, including changes in ELM-RPE thickness, EZ, and OS intensity, hold promise as differentiators between WT and rd10 mice before noticeable morphological abnormalities occur. These findings suggest the potential of this non-invasive imaging technique for the early detection of dysfunction in retinal photoreceptors.
Collapse
Affiliation(s)
- Jie Ding
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, United States
| | - Tae-Hoon Kim
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, United States
| | - Guangying Ma
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, United States
| | - Xincheng Yao
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, United States
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, United States
| |
Collapse
|
13
|
Kar D, Kim YJ, Packer O, Clark ME, Cao D, Owsley C, Dacey DM, Curcio CA. Volume electron microscopy reveals human retinal mitochondria that align with reflective bands in optical coherence tomography [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:5512-5527. [PMID: 37854576 PMCID: PMC10581790 DOI: 10.1364/boe.501228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 10/20/2023]
Abstract
Mitochondria are candidate reflectivity signal sources in optical coherence tomography (OCT) retinal imaging. Here, we use deep-learning-assisted volume electron microscopy of human retina and in vivo imaging to map mitochondria networks in the outer plexiform layer (OPL), where photoreceptors synapse with second-order interneurons. We observed alternating layers of high and low mitochondrial abundance in the anatomical OPL and adjacent inner nuclear layer (INL). Subcellular resolution OCT imaging of human eyes revealed multiple reflective bands that matched the corresponding INL and combined OPL sublayers. Data linking specific mitochondria to defined bands in OCT may help improve clinical diagnosis and the evaluation of mitochondria-targeting therapies.
Collapse
Affiliation(s)
- Deepayan Kar
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yeon Jin Kim
- Department of Biological Structure, University of Washington, Seattle, WA, USA
| | - Orin Packer
- Department of Biological Structure, University of Washington, Seattle, WA, USA
| | - Mark E. Clark
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dongfeng Cao
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dennis M. Dacey
- Department of Biological Structure, University of Washington, Seattle, WA, USA
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
14
|
Hernanz I, Moll-Udina A, Garcia-Tirado A, Garcia-Fernandez M, Gutierrez-Ezquerro R, Garcia-Arumi C, Llorenç V, Cuadros C, Fonollosa A, Sainz-de-la-Maza M, Adán A. The retinal bacillary layer detachment: Clinical features and outcomes in posterior uveitis. J Fr Ophtalmol 2023; 46:916-920. [PMID: 37210295 DOI: 10.1016/j.jfo.2022.12.031] [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: 11/09/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 05/22/2023]
Abstract
PURPOSE To describe the clinical characteristics, presentation and response to treatment in posterior uveitis patients with bacillary layer detachment (BLD) seen on optical coherence tomography (OCT). MATERIALS AND METHODS Retrospective review of patients with posterior uveitis and SD-OCT scans consistent with BLD. Data collected included demographics, uveitic etiology, treatment and duration of follow-up. Outcome measures included macular volume, central subfoveal thickness and visual acuity. RESULTS Sixteen patients (20 eyes) were included. Twelve were female (75%). The mean age was 43.68 ± 14.7 years. The most frequent etiology of the uveitis was Vogt-Koyanagi-Harada (VKH) disease (n=10), followed by sympathetic ophthalmia (n=2). BLD was bilateral in four patients. Eight patients were treated with intravenous methylprednisolone boluses. Immunosuppressive therapies were required in 8 patients. The mean follow-up was 70 months (range: 2.0-216.0). CONCLUSION BLD was observed in a series of posterior uveitis cases of various etiologies, showing functional and structural resolution with treatment in most cases.
Collapse
Affiliation(s)
- I Hernanz
- Department of ophthalmology, Fundación Jiménez Diaz Hospital, Avenue Reyes Católicos 2, 28003 Madrid, Spain.
| | - A Moll-Udina
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Garcia-Tirado
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain
| | | | | | - C Garcia-Arumi
- Departmentofophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Llorenç
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - C Cuadros
- Department of ophthalmology, Oviedo University Hospital, Oviedo, Spain
| | - A Fonollosa
- Department of ophthalmology, Cruces University Hospital, Bilbao, Spain
| | - M Sainz-de-la-Maza
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Adán
- Clínic Hospital of Barcelona, Clínic Institute of Ophthalmology, University of Barcelona, Barcelona, Spain; Biomedical Research Institute August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
15
|
Fasih-Ahmad S, Wang Z, Mishra Z, Vatanatham C, Clark ME, Swain TA, Curcio CA, Owsley C, Sadda SR, Hu ZJ. Potential Structural Biomarkers in 3D Images Validated by the First Functional Biomarker for Early Age-Related Macular Degeneration - ALSTAR2 Baseline. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.10.23295309. [PMID: 37745353 PMCID: PMC10516097 DOI: 10.1101/2023.09.10.23295309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Purpose While intermediate and late age-Related Macular Degeneration (AMD) have been widely investigated, rare studies were focused on the pathophysiologic mechanism of early AMD. Delayed rod-mediated dark adaptation (RMDA) is the first functional biomarker for incident early AMD. The status of outer retinal bands on optical coherence tomography (OCT) may be potential imaging biomarkers and the purpose is to investigate the hypothesis that the integrity of interdigitation zone (IZ) may provide insight into the health of photoreceptors and retinal pigment epithelium (RPE) in early AMD. Methods We establish the structure-function relationship between ellipsoid zone (EZ) integrity and RMDA, and IZ integrity and RMDA in a large-scale OCT dataset from eyes with normal aging (n=237), early AMD (n=138), and intermediate AMD (n=101) by utilizing a novel deep-learning-derived algorithm with manual correction when needed to segment the EZ and IZ on OCT B-scans (57,596 B-scans), and utilizing the AdaptDx device to measure RMDA. Results Our data demonstrates that slower RMDA is associated with less preserved EZ (r = -0.334; p<0.001) and IZ area (r = -0.591; p<0.001), and decreased IZ thickness (r = -0.434; p<0.001). These associations are not apparent when considering normal eyes alone. Conclusions The association with IZ area and RMDA in large-scale data is biologically plausible because retinoid availability and transfer at the interface attributed to IZ is rate-limiting for RMDA. This study supports the hypothesis that the IZ integrity provides insight into the health of photoreceptors and RPE in early AMD and is a potential new imaging biomarker.
Collapse
|
16
|
Benson MD, Mukherjee S, Agather AR, Blain D, Cunningham D, Mays R, Sun X, Li T, Hufnagel RB, Brooks BP, Huryn LA, Zein WM, Cukras CA. RPGR: Deep Phenotyping and Genetic Characterization With Findings Specific to the 3'-end of ORF15. Invest Ophthalmol Vis Sci 2023; 64:19. [PMID: 37695603 PMCID: PMC10501488 DOI: 10.1167/iovs.64.12.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose To describe a group of patients with retinitis pigmentosa GTPase regulator (RPGR)-related retinopathy with a tapetal-like retinal sheen and corresponding changes in the reflectivity of the ellipsoid zone on optical coherence tomography (OCT) imaging. Methods A retrospective case series of 66 patients with a disease-causing variant in RPGR was performed. An expert examiner, masked to patient demographics, clinical evaluations, and specific RPGR variant, analyzed color fundus photographs for the presence of a tapetal-like retinal sheen and assessed OCT images for the presence of an abnormally broad hyper-reflective band in the outer retina. Longitudinal reflectivity profiles were generated and compared with healthy controls. Results Twelve patients (18.2%) had a retinal sheen on color images that cosegregated with an abnormally broad hyper-reflective ellipsoid zone band on OCT imaging. Three-fourths of these patients were male, had a cone-rod dystrophy, and had pathogenic RPGR variants located toward the 3'-end of ORF15. This group had a different longitudinal reflectivity profile signature compared with controls. After a period of prolonged dark adaptation, the abnormal hyper-reflective band on OCT became less apparent, and the outer retinal layers adopted a more normal appearance. Conclusions RPGR-related retinopathy should be considered for males presenting with retinal sheen, abnormal ellipsoid zone hyper-reflectivity, and cone or cone-rod dysfunction on ERG, and pursued with molecular testing. Our results have implications for understanding the role of the C-terminal domain encoded by RPGR ORF15 in the phototransduction cascade. Further, the findings may be important to incorporate into both inclusion criteria and outcome measure developments in future RPGR-related cone or cone-rod dystrophy clinical trials.
Collapse
Affiliation(s)
- Matthew D. Benson
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Souvick Mukherjee
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Aime R. Agather
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Delphine Blain
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Denise Cunningham
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Robert Mays
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Xun Sun
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Tiansen Li
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Robert B. Hufnagel
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Brian P. Brooks
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Laryssa A. Huryn
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Wadih M. Zein
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Catherine A. Cukras
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| |
Collapse
|
17
|
Goerdt L, Weinhold L, Isselmann B, Garcia JLR, Künzel SH, Schmid M, Holz FG, Tzaridis S, Thiele S. Relative Ellipsoid Zone Reflectivity in Macular Telangiectasia Type 2. Invest Ophthalmol Vis Sci 2023; 64:21. [PMID: 37462978 PMCID: PMC10362918 DOI: 10.1167/iovs.64.10.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Purpose The relative ellipsoid zone reflectivity (rEZR) has been proposed as an innovative biomarker for photoreceptor integrity. This study evaluates the rEZR in macular telangiectasia type 2 (MacTel) eyes of different disease stages. Methods The mean rEZR (ratio ellipsoid zone [EZ]/external limiting membrane [ELM] reflectivity [arbitrary units {AUs}], grey level range = 0-1) was analyzed for an entire spectral domain optical coherence tomography volume scan (global) and for each subfield of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid (topographic) in patients with MacTel and controls. MacTel disease severity was classified according to Gass and Blodi. Results Linear mixed-model analysis of 145 eyes of 74 patients and 50 eyes of 25 controls revealed globally lower, yet not statistically significant, rEZR values in MacTel eyes. Topographically, most pronounced decreases were found in stages 3 and 4/5 for the temporal inner (coefficient estimates [CEs] = -25.4 [-38.2; -12.6] and -34.1 [-48.7; -19.6] AU, both: P < 0.001), the inferior inner (-29.9 [-44.6; -15.6] and -35.3 [-52.1; -18.5] AU, both: P < 0.001), the nasal inner (-21.5 [-35.52; -7.4] and -31.6 [-47.6; -15.6] AU, P = 0,003 and P < 0.001), and in the superior inner subfield of stage 4/5 (-25.0 [-42.0; -7.9] AU, P = 0.004). Conclusions The rEZR showed association with disease severity and the predilection area of MacTel. Given the current understanding of the pathophysiological concept of MacTel, these findings underscore the value of the rEZR as a potential novel biomarker for outer retinal integrity. Longitudinal studies are demanded to better characterize its value as a biomarker for early photoreceptor alterations and disease progression in MacTel.
Collapse
Affiliation(s)
- Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Leonie Weinhold
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Ben Isselmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Simone Tzaridis
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- The Lowy Medical Research Institute, La Jolla, California, United States
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, United States
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Department of Ophthalmology, Gloucestershire Hospital NHS Foundation Trust, Cheltenham, United Kingdom
| |
Collapse
|
18
|
Palmieri F, Younis S, Raslan W, Fabozzi L. Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration: Case Series. Biomedicines 2023; 11:biomedicines11030988. [PMID: 36979967 PMCID: PMC10046666 DOI: 10.3390/biomedicines11030988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE This study seeks to report the clinical and multimodal imaging findings of eight eyes of seven patients with neovascular age-related macular degeneration (nAMD) who developed bacillary layer detachment (BALAD). Setting/Venue: The patients were analysed at the Western Eye Hospital in London, UK. METHODS The approaches of this research include clinical examinations and multimodal imaging-based description of cases of nAMD with BALAD. RESULTS We report multimodal imaging findings of bacillary layer detachment (BALAD) in patients with nAMD. CONCLUSIONS A bacillary layer detachment was detected in patients with neovascular age-related macular degeneration. This multimodal imaging finding is not commonly described in the literature for this disease.
Collapse
Affiliation(s)
- Filomena Palmieri
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Saad Younis
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Walid Raslan
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Lorenzo Fabozzi
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Surgery, Cancer and Cardiovascular Division, Ophthalmology Department, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
| |
Collapse
|
19
|
Kalra G, Cetin H, Whitney J, Yordi S, Cakir Y, McConville C, Whitmore V, Bonnay M, Reese JL, Srivastava SK, Ehlers JP. Automated Identification and Segmentation of Ellipsoid Zone At-Risk Using Deep Learning on SD-OCT for Predicting Progression in Dry AMD. Diagnostics (Basel) 2023; 13:diagnostics13061178. [PMID: 36980486 PMCID: PMC10047385 DOI: 10.3390/diagnostics13061178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The development and testing of a deep learning (DL)-based approach for detection and measurement of regions of Ellipsoid Zone (EZ) At-Risk to study progression in nonexudative age-related macular degeneration (AMD). METHODS Used in DL model training and testing were 341 subjects with nonexudative AMD with or without geographic atrophy (GA). An independent dataset of 120 subjects were used for testing model performance for prediction of GA progression. Accuracy, specificity, sensitivity, and intraclass correlation coefficient (ICC) for DL-based EZ At-Risk percentage area measurement was calculated. Random forest-based feature ranking of EZ At-Risk was compared to previously validated quantitative OCT-based biomarkers. RESULTS The model achieved a detection accuracy of 99% (sensitivity = 99%; specificity = 100%) for EZ At-Risk. Automatic EZ At-Risk measurement achieved an accuracy of 90% (sensitivity = 90%; specificity = 84%) and the ICC compared to ground truth was high (0.83). In the independent dataset, higher baseline mean EZ At-Risk correlated with higher progression to GA at year 5 (p < 0.001). EZ At-Risk was a top ranked feature in the random forest assessment for GA prediction. CONCLUSIONS This report describes a novel high performance DL-based model for the detection and measurement of EZ At-Risk. This biomarker showed promising results in predicting progression in nonexudative AMD patients.
Collapse
Affiliation(s)
- Gagan Kalra
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Hasan Cetin
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jon Whitney
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sari Yordi
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Yavuz Cakir
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Conor McConville
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Victoria Whitmore
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Michelle Bonnay
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jamie L Reese
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sunil K Srivastava
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Justis P Ehlers
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
20
|
Berkowitz BA, Podolsky RH, Childers KL, Roberts R, Waseem R. Multiple Bioenergy-Linked OCT Biomarkers Suggest Greater-Than-Normal Rod Mitochondria Activity Early in Experimental Alzheimer's Disease. Invest Ophthalmol Vis Sci 2023; 64:12. [PMID: 36867132 PMCID: PMC9988708 DOI: 10.1167/iovs.64.3.12] [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] [Indexed: 03/04/2023] Open
Abstract
Purpose In Alzheimer's disease, central brain neurons show evidence for early hyperactivity. It is unclear if this occurs in the retina, another disease target. Here, we tested for imaging biomarker manifestation of prodromal hyperactivity in rod mitochondria in vivo in experimental Alzheimer's disease. Methods Light- and dark-adapted 4-month-old 5xFAD and wild-type (WT) mice, both on a C57BL/6J background, were studied with optical coherence tomography (OCT). We measured the reflectivity profile shape of the inner segment ellipsoid zone (EZ) as a proxy for mitochondria distribution. Two additional indices responsive to mitochondria activity were also measured: the thickness of the external limiting membrane-retinal pigment epithelium (ELM-RPE) region and the signal magnitude of a hyporeflective band (HB) between photoreceptor tips and apical RPE. Retinal laminar thickness and visual performance were evaluated. Results In response to low energy demand (light), WT mice showed the expected elongation in EZ reflectivity profile shape, relatively thicker ELM-RPE, and greater HB signal. Under high energy demand (dark), the EZ reflectivity profile shape was rounder, the ELM-RPE was thinner, and the HB was reduced. These OCT biomarker patterns for light-adapted 5xFAD mice did not match those of light-adapted WT mice but rather that of dark-adapted WT mice. Dark-adapted 5xFAD and WT mice showed the same biomarker pattern. The 5xFAD mice exhibited modest nuclear layer thinning and lower-than-normal contrast sensitivity. Conclusions Results from three OCT bioenergy biomarkers raise the novel possibility of early rod hyperactivity in vivo in a common Alzheimer's disease model.
Collapse
Affiliation(s)
- Bruce A Berkowitz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Robert H Podolsky
- Biostatistics and Study Methodology, Children's National Hospital, Silver Spring, Maryland, United States
| | - Karen L Childers
- Beaumont Research Institute, Beaumont Health, Royal Oak, Michigan, United States
| | - Robin Roberts
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Rida Waseem
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| |
Collapse
|
21
|
Wu Z, Goh KL, Hodgson LAB, Guymer RH. Incomplete Retinal Pigment Epithelial and Outer Retinal Atrophy: Longitudinal Evaluation in Age-Related Macular Degeneration. Ophthalmology 2023; 130:205-212. [PMID: 36103931 DOI: 10.1016/j.ophtha.2022.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To examine the association between incomplete retinal pigment epithelial and outer retinal atrophy (iRORA) on OCT imaging and the subsequent risk of developing geographic atrophy (GA) defined on conventional color fundus photography (CFP) and to compare this with the specific features that define nascent GA (nGA). DESIGN Retrospective analysis of data from a longitudinal study. PARTICIPANTS A total of 280 eyes from 140 participants with bilateral large drusen without specific nGA-defining features or late age-related macular degeneration (AMD) at baseline. METHODS OCT imaging and CFP were performed at baseline and then at 6-month intervals for up to 36 months. Eyes that developed neovascular AMD were censored on the day it was detected. OCT volume scans were graded for the presence of iRORA and nGA separately, and CFP images were graded for the presence of GA. MAIN OUTCOME MEASURES Association with and variance explained in time to GA development. RESULTS A total of 58 eyes (21%) from 46 participants (33%) had iRORA at baseline, and a further 87 eyes (31%) developed iRORA over the follow-up period. Time-to-event analyses demonstrated that prevalent or incident iRORA was associated with an increased rate of GA development (adjusted hazard ratio [HR], 12.1; P = 0.021), as was incident nGA (adjusted HR, 78.6; P < 0.001). However, only the specific nGA features (adjusted P < 0.001), and not iRORA (adjusted P = 0.520), were associated with an increased rate of GA development when both features were included in the same multivariable model. The proportion of variance explained in the time to GA development by iRORA itself (R2 = 43%) was significantly lower than explained by nGA alone (R2 = 91%; P = 0.010). CONCLUSIONS In this cohort, iRORA is a significant risk factor for GA development, but its association with GA development appears to be accounted for by the development of the specific features that define nGA. Although requiring replication, these findings provide useful guidance on the relative utility of nGA and iRORA as risk factors for GA and as potential surrogate end points for future interventional studies in the early stages of AMD.
Collapse
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.
| | - Kai Lyn Goh
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Lauren A B Hodgson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, 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
| |
Collapse
|
22
|
Roshandel D, Lamey TM, Charng J, Heath Jeffery RC, McLaren TL, Thompson JA, De Roach JN, McLenachan S, Mackey DA, Chen FK. Microperimetry and Adaptive Optics Imaging Reveal Localized Functional and Structural Changes in Asymptomatic RPGR Mutation Carriers. Invest Ophthalmol Vis Sci 2023; 64:3. [PMID: 36607619 PMCID: PMC9836009 DOI: 10.1167/iovs.64.1.3] [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] [Indexed: 01/07/2023] Open
Abstract
Purpose Female carriers of RPGR mutations demonstrate no significant retinal dysfunction or structural change despite a characteristic tapetal-like reflex. In this study, we examined localized changes of pointwise sensitivity (PWS) and cone density (CD) using microperimetry (MP) and adaptive optics (AO) imaging in female carriers of RPGR mutations. Methods In this cross-sectional case-control study, MP (MAIA, 10-2 test grid) and AO imaging (rtx1) were performed in female carriers of RPGR mutations and unrelated age-matched healthy controls. PWS at 68 loci located 1 degree to 9 degrees away from the preferred retinal locus and CD at 12 loci located 1 degree to 3 degrees away from the foveal center were measured. Severity of defect was defined by standard deviation (SD) from age-matched healthy control means: normal (<1 SD from normal average), moderate defect (1-2 SD from normal average), and severe defect (>2 SD from normal average). Results Twelve patients from seven unrelated families were enrolled. Seven patients were asymptomatic, 5 of whom had visual acuity 20/20 or better in both eyes. PWS and CD were available in 12 and 8 patients, respectively. Severe PWS and CD defect in at least 1 test location was observed in 10 of 12 patients and 7 of 8 patients, respectively. Among the five asymptomatic patients who had normal visual acuity, severe PWS and CD defects were observed in three of five and four of five patients, respectively. Conclusions MP and AO imaging revealed early functional and structural changes in asymptomatic RPGR mutation carriers and should be considered in clinical assessment of these patients.
Collapse
Affiliation(s)
- Danial Roshandel
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Tina M. Lamey
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jason Charng
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Department of Optometry, School of Allied Health, University of Western Australia, Western Australia, Australia
| | - Rachael C. Heath Jeffery
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Terri L. McLaren
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jennifer A. Thompson
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - John N. De Roach
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Samuel McLenachan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - David A. Mackey
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Fred K. Chen
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia,Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia,Department of Optometry, School of Allied Health, University of Western Australia, Western Australia, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
23
|
Martins Melo I, Bansal A, Naidu S, Oquendo PL, Hamli H, Lee WW, Muni RH. Morphologic Stages of Rhegmatogenous Retinal Detachment Assessed Using Swept-Source OCT. Ophthalmol Retina 2022; 7:398-405. [PMID: 36464211 DOI: 10.1016/j.oret.2022.11.013] [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: 09/06/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To describe the sequential morphologic changes after rhegmatogenous retinal detachment (RRD) utilizing a novel, objective, and clinically relevant staging system based on swept-source OCT (SS-OCT) and determine its association with the duration of fovea-off and postoperative visual acuity (VA). DESIGN Prospective cohort study. SUBJECTS Consecutive patients with primary fovea-involving RRD referred to St. Michael's Hospital, Toronto, Canada, from January 2020 to April 2022. METHODS All patients underwent SS-OCT and ultrawide-field SS-OCT at baseline. Primary RRDs with breaks above the 8- and 4-o'clock meridians were included. Patients with vision loss for ≥ 3 months, proliferative vitreoretinopathy grade C or worse, a demarcation line, previous vitrectomy, or other retinal pathology were excluded. The staging was based on an assessment of outer retinal morphology on successive SS-OCT scans from the peripheral break to the most posterior aspect of the RRD, following its direction of progression. MAIN OUTCOME MEASURES Sequential outer retinal morphologic changes observed using SS-OCT and associated VA at 3 months after surgery. RESULTS Forty-nine eyes were included. The mean age (standard deviation [SD]) was 61.2 (15.2) years. The mean presenting logarithm of the minimum angle of resolution (SD) acuity was 1.09 (0.75). All stages observed on a high-definition horizontal 51-line scan were reported. Outer retinal changes occurred in 5 stages: (1) separation of the neurosensory retina from the retinal pigment epithelium (42/49, 85.7%); (2) thickening of inner and outer segments of photoreceptors (45/49, 91.8%); (3) outer retinal corrugation formation: (3a) low-frequency (44/49, 93.6%) and (3b) high-frequency outer retinal corrugations (42/49, 85.7%); (4) loss of the definition of outer retinal corrugations, with concurrent thickening of inner and outer segments (26/49, 53.1%); and (5) patchy (moth-eaten) or complete loss of inner and outer segments (17/49, 34.7%). The mean duration of fovea-off by stage in the parafovea (SD) was 2 (1.4), 2.3 (1.2), 11.4 (8.1), and 12 (13.3) days for stages 3a, 3b, 4, and 5, respectively. There was a statistically significant association between increasing stage of RRD and longer duration of foveal involvement (P = 0.001) and, most importantly, between increasing stage and worse VA at 3 months after surgery (P = 0.011). CONCLUSIONS This novel staging system describes the sequential morphologic changes in RRD using SS-OCT. Increasing stage of RRD was associated with worse VA at 3 months after surgery. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Isabela Martins Melo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Aditya Bansal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sumana Naidu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paola L Oquendo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Hesham Hamli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Wei Wei Lee
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Institute, Toronto, Ontario, Canada.
| |
Collapse
|
24
|
Natural History of the Relative Ellipsoid Zone Reflectivity in Age-Related Macular Degeneration. Ophthalmol Retina 2022; 6:1165-1172. [PMID: 35709960 DOI: 10.1016/j.oret.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/08/2022] [Accepted: 06/06/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Relative ellipsoid zone reflectivity (rEZR) has been reported to be reduced in intermediate age-related macular degeneration (iAMD). However, longitudinal changes in rEZR remain unknown. This study investigated the natural history of rEZR in iAMD and its association with risk factors for disease progression, including the presence or extent of drusen volume, reticular pseudodrusen (RPD), and pigmentary abnormalities (PAs). DESIGN Longitudinal observational study. PARTICIPANTS Subjects with bilateral large drusen. METHODS Spectral-domain (SD) OCT images of both eyes from each participant were obtained every 6 months for 3 years. Using an automated rEZR determination approach, the average rEZR of the central 20° macula was determined for each SD-OCT volume scan. Linear mixed models were used to determine the rate of change in rEZR with age (using the cross-sectional data at baseline) and over time (longitudinal data) and the interactions between the rate of rEZR changes with AMD risk factors at baseline. MAIN OUTCOME MEASURES Relative ellipsoid zone reflectivity and its rate of change with age and over time. RESULTS A total of 280 eyes from 140 individuals with bilateral large drusen were included in this study. Cross-sectional data showed that rEZR reduced with increasing age (-8.4 arbitrary units [AUs] per decade; 95% confidence interval [CI], -11.5 to -5.2; P < 0.001). Longitudinal data showed that, on average, rEZR declined at a rate of -2.1 AU per year (95% CI, -2.6 to -1.6 AU per year; P < 0.001). Larger RPD area (P = 0.042) at baseline was associated with a faster rate of rEZR decline over time, whereas the presence of PAs and the drusen volume at baseline showed no significant association with rEZR decline over time (P = 0.068 and P = 0.529, respectively). CONCLUSIONS The rEZR significantly reduces over 3 years in subjects with iAMD, and both the presence and increasing extent of coexistent RPD at baseline are associated with a faster rate of decline. These findings warrant further studies to understand the value of rEZR as a biomarker of AMD progression.
Collapse
|
25
|
Berkowitz BA, Podolsky RH, Childers KL, Roberts R, Katz R, Waseem R, Robbings BM, Hass DT, Hurley JB, Sweet IR, Goodman C, Qian H, Alvisio B, Heaps S. Transducin-Deficient Rod Photoreceptors Evaluated With Optical Coherence Tomography and Oxygen Consumption Rate Energy Biomarkers. Invest Ophthalmol Vis Sci 2022; 63:22. [PMID: 36576748 PMCID: PMC9804021 DOI: 10.1167/iovs.63.13.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose To test the hypothesis that rod energy biomarkers in light and dark are similar in mice without functional rod transducin (Gnat1rd17). Methods Gnat1rd17 and wildtype (WT) mice were studied in canonically low energy demand (light) and high energy demand (dark) conditions. We measured rod inner segment ellipsoid zone (ISez) profile shape, external limiting membrane-retinal pigment epithelium (ELM-RPE) thickness, and magnitude of a hyporeflective band (HB) intensity dip located between photoreceptor tips and apical RPE; antioxidants were given in a subset of mice. Oxygen consumption rate (OCR) and visual performance indexes were also measured. Results The lower energy demand expected in light-adapted wildtype retinas was associated with an elongated ISez, thicker ELM-RPE, and higher HB magnitude, and lower OCR compared to high energy demand conditions in the dark. Gnat1rd17 mice showed a wildtype-like ISez profile shape at 20 minutes of light that became rounder at 60 minutes; at both times, ELM-RPE was smaller than wildtype values, and the HB magnitude was unmeasurable. OCR was higher than in the dark. Light-adapted Gnat1rd17 mice biomarkers were unaffected by anti-oxidants. Gnat1rd17 mice showed modest outer nuclear layer thinning and no reduction in visual performance indexes. Conclusions Light-stimulated changes in all biomarkers in WT mice are consistent with the established light-induced decrease in net energy demand. In contrast, biomarker changes in Gnat1rd17 mice raise the possibility that light increases net energy demand in the absence of rod phototransduction.
Collapse
Affiliation(s)
- Bruce A Berkowitz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Robert H Podolsky
- Biostatistics and Study Methodology, Children's National Hospital, Silver Spring, Maryland, United States
| | - Karen Lins Childers
- Beaumont Research Institute, Beaumont Health, Royal Oak, Michigan, United States
| | - Robin Roberts
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Ryan Katz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Rida Waseem
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Brian M Robbings
- Department of Biochemistry, Department of Ophthalmology, University of Washington, Seattle, Washington, United States.,Department of Medicine, UW Medicine Diabetes Institute, University of Washington, Seattle, Washington, United States
| | - Daniel T Hass
- Department of Biochemistry, Department of Ophthalmology, University of Washington, Seattle, Washington, United States
| | - James B Hurley
- Department of Biochemistry, Department of Ophthalmology, University of Washington, Seattle, Washington, United States
| | - Ian R Sweet
- Department of Medicine, UW Medicine Diabetes Institute, University of Washington, Seattle, Washington, United States
| | - Cole Goodman
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Haohua Qian
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Bruno Alvisio
- OSIO Bioinformatics Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Sam Heaps
- OSIO Bioinformatics Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| |
Collapse
|
26
|
Mainster MA, Desmettre T, Querques G, Turner PL, Ledesma-Gil G. Scanning laser ophthalmoscopy retroillumination: applications and illusions. Int J Retina Vitreous 2022; 8:71. [PMID: 36180893 PMCID: PMC9524008 DOI: 10.1186/s40942-022-00421-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022] Open
Abstract
Scanning laser ophthalmoscopes (SLOs) are used widely for reflectance, fluorescence or autofluorescence photography and less commonly for retroillumination imaging. SLOs scan a visible light or near-infrared radiation laser beam across the retina, collecting light from each retinal spot as it’s illuminated. An SLO’s clinical applications, image contrast and axial resolution are largely determined by an aperture overlying its photodetector. High contrast, reflectance images are produced using small diameter, centered apertures (confocal apertures) that collect retroreflections and reject side-scattered veiling light returned from the fundus. Retroillumination images are acquired with annular on-axis or laterally-displaced off-axis apertures that capture scattered light and reject the retroreflected light used for reflectance imaging. SLO axial resolution is roughly 300 μm, comparable to macular thickness, so SLOs cannot provide the depth-resolved chorioretinal information obtainable with optical coherence tomography’s (OCT’s) 3 μm axial resolution. Retroillumination highlights and shades the boundaries of chorioretinal tissues and abnormalities, facilitating detection of small drusen, subretinal drusenoid deposits and subthreshold laser lesions. It also facilitates screening for large-area chorioretinal irregularities not readily identified with other en face retinal imaging modalities. Shaded boundaries create the perception of lesion elevation or depression, a characteristic of retroillumination but not reflectance SLO images. These illusions are not reliable representations of three-dimensional chorioretinal anatomy and they differ from objective OCT en face topography. SLO retroillumination has been a useful but not indispensable retinal imaging modality for over 30 years. Continuing investigation is needed to determine its most appropriate clinical roles in multimodal retinal imaging.
Collapse
Affiliation(s)
- Martin A Mainster
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, KS, USA
| | | | - Giuseppe Querques
- Ophthalmology Department, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patricia L Turner
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, KS, USA
| | - Gerardo Ledesma-Gil
- Retina Department, Institute of Ophthalmology, Fundacion Conde de Valenciana, Chimalpopoca 14, Colonia Obrera, Cuauhtemoc, 06800, Mexico City, Mexico.
| |
Collapse
|
27
|
Saßmannshausen M, Behning C, Isselmann B, Schmid M, Finger RP, Holz FG, Schmitz-Valckenberg S, Pfau M, Thiele S. Relative ellipsoid zone reflectivity and its association with disease severity in age-related macular degeneration: a MACUSTAR study report. Sci Rep 2022; 12:14933. [PMID: 36056113 PMCID: PMC9440143 DOI: 10.1038/s41598-022-18875-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/22/2022] [Indexed: 12/03/2022] Open
Abstract
Quantification of the relative ellipsoid zone reflectivity (rEZR) might be a structural surrogate parameter for an early disease progression in the context of age-related macular degeneration (AMD). Within the European multicenter, cross-sectional MACUSTAR study, we have devised an automatic approach to determine the mean rEZR [arbitrary units, AU] at two independent visits in SD-OCT volume scans in study participants. Linear mixed-effects models were applied to analyze the association of AMD stage and AMD associated high-risk features including presence of pigmentary abnormalities, reticular pseudodrusen (RPD), volume of the retinal-pigment-epithelial-drusenoid-complex (RPEDC) with the rEZR. Intra-class correlation coefficients (ICC) were determined for rEZR reliability analysis. Within the overall study cohort (301 participants), we could observe decreased rEZR values (coefficient estimate ± standard error) of - 8.05 ± 2.44 AU (p = 0.0011) in the intermediate and of - 22.35 ± 3.28 AU (p < 0.0001) in the late AMD group. RPD presence was significantly associated with the rEZR in iAMD eyes (- 6.49 ± 3.14 AU; p = 0.0403), while there was a good ICC of 0.846 (95% confidence interval: 0.809; 0.876) in the overall study cohort. This study showed an association of rEZR with increasing disease severity and the presence of iAMD high-risk features. Further studies are necessary to evaluate the rEZR's value as a novel biomarker for AMD and disease progression.
Collapse
Affiliation(s)
- Marlene Saßmannshausen
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Ben Isselmann
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- GRADE Reading Center, University of Bonn, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- GRADE Reading Center, University of Bonn, Bonn, Germany
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- GRADE Reading Center, University of Bonn, Bonn, Germany
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Bethesda, MD, USA
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- GRADE Reading Center, University of Bonn, Bonn, Germany.
| |
Collapse
|
28
|
Srinivasan VJ, Kho AM, Chauhan P. Visible Light Optical Coherence Tomography Reveals the Relationship of the Myoid and Ellipsoid to Band 2 in Humans. Transl Vis Sci Technol 2022; 11:3. [PMID: 36053140 PMCID: PMC9440607 DOI: 10.1167/tvst.11.9.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose We employ visible light optical coherence tomography (OCT) to investigate the relationship between the myoid, ellipsoid, and band 2 in the living human retina. Rather than refute existing theories, we aim to reveal new bands and better delineate the structures at hand. Methods An upgraded spectral/Fourier domain visible light OCT prototype, with 1.0-µm axial resolution, imaged 13 eyes of 13 young adult human subjects (23–40 years old) without a history of ocular pathology. The external limiting membrane (band 1) and band 2 edges were segmented. Reflectivity was examined along the inner segment (IS), defined as extending from band 1 to the band 2 center, and within band 2 itself. Results Images highlight a nearly continuously resolved extrafoveal internal limiting membrane, the peripheral single-cell thick ganglion cell layer, and the peripheral photoreceptor axonal fiber layer, a peripheral division of band 2 into bands 2a and 2b, and a reflectivity-based division of the IS into “m” and “e” zones. Discussion Topography and transverse intensity variations of the outermost band 2b suggest an association with rods. The “m” and “e” zone border is consistent with the myoid–ellipsoid boundary, even recapitulating the well-documented distribution of mitochondria throughout the IS at the foveal center. Theories of outer retinal reflectivity in OCT must adequately explain these observations. Translational Relevance Findings support that band 2 does partially overlap with the ellipsoid in transversally averaged OCT images due to photoreceptor IS length dispersion but argue that the inner ellipsoid must be inner to band 2, as suggested by prior quantitative measurements.
Collapse
Affiliation(s)
- Vivek J Srinivasan
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA.,Department of Radiology, NYU Langone Health, New York, NY, USA.,Tech4Health Institute, NYU Langone Health, New York, NY, USA.,Department of Biomedical Engineering, University of California, Davis, CA, USA
| | - Aaron M Kho
- Department of Biomedical Engineering, University of California, Davis, CA, USA
| | - Pooja Chauhan
- Department of Radiology, NYU Langone Health, New York, NY, USA.,Tech4Health Institute, NYU Langone Health, New York, NY, USA
| |
Collapse
|
29
|
Fehér J, Élő Á, István L, Nagy ZZ, Radák Z, Scuderi G, Artico M, Kovács I. Microbiota mitochondria disorders as hubs for early age-related macular degeneration. GeroScience 2022; 44:2623-2653. [PMID: 35978068 PMCID: PMC9385247 DOI: 10.1007/s11357-022-00620-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/01/2022] [Indexed: 01/07/2023] Open
Abstract
Age-related macular degeneration (AMD) is a progressive neurodegenerative disease affecting the central area (macula lutea) of the retina. Research on the pathogenic mechanism of AMD showed complex cellular contribution governed by such risk factors as aging, genetic predisposition, diet, and lifestyle. Recent studies suggested that microbiota is a transducer and a modifier of risk factors for neurodegenerative diseases, and mitochondria may be one of the intracellular targets of microbial signaling molecules. This review explores studies supporting a new concept on the contribution of microbiota-mitochondria disorders to AMD. We discuss metabolic, vascular, immune, and neuronal mechanism in AMD as well as key alterations of photoreceptor cells, retinal pigment epithelium (RPE), Bruch's membrane, choriocapillaris endothelial, immune, and neuronal cells. Special attention was paid to alterations of mitochondria contact sites (MCSs), an organelle network of mitochondria, endoplasmic reticulum, lipid droplets (LDs), and peroxisomes being documented based on our own electron microscopic findings from surgically removed human eyes. Morphometry of Bruch's membrane lipids and proteoglycans has also been performed in early AMD and aged controls. Microbial metabolites (short-chain fatty acids, polyphenols, and secondary bile acids) and microbial compounds (lipopolysaccharide, peptidoglycan, and bacterial DNA)-now called postbiotics-in addition to local effects on resident microbiota and mucous membrane, regulate systemic metabolic, vascular, immune, and neuronal mechanisms in normal conditions and in various common diseases. We also discuss their antioxidant, anti-inflammatory, and metabolic effects as well as experimental and clinical observations on regulating the main processes of photoreceptor renewal, mitophagy, and autophagy in early AMD. These findings support an emerging concept that microbiota-mitochondria disorders may be a crucial pathogenic mechanism of early AMD; and similarly, to other age-related neurodegenerative diseases, new treatment approaches should be targeted at these disorders.
Collapse
Affiliation(s)
- János Fehér
- PRIMAVERA Program, Nutripharma Hungaria Ltd., Budapest, Hungary
| | - Ágnes Élő
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lilla István
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zsolt Radák
- grid.472475.70000 0000 9243 1481Research Institute of Sport Science, University of Physical Education, Budapest, Hungary
| | - Gianluca Scuderi
- grid.7841.aOphthalmology Unit, NESMOS Department, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Artico
- grid.417007.5Department of Sensory Organs, “Sapienza” University of Rome, Roma, Italy
| | - Illés Kovács
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary ,grid.5386.8000000041936877XDepartment of Ophthalmology, Weill Cornell Medical College, New York City, NY USA
| |
Collapse
|
30
|
Chauhan P, Kho AM, FitzGerald P, Shibata B, Srinivasan VJ. Subcellular Comparison of Visible-Light Optical Coherence Tomography and Electron Microscopy in the Mouse Outer Retina. Invest Ophthalmol Vis Sci 2022; 63:10. [PMID: 35943734 PMCID: PMC9379865 DOI: 10.1167/iovs.63.9.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose We employed in vivo, 1.0-µm axial resolution visible-light optical coherence tomography (OCT) and ex vivo electron microscopy (EM) to investigate three subcellular features in the mouse outer retina: reflectivity oscillations inner to band 1 (study 1); hyperreflective band 2, attributed to the ellipsoid zone or inner segment/outer segment (IS/OS) junction (study 2); and the hyperreflective retinal pigment epithelium (RPE) within band 4 (study 3). Methods Pigmented (C57BL/6J, n = 10) and albino (BALB/cJ, n = 3) mice were imaged in vivo. Enucleated eyes were processed for light and electron microscopy. Using well-accepted reference surfaces, we compared micrometer-scale axial reflectivity of visible-light OCT with subcellular organization, as revealed by 9449 annotated EM organelles and features across four pigmented eyes. Results In study 1, outer nuclear layer reflectivity peaks coincided with valleys in heterochromatin clump density (-0.34 ± 2.27 µm limits of agreement [LoA]). In study 2, band 2 depth on OCT and IS/OS junction depth on EM agreed (-0.57 ± 0.76 µm LoA), with both having similar distributions. In study 3, RPE electron dense organelle distribution did not agree with reflectivity in C57BL/6J mice, with OCT measures of RPE thickness exceeding those of EM (2.09 ± 0.89 µm LoA). Finally, RPE thickness increased with age in pigmented mice (slope = 0.056 µm/mo; P = 6.8 × 10-7). Conclusions Visible-light OCT bands arise from subcellular organization, enabling new measurements in mice. Quantitative OCT-EM comparisons may be confounded by hydration level, particularly in the OS and RPE. Caution is warranted in generalizing results to other species.
Collapse
Affiliation(s)
- Pooja Chauhan
- Department of Radiology, NYU Langone Health, New York, New York, United States
| | - Aaron M. Kho
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States
| | - Paul FitzGerald
- Department of Cell Biology and Human Anatomy, University of California Davis, Davis, California, United States
| | - Bradley Shibata
- Biological Electron Microscopy Facility, University of California Davis, Davis, California, United States
| | - Vivek J. Srinivasan
- Department of Radiology, NYU Langone Health, New York, New York, United States
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
| |
Collapse
|
31
|
Avrutsky MI, Lawson JM, Smart JE, Chen CW, Troy CM. Noninvasive Ophthalmic Imaging Measures Retinal Degeneration and Vision Deficits in Ndufs4-/- Mouse Model of Mitochondrial Complex I Deficiency. Transl Vis Sci Technol 2022; 11:5. [PMID: 35921115 PMCID: PMC9360534 DOI: 10.1167/tvst.11.8.5] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To characterize postnatal ocular pathology in a Ndufs4−/− mouse model of complex I deficiency using noninvasive retinal imaging and visual testing. Methods Ndufs4−/− mice and wild-type (WT) littermates were analyzed at 3, 5, and 7 weeks postnatal. Retinal morphology was visualized by optical coherence tomography (OCT). OCT images were analyzed for changes in retinal thickness and reflectivity profiles. Visual function was assessed by electroretinogram (ERG) and optomotor reflex (OMR). Results Ndufs4−/− animals have normal OCT morphology at weaning and develop inner plexiform layer atrophy over weeks 5 to 7. Outer retinal layers show hyporeflectivity of the external limiting membrane (ELM) and photoreceptor ellipsoid zone (EZ). Retinal function is impaired at 3 weeks, with profound deficits in b-wave, a-wave, and oscillatory potential amplitudes. The b-wave and oscillatory potential implicit times are delayed, but the a-wave implicit time is unaffected. Ndufs4−/− animals have normal OMR at 3 weeks and present with increasing acuity and contrast OMR deficits at 5 and 7 weeks. Physiological thinning of inner retinal layers, attenuation of ELM reflectivity, and attenuation of ERG b- and a-wave amplitudes occur in WT C57BL/6 littermates between weeks 3 and 7. Conclusions Noninvasive ocular imaging captures early-onset retinal degeneration in Ndufs4−/− mice and is a tractable approach for investigating retinal pathology subsequent to complex I deficiency. Translational Relevance Ophthalmic imaging captures clinically relevant measures of retinal disease in a fast-progressing mouse model of complex I deficiency consistent with human Leigh syndrome.
Collapse
Affiliation(s)
- Maria I Avrutsky
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jacqueline M Lawson
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jade E Smart
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Claire W Chen
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Carol M Troy
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,The Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
32
|
Moos WH, Faller DV, Glavas IP, Harpp DN, Kamperi N, Kanara I, Kodukula K, Mavrakis AN, Pernokas J, Pernokas M, Pinkert CA, Powers WR, Sampani K, Steliou K, Tamvakopoulos C, Vavvas DG, Zamboni RJ, Chen X. Treatment and prevention of pathological mitochondrial dysfunction in retinal degeneration and in photoreceptor injury. Biochem Pharmacol 2022; 203:115168. [PMID: 35835206 DOI: 10.1016/j.bcp.2022.115168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
Pathological deterioration of mitochondrial function is increasingly linked with multiple degenerative illnesses as a mediator of a wide range of neurologic and age-related chronic diseases, including those of genetic origin. Several of these diseases are rare, typically defined in the United States as an illness affecting fewer than 200,000 people in the U.S. population, or about one in 1600 individuals. Vision impairment due to mitochondrial dysfunction in the eye is a prominent feature evident in numerous primary mitochondrial diseases and is common to the pathophysiology of many of the familiar ophthalmic disorders, including age-related macular degeneration, diabetic retinopathy, glaucoma and retinopathy of prematurity - a collection of syndromes, diseases and disorders with significant unmet medical needs. Focusing on metabolic mitochondrial pathway mechanisms, including the possible roles of cuproptosis and ferroptosis in retinal mitochondrial dysfunction, we shed light on the potential of α-lipoyl-L-carnitine in treating eye diseases. α-Lipoyl-L-carnitine is a bioavailable mitochondria-targeting lipoic acid prodrug that has shown potential in protecting against retinal degeneration and photoreceptor cell loss in ophthalmic indications.
Collapse
Affiliation(s)
- Walter H Moos
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA.
| | - Douglas V Faller
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Cancer Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Ioannis P Glavas
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - David N Harpp
- Department of Chemistry, McGill University, Montreal, QC, Canada
| | - Natalia Kamperi
- Center for Clinical, Experimental Surgery and Translational Research Pharmacology-Pharmacotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | | | | | - Anastasios N Mavrakis
- Department of Medicine, Tufts University School of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA
| | - Julie Pernokas
- Advanced Dental Associates of New England, Woburn, MA, USA
| | - Mark Pernokas
- Advanced Dental Associates of New England, Woburn, MA, USA
| | - Carl A Pinkert
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Whitney R Powers
- Department of Health Sciences, Boston University, Boston, MA, USA; Department of Anatomy, Boston University School of Medicine, Boston, MA, USA
| | - Konstantina Sampani
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Kosta Steliou
- Cancer Research Center, Boston University School of Medicine, Boston, MA, USA; PhenoMatriX, Inc., Natick, MA, USA
| | - Constantin Tamvakopoulos
- Center for Clinical, Experimental Surgery and Translational Research Pharmacology-Pharmacotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Demetrios G Vavvas
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Robert J Zamboni
- Department of Chemistry, McGill University, Montreal, QC, Canada
| | - Xiaohong Chen
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Retina Service, Angiogenesis Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China.
| |
Collapse
|
33
|
Berkowitz BA, Podolsky RH, Childers KL, Burgoyne T, De Rossi G, Qian H, Roberts R, Katz R, Waseem R, Goodman C. Functional Changes Within the Rod Inner Segment Ellipsoid in Wildtype Mice: An Optical Coherence Tomography and Electron Microscopy Study. Invest Ophthalmol Vis Sci 2022; 63:8. [PMID: 35816042 PMCID: PMC9284466 DOI: 10.1167/iovs.63.8.8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To test the hypothesis that changing energy needs alter mitochondria distribution within the rod inner segment ellipsoid. Methods In mice with relatively smaller (C57BL/6J [B6J]) or greater (129S6/ev [S6]) retina mitochondria maximum reserve capacity, the profile shape of the rod inner segment ellipsoid zone (ISez) was measured with optical coherence tomography (OCT) under higher (dark) or lower (light) energy demand conditions. ISez profile shape was characterized using an unbiased ellipse descriptor (minor/major aspect ratio). Other bioenergy indexes evaluated include the external limiting membrane-retinal pigment epithelium (ELM-RPE) thickness and the magnitude of the signal intensity of a hyporeflective band located between the photoreceptor tips and apical RPE. The spatial distribution of rod ellipsoid mitochondria were also examined with electron microscopy. Results In B6J mice, darkness produced a greater ISez aspect ratio, thinner ELM-RPE, and a smaller hyporeflective band intensity than in light. In S6 mice, dark and light ISez aspect ratio values were not different and were greater than in light-adapted B6J mice; dark-adapted S6 mice showed smaller ELM-RPE thinning versus light, and negligible hyporeflective band intensity in the light. In B6J mice, mitochondria number in light increased in the distal inner segment ellipsoid and decreased proximally. In S6 mice, mitochondria number in the inner segment ellipsoid were not different between light and dark, and were greater than in B6J mice. Conclusions These data raise the possibility that rod mitochondria activity in mice can be noninvasively evaluated based on the ISez profile shape, a new OCT index that complements OCT energy biomarkers measured outside of the ISez region.
Collapse
Affiliation(s)
- Bruce A Berkowitz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Robert H Podolsky
- Biostatistics and Study Methodology, Children's National Hospital, Silver Spring, Maryland, United States
| | - Karen Lins Childers
- Beaumont Research Institute, Beaumont Health, Royal Oak, Michigan, Unites States
| | - Tom Burgoyne
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Giulia De Rossi
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Haohua Qian
- Visual Function Core, National Eye Institute, National Institutes of Health, Bethesda, Maryland, Unites States
| | - Robin Roberts
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Ryan Katz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Rida Waseem
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Cole Goodman
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| |
Collapse
|
34
|
Kim TH, Ma G, Son T, Yao X. Functional Optical Coherence Tomography for Intrinsic Signal Optoretinography: Recent Developments and Deployment Challenges. Front Med (Lausanne) 2022; 9:864824. [PMID: 35445037 PMCID: PMC9013890 DOI: 10.3389/fmed.2022.864824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Intrinsic optical signal (IOS) imaging of the retina, also termed as optoretinogram or optoretinography (ORG), promises a non-invasive method for the objective assessment of retinal function. By providing the unparalleled capability to differentiate individual retinal layers, functional optical coherence tomography (OCT) has been actively investigated for intrinsic signal ORG measurements. However, clinical deployment of functional OCT for quantitative ORG is still challenging due to the lack of a standardized imaging protocol and the complication of IOS sources and mechanisms. This article aims to summarize recent developments of functional OCT for ORG measurement, OCT intensity- and phase-based IOS processing. Technical challenges and perspectives of quantitative IOS analysis and ORG interpretations are discussed.
Collapse
Affiliation(s)
- Tae-Hoon Kim
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Guangying Ma
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Taeyoon Son
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Xincheng Yao
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, United States
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
35
|
Hamann T, Wiest MRJ, Zweifel SA. Total Neuro-retinal Tubulation (TNT), a novel imaging finding. Am J Ophthalmol Case Rep 2022; 25:101278. [PMID: 35128151 PMCID: PMC8807972 DOI: 10.1016/j.ajoc.2022.101278] [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] [Received: 05/01/2020] [Revised: 07/30/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
A peculiar tubular structure was found in the left eye (LE) of a 71-year-old patient with diabetic retinopathy, who already had undergone panretinal-photocoagulation, detected by spectral-domain optical coherence tomography (SD-OCT) as an incidental finding. The reason for consultation was vitreous hemorrhage of the fellow-eye. Fundoscopic examination of LE revealed three oval retinal holes separated by small bridges of retinal tissue, which corresponded to tubular structures visible in SD-OCT, surrounded by photocoagulation scars. Optical coherence tomography B-scans of these structures revealed a tubular arrangement of tissue, composed of solid parts and hyporeflective cystoid spaces. Intermittent choroidal hypertransmission was detected deep to the tubular structures indicating impaired or absent retinal pigment epithelium (RPE). OCT-Angiography was performed using the Zeiss Plex Elite 9000 swept source device (Zeiss Meditec, Dublin, California, USA). Within the tubular structures, no flow signal was detected. Segmentation at the level of the outer retina choriocapillaris (ORCC) indicated partially intact choriocapillaris in the areas of tubular structures and retinal holes. We hypothesize that the tubular structures mainly consist of neuro-retinal tissue and propose the term total neuro-retinal tubulation (TNT). We postulate that the edge curling effect that leads to the tubular arrangement relates to focal retinal tears caused by tractional forces acting on the retina in this case by scarring in response to laser photocoagulation. Since the retinal periphery is more prone to retinal tears, widefield OCT imaging modalities are likely to offer further insights into this newly described finding and shed greater light on the biomechanical properties of the retina. Histopathological investigation is required to make a valid statement about the histology of TNT.
Collapse
|
36
|
Brinkmann M, Bacci T, Kar D, Messinger JD, Sloan KR, Chen L, Hamann T, Wiest M, Freund KB, Zweifel S, Curcio CA. Histology and Clinical Lifecycle of Acquired Vitelliform Lesion, a Pathway to Advanced Age-Related Macular Degeneration. Am J Ophthalmol 2022; 240:99-114. [PMID: 35192790 PMCID: PMC9592119 DOI: 10.1016/j.ajo.2022.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate hypotheses about the role of acquired vitelliform lesion (AVL) in age-related macular degeneration pathophysiology. DESIGN Laboratory histology study; retrospective, observational case series. METHODS Two donor eyes in a research archive with AVL and age-related macular degeneration were analyzed with light and electron microscopy for AVL content at locations matched to ex vivo B-scans. A retrospective, observational clinical cohort study of 42 eyes of 30 patients at 2 referral clinics determined the frequency of optical coherence tomography features stratified by AVL fate. RESULTS Histologic and clinical cases showed subretinal drusenoid deposit and drusen. Ultrastructural AVL components in 2 donor eyes included retinal pigment epithelium (RPE) organelles (3%-22% of volume), outer segments (2%-10%), lipid droplets (0.2%-12%), and a flocculent material (57%-59%). Of 48 AVLs (mean follow-up 46 ± 39 months), 50% collapsed to complete RPE and outer retinal atrophy, 38% were stable, 10% resorbed, and 2% developed neovascularization. The Early Treatment Diabetic Retinopathy Study grid central subfield contained 77% of AVLs. Hyperreflective foci, ellipsoid zone disruption, and hyperreflective thickening of the RPE-basal lamina-Bruch membrane band were common at maximum AVL expansion. Collapsing and noncollapsing AVLs had different growth rates (rapid vs slow, respectively). CONCLUSIONS AVL deposits contain unexpectedly low levels of RPE organelles and outer segments. Subfoveal predilection, reflectivity on optical coherence tomography, hyperautofluorescence, yellow color, and growth-regression phases suggest dysregulation of lipid transfer pathways specific to cone photoreceptors and supporting cells in formation of AVL deposit, analogous to drusen and subretinal drusenoid deposit. Prediction of AVL outcomes via growth rates should be confirmed in larger clinical studies.
Collapse
Affiliation(s)
- Max Brinkmann
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA; Department of Ophthalmology (M.B., T.H., M.W., S.Z.), University Hospital Zurich, Zurich, Switzerland
| | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York (T.B., K.B.F.), New York University School of Medicine, New York, New York, USA
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Jeffrey D Messinger
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Kenneth R Sloan
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Ling Chen
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA; First Affiliated Hospital of Chongqing Medical University (L.C.), Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
| | - Timothy Hamann
- Department of Ophthalmology (M.B., T.H., M.W., S.Z.), University Hospital Zurich, Zurich, Switzerland
| | - Maximilian Wiest
- Department of Ophthalmology (M.B., T.H., M.W., S.Z.), University Hospital Zurich, Zurich, Switzerland
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York (T.B., K.B.F.), New York University School of Medicine, New York, New York, USA; LuEsther T. Mertz Retinal Research Center (K.B.F.), New York University School of Medicine, New York, New York, USA; Manhattan Eye, Ear and Throat Hospital, and the Department of Ophthalmology (K.B.F.), New York University School of Medicine, New York, New York, USA
| | - Sandrine Zweifel
- Department of Ophthalmology (M.B., T.H., M.W., S.Z.), University Hospital Zurich, Zurich, Switzerland; Department of Ophthalmology, University of Zurich (S.Z.), Zurich, Switzerland
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
| |
Collapse
|
37
|
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.
Collapse
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.
| |
Collapse
|
38
|
Ramtohul P, Engelbert M, Malclès A, Gigon E, Miserocchi E, Modorati G, Cunha de Souza E, Besirli CG, Curcio CA, Freund KB. BACILLARY LAYER DETACHMENT: MULTIMODAL IMAGING AND HISTOLOGIC EVIDENCE OF A NOVEL OPTICAL COHERENCE TOMOGRAPHY TERMINOLOGY: Literature Review and Proposed Theory. Retina 2021; 41:2193-2207. [PMID: 34029276 DOI: 10.1097/iae.0000000000003217] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To clarify the histologic basis of bacillary layer detachment (BALAD) through a review of the current literature and an analysis of retinal imaging. METHODS The literature for previous reports of BALAD were reviewed. An analysis of retinal images was performed to support anatomical conclusions. RESULTS A total of 164 unique patients with BALAD on optical coherence tomography (OCT) were identified from the published literature. Twenty-two underlying etiologies, all associated with subretinal exudation, were identified. Forty-one different OCT terminologies were found. The defining OCT feature of BALAD was a split at the level of the photoreceptor inner segment myoid creating a distinctive intraretinal cavity. Resolution of BALAD was followed by a rapid restoration of the ellipsoid zone. Histology of age-related macular degeneration eyes suggests that individual photoreceptors can shed inner segments. Furthermore, detachment of the entire layer of inner segments is a common postmortem artifact. It is proposed that BALAD occurs when outwardly directed forces promoting attachment of photoreceptor outer segments to the retinal pigment epithelium exceed the tensile strength of the photoreceptor inner segment myoid. CONCLUSION This review serves to strengthen the OCT nomenclature "bacillary layer detachment," based on specific reflectance information obtained by OCT and previously published histologic observations.
Collapse
Affiliation(s)
- Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, Marseille, France
| | - Michael Engelbert
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Langone School of Medicine, New York, New York
| | - Ariane Malclès
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Edward Gigon
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Giulio Modorati
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | | | - Cagri G Besirli
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; and
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Langone School of Medicine, New York, New York
| |
Collapse
|
39
|
Lee KE, Heitkotter H, Carroll J. Challenges Associated With Ellipsoid Zone Intensity Measurements Using Optical Coherence Tomography. Transl Vis Sci Technol 2021; 10:27. [PMID: 34665233 PMCID: PMC8543396 DOI: 10.1167/tvst.10.12.27] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/16/2021] [Indexed: 12/11/2022] Open
Abstract
Translational Relevance Qualitative evaluation of the ellipsoid zone band on optical coherence tomography is a valuable clinical tool for assessing photoreceptor structure, though more quantitative metrics are emerging. Awareness of the challenges involved in interpreting quantitative metrics is important for their clinical translation.
Collapse
Affiliation(s)
- Karen E. Lee
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Heather Heitkotter
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Carroll
- Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
40
|
Abstract
PURPOSE To describe the clinical and multimodal imaging features of bacillary layer detachment (BD), and its response to intravitreal anti-vascular endothelial growth factor therapy, in eyes with macular neovascularization. METHODS Retrospective, observational case series of 14 eyes (14 patients, 7 men) imaged with eyes (14 patients, 7 men) were imaged with spectral-domain optical coherence tomography, and either fluorescein angiography or optical coherence tomography angiography. Therapeutic response was monitored with serial imaging and best-corrected visual acuity assessments. RESULTS The mean age was 75 ± 13 (range: 45-96) years, with mean follow-up duration of 27 ± 21 (range: 1-56) months. Neovascular age-related macular degeneration was found in 71% (10/14) eyes. Type 2 macular neovascularization lesions were associated with BD in all 14 eyes. Subretinal hemorrhage was noted in 79% (11/14) eyes. BD promptly resolved after intravitreal antivascular endothelial growth factor therapy in all eyes. The baseline best-corrected visual acuity improved from logarithm of the minimum angle of resolution 0.84 ± 0.32 (Snellen equivalent 20/138) to logarithm of the minimum angle of resolution 0.48 ± 0.31 (Snellen equivalent 20/60) at the last follow-up, with treatment of the macular neovascularization. CONCLUSION Type 2 macular neovascularization and subretinal hemorrhage are associated with BDs, which may be due to a rapid influx of exudative fluid into the potential space between the external limiting membrane and ellipsoid zone. Intravitreal antivascular endothelial growth factor therapy results in rapid resolution of BDs and visual improvement in most eyes.
Collapse
|
41
|
Gaffney M, Cooper RF, Cava JA, Follett HM, Salmon AE, Freling S, Yu CT, Merriman DK, Carroll J. Cone photoreceptor reflectance variation in the northern tree shrew and thirteen-lined ground squirrel. Exp Biol Med (Maywood) 2021; 246:2192-2201. [PMID: 34308656 PMCID: PMC8718250 DOI: 10.1177/15353702211029582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 12/30/2022] Open
Abstract
In vivo images of human cone photoreceptors have been shown to vary in their reflectance both spatially and temporally. While it is generally accepted that the unique anatomy and physiology of the photoreceptors themselves drives this behavior, the exact mechanisms have not been fully elucidated as most studies on these phenomena have been limited to the human retina. Unlike humans, animal models offer the ability to experimentally manipulate the retina and perform direct in vivo and ex vivo comparisons. The thirteen-lined ground squirrel and northern tree shrew are two emerging animal models being used in vision research. Both models feature cone-dominant retinas, overcoming a key limitation of traditional rodent models. Additionally, each possesses unique but well-documented anatomical differences in cone structure compared to human cones, which can be leveraged to further constrain theoretical models of light propagation within photoreceptors. Here we sought to characterize the spatial and temporal reflectance behavior of cones in these species. Adaptive optics scanning light ophthalmoscopy (AOSLO) was used to non-invasively image the photoreceptors of both species at 5 to 10 min intervals over the span of 18 to 25 min. The reflectance of individual cone photoreceptors was measured over time, and images at individual time points were used to assess the variability of cone reflectance across the cone mosaic. Variability in spatial and temporal photoreceptor reflectance was observed in both species, with similar behavior to that seen in human AOSLO images. Despite the unique cone structure in these animals, these data suggest a common origin of photoreceptor reflectance behavior across species. Such data may help constrain models of the cellular origins of photoreceptor reflectance signals. These animal models provide an experimental platform to further explore the morphological origins of light capture and propagation.
Collapse
Affiliation(s)
- Mina Gaffney
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Robert F Cooper
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI 53233, USA
| | - Jenna A Cava
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Hannah M Follett
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Alexander E Salmon
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Translational Imaging Innovations, Inc., Hickory, NC 28601, USA
| | - Susan Freling
- Max Planck Florida Institute for Neuroscience, Jupiter, FL 33458, USA
| | - Ching T Yu
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Dana K Merriman
- Department of Biology, University of Wisconsin Oshkosh, Oshkosh, WI 54901, USA
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI 53233, USA
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| |
Collapse
|
42
|
REVISED CLASSIFICATION OF THE OPTICAL COHERENCE TOMOGRAPHY OUTER RETINAL BANDS BASED ON CENTRAL SEROUS CHORIORETINOPATHY ANALYSIS. Retina 2021; 41:181-188. [PMID: 32271277 DOI: 10.1097/iae.0000000000002792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the optical coherence tomography (OCT) imaging findings in recent onset neurosensory retinal detachments induced by central serous chorioretinopathy and to attempt to corroborate these findings with proposed anatomical correlates. METHODS Retinal detachments due to central serous chorioretinopathy of less than 3 months' duration and the surrounding area were scanned with OCT. The imaging of the outer retinal bands was evaluated according to proposals by Cuenca et al and the IN•OCT Consensus classification. RESULTS Optical coherence tomography findings in 11 eyes (11 patients) with CSC showed that all hyperreflective bands above Band 4 were variably continuous within the outer portion of the serous detachment. We then attempted to reconcile inconsistencies in current explanations for the outer retinal bands to propose changes to the outer retinal OCT nomenclature. CONCLUSION Our patients' OCT findings support the current standard that Band 3 is an outer retinal structure and that Band 4 represents the retinal pigment epithelium/Bruch complex. Confusion exists regarding whether the interdigitation zone extends halfway up or for the full length of the outer segments, and the hyporeflective band between Bands 3 and 4 has yet to receive an appropriate term. We therefore propose a modification to the IN•OCT Consensus classification by renaming the trilaminar hyporeflective, hyperreflective, and hyporeflective bands between Bands 2 and 4 as the outer segment-interdigitation zone complex consisting of the inner, middle, and outer segment-interdigitation zone, respectively.
Collapse
|
43
|
Lin KH, Tran T, Kim S, Park S, Chen J, Stout JT, Chen R, Rogers J, Yiu G, Thomasy S, Moshiri A. Age-related changes in the rhesus macaque eye. Exp Eye Res 2021; 212:108754. [PMID: 34506802 PMCID: PMC8785649 DOI: 10.1016/j.exer.2021.108754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess age-related changes in the rhesus macaque eye and evaluate them to corresponding human age-related eye disease. METHODS Data from eye exams and imaging tests including intraocular pressure (IOP), lens thickness, axial length, and retinal optical coherence tomography (OCT) images were evaluated from 142 individuals and statistically analyzed for age-related changes. Quantitative autofluorescence (qAF) was measured as was the presence of macular lesions as related to age. RESULTS Ages of the 142 rhesus macaques ranged from 0.7 to 29 years (mean = 16.4 years, stdev = 7.5 years). Anterior segment measurements such as IOP, lens thickness, and axial length were acquired. Advanced retinal imaging in the form of optical coherence tomography and qAF were obtained. Quantitative assessments were made and variations by age groups were analyzed to compare with established age-related changes in human eyes. Quantitative analysis of data revealed age-related increase in intraocular pressure (0.165 mm Hg per increase in year of age), ocular biometry (lens thickness 7.2 μm per increase in year of age; and axial length 52.8 μm per increase in year of age), and presence of macular lesions. Age-related changes in thicknesses of retinal layers on OCT were observed and quantified, showing decreased thickness of the retinal ganglion cell layer and inner nuclear layer, and increased thickness of photoreceptor outer segment and choroidal layers. Age was correlated with increased qAF by 1.021 autofluorescence units per increase in year of age. CONCLUSIONS The rhesus macaque has age-related ocular changes similar to humans. IOP increases with age while retinal ganglion cell layer thickness decreases. Macular lesions develop in some aged animals. Our findings support the concept that rhesus macaques may be useful for the study of important age-related diseases such as glaucoma, macular diseases, and cone disorders, and for development of therapies for these diseases.
Collapse
Affiliation(s)
- Kira H Lin
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, 1 Garrod Drive, Davis, CA, 95695, USA
| | - Tu Tran
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA
| | - Soohyun Kim
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - Sangwan Park
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - Jiajia Chen
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA
| | - J Timothy Stout
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Rui Chen
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA; Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jeffrey Rogers
- Human Genome Sequencing Center and Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA
| | - Sara Thomasy
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA; Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA, 95616, USA
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, School of Medicine, U.C. Davis, Sacramento, CA, 95817, USA.
| |
Collapse
|
44
|
Gong Y, Xia H, Zhang A, Chen LJ, Chen H. Optical coherence tomography biomarkers of photoreceptor degeneration in retinitis pigmentosa. Int Ophthalmol 2021; 41:3949-3959. [PMID: 34304340 DOI: 10.1007/s10792-021-01964-1] [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: 01/10/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Several parameters on optical coherence tomography (OCT) have been suggested as biomarkers for photoreceptor degeneration in retinitis pigmentosa (RP). This study is to compare the spatial distribution of the changes of OCT biomarkers in RP patients. METHODS OCT line scans of the horizontal meridian were conducted in 22 eyes of 22 RP patients and 30 eyes of 30 healthy controls. Longitudinal reflectance profiles were obtained using ImageJ at every 5 pixels. The following parameters on OCT were quantitatively measured: (1) relative optical intensity (ROI) of ellipsoid zone (EZ) and interdigitation zone (IZ); (2) thickness of outer nuclear layer (ONLT), photoreceptor (PRT), inner segment (IST) and outer segment (OST). The variations of these parameters across different regions were analyzed. RESULTS From fovea to perifoveal region, all the OCT biomarkers declined before disappeared, except IST and IZ-ROI. There was no identifiable declining zone for the IST and IZ-ROI between the normal and disappeared zones in some patients. The most central biomarker was the reduction of OST and IZ-ROI, followed by the PRT, EZ-ROI, then IST and finally ONLT. All these biomarkers had significant correlations with best-corrected visual acuity, except ONLT. CONCLUSION In retinitis pigmentosa, EZ-ROI, IZ-ROI, PRT, OST, IST and ONLT are valuable biomarkers of photoreceptor degeneration. Changes of OST and IZ-ROI are located most centrally and may be the early biomarkers.
Collapse
Affiliation(s)
- Yuting Gong
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Honghe Xia
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Anlin Zhang
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China.
| |
Collapse
|
45
|
Cideciyan AV, Krishnan AK, Roman AJ, Sumaroka A, Swider M, Jacobson SG. Measures of Function and Structure to Determine Phenotypic Features, Natural History, and Treatment Outcomes in Inherited Retinal Diseases. Annu Rev Vis Sci 2021; 7:747-772. [PMID: 34255540 DOI: 10.1146/annurev-vision-032321-091738] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Inherited retinal diseases (IRDs) are at the forefront of innovative gene-specific treatments because of the causation by single genes, the availability of microsurgical access for treatment delivery, and the relative ease of quantitative imaging and vision measurement. However, it is not always easy to choose a priori, from scores of potential measures, an appropriate subset to evaluate efficacy outcomes considering the wide range of disease stages with different phenotypic features. This article reviews measurements of visual function and retinal structure that our group has used over the past three decades to understand the natural history of IRDs. We include measures of light sensitivity, retinal structure, mapping of natural fluorophores, evaluation of pupillary light reflex, and oculomotor control. We provide historical context and examples of applicability. We also review treatment trial outcomes using these measures of function and structure. Expected final online publication date for the Annual Review of Vision Science, Volume 7 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Collapse
Affiliation(s)
- Artur V Cideciyan
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
| | - Arun K Krishnan
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
| | - Alejandro J Roman
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
| | - Alexander Sumaroka
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
| | - Malgorzata Swider
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
| | - Samuel G Jacobson
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
| |
Collapse
|
46
|
PRESUMED FOVEAL BACILLARY LAYER DETACHMENT IN A PATIENT WITH TOXOPLASMOSIS CHORIORETINITIS AND PACHYCHOROID DISEASE. Retin Cases Brief Rep 2021; 15:391-398. [PMID: 30142112 DOI: 10.1097/icb.0000000000000817] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a detachment that apparently separated photoreceptor inner segment myoids from inner segment ellipsoids as a manifestation of toxoplasmosis chorioretinitis in a patient with pachychoroid spectrum disease. METHODS Multimodal imaging including fundus photography, spectral domain and enhanced-depth imaging optical coherence tomography (OCT), indocyanine green angiography, and OCT angiography. RESULTS A 33-year-old man with a history of toxoplasmosis chorioretinitis reported 1 week of decreased vision to 20/200 in his right eye. Examination of the right eye demonstrated mild vitritis with recurrent chorioretinitis inferior to the fovea and adjacent to a chorioretinal scar. A dome-shaped, foveal photoreceptor layer-splitting detachment was noted on OCT. Because degenerating cone photoreceptors are capable of shedding their inner segments, we inferred the location of the detachment at the level of the inner segment myoid and provided a histological example of such from an unrelated donor case. In addition, multimodal imaging revealed dilated choroidal veins (pachyvessels) with attenuation of the inner choroid in both eyes and asymptomatic findings of central serous chorioretinopathy in the left eye. After 1 month of antibiotic and steroid therapy, the chorioretinitis resolved, as did the detachment. Hyperreflective foci on the vitreoretinal interface were appreciated with en face OCT that appeared to aggregate throughout the course of therapy, induce inner retinal striae, and resolve without inducing epiretinal membrane formation. CONCLUSION Patients with preexisting pachychoroid spectrum disease may manifest a more significant retinal fluid accumulation in the setting of superimposed chorioretinal inflammation. In this case of macular toxoplasmosis chorioretinitis, inflammation manifested as a retinal detachment at the level of photoreceptor inner segment myoids that we named as a bacillary layer detachment. In this case, inflammatory sequelae of toxoplasmosis reactivation responded well to oral and intravitreal therapy.
Collapse
|
47
|
Etheridge T, Dobson ETA, Wiedenmann M, Oden N, VanVeldhuisen P, Scott IU, Ip MS, Eliceiri KW, Blodi BA, Domalpally A. Ellipsoid Zone Defects in Retinal Vein Occlusion Correlates With Visual Acuity Prognosis: SCORE2 Report 14. Transl Vis Sci Technol 2021; 10:31. [PMID: 34003964 PMCID: PMC7998009 DOI: 10.1167/tvst.10.3.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate the association between ellipsoid zone (EZ) on spectral domain optical coherence tomography (SD-OCT) and visual acuity letter score (VALS) in participants with retinal vein occlusion in the Study of Comparative Treatments for Retinal Vein Occlusion 2. Methods SD-OCT scans of 362 participants were qualitatively assessed at baseline and months 1, 6, 12, and 24 for EZ status as normal, patchy, or absent. The thickness of EZ layer in the central subfield was also obtained using machine learning. Results EZ assessments were not possible at baseline due to signal blockage in >75% of eyes. At month 1, EZ was normal in 37.6%, patchy in 48.1%, and absent in 14.3%. EZ was measurable in 48.7% with a mean area of 0.07 ± 0.16 mm2. Mean VALS was better in eyes without an EZ defect compared to eyes with an EZ defect (P < 0.0001 at all visits). EZ defect at month 1 was associated with poorer VALS at all follow-up visits (P < 0.0001). Conclusions Both qualitative and quantitative assessments of EZ status strongly correlated with VALS. Absence of EZ was associated with poorer VALS at both corresponding and future visits, with larger areas of EZ loss associated with worse VALS. Translational Relevance Assessment of EZ can be used to identify patients with potentially poor response in eyes with retinal vein occlusion.
Collapse
Affiliation(s)
- Tyler Etheridge
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ellen T A Dobson
- Laboratory for Optical and Computational Instrumentation, Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Neal Oden
- The Emmes Company, LLC, Rockville, MD, USA
| | | | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Michael S Ip
- Doheny Eye Institute, University of California Los Angeles Stein Eye Institute, Los Angeles, CA, USA
| | - Kevin W Eliceiri
- Laboratory for Optical and Computational Instrumentation, Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA.,McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, USA
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
48
|
Maltsev DS, Kulikov AN, Burnasheva MA, Kazak AA, Chhablani J. Retinal Pigment Epithelium Reflectivity at Leakage Site on Spectral-Domain Optical Coherence Tomography in Acute Central Serous Chorioretinopathy. Semin Ophthalmol 2021; 36:354-359. [PMID: 33949912 DOI: 10.1080/08820538.2021.1889613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the reflectivity of the retinal pigment epithelium (RPE) at the leakage site in acute central serous chorioretinopathy (CSC). METHODS Twenty-nine patients (24 males and 5 females, mean age 46.1 ± 11.0 years) were included. The mean relative RPE reflectivity and the difference between the maximum and minimum relative RPE reflectivity at the leakage site and control site were measured on cross-sectional optical coherence tomography (OCT) scans. In eyes with pinpoint leakage, cross-sectional OCT scans and corresponding reflectivity profile plots were reviewed by a masked grader for the presence of visible RPE defects and focal depression of relative RPE reflectivity at the leak. RESULTS Twenty-one (61.7%) and 13 (38.2%) leaks showed pinpoint and diffuse leakage, respectively. The mean relative RPE reflectivity at the leakage site was statistically significantly higher than that of the control site (0.82 ± 0.09 and 0.79 ± 0.12, respectively, p=0.03) in eyes with pinpoint leakage as well as in eyes with diffuse leakage (0.81 ± 0.10 and 0.74 ± 0.13, respectively, p=0.01). The difference of relative RPE reflectivity was statistically significantly higher at the leakage site compared to control site (0.56 ± 0.20 and 0.41 ± 0.06, respectively, p=0.002) in eyes with pinpoint leakage, but not in eyes with diffuse leakage (0.46 ± 0.12 and 0.40 ± 0.07, respectively, p=0.16). On cross-sectional OCT scans visible RPE defects at pinpoint leakage were found in 10 out of 21 (47.6%) cases. Focal depressions of RPE reflectivity corresponding to presumed RPE defects were found in 18 out of 21 (85.7%) cases. CONCLUSION Leakage in acute CSC is associated with significant local increase of RPE reflectivity.
Collapse
Affiliation(s)
- Dmitrii S Maltsev
- - Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Alexei N Kulikov
- - Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Maria A Burnasheva
- - Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Alina A Kazak
- - Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Jay Chhablani
- - University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA
| |
Collapse
|
49
|
SUBRETINAL DRUSENOID DEPOSIT IN AGE-RELATED MACULAR DEGENERATION: Histologic Insights Into Initiation, Progression to Atrophy, and Imaging. Retina 2021; 40:618-631. [PMID: 31599795 DOI: 10.1097/iae.0000000000002657] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To clarify the role of subretinal drusenoid deposits (SDD; pseudodrusen) in the progression of age-related macular degeneration through high-resolution histology. METHODS In 33 eyes of 32 donors (early age-related macular degeneration, n = 15; geographic atrophy, n = 9; neovascular age-related macular degeneration, n = 7; unremarkable, n = 2), and 2 eyes of 2 donors with in vivo multimodal imaging including optical coherence tomography, examples of SDD contacting photoreceptors were assessed. RESULTS Subretinal drusenoid deposits were granular extracellular deposits at the apical retinal pigment epithelium (RPE); the smallest were 4-µm wide. Outer segment (OS) fragments and RPE organelles appeared in some larger deposits. A continuum of photoreceptor degeneration included OS disruption, intrusion into inner segments, and disturbance of neurosensory retina. In a transition to outer retinal atrophy, SDD appeared to shrink, OS disappeared, inner segment shortened, and the outer nuclear layer thinned and became gliotic. Stage 1 SDD on optical coherence tomography correlated with displaced OS. Confluent and disintegrating Stage 2 to 3 SDD on optical coherence tomography and dot pseudodrusen by color fundus photography correlated with confluent deposits and ectopic RPE. CONCLUSION Subretinal drusenoid deposits may start at the RPE as granular, extracellular deposits. Photoreceptor OS, RPE organelles, and cell bodies may appear in some advanced deposits. A progression to atrophy associated with deposit diminution was confirmed. Findings support a biogenesis hypothesis of outer retinal lipid cycling.
Collapse
|
50
|
Ma G, Son T, Kim TH, Yao X. In vivo optoretinography of phototransduction activation and energy metabolism in retinal photoreceptors. JOURNAL OF BIOPHOTONICS 2021; 14:e202000462. [PMID: 33547871 PMCID: PMC8240094 DOI: 10.1002/jbio.202000462] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 05/05/2023]
Abstract
The objective of this study is to verify the anatomic correlate of the second (2nd) outer retina band in optical coherence tomography (OCT), and to demonstrate the potential of using intrinsic optical signal (IOS) imaging for concurrent optoretinography (ORG) of phototransduction activation and energy metabolism in stimulus activated retinal photoreceptors. A custom-designed OCT was employed for depth-resolved IOS imaging in mouse retina activated by a visible light flicker stimulation. The spatiotemporal properties of the IOS changes at the photoreceptor outer segment (OS) and inner segment (IS) were quantitatively evaluated. Rapid IOS change was observed at the OS almost right away, and the IOS at the IS was relatively slow. Comparative analysis indicates that the OS-IOS reflects transient OS deformation caused by the phototransduction activation, and IS-IOS might reflect the energy metabolism caused by mitochondria activation in retinal photoreceptors. The consistency of the distribution of the IS-IOS and the 2nd OCT band supports the IS ellipsoid (ISe), which has abundant mitochondria, as the signal source of the 2nd OCT band of the outer retina.
Collapse
Affiliation(s)
- Guangying Ma
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Taeyoon Son
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Tae-Hoon Kim
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
- Correspondence: Xincheng Yao, Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA.
| |
Collapse
|