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Crincoli E, Catania F, Sacconi R, Ribarich N, Ferrara S, Parravano M, Costanzo E, Querques G. DEEP LEARNING FOR AUTOMATIC PREDICTION OF EARLY ACTIVATION OF TREATMENT-NAIVE NONEXUDATIVE MACULAR NEOVASCULARIZATIONS IN AGE-RELATED MACULAR DEGENERATION. Retina 2024; 44:1360-1370. [PMID: 38489765 DOI: 10.1097/iae.0000000000004106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND Around 30% of nonexudative macular neovascularizations exudate within 2 years from diagnosis in patients with age-related macular degeneration. The aim of this study is to develop a deep learning classifier based on optical coherence tomography (OCT) and OCT angiography (OCTA) to identify nonexudative macular neovascularizations at risk of exudation. METHODS Patients with age-related macular degeneration showing OCTA and fluorescein angiography-documented nonexudative macular neovascularization with a 2-year minimum imaging follow-up were retrospectively selected. Patients showing OCT B-scan-documented macular neovascularization exudation within the first 2 years formed the EX GROUP while the others formed the QU GROUP. ResNet-101, Inception-ResNet-v2, and DenseNet-201 were independently trained on OCTA and OCT B-scan images. Combinations of the six models were evaluated with major and soft voting techniques. RESULTS Eighty-nine eyes of 89 patients with a follow-up of 5.7 ± 1.5 years were recruited (35 EX GROUP and 54 QU GROUP). Inception-ResNet-v2 was the best performing among the three single convolutional neural networks. The major voting model resulting from the association of the three different convolutional neural networks resulted in an improvement of performance both for OCTA and OCT B-scan (both significantly higher than human graders' performance). The soft voting model resulting from the combination of OCTA and OCT B-scan-based major voting models showed a testing accuracy of 94.4%. Peripheral arcades and large vessels on OCTA en face imaging were more prevalent in the QU GROUP. CONCLUSION Artificial intelligence shows high performances in identifications of nonexudative macular neovascularizations at risk for exudation within the first 2 years of follow-up, allowing better customization of follow-up timing and avoiding treatment delay. Better results are obtained with the combination of OCTA and OCT B-scan image analysis.
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Affiliation(s)
- Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Fiammetta Catania
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, Paris, France
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Ribarich
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Ferrara
- Ophthalmology Department, Sant'Eugenio Hospital, Rome, Italy; and
| | | | | | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Vidal-Oliver L, Montolío-Marzo E, Gallego-Pinazo R, Dolz-Marco R. Optical coherence tomography biomarkers in early and intermediate age-related macular degeneration: A clinical guide. Clin Exp Ophthalmol 2024; 52:207-219. [PMID: 38214056 DOI: 10.1111/ceo.14337] [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: 08/30/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
Advanced forms of age-related macular degeneration (AMD), characterised by atrophic and neovascular changes, are a leading cause of vision loss in the elderly population worldwide. Prior to the development of advanced AMD, a myriad of risk factors from the early and intermediate stages of AMD have been published in the scientific literature over the last years. The ability to precisely recognise structural and anatomical changes in the ageing macula, altogether with the understanding of the individual risk implications of each one of them is key for an accurate and personalised diagnostic assessment. The present review aims to summarise updated evidence of the relative risk conferred by diverse macular signs, commonly seen on optical coherence tomography, in terms of progression to geographic atrophy or macular neovascularization. This information may also serve as a basis for tailored follow-up monitoring visits.
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Affiliation(s)
- Lourdes Vidal-Oliver
- Department of Ophthalmology, Fundación Oftalmología Médica de la Comunidad Valenciana, Valencia, Spain
- Department of Ophthalmology, Clínico San Carlos Hospital, Madrid, Spain
- Macula Unit, Oftalvist Clinic, Valencia, Spain
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Tombolini B, Crincoli E, Sacconi R, Battista M, Fantaguzzi F, Servillo A, Bandello F, Querques G. Optical Coherence Tomography Angiography: A 2023 Focused Update on Age-Related Macular Degeneration. Ophthalmol Ther 2024; 13:449-467. [PMID: 38180632 PMCID: PMC10787708 DOI: 10.1007/s40123-023-00870-2] [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: 09/14/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Optical coherence tomography angiography (OCTA) has extensively enhanced our comprehension of eye microcirculation and of its associated diseases. In this narrative review, we explored the key concepts behind OCTA, as well as the most recent evidence in the pathophysiology of age-related macular degeneration (AMD) made possible by OCTA. These recommendations were updated since the publication in 2020, and are targeted for 2023. Importantly, as a future perspective in OCTA technology, we will discuss how artificial intelligence has been applied to OCTA, with a particular emphasis on its application to AMD study.
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Affiliation(s)
- Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Emanuele Crincoli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Federico Fantaguzzi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Servillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Division of Head and Neck, Ophthalmology Unit, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Nissen AHK, Kiilgaard HC, van Dijk EHC, Hajari JN, Huemer J, Iovino C, Schneider M, Sørensen TL, Grauslund J, Subhi Y. Exudative Progression of Treatment-Naïve Nonexudative Macular Neovascularization in Age-Related Macular Degeneration: A Systematic Review With Meta-Analyses. Am J Ophthalmol 2024; 257:46-56. [PMID: 37659600 DOI: 10.1016/j.ajo.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE To systematically review and report the rate of exudative progression over time in patients with nonexudative macular neovascularization (MNV) in age-related macular degeneration (AMD). DESIGN Systematic review with prevalence meta-analyses and individual participant meta-analysis. METHODS We searched 10 literature databases on March 26, 2023, for studies of consecutive patients with treatment-naïve nonexudative MNV in AMD. The primary outcome of interest was time from diagnosis to exudative progression. We conducted meta-analyses on the prevalence of exudative progression at 1 and 2 years. Where possible, we extracted individual participant data from studies and conducted an individual participant meta-analysis and explored the exudative progression using a time-to-event curve. RESULTS We identified 16 eligible studies with a total of 384 eyes with nonexudative MNV. Exudative progression had occurred in 20.9% (95% CI 13.1%-29.8%) of eyes at 1 year and in 30.7% (95% CI 21.8%-40.4%) at 2 years. Similar results were observed in the individual participant meta-analysis, showing exudative progression in 18.9% (95% CI 13.5%-26.3%) of eyes at 1 year and 31.3% (95% CI 24.2%-40.0%) at 2 years. Risk factors for a fast exudative progression were the presence of subretinal lipid globules, large MNV areas, rapid MNV growth, growth in pigment epithelium detachment height and width, appearance of a branching pattern, and development of a hyporeflective halo around the MNV. CONCLUSIONS Nonexudative MNVs in AMD are at high risk of exudative progression. Recognition of these lesions may allow for better individualized follow-up regimens in which closer monitoring may facilitate earlier diagnosis of exudative progression.
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Affiliation(s)
- Anne Helene Køllund Nissen
- From the Department of Ophthalmology, Odense University Hospital (A.H.K.N., H.C.K., J.G.), Odense, Denmark
| | - Hans Christian Kiilgaard
- From the Department of Ophthalmology, Odense University Hospital (A.H.K.N., H.C.K., J.G.), Odense, Denmark
| | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Centre (E.H.C.v.D.), Leiden, the Netherlands; Department of Ophthalmology, Alrijne Hospital (E.H.C.v.D.), Leiderdorp, the Netherlands
| | - Javad Nouri Hajari
- Department of Ophthalmology, Rigshospitalet (J.N.H., M.S., Y.S.), Copenhagen, Denmark
| | - Josef Huemer
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (J.H.), London, United Kingdom; Department of Ophthalmology and Optometry, Kepler University Hospital (J.H.), Linz, Austria
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli (C.I.), Naples, Italy
| | - Miklos Schneider
- Department of Ophthalmology, Semmelweis University (M.S.), Budapest, Hungary
| | - Torben Lykke Sørensen
- Department of Ophthalmology, Zealand University Hospital (T.L.S.), Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen (T.L.S.), Copenhagen, Denmark
| | - Jakob Grauslund
- From the Department of Ophthalmology, Odense University Hospital (A.H.K.N., H.C.K., J.G.), Odense, Denmark; Department of Clinical Research, University of Southern Denmark (J.G., Y.S.), Odense, Denmark; Department of Ophthalmology, Vestfold Hospital Trust (J.G.), Tønsberg, Norway
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet (J.N.H., M.S., Y.S.), Copenhagen, Denmark; Department of Clinical Research, University of Southern Denmark (J.G., Y.S.), Odense, Denmark.
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